Universal Healthcare and Fat

On the subject of whether universal healthcare is better for fat people than the system we currently have, here are a couple of comments about fat and universal healthcare I thought especially illuminating. One is from deannacorbeil, who left it on my About page because I closed the comments for the other post 😉 The others are from richie79 and osxgirl, commenting on a recent blog post on Big Fat Blog.

deannacorbeil writes:

I thought I’d write you here, as you’ve closed comments on your post on libertarianism and obesity and health care.  As a nurse who’s been working in this American system of ours for almost a quarter century (damn!  how did I get this old?), this is obviously a topic of interest to me.  I continue to be perplexed at those who think that socialized medicine might somehow  a) be free (that one always cracks me up) b) improve the quality of care and c) be fairer to those of us who, ahem, don’t “fit” into the prevailing weight standards of today.

I thought you might want to post some of the following links sometime about the problems with socialized medicine.  Most of them are from the CATO institute.  (I’m certain some will discard any of the info on that fact alone, since it is a libertarian think tank.)

1.  Five Myths of Socialized Medicine

and the more detailed policy analysis–Health Care in a Free Society: Rebutting the Myths of National Health Insurance

2.  The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World (This is a pretty recent, quite long and detailed policy analysis—definitely worth reading.)

3.  The Top Ten Myths of American Health Care

I heard one of the congressman here in Michigan (Rep. Dingell) being interviewed about this topic last week.  He flat out denied that there was any sort of problem with waiting periods for procedures/tests in Canada, and then stated that things were so expensive here because we just had too many CAT Scan and MRI machines!!!  Damn those machines, anyway!  And people think they want these idiots in charge of our health system.

Sorry if this was too long….

It wasn’t too long at all, and I think it provides an insider perspective that can be sorely lacking in some comments which blindly promote universal healthcare under the assumption that all the various abuses of the current system would magically disappear or at the very least, dissipate.

richie79, a UK citizen and close observer of the NHS policies (Britain’s universal healthcare system), begs to differ with this fantasy:

richie79 writes:

The healthcare system in the US is totally broken and our only hope is to adopt a universal care model under which all US citizens — regardless of health, age, employment, etc. — will have access to care

Oh don’t you believe it. Whilst I fundamentally believe in universal state-provided healthcare free at the point of use, the fact remains that in the UK we do have such a system (falling apart though it may be due to a population which demands European public services for US levels of taxation) and far from easing the problems of discrimination and resentment against fat people it actually amplifies them – and throws up a whole host of new ones.

The recent shift toward public health promotion and preventative medicine means that there is far more propaganda in the guise of ‘advice’ being peddled through the media, most of it from ‘respectable’ Government sources. And because the NHS at central level is a single monolitic entity with a Cabinet Minister in charge, it’s also much easier for the frankly huge number of single-issue pressure groups, misguided charities and self-styled ‘obesity experts’ to force their frequently extreme views on tackling the ‘obesity timebomb’ onto the Government.

But most importantly, because everyone pays into the system and given the way in which it’s been starved of funding over the years, there’s an increasing sense of public and media bitterness toward anyone who are accused of taking more than their fair share – smokers, drinkers and fat people.

The fact that supposedly respectable news outlets and professional organisations such as the BBC and the British Medical Journal are now blaming fat people for the resourcing crisis within the NHS is keeping the issue pinned to the top of the health agenda.

The NHS is being used as a stick with which to beat anyone who is considered not to be paying adequate attention to their health back into line, and there have even been proposals advanced to deny fat people treatment for conditions related and unrelated to their size, on the grounds that these are ‘self-inflicted’.

With socialised healthcare you add the concepts of fairness and social responsibility to the anti-fat brigade’s arsenal of weapons, and that can’t possibly be a good thing.

Right on, richie!

osxgirl also has a great comment on that same post:

…socialized medicine WON’T fix this problem. In fact, I think in many ways, it will make it worse.

Why do I say this? Well, under socialized medicine, the IDEAL is that everyone gets to go to the doctor, no matter what. And that’s true, sort of. The problem is, in order to control costs, a rationing of supply inevitably occurs. And how do “they” decide how to ration the supply?

