Whaddaya gonna do about it?

I would be seriously remiss if I didn’t highlight Meowser’s terrific post, at Shakesville and cross-posted at Fat Fu, in response to this comment by Barack Obama:

“If we could go back to the obesity rates of 1980 we could save the Medicare system a trillion dollars.”—Barack Obama during Democratic Presidential Debate, 12/13/07

Says Meowser:

But we have an election coming up next year, and strictly from a fat perspective, I worry about who is going to replace him. When I found out Barack Obama (much like Hillary Clinton, who has made similar remarks in the past) wanted to disappear me solely because of my weight in order to save the government money, I had to ask: Just how far are they willing to go to make that a reality?

No, really, I want to know. I’m willing to sacrifice a lot in order to make life better for poor people, gays, Muslims, waterboarding victims, and a whole lot of other folks who have been personally kicked in the rear a lot more severely than I have by the current administration. I’m willing to sacrifice a lot for a cleaner environment, safer food, no war, no wiretapping or torturing just because you don’t like someone’s mustache, and more affordable housing for all. Which is why I’m a Democrat. They may not be perfect, but at least they make a pass at giving a damn about those issues.

But I still think I have a right to know just how much agency they are willing to remove from people—and especially fatasses like myself—in the name of “health care cost containment.” You’d think the Democrats would be all about personal agency and individual freedom. They damn well ought to be. But I’m afraid that when it comes to nosing around in people’s body autonomy, they’re just as guilty as the people they want to replace; they just want to nose around in a different part of our bodies, that’s all.

Getting the vapors about health care costs and blaming the fatties for driving up the cost of health care seems to be the very latest fashion. And here’s the thing: I haven’t seen one reliable study that shows that fat people, over a lifetime, actually have higher healthcare costs than other people.

Oh, sure, people will always bring up diabetes as an example. But does a fat diabetic actually cost the health care system more than a thin diabetic?

Not to mention, if fatasses are all doomed to drop dead at an early age, then that actually saves money in the long run, doesn’t it? Certainly it would seem to eliminate costly elder care, since all the fatties dropped dead in their 40s and aren’t clogging up nursing homes 50 years on.

Then there’s the issue of fat being blamed as an independent variable for all sorts of things when that’s never been shown to be the case. In addition, as Meowser points out, weight gain is often a symptom of underlying health problems (the kind that might have been detected earlier if we had universal health care and a focus on preventive medicine) or a result of treatments for certain conditions — and many of those treatments have been developed since 1980.

Meowser gives a list of questions about weight and health care policy that she’d like to see the candidates (especially those inclined to put the blame and burden on the shoulders of fat people without actually examining other factors that might be driving up health care costs) answer in the next debate. But I have a few to add:

What do you intend to do about the massive corn subsidies that result in cheap crap and high fructose corn syrup in just about every kind of foodstuff?

What do you intend to do to raise school funding so that schools don’t have to rely on soda and candy sales (or ads for fast food) to make ends meet, to fund athletic teams, to pay for physical activities, to pay for space for physical activities, or to buy healthy food for school lunches?

What do you plan to do to address the fact that we keep telling kids to eat healthy, but federal nutrition and school lunch programs keep feeding them crap because of the influence of the beverage industry and agribusiness, who need a place to dump their surplus?

What do you plan to do about making fresh fruits and vegetables and other healthy items available, accessible and affordable to people who receive public assistance in the form of food stamps or other food-assistance programs?

How will you close the grocery gap?

What will you do to make it easier for low-income people to do their own cooking if they don’t have facilities, particularly on a community basis?

What will you do to address suburban sprawl and increase public transportation and affordable housing so people have time to exercise, the roads are a little safer to walk along or bike on, and people maybe aren’t so stressed out because of commuting?

What kind of preventive care are you envisioning as part of your healthcare plan?

Do you have the guts to take on Big Ag, Big Pharma and the insurance industry?
____

Thoughts?


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87 Responses to Whaddaya gonna do about it?

  1. D.N. Nation says:

    It’s easier to bash the fatties than to reform anything. Which is pretty much the same it is on any topic, from terrorism (easier to bash the Muslims) to energy (easier to bash gas taxes) to immigranttion (easier to bash the Mexicans) to, to, to…

  2. SarahMC says:

    If we got rid of smokers like him, we could save the government a nice chunk of change as well.

    I’m a smoker, btw.

  3. Heather says:

    Do you have the guts to take on Big Ag, Big Pharma and the insurance industry?

    This is the real question that I think underlies all the rest. I want a candidate in office that will call these industries on what they are doing.

  4. Mnemosyne says:

    And here’s the thing: I haven’t seen one reliable study that shows that fat people, over a lifetime, actually have higher healthcare costs than other people.

    There’s a lot of confounding factors, though — many times, “fat” is a symptom of an underlying problem (like uncontrolled or poorly-controlled diabetes). Once you eliminate the health factors than can actually cause fatness as a symptom or side effect, that’s the only time you can really get a good look at it. A lot of people are put on steroids by their doctors for various health problems and are not adequately informed that, yes, THEY WILL GAIN WEIGHT. It’s not a personal failing — it’s what happens with that medication, and it will happen no matter how much you eat/exercise. You just have to wait it out and not panic.

    I will say, there probably is a specific health area directly related to fatness: joint replacements for older people. The extra mass does tend to wear the joints down faster, but even that could be confounded by pre-existing conditions like arthritis or other joint issues that can lead to someone getting fat since it’s difficult or impossible to exercise through the pain.

  5. Mary says:

    Great post, zuzu. I was talking with a libertarian friend of mine about the need for universal healthcare, and of course, he’s against it. His reason? Because he doesn’t want to pay for the fatties’ health problems, since they just need to stop eating donuts all day.

    This is a man who is somewhat overweight due to an injury that has forced him to give up lots of physical activity. (An injury that, btw, could have been taken care of well before crisis set in if he’d had better healthcare insurance.) He just couldn’t figure out that a lot of people gain weight because of something other than eating donuts all day; he must be the exception. A lot of people gain weight because of physical disability, whether permanent or temporary, yet our society just will not acknowledge this.

  6. FashionablyEvil says:

    What do you intend to do about the massive corn subsidies that result in cheap crap and high fructose corn syrup in just about every kind of foodstuff?

    Dude, even my store brand of BRAN FLAKES have corn syrup in them. Bran flakes!

  7. Shinobi says:

    I haven’t seen any statistics on the joint replacement theory, but I can’t help but doubt that the non exsistant obesity epidemic will cause an increase in those. As some Doctors are refusing to preform joint replacements on obese patients now. TeH FaT iS in UR HuspITaL eaTING UR PaTIenTS!

  8. emjaybee says:

    I work for a Giant Health Insurer, and they talk a good game about “wellness.” There’s financial incentives to join fitness clubs, in-house Weight Watchers, email reminder programs, and all that. Great.

    But in our building’s cafeteria, the healthiest items are still a) not that great (wilty salad) and b) more expensive than, say, the burger and fries. If I wanted to eat healthy the way my company wants me too…I would never eat the food that they sell to their employees.

    These kinds of disconnects are just writ larger in our national food policy; truly making “wellness” and health a priority would mean more fresh, healthy, organic food and less crap, everywhere. It would mean subsidies for organic vegetables, not GMO Cheetos. It would mean looking at food availability in poor areas, and subsidizing/pressuring grocery stores to move into underserved areas.

    I mean, why not invest in urban gardens and encourage people to grow their own veggies, ala Victory Gardens? Why shouldn’t schools incorporate organic gardening into their curricula to supplement the cafeteria offerings (think of the science and math lessons learned by figuring out a good yield on carrots and potatoes. Also, manual labor=exercise, no)? Why not give tax breaks to co-ops and local growers? There are a thousand good ways to improve eating health without shaming people for their weight.

  9. RacyT says:

    Considering how many “thin” people I know who are that way due to starvation diets or who are just naturally thin despite horribly unhealthy eating habits, I’m certain weight is not a reliable indicator for overall health.

  10. tannenburg says:

    There’s something supremely ironic in the fact that I commonly observe advertisements for weight-loss products (which are, frankly, all useless and marginally dangerous crap that the loopholes about “herbal supplements” the FDA allows through) juxtaposed with advertisements for the MegaUltraSuperBigGulp Meal at Random Food Restaurant. Let’s face it, throughout most of history the poor were the ones with waif-thin physiques through malnutrition, and the wealthy those dying of gout and other indulgence-related illnesses. Here and now many forms of food are cheap and convenient – i.e. those with the worst possible nutritional profiles.

