Government Healthcare is Bad for Fat People


Read the links on this page.

While employers can currently establish plans that incentivize weight loss, it’s not illegal and/or will not cause your taxes to go up to decide not to participate in such programs. Additionally, there is some measure of direct voting by employees — complaining about the plan, leaving the business to work elsewhere, not participating in the plan — that is much closer to the decisionmaker in the process and could ostensibly much more quickly repeal a plan decision than waiting for a large enough group of people to be voted in who commit to weeding out problems in legislation, which can take at its quickest years, and at its slowest, never (as the problems become too deeply institutionalized).

If the government forces everyone to buy private or public plans, then encourages (through subsidies to private plans, or directly in public plans) plans that create initiatives or penalties based on weight, then there is no escape. Even if it’s just verbal encouragement, it gives employers the sense that they can discriminate against unpopular groups and lower their own costs without the possibility of losing an employee that is a member of an unpopular group, since even if that employee was to leave, chances are the same discriminatory initiatives would be in place wherever else they’d choose to seek employment.

The choice to participate in health care should not be forced. Choice is sometimes the last check one has on a virtually universal discriminatory and unethical system with deeply rooted institutional bias. The ability to choose to opt out of healthcare, to have the choice not to participate, is essential. Those who want to argue about public costs are only doing so in the context of the current healthcare framework under which we suffer: though the nature of insurance re: pooling risks does mean that some will pay in and never take out as much as they pay in, while others will take out more than they pay in, it doesn’t mean that anyone’s health is technically anyone else’s business. That’s just the nature of insurance.

This would not be the case if health decisions and health behaviors and being a member of an unpopular health class literally become public business. By definition. One would have to completely trust the government not to fall in with popular Healthist sentiments that have a tendency to put a good deal of the blame for unaffordability and poor public health on fat people. In my humble opinion, placing such immense trust in a fickle, by nature ever-changing, populist, and power-hungry entity is foolish.

Those who are interested in freedom from institutionalized discrimination should always be concerned when choices are taken away, rather than offered up. The way to fight discrimination is to open doors, not close them. Many pro-fat activists are in favor of universal healthcare because they believe it will force insurers to cover those who are currently not covered, or allow the government to provide a plan that will cover them (they currently already have this power, by the way). But this is an example of closing doors, not opening them. Fatphobia is still out there, and it runs rampant in government — and is no less present in Progressive political circles than any other circle. If fat people can be used as scapegoats to save money in what is sure to be a very expensive system (TNSTAAFL*), that is what is going to happen.

And that is already what is happening, as the healthcare bills currently being proposed are overrunning their cost goals, even taking into consideration that every gimmicky scheme to shift money around has been called upon in order to make the bills look less expensive than they already are (frontloading payins, backloading payouts, political promises of savings that won’t be kept, etc). Since the government doesn’t have to worry about doing anything scientifically sound if their electorate cares more about money than science, they’ll pick groups to discriminate against (or promote discrimination against) re: insurance in the order that these groups are medically unpopular. Fat people and smokers are, without a doubt, the top of that list.

Universal or forced coverage is not good for fat people. What you gain in terms of being technically covered you will lose in the inevitable discrimination, higher costs, public shaming, fat hate and the wider spread of fat hate and focus on fat people as a “problem,” and so on.

Besides, I (and many others) know how to really lower costs, so that even groups that insurers put in a higher rate category would be able to afford insurance. But to lower costs would require less regulation, less control, more choices for individuals to buy care…in other words, a free market injection in a hopelessly overregulated industry. I’m certain that the cost of a plan for a “fit” family of four in Massachusetts currently would be the maximum of what you’d see for a non-“fit” family of four in a freer market.

The answer to the problem of fat people not being covered (or covered affordably) does not lie in handing over our fates to politicians and bureaucrats who are the ultimate barometer of public whims and misinformation.

If you have any questions, here is a bit of reading.