I contend that a lot of the rationing will be done based on how morally “deserving” you are of treatment. Accident victims get first priority. People who have diseases get higher priority. Low-ranking will be people with lung and liver cancer (alcoholics and smokers), people with drug-addict-related conditions, and fat people in general. Because, after all, we all did that to ourselves, according to “them”.

It’s what’s happening with insurance now. The reason insurance companies do it is to reduce costs. Government has NEVER been able to do anything cheaper than the private sector. So socialized medicine will be more costly than it is under the current scheme of private insurance managed by the government. (Medicare and Medicaid only come in cheaper because government mandates the prices as cheaper than the market, which is why so many doctors and hospitals will refuse Medicare/Medicaid patients when possible. When there is no market to subsidize the government anymore, the government will have to find ways to reduce costs.)

Given the current popular thinking, what do you think the government means of reducing health care costs will be? I think it will be exactly what we are seeing – set up a system where a certain amount of “blame” for the state of a person’s health is assigned to each person, and that amount of blame will determine the level of care the person receives. It won’t be stated that way, but it’s what it will boil down to.

Even then, assume the system was instituted in an ideal manner. The inherent prejudices of the doctors would not go away. I don’t think fat people would get any better care than they currently get. In fact, I think it would be worse. At least now, if I go to a doctor and that doctor won’t treat me because all he can say is “You’re fat,” I can realize he’s an idiot, and go find another doctor. Under socialized medicine, I would no longer have that choice. How am I going to shop around for help when my entry into the system insists there is no problem that weight loss wouldn’t cure, and refuses to give me a referral to a new doctor? And there’s a waiting list to even get in to see a doctor, and I’m not allowed to just pick a doctor..perhaps I’m even assigned one.

Believe me, I’m no fan of our current health care system, or of the health insurance system as it stands. But socialized health care scares me far more. ESPECIALLY as a fat person!

I also wanted to link to my Universal Healthcare category, that has several other posts where I describe in detail my position on universal healthcare and fat (so I don’t have to always repeat myself in the comments!).

I want to keep these comments open, and in order to do that and fit everything into my busy schedule I’m not sure if I’ll be able to reply to comments on this as readily as the last one. Just a head’s up!

10 comments on “Universal Healthcare and Fat

  1. Tiana says:

    I don’t have the time to go into this in detail and download all the PDFs now, but I hope I’ll be able to come back later. I just wanted to throw in that maybe the reason why these discussions always go wrong is that we all have different ideas of what “universal healthcare” means, as well as some of the other terms being used. Take this, for example:

    I continue to be perplexed at those who think that socialized medicine might somehow a) be free (that one always cracks me up)

    As someone who may or may not be alive today if she hadn’t been provided with free healthcare for most of her life, I just don’t see what’s so funny.

  2. bigliberty says:

    Tiana, I think what she meant is “free” in the absolute sense – that is, that no one at all is paying for it. She’s just illustrating the magical thinking one sometimes encounters in these socialized medicine arguments.

  3. presq-t'j says:

    You’ve told us why you think universal healtcare sucks in general and for fat people in particular.

    We all know that it’s the same in the current US system.

    So why are libertarians better for fat people?

  4. richie79 says:

    “So why are libertarians better for fat people?”

    The way I see it libertarians are content to let everyone do and be whatever they want provided that in doing so they don’t affect the freedoms of others to equally do and be whatever they want.

    Whereas some ‘progressives’ are so focused on moulding the world into their own particular version of Utopia that they forget to ask the people they’re pushing about what they actually want; in the case of fat people I suspect it’s overwhelmingly to be left the hell alone.

    What one considers Utopia may be hell for another, and that’s why government power – the power to jail or otherwise disenfranchise those who have a different concept of Utopia to you – must be used so cautiously, and never overextended.

    Oh, and thanks for the shout BL!

  5. Tiana says:

    I am returning here only because I feel compelled to explain why I disappeared. I was incapable of going online for a few days and then forgot about this post for a few more. By the time I remembered, I had decided that I was not going to participate in political discussions anymore – not because I’m giving up on politics altogether, but rather because my idea of an ideal system is so far removed from the current reality that there is no need to bring it up in a context as specific as this one.