    As is typical with our present-day culture, the constant demands to indulge – “all-you-can-eat” – is constantly thrust at us in combination with the “don’t-get-fat-or-you’ll-be-all-alone-and-unloved” message. We are told to splurge, then punished for doing so. That sets aside the issues of those who cannot diet, due to genetics or other non-“weak-will” situations.

    So what’s the solution? How about encouraging health outside of phenotype? How about really encouraging food corporations to provide food items not saturated (pun intended) with excess fats, salts, sugars, and other tasty-but-unnecessary ingredients? The cultural bias towards “thin = wonderful, fat = nasty” is still going to be there, and those who are over the societally-defined measures of weight are going to be stigmatized for having weak wills and uncontrollable, gluttonous appetites.

    No, I’m sure lots of taxpayers don’t want to “subsidize the fatties” by paying for health care for diabetes and so forth. On the other hand, I don’t particularly want to subsidize health care for smokers or people with alcohol-related illnesses, since I don’t drink or smoke. Come to think of it, I don’t want to pay taxes to subsidize the illiterate, since I can read, or those people who have bad mortgage loans, since I don’t, or the fire-fighters for the next town over, since if their houses burn down it’s not going to impact me…but that’s not the choice, people. You pay taxes for the common good, with the understanding that some may get more than others.

  11. Shankar Gupta says:

    Great post, zuzu. I was talking with a libertarian friend of mine about the need for universal healthcare, and of course, he’s against it. His reason? Because he doesn’t want to pay for the fatties’ health problems, since they just need to stop eating donuts all day.

    The flipside of this coin, from the portlier libertarian perspective, is that the moment you allow the government to provide healthcare, you put it in the business of deciding what’s good for you, granting them a potentially limitless justification for interfering in your life.

    The fat thing is just the beginning, because, as Zuzu said, fat folks are easy for politicians to pick, but you can be absolutely certain it doesn’t stop there. Smoking, exercise schedules, dangerous hobbies/lifestyles, “risky” sexual behavior, diet, psychiatric care–once the government is a healthcare provider, all of these things are “legitimate” area of debate for legislation. If you’re even a little bit worried about how evangelical Christian conservatives want to tell you how to live, the prospect of putting the government in charge of your health should worry you just as much.

  12. Orly? says:

    You know what would be sweet? If Zuzu took the time to look for information before declaring that she’s never seen evidence of something. This is hilariously obtuse:

    Oh, sure, people will always bring up diabetes as an example. But does a fat diabetic actually cost the health care system more than a thin diabetic?

    Not to mention, if fatasses are all doomed to drop dead at an early age, then that actually saves money in the long run, doesn’t it? Certainly it would seem to eliminate costly elder care, since all the fatties dropped dead in their 40s and aren’t clogging up nursing homes 50 years on.

    That first sentence is just unbelievable: nobody says fat diabetics cost the health care system more than thin diabetics, but what they say — what’s true — is that obese people are overwhelmingly more likely to *become diabetics* than people who are at a healthy (or “thin,” if we must label via appearance) weight. And since you use diabetes as an example, let’s point out that as weights have ballooned in recent decades, the formerly unheard-of Type II child diabetes cases have correspondingly skyrocketed. And diabetes is likely to be the preeminent cost drain on the health care system in the near future, with one in three children born in 2000 likely to contract Type II. One in three!! If you don’t think that’s a health issue, well, I don’t know what to tell you.

    As for the second part, I call straw man. I’m not saying this to be crude or dismissive; this is simply the fact: people who are obese don’t die from being unhealthily overweight, they develop chronic conditions that are a drain on their lives, on productivity, and on, yes, health care costs.

    Now, the solution to this certainly isn’t to fat shame! Reduce subsidies on wheat and corn to start, raise subsidies hugely for fruits and vegetables, do better with education and oversight on dietary habits (from school lunches to city grocery availability to promoting excercise) — it’s all important.
    Solutions are crucial . . . and on our way to solutions, let’s not pretend that obesity isn’t a health (and health care) problem.

  13. roses says:

    …the prospect of putting the government in charge of your health should worry you just as much.

    As a Canadian, I really haven’t found having the government “in charge of my health” to be so terrible. Every once in a while there’s a rumbling about taxes on junk food or tax incentives for people who show good health, etc., but it never comes to fruition. Despite the system being in place for over 40 years now, there is no legislation on exercise schedules, dangerous hobbies/lifestyles, “risky” sexual behavior, diet, psychiatric care… we are starting to see some legislation about smoking in public areas, but it’s no different than what you have in the US. And the war on obesity over here doesn’t hold a candle to the one in the US… probably because Canada wasn’t founded by Puritans.

    Now, having an an insurance company in charge of my health…

  14. Mnemosyne says:

    I haven’t seen any statistics on the joint replacement theory, but I can’t help but doubt that the non exsistant obesity epidemic will cause an increase in those.

    You might want to actually, you know, look at some scientific information before you decide that there can’t possibly be a link between obesity and joint replacement. Just for laffs.

  15. Great questions, zuzu. Right on target.

  16. Cara says:

    The fat thing is just the beginning, because, as Zuzu said, fat folks are easy for politicians to pick, but you can be absolutely certain it doesn’t stop there. Smoking, exercise schedules, dangerous hobbies/lifestyles, “risky” sexual behavior, diet, psychiatric care–once the government is a healthcare provider, all of these things are “legitimate” area of debate for legislation. If you’re even a little bit worried about how evangelical Christian conservatives want to tell you how to live, the prospect of putting the government in charge of your health should worry you just as much.

    Funny, because most European countries have public healthcare and yet they still smoke plenty and are generally way more sex-positive and gay-friendly than America is. I lived in Australia for 3 years, where they have socialized medicine. My husband lived there for 23 years. And strangely enough, they never told him when to exercise, or what hobbies he could and couldn’t have, and I know that his mother smokes plenty and Australians sure to love their alcohol. Also, I could get three months — THREE MONTHS — of birth control pills for only $10 Australian dollars, but no one made me take them, or even suggested it, other than me. Hmm.

    And though it would be a shitty trade off, I have to say that I would rather have a nationally mandated exercise schedule than die because no one will pay for my life-saving surgery. So no, not worried.

    Thanks for writing about this, zuzu, that comment in the debate got under my skin, too.

  17. Lorelei says:

    oh christ. half the reason medicare’s so fucked up seems to be that it’s a faulty system within itself, and even if that isn’t entirely accurate, it certainly doesn’t help that there’s practically 0 oversight on money going in and out and that congress is stealing money from all the various social security programs via ‘unified budgeting.’

    but thanks for blaming it on us, guys! :D

  18. napthia9 says:

    The fat thing is just the beginning, because, as Zuzu said, fat folks are easy for politicians to pick, but you can be absolutely certain it doesn’t stop there. Smoking, exercise schedules, dangerous hobbies/lifestyles, “risky” sexual behavior, diet, psychiatric care–once the government is a healthcare provider, all of these things are “legitimate” area of debate for legislation. If you’re even a little bit worried about how evangelical Christian conservatives want to tell you how to live, the prospect of putting the government in charge of your health should worry you just as much.

    From the same perspective passing legislation to prevent murder, rape, and robbery is just the beginning because (as everyone knows) preventing violent crime is a very popular platform for politicians, but you can be absolutely certain it doesn’t stop there. Housing, traveling, dangerous hobbies/lifestyles, “risky” sexual behavior, alcohol consumption, career decisions- once the government is a physical safety provider, all of these things are “legitimate” areas of debate of legislation. If you’re even a little bit worried about the government providing healthcare, making the government responsible for your physical safety should worry you just as much. Because the moment you allow the government to make laws, you put it in the business of deciding what’s good for you, granting them a potentially limitless justification for interfering in your life.

    Sorry for the snark, but the government making healthcare available to everyone is different from the government legislating personal health decisions. After all, beer and cigarettes aren”t cheap, ne? And in Wisconsin you gotta give yourself permission for your own abortion. It’s not like healthcare is going to suddenly cause the government to interfere in these matters. The government already interferes with personal health decisions, so why lose the chance to provide a lot of people who couldn’t otherwise get it with healthcare?

  19. Lorelei says:

    funny thing, even my severely libertarian cousin who lives in Quebec has nothing bad to say about governmental health care. this is probably because it occurs to him that he was a sickly child, and god forbid there WASN’T government-funded healthcare, he would have never had his asthma/274982478 allergies/other random respiratory issues treated, what with his family not exactly havin’ a piece of the pie.