Do not give the public the ability to vote on your private health matters: No Fat People in Concentration Camps

Socialized medicine leads to more discrimination, higher costs, and fewer choices: Universal Healthcare and Fat

We should be free to do what we want, as long as that liberty doesn’t infringe on the liberty of others: Libertarians and Obesity, Take Two

A chain of back-of-the-envelope logic whereby involved government in healthcare in our current climate leads to dire consequences for fat people: Eliminate Fat People

Involving government in healthcare in our fatphobic environment can lead, and has led, to the breaking up of families. Additionally, it could lead to the state-sponsored eradication of fat children, by any means necessary: The Tide of Hate Rises

You should never give someone else the ability to make choices about your body: When Your Body is No Longer Yours

The state is not an objective third party with no profit motive, and will not operate as such in the distribution of health care: Why Universal Healthcare Should Be Opposed by Fat Activists

Junk science and fat unpopularity = the legislation of thinness: Universal Healthcare is Not Automatically Fat-Friendly

The Food Police are coming: “Lock-in” the Fatty Fat Fats

*There’s no such thing as a free lunch.

15 comments on “Government Healthcare is Bad for Fat People

  1. trabbsboy says:

    No. No, no, no, no, no. Deregulation does not help anybody but the heads of, and investors in, insurance companies. Look, insurance companies are for-profit institutions, and their overarching purpose — their entire purpose — is to make a profit. This means that, as an institution (not individuals in the institution), they are prohibited from caring about anything. They will charge fat people more if they can get away with it. They will withdraw coverage when someone gets sick if they can get away with it. They will deny coverage to anyone with a higher risk of bad health and do whatever they can to find out who is at higher risk if they can get away with it. Profit comes from people paying into the company as much as possible and the company paying out to people as little as possible.

    “Choice” — the mantra of free marketers — is an illusion here. Individuals do not choose their health care providers. The employers do. Employers have a desire to spend as little on health care as they can, which means they will adopt a plan that discriminates against fat people and smokers and people with preexisting conditions if one is offered to them, because those plans will be cheaper.

    The government is not perfect by any means. The minute something begins to come out of “tax dollars” the whole country starts to get all riled up about the details. And it certainly appears that many high level government positions in health areas are filled by people with ties to the weight loss industry. But there is absolutely nothing bad you can say about government insurance that isn’t ten times worse with private. The government has an incentive to keep the program cheap, but it does not want to make a profit. It wants to pay for people’s health care!!!!!

    And the government plan is just another choice being offered. It’s not like it’s mandatory or anything.

    What is needed here is regulation. LOTS of regulation. Regulation saying that insurers can’t withdraw coverage of people who get sick. That insurers have to take everyone regardless of preexisting conditions. That insurers can’t can’t have a policy of refusing to pay claims and make a profit off anyone too tired or poor or helpless to fight back. And there should be regulation saying that insurers cannot discriminate on the basis of weight.

    The problem is with this one, tiny issue — of the lobbyists for the weight loss industry getting wrong incentives into the bill. The problem is not the offer of a government option.

    I’m sorry to be so longwinded, but having moved from the States to Canada I am horrified by the private insurance system in the US. Here, the VOTERS get to make the policy. Maybe there is an occasional tyranny of the majority issue (though fat-hatred has not been much of an issue at all here), but every single person here gets health care for free, with no paperwork, extremely few of the wait times so exaggerated by the American right. Nobody dies when they get cancer because the insurance company points to an undisclosed hernia and withdraws coverage. Nobody sells their home to pay for health care.

    The way to cut costs is to get rid of the profit makers, the layers of overlapping administration, the constant battling and court cases over who has to pay for what, the bankruptcies and new welfare cases and funerals all caused by not having the government running the health insurance system. Any step toward universal public coverage is a step out of the dark ages. For fatties as well as thin people.

  2. Heidi says:

    On the other hand, doctors in the UK put no pressure on me to lose weight, were far more size-friendly than the practitioners I’ve seen here in the US, let me labor for 42 hours to give birth vaginally when a hospital in the US would almost certainly have treated me, a deathfat pregnant woman, as a high-risk case and rushed me to a c-section long before, had plus-size cuffs that they knew how to use and automatically picked up when I came in without my having to ask for one, and all that for a far, far lower price than any of the care I’ve received in this country.

    There’s a good reason that the US lags behind in medical stats, despite paying twice as much as any other industrialized nation for our healthcare. On this, I simply cannot agree with you, much as I appreciate your other perspectives!

  3. bigliberty says:

    I think you’re confused. What we have now is not by any stretch of the imagination a free market health care system, and the problems it has are a direct result of over-regulation (high costs, low choice, portability) not under-.