    I just wrote the longest comment in the history of forever, so I decided to turn it into a blog post instead … but alas I don’t feel up to that at the moment and like annaham I don’t want to shut up just because I can’t always be a perfect blogger/commenter. Here’s to hoping I will manage to finish the comment-turned-post before next month. Until then I’ll just have you know that I do disagree with your theory, but not in the way that you probably think, and I apologise for my other comment up there because in retrospect it doesn’t seem to make a lot of sense. I was trying to say that what you call “universal healthcare” is not what I mean when I use that phrase – no idea where that train of thought disappeared to mid-paragraph. What you describe is, in my opinion, not universal or social at all. That is where communication gets difficult.

  6. […] On Politics April 7, 2009 — Tiana This started out as a comment on Big Liberty’s Universal Healthcare and Fat post. When I set up my “About” page a mere seven months ago, I wrote, “I know […]

  7. anniemcphee says:

    Ok, I haven’t read all of this one yet (BL, you have a terrific talent for composing amazingly rich, thorough, well-referenced posts that can take days to really absorb! Wow!) but I’m loving it. Richie, I haven’t read your part of the actual post, but the comment you left above is amazing – it’s kind of like a mirror of BL’s talent; meaning, to be able to put SO MUCH into so few words! In other words, at the risk of sounding gushy, I feel like I’m in wonderful company here.

    Deana struck a big nerve with me – that part when people from places with socialized medicine tell us how great it is because it’s free, and that we should have it for free too, always cracks me up. I knew a Swedish woman (oh, she was obnoxious) who used to love to tout what a wonderful economy they had there, and how morally superior they were as a people because all their medical care was “free” and in fact their society was so free and un-greedy that if a stranger wanted to sleep for the night in someone else’s backyard, it was just customary that you let them do so. Even if they didn’t ask first. (Which sounds like trespassing and a dangerous practice, but hey, they’re all just good and non-dangerous and so forth.) Anyway, point was that I kept explaining to her that the word “FREE” did not mean what she thinks it means. I kept asking her what she thought free meant, and her concept of it was so shallow that she really thought it meant that one didn’t have to pay for it.

    Look, when I was 15 years old, that’s what I thought it meant too. But when you’re a 40-something year old woman who claims to be a PhD and you don’t understand what “free” means even when someone explains it to you, there’s a problem.

    Now, I am coming to a point here, please bear with me. I’m going to do it in a roundabout way. If it’s too long and boring, I won’t be insulted if you skip it; fair warning that I’m long-winded tonight.

    Ok, let me start with Patch Adams. Has anyone seen that movie? Because Patch Adams had this dream of a new style of medicine (and I found it pretty gross that even though his idea got his dear friend murdered he still thought it was good, but that’s an aside). Clearly he was an intelligent man and a talented doctor; no argument there. But when he wanted to practice his style of medicine, he and his friends had to raid the supplies of a nearby “stodgy” hospital – the kind that was hampered by the necessity of, you know, PAYING for the stuff they used to help the sick people. In other words, they STOLE the stuff and then called it “free.” And this was supposed to be a good thing. See, if you do it for a good reason, it doesn’t matter what the unintended consequences are (such as, say, the hospital losing expensive supplies that they had bought and thus needing to cover their losses, probably by being horribly mean and charging even more for their services). It was all very light-hearted, and one of those fun “bonding” experiences going into the hospital and stealing stuff for their own patients. It made them the good guys, because they were doing it to help people for free. But it wasn’t free. There are people working for low wages in the places that MAKE those cotton balls and bottle that rubbing alcohol and ship it and drive the trucks that deliver it, and they have to be paid. There are people who harvest the cotton and people who grow it and people who chop down the trees to make the tongue depressors. There are all these millions of people involved in doing the WORK to get those supplies to that hospital.

    There are doctors who spend many years in school studying very difficult subjects and sacrificing years of their lives who either have to have rich families, or take out massive student loans which later have to be repaid, then further years working as residents with scant sleep and a very demanding physical and mental task. There are nurses who spend years studying as well, then spend their own years dealing with rowdy drunks who end up in the ER after fights and sometimes get combative, who barely have time to eat and spend countless hours on their feet and putting people on bedpans. There are orderlies who have to do a buttload of heavy work.

