Other reasons why fat person cost calculations are bogus

Ragen has a great article out today, please take a look if you haven’t seen it already:

The True Cost of Fatties

In her post, Ragen talks about how the back of the envelope ‘study’ done a couple of years ago that suggests fat people are killing the planet with all the extra gas we consume, and the usual shady numbers we see about how much extra healthcare dollars fat people consume. Apparently fat fatties eat money just like they eat Twinkies — in excess, and uncaring as to how it effects anyone else in their lives. We’re truly terrible people, a costly evil scourge that must be eradicated…at all costs.

Which leads me to my first additional point to Ragen’s post:

When we hear fat person cost calculations, there’s an ever-present underlying assumption that if fatties were thinnies or normals, we wouldn’t consume those extra resources. However, overwhelming evidence shows that in order to maintain a significant amount of weight loss down from a natural setpoint of significantly higher, individuals need to dedicate something like a part-time job to it: exercising for several hours a day, paying for expensive diet plans or special meals or therapies, measuring and weighing and planning and special shopping trips and scribbling in a journal–you get the picture. There’s a $60 billion dollar diet industry that derives most of its income from people going on and off temporary diets. If fat people were to do what the above ‘experts’ claim and go on mandatory, permanent, life-long diets, imagine how that number would explode. It would likely eclipse the (shady) amount (badly) estimated spent on fatty healthcare ($147 billion in 2008).

The next part of the fat person cost calculation has to do with absenteeism and the murkily-defined and -exampled presenteeism. Presenteeism is, as defined, when workers show up to work but have much lower levels of productivity than a coworker doing the same job.

…presenteeism was measured and monetized as the lost time between arriving at work and starting work on days when the employee is not feeling well, and the average frequency of losing concentration, repeating a job, working more slowly than usual, feeling fatigued at work, and doing nothing at work. [2]

From what I’ve seen, fat people are accused of presenteeism because they’re assumed to have greater health-related obstructions to doing their job. This would be most pronounced in markets that rely on physical labor. However, the studies I’ve seen that show a ‘significant’ (1% difference! Le gasp!) increase in presenteeism as defined don’t correct for age, which is strongly positively associated with both fatness and decreased productivity in manual jobs.

Fatty presenteeism and absenteeism is estimated to cost employers $73.1 billion annually. My question is, naturally: how much more productive is a starving person? (dieting is indistinguishable from a famine state) How much more productive is someone who spends a part-time job in addition to their full time job keeping off weight? How much would it cost the economy as a whole if we estimated the lost productivity of fat people due to the fact that in order to maintain a thinner state, they would have to dedicate something like 15 – 20 hours a week they could have spent working additional hours, raising up a new generation of workers, or supporting their community and the productivity of others? Methinks that would be a hella more than $73.1 billion a year.

Now for the second point I wanted to add to, or rather stress, in Ragen’s analysis:

You can single out practically any group of people you want and find additional ‘costs’ associated to their ‘lifestyles’ or genetic differences. Thin people are the awesome du jour, but they’ve got their own set of associated costs (if you believe the hype that they’re more active and so on): cost of gas getting back and forth to the gym, athletic injuries, diet plans, they live longer and hoo boy is that expensive, they take more vacations, they tend to be richer and hence de facto consume more resources, and so on. Let’s add that up.

Or parents, as mentioned by Ragen and by me in another forum: parents, especially of unfashionably large families, consume mountains more resources than childless people, have high levels of absenteeism in the workplace, and cost their employers much more in family insurance plans, childcare benefits, and so on. Let’s add that up.

Or people who get tattoos — let’s go after them, shall we? They get sicker more often, as a new tattoo is the same as an open wound. They tend to hang out in edgier clubs, are exposed to the possibility of more violence, and are probably more likely to be drug users (a purely correlative assessment, of course). Let’s add that up. And don’t get me started on people with psychological disorders like depression, bipolar, or those who’ve had traumatic backgrounds, or who are part of prejudicial groups — the extra health costs associated with their therapies and prescriptions and their decreased productivity is nigh-on criminal(big flashing sarcasm meter on all these points, of course)

And so on, and on, and on…

So why fatties? Because we cost so much more than other groups? Nope. Because our costly status is preventable, or cheaper to treat? Nope (see my Truth About Fat: References page). Because:

Fat people are scapegoats.

For what? For a breaking healthcare system, a broken health insurance paradigm, a slowing economy, global warming, hunger in non-Western countries, the declining standard of Western beauty, and pretty much anything else some random person doesn’t like and doesn’t want to either understand or tolerate.

We are in a moral panic, not an epidemic. Fat people ‘cost more’ because we are hated. Fat people destroying the earth, or anything else for that matter, is a proxy for how the moral crusaders believe we are destroying humanity.

References

1. Rising obesity will cost U.S. health care $344 billion a yearUSA TODAY, November 17, 2009.

2. Obese Workers Cost Workplace More Than Medical Expenses, Absenteeism. Duke Global Health Institute, October 7, 2010.

3. Obesity Promotes Global Warming? John Tierney.The New York Times, May 16, 2008, 9:49 AM

4. Wrestling with the ‘Double Burden’: Hunger and ObesityWorld Food Program USA. By Sara Draper-Zivetz  Published on February 18, 2011

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Of Breasts and Money

Or, you know, health care.

This was a comment I made on BL’s last post and she requested that I make it a stand-alone for further discussion. I was so flattered I did it immediately.

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.