  20. zuzu says:

    You know what would be sweet? If Zuzu took the time to look for information before declaring that she’s never seen evidence of something. This is hilariously obtuse:

    Nice way to start. I’m only letting your comment through to respond to a few things, then you’re getting modded because you’re a rude twit.

    That first sentence is just unbelievable: nobody says fat diabetics cost the health care system more than thin diabetics, but what they say — what’s true — is that obese people are overwhelmingly more likely to *become diabetics* than people who are at a healthy (or “thin,” if we must label via appearance) weight.

    And since fat doesn’t *cause* diabetes, but merely *correlates* with it, there’s no evidence that *fat people* are more expensive to care for over a lifetime than *thin people* just because they’re *fat people.* And even if the majority of *diabetics* are fat, what does not follow is that the majority of *fat people* are *diabetics,* no more than the majority of thin people are. And yet the popular misconception is that all fat people are just ticking time bombs who OMG ARE GONNA COST US MONNNNNEEEEYYYYY!

    Moreover, any number of factors that cause diabetes or are precursors to diabetes (i.e., insulin resistance) are responsible for weight gain in the first place. Which, you know, might be avoided if we focused on preventive care. Which insurance companies don’t like to pay for and drug companies would rather not see come into wide use.

    As for the second part, I call straw man. I’m not saying this to be crude or dismissive; this is simply the fact: people who are obese don’t die from being unhealthily overweight, they develop chronic conditions that are a drain on their lives, on productivity, and on, yes, health care costs.

    So again, it’s the chronic conditions and not the fat itself that’s the problem. Moreover, fat people are not the only people who develop chronic conditions that are expensive to care for. The sick elderly, whose lives we prolong long past the point when they would have died just because we can, are tremendously expensive to care for. So are preemies and micropreemies — it’s not unusual for a preemie to exceed his or her lifetime insurance-policy benefit prior to his or her first birthday (and then become impossible to insure). And yet nobody talks about what a drain on our taxes the elderly or the premature or the people who have preventable forms of cancer or who get into catastrophic accidents because they didn’t wear their seat belts are. Hell, even medical malpractice and side effects from drugs used correctly and hospital staph infections are big drains.

    The point, which you seem determined to miss, is that fat people are being scapegoated for the sad state of the health-care system, when there’s no good evidence that fat, independent of any other variable, causes all kinds of health-care expense out of proportion to that attributable to any other group of people who tend to fall into the health care system.

  21. Mary says:

    probably because Canada wasn’t founded by Puritans.

    And that is the real issue, I think. I really don’t think people are concerned for everyone’s health, but rather, with feeling superior to others because they have such control over desires, which may or may not actually be true.

    The flipside of this coin, from the portlier libertarian perspective, is that the moment you allow the government to provide healthcare, you put it in the business of deciding what’s good for you, granting them a potentially limitless justification for interfering in your life.

    As opposed to a profit-making insurance company, which already refuses to insure me because of preexisting conditions that I didn’t bring on myself?

    That argument sounds a lot like the argument conservatives make against same-sex marriage, that once we allow that, people will want to marry animals and such. There is a gray area that people often forget about.

  22. roses says:

    You might want to actually, you know, look at some scientific information before you decide that there can’t possibly be a link between obesity and joint replacement. Just for laffs.

    You selectively quoted. She said rising obesity rates won’t cause an increase in joint replacements if doctors just refuse to do joint replacements on obese patients. Which is happening in the UK.

    As for “skyrocketing” rates of Type II diabetes among children – they never used to test for Type II diabetes in children, because it was assumed to be an adult onset disease. When they started testing for it, they started finding it, leading to the rates “skyrocketing” from 0 to… not 0. But we have no way of knowing how much rates have actually increased, because we have no previous data.

  23. FashionablyEvil says:

    As for the second part, I call straw man. I’m not saying this to be crude or dismissive; this is simply the fact: people who are obese don’t die from being unhealthily overweight, they develop chronic conditions that are a drain on their lives, on productivity, and on, yes, health care costs.

    Nope, not a strawman. Zuzu is correct that economic models should reflect someone’s early death. You just add up net costs and net “benefits” (ie, not paying the health care costs associated with another 30+ years of life). Also, there are plenty of non-obese individuals who have chronic conditions.

  24. Meowser says:

    Oh, sure, people will always bring up diabetes as an example. But does a fat diabetic actually cost the health care system more than a thin diabetic?

    Not to mention that type 2 diabetes is VERY strongly linked to heredity. As is fatness. Hmmm…

    What do you intend to do about the massive corn subsidies that result in cheap crap and high fructose corn syrup in just about every kind of foodstuff?

    While I’d certainly like to see HFCS not wind up in bloody near everything — hello? tomato soup? — and I definitely prefer cane-sugar soda if I’m going to drink soda simply because I prefer my beverages not to taste like ass, my Australian correspondents tell me that HFCS is extremely rare in their foodstuffs (and growth hormones in meat and dairy are banned entirely), yet Australians are about as fat as Americans are. Agreed, though, that the way food is grown and distributed in this world is absolutely scandalous, and all your other “candidate questions” are bang-on. Thanks for the shout!

  25. Meowser says:

    Oops, sorry for not blockquoting the second quote. Feel free to fix it if you like.

  26. Meowser says:

    (this refers to a post that is in the mod queue)

  27. Mnemosyne says:

    You selectively quoted. She said rising obesity rates won’t cause an increase in joint replacements if doctors just refuse to do joint replacements on obese patients. Which is happening in the UK.

    Well, let’s see what s/he said:

    I haven’t seen any statistics on the joint replacement theory, but I can’t help but doubt that the non exsistant obesity epidemic will cause an increase in those. As some Doctors are refusing to preform joint replacements on obese patients now. TeH FaT iS in UR HuspITaL eaTING UR PaTIenTS!

    Since I was the only one referencing joint replacements, I assumed she was responding to me and not making a general response about the (frankly idiotic) policy that some places in the UK were trying to make.

    Just so it’s clear: yes, I think it’s possible that obesity in and of itself may cause one’s joints to wear out more quickly. That doesn’t mean I think obese people should be denied joint replacements any more than I think that smokers should be denied cancer treatment for cancers that are linked to smoking.

  28. nonskanse says:

    As for you fatties, stay fat, diet or don’t diet, it’s really your problem or your non-problem (depending on how you view it – you’re free to dislike being fat or not too). Even if you did need vastly more medical care. It’s amazing that we’re living longer, outliving our hospice welcomes, dying of cancer because there’s nothing left to die of (medicine saves us) more and more every year, and someone can blame FAT for raising medical costs.

    [lighthearted] I hope someone hurries up and make plane seats wider for America’s collective not-as-thin-as-1980 asses. Cuz that shit is uncomfortable.[/lighthearted]

  29. Raging Moderate says:

    I haven’t seen one reliable study that shows that fat people, over a lifetime, actually have higher healthcare costs than other people.

    In that vein, there was a study a few years ago here in Canada that caused quite a stir in some circles. It stated that smokers, alcoholics, drug addicts, and the obese actually cost our health care system less as they tend to die significantly earlier than healthier citizens who live longer, but then need more health care in their old age.

    So smoke ’em, shoot ’em, drink ’em and eat ’em if ya got ’em.

  30. Lorelei says:

    yeah let’s not mention that no-one ACTUALLY knows how people get diabetes, unless there really has been some randomass breakthrough in research that i’ve yet to come across. but last i heard, we just know what gets fucked up in the pancreas, but not why or how it comes about.

  31. Lorelei says:

    in which case i’d wicked love to see the publication indicating the discovery of the mechanism that causes diabetes. :)

  32. Hector B. says:

    Some observations:

    The two people I know who had joint replacements (hips and knees) had been very athletic in their youth and simply wore them out; they were not “overweight”.

    There does seem to be a “metabolic disease” associated with being overweight, which leads to high blood pressure, high cholesterol, and type II diabetes. But, the two people I know with type II diabetes were simply overweight, not obese. No one would have given them a second look.

    Our modern lifestyles require a lot of time with our asses planted in a chair, in fear of losing our jobs. Europeans with much more job security work far fewer hours. Exercise by walking is part of their lives because they’re not rushing to accomplish so much of their lives in the few hours they can call their own.

  33. Sniper says:

    The people I’ve known who’ve had joint replacements were fragile and birdlike and old. Our population is getting older, we’ve living longer than ever. These are not bad things but older people do have more health care requirements – and these should be taken care of.

  34. Mnemosyne says:

    yeah let’s not mention that no-one ACTUALLY knows how people get diabetes, unless there really has been some randomass breakthrough in research that i’ve yet to come across. but last i heard, we just know what gets fucked up in the pancreas, but not why or how it comes about.