    Do these people not deserve the money they earn? All of them, from the cotton pickers to the surgeons? What right does anyone have to steal the fruits of their labor or to demand that they shouldn’t receive their salaries? Where does anyone get the idea that just because they themselves might not have to pay for any of it that that means it is FREE? None of it is free.

    To socialize it only means to shift the cost somewhere else and add an entirely new level of bureaucracy in order to administrate it, which means that it costs that much more to pay the people who do THAT part of it. Which is, on its surface, a net loss. If you can still find an elderly doctor, the kind who used to hang out a shingle (I have one myself, and it’s a rare treasure) they will tell you that before costs started going through the roof with the first bureaucracy (insurance, and later the worse HMOs) it was little to no trouble to treat most patients at a reasonable rate and have more than enough to treat poorer patients at a reduced rate or for free. But with each new bureaucracy and each resulting increase in COSTS, it became more and more difficult to keep treating people for free or on the cheap, and thus more people ended up *needing* more help, and more bureaucracies and more cost increases, in a vicious cycle.

    But what galls me the most about all this occurring and spiraling ever downward is that all these horrible things – that dirty dirty word – that whole **profit** thing, was what went into research and development! The more money the medical profession made and was allowed to actually keep and use, the more nifty new things they could INVENT and learn about. Profit, in the medical profession, translated into BETTER medical care, better machines, new and better treatments, new and better medicines, more help for people to live healthier and more enjoyable lives. But all our entitled people can see is that some of those guys drive a fucking Porsche and dammit, I don’t have one, so why should he? Well, why SHOULDN’T he? Haven’t they helped make things better for us all? It’s the same with everyone being mad at CEOs for getting big bonuses (I’m not talking about AIG here; this has been an issue way before bailouts, which are a different animal.) Everyone wants to bite the hand that feeds them because that hand has a pretty ring on it. Prettier than mine, thus bad.

    So the long and short of it is, you socialize the health care further and further, eventually completely, and medical progress comes to a grinding HALT. Doesn’t this bother anyone? Do we think there is no further progress coming? Because human ingenuity, combined with the means, derived from profits, can make amazing progress and can KEEP making progress. What the hell good is free health care for everyone if they’re never going to find a cure or invent a decent machine to even diagnose what’s ailing you? It sounds good now because we HAVE already made so much progress and we think it’s good enough where it is – but it can be better, and why shouldn’t it be? Why shouldn’t it be ALLOWED to become even better as we go? I know they spend a lot of it on bullshit like Viagra and baldness cures, but that’s because there’s a demand for these things, and it isn’t stopping anyone from seeking better treatments for cancer. If they make more money on Viagra and baldness, they can also spend more on lupus and fibromyalgia, can’t they? So why not? Supply and demand WORKS. And pray tell, if doctors are not going to be earning more money than anyone else, or are going to be taxed so heavily that they are just not allowed to make a profit, who is going to spend all that time and money to BECOME one? It’s like that ridiculous comment Obama made that capping salaries in an industry will draw MORE and BETTER people INTO that industry…WTF? Does that even make sense to anyone? So not only does progress stop, we give no one any incentive to dedicate their lives, and so much time and work, into even providing the service. Fewer doctors, not more.

    Also, and I think I’m winding down here, the fact is that because supply and demand works so well, and because profits in fact do many good things for many people, for the common good, the market is self-adjusting, IF it’s left alone. So let me veer off into economics, though keep in mind that this applies to medicine just as it does to everything else. Because yes, it IS a business – the supplies, the service – that’s what it is. (People who think it isn’t, don’t bother telling me because I can not comprehend your thinking there; I think I’ve already illustrated why it is in fact a business, an industry.)

    Let me compare this with breastfeeding for a moment because it’s a perfect analogy. When a baby is new it will nurse quite frequently, if he’s allowed to do so at will. The breasts, feeling the demand of the suckling by the infant, begin to produce a steady milk supply. If the baby goes through a growth spurt and requires more for a week or two, the breasts quickly adjust to the growing demand and produce even more. When the baby slows down and stops making the same demand on the breasts, in a day or two (though it’s a bit painful for that day or two) produce that much less. It adjusts quite naturally; and any nursing mom knows that if she wants to have some to save or to donate to a milk bank, she has to place additional demand on that breast by pumping when the baby isn’t eating. When the baby weans gradually, the milk dries up and you don’t produce it anymore. Another resource – solid food and other drinks – has taken its place, it isn’t being demanded anymore, so no more is made.