    Also, health insurance in Canada is not free. It comes at the price of people keeping more of their own money to spend how they see fit (on a different kind of healthcare plan, or perhaps no plan at all), and decreasing choice in markets drives up price and the cost of living, ultimately.

    The idea that the government plan would be a “choice” which would compete the same way other private plans is fallacious and shows a lack of understanding of economics. Subsidizing a particular plan with nearly limitless funds is not fair competition, and it will potentially be able to undercut nearly every other private plan (while driving up their costs through higher taxes and required benefits, etc). Private healthcare will not survive long if there is a public “option.” It’s not a fair fight.

    I think you should read my other links, especially the Cato link. The problems I see with much of the counter-arguments to government healthcare is a fundamental misunderstanding of how markets operate, and a lack of understanding of the consequences of the existing regulatory policies in the States (Vermont, Maine, Massachusetts are good examples).

    And though you don’t cite any healthcare-institutionalized fat hatred from Canada, the point is that if a political entity has control of healthcare, they can indeed use that power to focus on unpopular groups to the detriment of those groups, and use healthcare as a way to force behavioral changes.

    Just a short point to those who fear and loathe (and don’t understand) the free market system: historically, fascism has been a function of governments. There’s been no instance in history where corporations operating without state help or control have had complete and utter forcible control over a people. So the idea that fascism and the free market are in any way alike is just socialist propaganda and has no basis in reality.

  4. bigliberty says:

    @Heidi: without discounting your individual experience, I have to say that it has nothing to do with the topic, which is about populations, not individuals. (i.e., anecdata isn’t a rigorous argument in this case) Your conclusion relies on hypotheses of theoretical treatment — just not rigorous.

    And I’m a bit disappointed in the apparent spin here — there are many cases out of the UK where the NHS has mistreated fat people and fat families for being fat.

    Do you really see no difference between being denied coverage or having to pay more for coverage, and having your children taken away from you by the State, for being fat?

    I’ve got to drive home that the way to make healthcare available to the most amount of people and still remain free is to lower costs. The best way known in economics and in the history of mankind to lower the cost of a product is rely on the market to read the demand, create supply, and set prices.

  5. trabbsboy says:

    Sorry, but I understand economics just fine. The folks at Cato Institute are purists of the sort that have been around since Ronald “the government is the problem” Reagan. The Chicago school failed all over South America and, as the last eight years have made clear to most people, they failed in the U.S. A purely free market will always favour the rich over the poor, widening the economic divide until the rich completely take over the government, creating a very nasty little oligarchy. The ideal of a free market in which all individuals have equal bargaining power is a farce.

    We clearly come from very different ends of the political spectrum, and I think the odds of either of us changing the other’s mind are very slim. I think we can agree that discrimination against fat people in health care is a bad thing, and maybe I should just leave it at that.

  6. bigliberty says:

    Oh, I’m not trying to change your mind. And you’re wrong about the failure of the free market system and especially blaming the hotbed of socialism that is many countries in South America on the free market system…the twain can never meet. It’s just that there are people who don’t understand market economics (and you clearly don’t, despite what you say) who are assigning wrong definitions to what a free market system is and then using their wrong definitions as “proof” that the system is broken.

    (oh yes, and the depth of the recent financial meltdown has everything to do with the devaluing of risk — backed by government ratings and promises — and nothing to do with the free market, as it were. Though a free market system will always experiences a cycle of ups and downs with a constant trend up, the market self-corrects both the bottoms and bubbles. It’s when the government intervenes that the market gets distorted, and bubbles get bigger and bottoms get deeper (and wider))

  7. bigliberty says:

    Oh, and “The folks at Cato Institute are purists of the sort that have been around since Ronald “the government is the problem” Reagan. ”

    Poisoning the Well

  8. deannacorbeil says:

    The problem with anecdotes is that they are only one individual’s experiences. I could counter praise for the Canadian system with numerous stories of my own. (I worked as an RN in Detroit for years; I can’t tell you how many Canadians I personally cared for who were paying cash for cancer treatment because of lengthy wait times at home.) We need to look at studies documenting actual patient outcomes, wait times, etc.