    I saw a fascinating article recently that they’ve discovered that a certain percentage of adult-onset diabetes cases are not Type II — they’re actually very slow onset Type I. You only find this out when your doctor puts you on meds for Type II and they don’t work. So, yeah, lots we don’t know.

  35. Mnemosyne says:

    The people I’ve known with joint replacements have been somewhat elderly though not ancient (60s-70s) and overweight, and usually had some degree of arthritis first. So, obviously, there’s quite a range.

    Joint overuse in your youth can lead to arthritis, which is why Fred Astaire and other professional dancers were basically disabled in their later years.

  36. Ashley says:

    And since fat doesn’t *cause* diabetes, but merely *correlates* with it, there’s no evidence that *fat people* are more expensive to care for over a lifetime than *thin people* just because they’re *fat people.* And even if the majority of *diabetics* are fat, what does not follow is that the majority of *fat people* are *diabetics,* no more than the majority of thin people are.

    Regarding the second half of this, it’s not an issue of majority of diabetics or overweight people — this is like saying that smoking isn’t a problem for health care because the majority of smokers don’t have lung cancer.

    As for correlation versus causation, it’s true that being overweight hasn’t been definitively proven to cause diabetes, just like it’s true that gravity is a theory. But I trust these folks more than I trust Zuzu when it comes to medicine:

    National Institute of Health: “[S]oaring obesity rates [in kids] are making type 2 diabetes, a disease that used to be seen primarily in adults over age 45, more common among young people.”

    American Diabetes Association: “Most people who get type 2 diabetes are overweight, and losing weight is often the first step in controlling type 2 diabetes.”

    Center for Disease Control: Increase in Type 2 diabetes is an epidemic.

    Journal of the American Medical Association: “intentional weight loss is associated with reduced mortality among overweight persons with diabetes.”

    It goes on and on.

    Actually, thinking about it more, the smoking analogy really is a good one. On the one hand, a person could rightly say, evidence of smoking causing lung cancer still hasn’t been proven, and there are plenty of other contributing factors: genetics, environment, pollution, etc. And not all smokers get lung cancer, of course, so why blame it all on smoking, even though it’s the strongest correlative factor?

    The answer to the connection between being overweight and developing diabetes isn’t to tell people that they’re terrible because they’re fat, it’s to change the factors that *make* people fat — all the stuff other people have mentioned. But if you want to avoid diabetes, the bottom line is, maintain a healthy weight. Most people aren’t overweight because they eat great and exercise — anybody for whom that’s true *is* at their healthy weight, most likely — but rather because their diet sucks and they’re too sedentary. Eating well and exercising is to diabetes what quitting smoking is to lung cancer. And to label this kind of analysis “fat-shaming” is profoundly weird.

  37. La Lubu says:

    Smoking, exercise schedules, dangerous hobbies/lifestyles, “risky” sexual behavior, diet, psychiatric care–once the government is a healthcare provider, all of these things are “legitimate” area of debate for legislation. If you’re even a little bit worried about how evangelical Christian conservatives want to tell you how to live, the prospect of putting the government in charge of your health should worry you just as much.

    Huh? Then why hasn’t this been a problem during the entire tenure of Medicare? Ya think it might have something to do with voters? And do you really think the government, which has to answer to the voting populace, is going to gatekeep more than insurance companies, who answer to damn near no one? (yeah, I know, “stockholders”. Yet considering that most folks own anywhere from no stock, to a postage stamps’ worth—certainly not enough stock to have a voice, let alone a vote—might as well say “oligarchy”). Libertarian health care: No money? Too bad! Hurry the fuck up and die, willya?

    Medicare costs aren’t going up because of fat people. They’re going up because the populace is aging. Funny how no one talks about throwing grandma under the train though.

  38. Ruth says:

    I have had two joint replacements. Before age 50. Neither was a weight bearing joint.

    My doctor calls it “luck of the genes.”

  39. Shankar Gupta says:

    As opposed to a profit-making insurance company, which already refuses to insure me because of preexisting conditions that I didn’t bring on myself?

    I realize that often this is a choice between the devil and the deep blue sea, but the big difference is that you choose to participate in the limits that an insurance company sets on you, whereas you cannot choose not to participate in universal healthcare.

    That argument sounds a lot like the argument conservatives make against same-sex marriage, that once we allow that, people will want to marry animals and such. There is a gray area that people often forget about.

    There’s a huge, huge difference between the two slippery slopes you’re comparing. The one that conservatives (and not just conservatives, I’d hasten to point out) point to when they don’t want to allow gay marriage (among other consensual behaviors) is a slippery slope that ends with too many things being permitted (which is why it’s not really a concern), whereas the one I’m describing leads to nothing being permitted.

    When religious politicians say “gay marriage will lead to people marrying animals,” even if you accept that to be true, that only goes as far as people’s desire to marry animals–which can’t be too great, or people would be doing it already. When I say “universal health care will lead to the government regulating aspects of your life you’d prefer they do not,” that ends with politicians’ desire to regulate your life. Which d’you reckon goes further?

  40. Tapetum says:

    Speaking as someone who is overweight and likely to develop Type II diabetes – Orly? You’ve got some assumptions that need to be checked. I’m not likely to get Type II diabetes because I’m overweight. I’m overweight because I’m insulin resistent, which causes fatigue and weight gain and is associated with future development of diabetes. Once the insulin resistence was diagnosed and treated (only took about 10 years of doctors yelling at me about weight gain without checking my insulin levels), glory be! I started losing weight! Yet, I’m still more likely than your average Joe to progress to diabetes at some point.

    Most cases of Type II diabetes are preceeded by insulin resistence, which is frequently undiagnosed – which is going to lead to what? Fat people developing diabetes, because they were gaining weight due their already poor sugar-processing.

  41. jacko says:

    You know, to be honest here, zuzu. I’m not sure I’m quite with you guys on this.

    You compare the health costs of obesity to the health care costs of premature babies or alzheimers. And you’re right, if Obama had said:
    “If we could go back to the elderly patient costs of 1980 we could save the Medicare system a trillion dollars”

    It would have been dangerous, offensive and ridiculous. Dementia and developmental problems are things that just happen, and we deal as best as we can with the health care costs when they do happen. The difference is that, unlike most dementia, obesity is a phenomenon that we, as a society, are very much capable of confronting. To say that coronary heart disease and diabetes are things that ‘just happen’ and we’ll do the angioplasty and the bypass surgeries when they do, is to give up all of the potential of preventative care of obesity before the problems happen!

    I understand Meowser’s concern about the threat to bodily autonomy, but obesity is dangerous. Think of smoking as an analogy. The aggressive public health campaign against smoking probably offended alot of smokers, and was probably seen as a threat to their autonomy as free citizens in a free country. Nonetheless, you’re still allowed to smoke, but your right to make choices that are unhealthy does not extend over the need to persuade others against those same choices.

    I’m not saying obesity is ‘moral failure’. Just like smoking, confronting obesity is as much about confronting the industry that profits and propagates from it, as it is about education and public health. I just think that to pretend that obesity is a personal choice that the government has no business talking about wrong, when people’s lives are at risk.

  42. RKMK says:

    I really don’t think people are concerned for everyone’s health, but rather, with feeling superior to others because they have such control over desires, which may or may not actually be true.

    But… I kind of am concerned for someone’s health. Really. I’m what my friends call (affectionately) a raging feminazi. I hate patriarchal standards of beauty/the beauty industry/the misgynistic fashion industry, the way TMZ harrasses starlets if they dare gain a pound here or there (because they had the audacity to age, OMG).

    But I did have a roommate, a good friend, who was obese. I know the million critical messages she gets daily, and went out of my way to be sensitive to that – I resisted the urge to sigh about the state of my thighs in her presence (which is a bad, bad habit I’ve been trying to break for years anyway) or otherwise grump when I felt my clothes getting a bit tight – I never wanted to her to feel badly in that “UGH, if R thinks SHE’S fat, what about me?” way, ever.

    But the woman is 23 years old, and having recurring chest pains. And in the year we lived together, she injured herself twice (once her ankle, once her knee), both simply resulting from prolonged standing. And that does scare me. All things being equal, 23 year olds should not be having chest pains. And I was (am) so scared of offending her or making her feel bad about herself that I don’t say anything. (Much like I’m afraid to say it here, for fear of being misunderstood in a similar way.)

    Just saying… sometimes people really are worried about the health aspects.

  43. zuzu says:

    As for correlation versus causation, it’s true that being overweight hasn’t been definitively proven to cause diabetes, just like it’s true that gravity is a theory. But I trust these folks more than I trust Zuzu when it comes to medicine:

    You’ll note that none of those sources actually say that fat causes diabetes.