    Basically, the body reacts like this: if a breast feels “full” for too long, it sends a signal to the factory that it’s making too much and tells it “too much – make less!” If a lactating breast is suckled and is consistently empty, it sends a message to the factory, “not enough – make more!” Aside: this is why I get so angry when people get bad nursing advice from ignorant doctors, though this is less common now. Basically, breast milk spends 1 1/2 hours in a new baby’s stomach to be processed – so at first you feel like you’re doing it constantly. But if the baby is allowed to continue to demand it, and everything is working properly, the breast will start to produce a much fuller supply; it all ends up being self-regulating. Yet I have witnessed famous pediatricians tell a new mother, whose baby was nursing every two hours (which is pretty good – it can be a lot more often, believe me) that she should cut it DOWN to once every three hours, because she should let the breast become “full” first so that the baby would have more there to drink. Um – if you have read this far, you know what that means, right? It means that her breasts, feeling “full”, would send a signal to her factory saying “too much – make less!” If she took his advice, I can guarantee you that woman was formula-feeding within weeks. If that. This is the whole problem with the practice of “scheduling” – it’s all right to schedule a baby who is drinking formula, to a degree. But if you distort this bodily process with a false schedule, your factory has no way of knowing how much to make and when – this is one reason why about 77% of mothers nurse for the first week or two and then stop – you can’t schedule, or regulate a self-regulating system. It is a *distortion* of the natural process of supply and demand. Now apply this reality to the market.

    If there are 10 million prices and the people involved in each industry allow the demand to set the price, then adjust their production of each thing based on the demand for it (which is what happens when they are left alone to do it) then production of some things will go down and others will go up. How in bloody hell can a bureaucracy, from above, attempt to regulate such a system beyond the very obvious things like protecting people’s property rights? (That is, the right to make, own, earn and produce, along with the enforcement of contracts and the protection of them from bodily encroachment.) Every single distortion of this type screws with the natural, self-regulating process of the market. A bureaucracy can not POSSIBLY hope to try to direct the methods in which people ought to employ their capital or their production – it can only cause shortages in one place and overages in another place. We used to use whale oil in this country. When it became too expensive, people couldn’t afford it and it became obsolete, so we started with kerosene. This all happened without the government *telling* people to stop using it or making it – the prices did that. The supply and demand did that. This is why oil isn’t going to “run out” anytime soon – when it gets too expensive, as it did a year + ago, people stopped using so much of it. No one had to force them to do that – they started walking more when they didn’t need to drive, etc. Prices did what? They fell.

    Anyway, whether it’s medicine or groceries or any product or service in the world, it’s not supply and demand that has caused problems – it’s distortions in supply and demand by *regulation*. I, for one, do not want to put my health care in the hands of a faceless bureaucracy that, for all its facelessness, can still put me in jail and use deadly force against me. It’s bad enough that so much of the money I work for is taken by this same faceless bureaucracy at the point of a gun – and yes, it is at the point of a gun – they put you in jail for not paying that money, don’t they? That’s force. It should only be used extremely sparingly and for the purposes of protecting people from harm and fraud. This is what the founding fathers fought and died for, and while I know we’re not going to get back there in my lifetime, I’ll be damned if I will allow it to KEEP going further and further in that direction without a fight. This giant isn’t sleeping.

    Ok, if you aren’t asleep by now and have actually read this monstrous comment, and if it made any sense at all, please please do have a look at this essay, which explains it all in a charming and entertaining way. It’s Leonard Reed’s classic, I, Pencil. Please skip the foreward by Milton Friedman until after reading the actual essay, ok? It kind of ruins it if you haven’t read it before.

    P.S. Did you know that if the AIG bonuses were split evenly among the population of this country we would each get 43 cents? Hehe. Just thought I’d throw that in there.

  8. bigliberty says:

    Hey Annie,

    What a fantastic comment! It really deserves its OWN comments. Do you mind making it into a standalone post?

  9. anniemcphee says:

    Oh hell yeah! I was just hoping it at least made sense; it was a stream-of-consciousness post lol. I didn’t know it would actually be good. Yeah, I’ll make up a draft. Thanks 🙂

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