    I don’t have time to write a lengthy response right now. (Maybe I will later—I’ve a lot to say on this topic.) However, for those who are so fearful of insurance companies (who are not all for-profit institutions, by the way), think about the last time you heard about an insurance company arresting, taxing, imprisoning, siezing property, etc. That’s right. They don’t have the power to do those things. But our governmental institutions do have that right. My healthy fear is of those who have the most power over me.

  9. deannacorbeil says:

    Just one example of a government health plan (in this case, the NHS) at work on our kids:

    “Labour’s secret plan to send overweight children to NHS fat camps”

    Could Blue Cross do this?

  10. mrsdorr says:

    Hi BigLiberty,

    I’m hoping you can answer a question for me about healthcare in a free market (I will freely admit to not being an expert on this topic, although I did follow your links to try and sort it out). How would people with “pre-existing conditions” ever have a prayer of getting health care? If you have cancer, how could you prevent your insurance from dumping you when your care becomes “too expensive” for them?
    And I read this, but it really isn’t an answer as to how exactly this would save money. “The expansion of “health status insurance” would protect many of those with preexisting conditions.”


    • bigliberty says:

      Hi MrsDorr,

      Thanks for commenting, and thanks for following the links. I think your question has a two part answer: one is purely markets, dollars, and cents, and the other is moral.

      In dollars and cents, when a market is deregulated that means that players usually have a lot less overhead in order to enter the game. For instance, in Massachusetts insurers are required to offer a particular number of benefits. Not all people use these benefits, but all must purchase them. That drives the cost of the average plan way up. Now, insurance is a risk-rewards game (I mean “game” in the economic sense). If you get enough people in the game who may not utilize all the pay in for, you can afford to take on more people who would utilize more than they pay for. Obviously you would have to have more people paying in than have people who are getting more payouts than payins in order to make the model financially viable or “worth it” for the insurer to get involved.

      Now, it’s in the insurer’s best interest to maximize payins and minimize payouts. That’s why people without pre-existing conditions can buy cheaper plans – if you have a pre-existing condition, then (depending on the condition) you’re almost sure to cost more than you’d pay in. In order to balance that out — because insurers do indeed want the money of those with pre-existing conditions — they raise the rates on those plans.

      However, a person with a pre-existing condition could, in an unregulated market, pick and choose which benefits they are interested in in order to lower the cost of their more expensive plan. Right now most states require a certain list of benefits to be covered; a person with a pre-existing condition could get a custom plan which allows them to pay in to help defray costs for their condition but not pay for all that other stuff. The plans would probably still be expensive, but less so than now, and could give people with pre-existing conditions a fighting chance to afford their own coverage.

      I’m not an insurance expert — I’m mostly interested in complex political/social/economic systems (I research and build computational systems which model these phenomena). So I urge you to get in touch with someone who knows the ins and outs of the system now (and has enough imagination to extrapolate to a deregulated system), and could provide you with more detailed answers.

      There are other ways such cases could be covered: foundations to help defray costs through private charitable contributions, an optional tax which would go directly to those who can’t afford healthcare, and so on.

      This brings me to the moral question. Should people be forced to pay for the healthcare of others? I don’t think so. I think a system which forces people to subsidize others’ health insurance plans is unsustainable and will lead to the rampant cost overruns and inevitable political scapegoating in order to save money (as detailed above). I also being that kind of compulsion is wrong.

      There’s no reason private charity can’t be robust enough to help support the unfortunate health situations of those in the community. Concerned individuals, or those with an interest or stake in the cause, could contribute via optional taxes or, even better, directly. It still might not cover everyone. But that’s the way markets work — there are always a few that slip through the cracks. The idea is to try to set things up so that the fewest slip through the cracks as possible, and creating conditions for health care to be privately offered through many competing entities where people can create custom plans is the best, most stable way to lower costs and hence cover as many people as possible. Charities can be set up to try to take care of the rest.

      Sorry if this is somewhat rambly or incoherent, I’m absolutely exhausted after a long day.