    However, if you’ll give it a moment of thought, you’ll look at that recommendation to lose weight as a way of controlling diabetes and see that what it’s really saying is *not* that being fat causes diabetes and losing weight cures it, but rather that adopting behaviors that have the effect of losing weight — ie., exercising and eating better — are beneficial to people with diabetes.

    The problem with focusing on fat itself and not the underlying behaviors is that the underlying behaviors are unhealthy for anyone, not just the people who tend to gain weight as a result of them.

    You compare the health costs of obesity to the health care costs of premature babies or alzheimers. And you’re right, if Obama had said:
    “If we could go back to the elderly patient costs of 1980 we could save the Medicare system a trillion dollars”

    It would have been dangerous, offensive and ridiculous. Dementia and developmental problems are things that just happen, and we deal as best as we can with the health care costs when they do happen. The difference is that, unlike most dementia, obesity is a phenomenon that we, as a society, are very much capable of confronting. To say that coronary heart disease and diabetes are things that ‘just happen’ and we’ll do the angioplasty and the bypass surgeries when they do, is to give up all of the potential of preventative care of obesity before the problems happen!

    You know, I really don’t get why you think that I’ve ever said that preventive care is not necessary. In fact, I believe my entire damn list of questions up there in the post address things that need to be addressed if we’re going to actually do anything about the “obesity crisis.”

    In fact, my argument, which you and the other people who were so disturbed by the idea that someone might not be properly blaming fat people for being unhealthy and ticking time bombs who should be denied healthcare until they’ve shown the proper remorse have apparently failed to grasp, is that scapegoating fat people accomplishes exactly nothing, but thinking about societal factors does.

    I mean, Jesus. Why did so many of you to log in for the first time just to say that YES FAT PEOPLE DO *TOO* COST US MORE MONEY AND YOU’RE ALL UNHEALTHY AND YOU JUST WON’T ADMIT IT!!!?

  44. Hector B. says:

    whereas you cannot choose not to participate in universal healthcare.

    ??? You can always opt out of pretty much everything. I know lots of people who chose not to participate in universal public education, public transportation, and even public drinking water. I even know people who’d rather take their trash to the dump than have the city pick it up. As far as I know, every country that has a government health-care system also has fee-for-service doctors, so what is the big deal?

  45. zuzu says:

    I realize that often this is a choice between the devil and the deep blue sea, but the big difference is that you choose to participate in the limits that an insurance company sets on you, whereas you cannot choose not to participate in universal healthcare.

    You’ve got an awful rosy view of health insurance companies if you think they don’t find any way possible to deny coverage, regardless of the limits you’ve agreed to. Moreover, there are many forms of universal health care in the world, and only a few don’t allow for private care at all.

  46. Rose says:

    Jacko, many obese people are confronted by “Hey you disgusting fatty!” on a daily basis. And yet somehow that stunning observation, which is of course said with nothing but their health in mind, usually doesn’t suceed in making a person thin.

    People like you who actually imply that fat people are deluded into thinking they’re thin and need to be told the truth for their own good make my head want to explode into a million pieces!

  47. Shankar Gupta says:

    You’ve got an awful rosy view of health insurance companies if you think they don’t find any way possible to deny coverage, regardless of the limits you’ve agreed to. Moreover, there are many forms of universal health care in the world, and only a few don’t allow for private care at all.

    I do have health insurance, and I realize with what gusto they try to deny coverage.

    But even if the current system is flawed, I shudder to imagine what a universal healthcare system would look like in this nation. Even if I were to accept that models like Canada’s would work in the U.S., which I do not, Cananda does not have, for example, the religious right–who, the moment they gained control of the healthcare system would no doubt try to defund, for example, all manner of family planning and STD care–much in the same way they try to do now, only with far more success, since they control the pursestrings.

    Moreover, there are many forms of universal health care in the world, and only a few don’t allow for private care at all.

    Ah yes, what I’ve always wanted is to pay twice for healthcare–once for my universal healthcare that’s subject to the whims of elected/selected officials, and again for my artificially price-inflated private healthcare.

  48. zuzu says:

    But even if the current system is flawed, I shudder to imagine what a universal healthcare system would look like in this nation.

    I would imagine it would look a lot like Medicaid, which is not notable for its busybodyness.

  49. Meowser says:

    Jacko, giving people more options for taking better care of themselves is always a happy, as far as I’m concerned. Take smoking, for example. Anyone who has ever smoked more than a pack a day and tried to quit (which would probably be almost every smoker not named Whoopi Goldberg or Joni Mitchell) can tell you that nicotine replacement products that provide more than a pack a day’s worth of nicotine do not exist. The FDA does not allow them. It’s pretty safe to say that the heaviest smokers are at the greatest risk healthwise, are the most intractably addicted, and they also get the least amount of help in kicking their addiction. And it’s also pretty safe to say that if more options existed for them, more of them would probably quit.

    But fat is not smoking. As Marilyn Wann once put it, “Eating is a behavior. Drinking is a behavior. Drugs are a behavior. Smoking is a behavior. Fat is not a behavior.” Fat is complex and multifactorial and the causes (and chances of reversibility) vary widely from person to person. Smoking is invariably caused by one thing: Putting cigarettes in your mouth, lighting them, and taking a drag. At least with smoking, the point of entry is completely optional; if you never put a cigarette in your mouth and light it, you’ll never be a smoker. OTOH, you can become no-kidding-around faaaaat doing exactly what your doctor tells you to do. (I did.)

    We can give people more options to help them live “healthier,” and I’m all for that. It’s a crime that everyone doesn’t have access to good quality fresh produce and the means to prepare it. It’s a crime that so many people live in areas where it’s unsafe to walk, play, and bike even if they want to. If the government wants to step in and make improvements in those areas…yaaay.

    Where I get off the train is making “healthy living” and attaining a certain (arbitrary) weight a condition of future medical care. If a thin person refuses to take statins and then they have a stroke, it’s not like the doctor is going to say to them, “Fuck you, you should have taken the statin, you can live without the use of your left side forever for all I care.” But fat people experience this all the time when they are “noncompliant” with stringently unrealistic-for-them weight-loss goals, even if they are eating well and exercising.

  50. M. says:

    I love democracy. I think it’s awesome that I get a say in what happens rather than some inbred guy in a powdered wig calling all the shots. That being said, however, the major flaw of democracy is that politicians start basing their policy on uninformed public opinion rather than actual fact (not that monarchies base their policies on fact either, but that’s a whole other monster).

    Explaining to people that their prejudices about fat people and about socialized medicine are wrong will not get you the vote. Blaming the fatties, on the other hand, will make people nod in agreement, shake their heads at all those deadbeat fatties, and cast their votes.

  51. Smartpatrol says:

    Eating well and exercising is to diabetes what quitting smoking is to lung cancer. And to label this kind of analysis “fat-shaming” is profoundly weird.

    I would call it a lame cop-out, & say that it keeps happening whenever anyone brings up the obvious & points out the cavernous gaps in logic inherent in the rhetoric of Corpulence Glamourization.

    Jacko, many obese people are confronted by “Hey you disgusting fatty!” on a daily basis. And yet somehow that stunning observation, which is of course said with nothing but their health in mind, usually doesn’t suceed in making a person thin.

    WHAT!? You mean that shaming, guilt-tripping & other forms of negative reinforcement are ineffective as self-improvement motivators? I’m shocked, shocked I tell you. & that’s precisely what Jacko was doing. With an super-sized portion of finger-wagging. Truly.

    Just saying… sometimes people really are worried about the health aspects.

    Get out of here fat-hater! Don’t let the door hit your skinny ass on the way out, phatphobe! Take you fatbashing somewhere else! Take your disgusting hateful fat-shaming diatribe back to your friends at Little Green Footballs & Fitness World! *repeat ad nauseam*

  52. jacko says:

    zuzu: I agree with your questions 100%. I just think Obama was stating a fact, and nothing in that sentence implies, to me, that he was shaming fat people for their moral failures and letting big companies and other societal factors off the hook. And for now, I’m willing to give him the benefit of the doubt. To me, it’s just a sentence acknowledging the problem that obesity is. I just have an issue with the libertarian approach that ‘these are our bodies, don’t tell us what to do with them.’

    Meowser: I’m not sure how it works in the states with private insurance, but as a medical student up here in Canada, I can say that we treat people with lung cancer due to smoking with every bit of effort and ability that we do a child with leukemia. We’re taught to treat people as best we can even if they refuse what we consider to be the most rational treatment. We try our darndest to convince them otherwise, but in the end, what they say goes. And I don’t think that Obama was in any way arguing against that kind of approach to obese patients.

  53. zuzu says:

    That is an astonishingly hateful comment, Smartpatrol, but then, I’m not surprised, since I’ve seen similar hateful comments from you in other venues when this issue comes up.

    “Corpulence Glamourization”? I mean, for real? Could you be any more disconnected with reality?

    Though I suppose you’re the kind of person who thinks that basic human rights for, say, gay people are really “special rights.”

    I’ll repeat, because you seem to become unhinged at the sight of the word “fat” — exercise and eating well are good things in and of themselves. However, doing them at a level that’s beneficial for health is not necessarily going to make a fat person thin. Does that diminish the value of eating well and exercising? Not at all. Yet there are some people who should know better who evaluate health solely on the basis of body size and not on actual health.

    Moreover, there are people who use health as an excuse for venting their seething rage about fat people. Kinda like you.

  54. jacko says:

    Jacko, many obese people are confronted by “Hey you disgusting fatty!” on a daily basis. And yet somehow that stunning observation, which is of course said with nothing but their health in mind, usually doesn’t suceed in making a person thin.

    People like you who actually imply that fat people are deluded into thinking they’re thin and need to be told the truth for their own good make my head want to explode into a million pieces!

    I wasn’t saying that. I’m not saying that people who are obese need to be shamed and yelled at publicly until they hop on a treadmill! I was responding to Meowser’s belief that Obama’s statement was an affront to the autonomy of obese people over their bodies. I am saying that obesity is a problem that has to be talked about! It’s not something that happens out of the blue, and its not something we’re powerless at preventing or reversing. I agree that too often that discussion has been mired in the ‘fat shaming’ that you’re so concerned about, but it doesn’t mean that a rational, understanding, and effective discussion shouldn’t happen.

  55. zuzu says:

    I just think Obama was stating a fact, and nothing in that sentence implies, to me, that he was shaming fat people for their moral failures and letting big companies and other societal factors off the hook.

    Fact, huh? Where’s the study that shows that fat, as an independent variable (not lack of exercise, not too much refined starches, not god-knows-what that they’re putting in the food nowadays) is directly responsible for all those costs he cited?

    Moreover, you must not be aware of the obesity-crisis rhetoric here in the US if you think that singling out obesity, of all other possible factors (smoking, not exercising, drinking, seat belt use, mold, drug interactions) wasn’t meant to just simply get people nodding in agreement about those lazy fatties costing us money without actually addressing structural factors that are contributing and are out of the individual’s power to control. Especially with kids and with the poor, who often have their food provided by the government and feel the effects of funding cuts.

    It’s one of those dog-whistle phrases, sort of like “immigration.” Immigration is limited in the popular imagination to Mexicans crossing the border (thanks, Lou Dobbs!), and all the blame falls on them. Nobody bothers to look at the companies who are employing them illegally to save money, or for that matter at the nice Europeans who come here on planes and overstay their visas.

    And when you have countries like the UK denying people treatment (provided by the government) until they lose weight, you’re damn right it’s time to worry about bodily autonomy. Why should anyone’s medical care be delayed because of aesthetics?

  56. Rose says:

    Jacko, my point is that you talk about obesity as a problem to society that somehow needs to be dealt with. What if we deal with health, environment and nutrition without bringing body size into it?

    I have never met a fat person who didn’t know they were fat. Nor have I ever met a fat person who hasn’t been on endless diets usually since childhood. And even though diets fail to keep people thin 96% of the time, I’ve never met a fat person who didn’t feel like a personal failure for gaining weight back. You say you don’t want to encourage fat shaming you just want fat people to be encouraged to come to this epiphany that they’re really too fat and unhealthy and should stop what you perceive as bad behavior in order to become thin people. It’s condescending to scold people for their eating and exercise habits, especially when you have no idea what they actually are! You can’t tell how healthy a person is to look at them; I’m a good example of that. I went from a fat woman to a thin woman over the past year due to hyperthyroidism. This hasn’t stopped my family from constantly praising my new thin form. On some level they really would rather I be a sick thin person then a healthy fat person. The cultural pull to view thinness as desirable no matter how that thinness is achieved is very strong.

    Unlike Smartpol, who is too much of a mean-spirited fool to bother responding to, I actually think you might be well intentioned. But the road to hell is paved with good intentions, Jacko. There’s no contradiction in standing up for the rights of your fat brothers and sisters and pushing for a healthier, less toxic environment. A society that stands against discrimination, scapegoating, and marginalization of any group of people is a healthier society than one that does not.

  57. Hector B. says:

    Any honest for-profit corporation will tell you their highest duty is to their shareholders — not their customers or even their employees. Every penny an insurance company can save by denying treatment to sick people flows right to the bottom line. And yet people like Shankar would rather trust them with their health-care decisions than the government, whose highest duty is to their citizens.

  58. AB says:

    I would imagine it would look a lot like Medicaid, which is not notable for its busybodyness.

    Huh? This not-busybody Medicaid is the same program that does not provide funding for abortion because of the Hyde amendment. From the National Abortion Federation:

    After Roe v. Wade decriminalized abortion in 1973, Medicaid covered abortion care without restriction. In 1976, Representative Henry Hyde (R-IL) introduced an amendment that later passed to limit federal funding for abortion care. Effective in 1977, this provision, known as the Hyde Amendment, specifies what abortion services are covered under Medicaid.

    Over the past two decades, Congress has debated the limited circumstances under which federal funding for abortion should be allowed. For a brief period of time, coverage included cases of rape, incest, life endangerment, and physical health damage to the woman. However, beginning in 1979, the physical health exception was excluded, and in 1981 rape and incest exceptions were also excluded.

    In September 1993, Congress rewrote the provision to include Medicaid funding for abortions in cases where the pregnancy resulted from rape or incest. The present version of the Hyde Amendment requires coverage of abortion in cases of rape, incest, and life endangerment.

    Abortion, which is a pretty bedrock reproductive right, has been kicked back and forth between funding, to no funding, to barely any funding, to kinda-sorta-funded for the not-sluts only (you know, rape and incest victims) under Medicaid. I think there’s an excellent, excellent chance that we’ll have the same arguments about covering abortion, as well as Plan B and contraceptives for the unmarried or underage, under a single-payer system.

    However, I think the major libertarian flaw in opposing universal healthcare is that universal healthcare doesn’t have to be a single-payer system. Medicare (insurance for the old), for example, gives people the option of getting their services directly reimbursed from the government (kind of like a PPO) or using their Medicare to join a private health insurance plan, which presumably will offer a richer set of benefits than straight Medicare. Ta-da! Everyone’s covered, plus you have the choice of sticking with a private insurance company if the government starts to get too sexist in its coverage decisions. Everybody wins.

  59. nonskanse says:

    RKMK
    I know you think you’re concerned for your friend’s health… recommend she see a Dr for her chest pains if she mentions them to you, and keep your non-professional advice to yourself. If you are an MD of some sort, I recommend keeping your advice to your patients, and I sincerely hope you look at all factors, not just weight.
    I can’t speak for all, but I know that my genuine “concern for health” of people is mostly limited to me and my close family. I don’t concern myself with their weight unless it suddenly changes a lot, which is usually an indicator of something else going wrong. Like when my bordering-on-underweight mom lost 20 pounds to depression.
    Outside a close family group of maybe 4-6, with sudden gain or loss, if I say I’m concerned about anyone else’s health for weight reasons I’m probably lying.

  60. zuzu says:

    Abortion, which is a pretty bedrock reproductive right, has been kicked back and forth between funding, to no funding, to barely any funding, to kinda-sorta-funded for the not-sluts only (you know, rape and incest victims) under Medicaid. I think there’s an excellent, excellent chance that we’ll have the same arguments about covering abortion, as well as Plan B and contraceptives for the unmarried or underage, under a single-payer system.

    The Hyde Amendment was successful because Medicaid funds poor women, and a lot of people hate poor women. When everyone else gets covered under a universal health system, there’s likely to be a lot more resistance to that kind of meddling.

  61. Sniper says:

    You know what has been genuinely, truly been proven to improve cholesterol levels and blood sugar? Exercise – and not “feel the burn” exercise either, just plain old walking or any other moderately strenuous activity such as swimming or using an elliptical trainer or whatever’s your poison. Now exercise does not cause much weight loss, but somehow the message in mainstream media is still exercise for thinness!