  11. richie79 says:

    Yikes, Deanna, how on earth did I miss that one? I know how; because this Government are the nastiest, most devious lot we’ve endured in many a long year and I hope they’re utterly crucified at the polls next year. The short answer is no, Blue Cross or Kaiser or any of the others COULD NOT do this, not independently at least, unlike the network of local NHS ‘trusts’ who are now expected to ‘co-operate’ with local education authorities and (terrifyingly, in the wake of the Dundee case) the faceless, unaccountable and ever-judgmental bureaucrats at social services. Pound to a penny, those who exercise their ‘right to refuse’ to have their kids shipped off to fat camps for a bit of gastric origami will find themselves on the local At-Risk register and a nice little ‘noncompliant’ footnote in their son or daughter’s ContactPoint entry. Maybe if they’re really lucky they’ll get £114,000 spent on live-in minders to keep them away from the fridge and the TV set.

    Only government can operate in this so-called ‘multi-agency’ capacity, only it has the vast sums needed to build and run immense Orwellian databanks, and the more ‘joined-up’ it gets, the more dangerous for all of us. It’s becoming a nasty horrible world out there; Joe Public wants a scapegoat – someone to blame for why he’s paying more and getting less, and no-one fits the bill right now as well as fat people.

    (Did anyone else pick up on the way the child’s broken nose seemed to be framed as ‘losing weight also prevents bullying?’ It’s something I’ve heard stated and implied time and again, even more so since the media picked up the attack on Marsha Coupe a couple of weeks ago. It’s despicable that the threat of emotional and physical violence is increasingly being accepted as a legitimate weight-loss motivator by supposedly educated people and those allegedly concerned with child welfare, without so much as a passing acknowledgment of the dangerous implications of such warped ‘logic’.

  12. osxgirl says:

    Thanks for a great look at this, and for the well-researched look at it with all the links. I wrote on my blog about it as well, but I tend to write more emotionally and haven’t put up the research links to back up a lot of what I’ve said, though I have read a lot.

    Perhaps that should be one of my next steps, though unfortunately I have little motivation to do so. I fear that what “we the people” have to say about this issue matters very little, and that the elected officials will do what they want. At that level, it really has very little to do with actually providing care for people, and everything to do with seizing control of a large part of the economy, translating into a very large share of political power. If you don’t believe this, try looking up some of the back room deals that are being made in trade for votes to pass the health care bills – politicians who refused to vote for the bill unless they also got certain deals that benefited their districts.

    The politics of this country disgust me more every day. The politicians no longer represent us – they are there to get as much power for themselves as possible. And if anyone thinks that healthcare will be different, they are greatly misled. I work in the federal government (in one of the few areas where the federal government should be involved – defense). There is no way I want the government running my healthcare. I understand intimately how the government works, and what everyone fears about government control will inevitably happen – the cost will be at least 3 – 4 times what it is now (probably more), we will have less services, service will be rationed, bureaucrats will dictate to us what is medically necessary, regulations will not account for individual cases, and yes, I have no doubt that “scapegoats” will be needed – those that can be “blamed” for their own conditions, and therefore penalized in some way by denying services or making necessary services conditional on taking certain proscribed treatments. In the case of those of us who are fat, I am sure we will eventually be targeted for mandatory weight-loss programs, and at the very least strongly “encouraged” to get WLS. And if we don’t lose weight, we will be considered non-compliant, and will be denied anything but the most basic of life-saving services, or will find that we will be penalized monetarily, or other such methods of trying to make us “conform”. After all, we obviously just aren’t trying hard enough.

    And believe me, I’m not just worried about those of us who are fat. I’m worried about a whole lot of people if government health care gets enacted in this country. If you care to read it, my blog is

    • bigliberty says:

      osxgirl, thank you for your comment. I think emotional pleas against healthcare have as much a place as emotional pleas for healthcare (which most of them are). Not classify the worthiness of an argument based on its level of emotion — what I’m saying is that I really like seeing emotional pleas from the other side too. People who (like myself and apparently yourself) are frightened that a government takeover of such a large part of the economy means that sector of the economy will see quality/availability/efficiency of services suffer. In fact, there are some good arguments out there about how this takeover could result in LESS effective coverage. Saying that people like you and me don’t care about our neighbors (or family or friends) is ridiculous. This takeover would be a “good” thing for very few of us, certainly not the majority.

      Oh yes, and let me know if you’d like your blog to be added to the Fat Liberation feed. Cheers!

  13. […] Government Healthcare is Bad for Fat People […]

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