    A lot of fat people do exercise regularly for health and pleasure, but not because they’re made to feel welcome at gyms, on hiking trails or, indeed, anywhere in public. Fat people would be a lot more healthy if the scolds would keep their opinions (and their insults, and their flying junk-food containers) to themselves and if health professionals and society in general would encourage more walking, more fun activity, more leisure time. So would thin people, but everyone assumes they’re healthy.

  62. Meowser says:

    I was responding to Meowser’s belief that Obama’s statement was an affront to the autonomy of obese people over their bodies.

    An affront? No, a slippery slope is more like it. You think that if they actually did manage to get almost everyone thin (won’t happen, but let’s say it did), thin people wouldn’t be subjected to the same micromanagement of their personal behaviors in order to save “health care money”? You think your doctor isn’t going to tell you to stop drinking, stop smoking pot, get 8 hours of sleep every night, no playing high-impact sports, no having a baby after age 40 (if female), and you’d better take drug X and have procedure Y right now, or no more health care for you? No joint replacement when you’re in agonizing pain because you didn’t Listen To Your Doctor? You think that couldn’t possibly happen?

  63. Hugh Mannity says:

    Well, I’m a poster child for joint replacement. I’ve had both knees replaced due to arthritis. They wouldn’t do them 10 years ago because I was “too young”. Riiiiight. Seven years of immobility = 50lb. that I wasn’t carrying when I was first immobilised

    Now, 3 years after the left knee was done and 2 years after the right, I’m still heavy. But I’m a lot fitter than I was.

    I’ll never be skinny — I’m not built that way. I have very dense bones too — my surgeon complained that he ran out of battery packs for his saw doing my knees! I’ll never be 120lb — unless I also have a negative BMI!

    But that doesn’t mean I can’t be reasonably fit and reasonably healthy.

  64. AB says:

    Zuzu, I think that’s possible, that politicians are able to restrict poor women’s health care in a way that they won’t be able to do for women in general. But the recent battles over Plan B aren’t encouraging. Nor is the fact that the Federal Employees Health Benefits Program (FEHBP), which covers mainly high-income educated workers for the federal government, specifically prohibits plans that cover federal workers from covering abortion services. (Bush has been working to yank the provisions that FEHBP cover contraceptives, although has hasn’t been successful *yet*.) I’d love to believe that if we had a single-payer system, the women of the country would unite up and throw anyone out of office who tried to mess with our health care. However, that’s an extremely rosy view not particularly supported by recent events–and to my ears, it doesn’t sound that different from certain male progressive bloggers who said that it wouldn’t be such a bad thing if the Supreme Court overturned Roe, because the political backlash would result in the Republicans being thrown out of office. I don’t agree with that reasoning, and I don’t agree that we should assume that politicians will refrain from denying funding to anything they find immoral under the banner that “it’s personal choice and the taxpayers shouldn’t have to pay for it.”

    This is where the analogies to Canada’s health system and European countries health systems fall apart, I think: the reproductive rights debate in the United States was framed as a “choice” argument way back when, and I don’t think that frame has been challenged in the mainstream since then. So the Hyde amendment was seen as an acceptable compromise between pro-choicers and pro-lifers–if it’s really a woman’s choice to have an abortion or not have an abortion, then the government shouldn’t have to pay for it because it’s the woman’s choice. Elective surgery, if you will. (I obviously very strongly disagree with this, but that’s the political landscape as I see it.)

    In Canada and Europe, there’s much less of the culture of “don’t ban it, but don’t pay for it” individualism, so I think it’s really optimistic to assume we can simply transplant their institutions and have it work the same way here. Yes, there aren’t debates about paying for contraceptives and abortion in Canada, but this ain’t Canada and it may be politically dangerous to assume that we’re operating under the same frames and political assumptions.

  65. zuzu says:

    AB, I’m thinking that when people start thinking of health care as an entitlement for themselves instead of something that other people who are not deserving get, then you’ll see some of that changing.

  66. Sniper says:

    Anecdotal, but what the heck. I have lived in neighborhoods where I could walk to work and do grocery shopping during my “commute” and it was pretty cool. When we moved to our new (inexpensive, park-filled) neighborhood I checked out the possibility of taking public transit to work. The estimated trip was 45 minutes, not including the 20 minute walk to and from the bus stop. Not to mention that buses only come every 30 minutes during rush hour. Conversely, it takes me six minutes to drive to work – eight on a bad day.

  67. Hector B. says:

    This not-busybody Medicaid is the same program that does not provide funding for abortion because of the Hyde amendment.

    Abortions are cheaper than childbirth, so funding them saves taxpayer dollars. Imagine the cost of adding an extra 1.5 million beneficiaries every year to the system. But even if they weren’t covered, abortions are a lot cheaper for the self-payer than, say, a bone-marrow transplant, which some insurances won’t cover at all.

  68. D.N. Nation says:

    Sniper- If it takes you 6 minutes to drive to work, couldn’t you just walk straight there? Or is this 6 minutes on a highway?

  69. AB says:

    Hector B., I definitely support universal healthcare. I think every single person should have either health insurance or health coverage. However, I think a *lot* of the problems we have with health care in this country can be traced back to how policymakers originally planned to have health coverage provided–that is, they didn’t put a whole lot of thought into it, and that has created *a lot* of the problems we have now. (Literally, it was some dude at the IRS who said “why not?” when a company inquired whether health benefits could be a tax-exempt fringe benefit.) If someone had been thinking a bit more deeply about the entire idea of health coverage in the 1940s, they might have realized that tying health insurance (which one needs for one’s entire life) to a job (which one cannot generally count on for one’s entire life) is a bad way to set things up. But no one was really thinking about it, so we get the system we got.

    I’m feeling pretty confident that we’ll get universal healthcare in the next 5 years or so in this country. It’s the starry-eyed optimist in me. However, I’m not enough of an optimist to say, “Just cover everyone, and let’s work out the details later.” That way lies madness. I think politically-engaged people, and particularly feminists, need to start thinking about how different ways of structuring universal healthcare (single payer? government provided or insurance company provided? one benefits package, or multiple options? coverage for the household or for the individual?) and which configuration has the least potential of screwing women. Because once we have a system, institutional inertia is going to make it damn hard to change, so we better get it right the first time around.

    Yes, it’s cheaper to get an abortion than a bone marrow transplant. However, I think the fact that women of childbearing age consistently pay higher out-of-pocket costs for health care today (on the order of hundreds of dollars per year) has something to do with the feminization of poverty. I think the fact that many women don’t have access to reliable sources of affordable contraceptives, and the fact that having a child is the single largest predictor of sliding into poverty, has something to do with the feminization of poverty. These are huge, huge feminist issues, and although it’s not often recognized as one, health care equity is a huge, huge deal for women.

    /end rant

  70. AB says:

    In case anyone still reading is a huge health policy nerd, a really interesting report that came out in the past year from the National Women’s Law Center quantifies some of the cost differences that women face for health care, and why it’s most definitely an issue we need to consider when we’re talking about what “universal health care” is going to look like. Even when women have health insurance, if they face exclusions (for abortion or the pill or mental health coverage), they may still end up without needed care. Maybe it’s more likely that women will face fewer cost differentials if the government is setting the benefits package, but I think it’s certainly worth debating. I know I’d rather move to a system of multiple highly-regulated insurance companies (all of which would be forced to insure everyone in the geographic area at the same price, and couldn’t deny coverage to anyone who applied) competing for my business rather than have the government set one benefits package that might exclude a huge number of things that I’m likely to need (the HPV vaccine, the pill, etc). I don’t love insurance companies, but I trust an executive whose bottom line is profit motive (and thus might be motivated to offer good coverage to women if for no other reason than to make money off my premiums) more than some of our elected officials who are motivated by straight-up misogyny.

  71. April says:

    All great questions. =)

  72. Sniper says:

    If it takes you 6 minutes to drive to work, couldn’t you just walk straight there? Or is this 6 minutes on a highway?

    Highway, and I have to cross a pretty scary bridge and overpass section which divides two counties. I suspect that’s why the bus route is so incredibly circuitous.

  73. jacko says:

    AB said:

    So the Hyde amendment was seen as an acceptable compromise between pro-choicers and pro-lifers–if it’s really a woman’s choice to have an abortion or not have an abortion, then the government shouldn’t have to pay for it because it’s the woman’s choice. Elective surgery, if you will. (I obviously very strongly disagree with this, but that’s the political landscape as I see it.)

    Just like people who are ‘choosing’ whether or not to get chemotherapy for a cancer that will be hell to go through and extend their lives by a matter of months. Or people with inherited prest cancer mutations can ‘choose’ to have preventative mastectomy and give up their fertility or contend with an 85% chance of cancer.

    It’s really an obscene line of reasoning. Just because you make a choice, doesn’t mean it’s ‘elective’!

  74. jacko says:

    That would be breast. And not Prest.

    Prest cancer is far less of a problem!

  75. La Lubu says:

    I trust an executive whose bottom line is profit motive (and thus might be motivated to offer good coverage to women if for no other reason than to make money off my premiums) more than some of our elected officials who are motivated by straight-up misogyny.

    Then you’ve hot a helluva lot more faith in insurance company executives than I do. Racism and sexism are negatively affecting the bottom line of business on a daily basis, but than doesn’t stop companies from discriminating. Irrational? Yes. But that’s the point. Some folks are so wedded to their bigotries, that they are willing to pay a literal price in cash money to continue on with those bigotries. If the people who own enough shares in that insurance company hold the same bigotries as the executive, there will be no magical moment of market reckoning. It will simply be regarded as part of the cost of doing business.

    Contrast that with a politician who has to answer to various voting blocs, which he or she ignores at the risk of losing office. Not to mention the deals made with other politicians (“I’ll vote for yours if you’ll vote for mine”). Under a plan designed to cover the general public (over half of whom are women), denying coverage for birth control, the HPV vaccine, mammograms, isn’t going to fly. Would elective abortion be covered? Perhaps, perhaps not—but it’s a red herring to use that as an objection to single-payer universal health insurance, for the simple fact that very, very few health insurance plans cover elective abortion. (Where are all those maverick insurance execs offering competitive plans to employers that do cover elective abortion, hmm? Where’s that magic market juju?)

    Don’t kid yourself, “the market”, or rather, the small collection of human beings who control it, are quite motivated by misogyny (and racism, homophobia, ableism, etc.). And have fewer motivations to change their mind, or even act like they’ve changed their mind, than politicians.

    “The market” never did a damn thing to bring social justice to working people—it took the labor movement, the civil rights movement, and the women’s movement to do that. And how did we do it? Through the courts and the legislature. And we’ve made greater gains through the legislature.

  76. Lorelei says:

    okay couple of things and i’m only at about comment 50:

    Eating well and exercising is to diabetes what quitting smoking is to lung cancer. And to label this kind of analysis “fat-shaming” is profoundly weird.

    dude. what are you talking about? exercising and eating well does not prevent diabetes. WE DON’T KNOW WHAT CAUSES DIABETES.

    hell, not smoking doesn’t even really prevent lung cancer. you still have an OK chance at developing it either way.

    Quoth Ashley:

    As for correlation versus causation, it’s true that being overweight hasn’t been definitively proven to cause diabetes, just like it’s true that gravity is a theory. But I trust these folks more than I trust Zuzu when it comes to medicine:

    rofl rofl don’t trust the CDC too hard, bb. they admitted to faking the numbers that were supposed to ‘prove’ the ‘legacy of death’ that obesity causes or whatever romanticized bullshit.

    http://jama.ama-assn.org/cgi/content/full/293/15/1861

    whoops! they only got the number wrong by like 72% or something! :D

  77. Lorelei says:

    am i the only person who read ‘corpulence glamourization’ and thought about necrophilia? or was that seriously me?

    for real, people. my very pretentious boyfriend loves making up melodramatic phrases for theoretical phenomenon but i think he would have the blankest look if i showed him that one. that’s just. bizarre. i can’t even find it insulting, i can only giggle to myself about glamorous dead people.

    (of course it’s meant to be insulting and i’m not taking that away. i’m just saying it’s a ridiculously stupid phrase)

  78. Ailurophile says:

    Sniper, I found it a lot easier to get my exercise when I lived in a city and walked everywhere. I moved to the suburbs where I need and have a car and the weight crept on.

    I wonder how much healthier (not skinnier, just healthier) we as a nation would be if we could be like the Dutch who bike everywhere. Your average Dutch person gets a lot more exercise than your average American because he or she relies on biking or walking a lot more.

  79. Smartpatrol says:

    That is an astonishingly hateful comment … you seem to become unhinged at the sight of the word “fat” …

    Moi. Really. Because I would argue that line no.43 is a glaring example of both, with a deliberate misrepresenting of Jacko’s very polite & direct line of reasoning thrown in for good measure. Yet they aren’t getting called on it. Curious.

    I will be the 1st to admit that I’ve got a short fuse when someone tries to sell me shit & absolutely, positively insists that it is, in fact, champange.

    Though I suppose you’re the kind of person who thinks that basic human rights for, say, gay people are really “special rights.”

    Your assumption says nothing about me & a great deal about yourself. It’s also worth noting that when all attempts to rationalize faulty arguments fail, their proponents always resort to dead-end ad hominem attacks to distract from their positions lack of substance. Kinda like you. It’s one thing to see it at cesspools like RedState & FreeRepublic, but to deal with it happening here, a crucial site where people come to to get the news that’s not in the news & to get their critical faculties sharpened is disconcerning. To say the very least.

    I’ve seen like Ashley, jacko, RKMK & people like them approach this side of the body-image debate & present their points in a polite manner & more often than not their reward is to be screeched at, branded fatbashers, concern-trolls, threatened with moderation, etc: to be buried under an avalanche of lame cop-outs. So if being polite dosen’t get the point across, maybe a little belligerence & screeching back will.

    For the record, I think Feministe is great & that it & like minded sites are vital to the realization of seeing progressive values being made into public policy. Those of who take issue with obesity & those who seek to give a free pass a la these Our-Way-Or-The-Highway posturings do so because People. Die. From. This. Shit. & it’s something we wish to avoid if it’s people we admire, even more so when it’s someone close to us.

    & Lorelei? It’s just you. For real. It’s also “I” not “i’. But then first-year english majors just gotta do things differently, right?

  80. Smartpatrol says:

    Corrections (duh):

    – Line no.46 is a glaring example…

    – I’ve seen people like Ashley, jacko, RKMK approach this side of the body-image debate…

    – those who seek to give it a free pass a la…

  81. Sniper says:

    Your average Dutch person probably has a fairly short commute to work as well. I also got a lot more exercise when I worked a mere 20-minute walk from home, but it didn’t affect my weight one bit – just my muscle tone.

  82. kactus says:

    & Lorelei? It’s just you. For real. It’s also “I” not “i’. But then first-year english majors just gotta do things differently, right?

    Kind of like spelling “champagne” champange, right smartpatrol?

    There’s nothing funnier than a wiseguy who calls other people on their grammar, but can’t even use spellcheck correctly.

  83. zuzu says:

    Moi. Really. Because I would argue that line no.43 is a glaring example of both, with a deliberate misrepresenting of Jacko’s very polite & direct line of reasoning thrown in for good measure. Yet they aren’t getting called on it. Curious.

    Jacko was disagreed with, and responded, so I’m not sure where you’re getting this idea that the response was nearly as unhinged as your comment about “corpulence glamourization.” See, Jacko commented in good faith, and was disagreed with in good faith. You’re not commenting in good faith.

    I will be the 1st to admit that I’ve got a short fuse when someone tries to sell me shit & absolutely, positively insists that it is, in fact, champange.

    I don’t think it’s a “short fuse” you’ve got. In any event, what shit is anyone trying to sell as champagne? I mean, other than spinning some line of bullshit about how asking that fat people be treated as not presumptively diseased simply for being fat and perhaps not being blamed for all the nation’s healthcare expenditures when insurance companies are making out like bandits is “Corpulence Glamourization.”

    Nobody here disagrees that diabetes can kill you, or that exercise and eating well can help control diabetes. What people *are* saying, however, is that eating well and exercising will not necessarily make anyone thin even when it has beneficial health effects, and that doctors (and politicians) are entirely too focused on weight rather than health, which leads to a lot of distortion and, yes, fat-shaming of otherwise healthy people. Moreover, as several people have stated, we don’t know what actually causes diabetes, and weight gain is often the result of prediabetic conditions that might be better treated if we, oh, didn’t focus so much on weight and instead focused on health. Because if we wait until someone gets fat from insulin resistance to even look for diabetes, we’re not really serving anyone well, are we? Though I guess if we wait, someone like you gets to sit back and feel validated that another fatty got diagnosed with diabetes.

    Besides, given that the CDC got caught LYING about the actual risk of death from obesity, you might want to turn your bullshit detectors on the people who maintain that being fat is a sure ticket to mortality.

    Your assumption says nothing about me & a great deal about yourself. It’s also worth noting that when all attempts to rationalize faulty arguments fail, their proponents always resort to dead-end ad hominem attacks to distract from their positions lack of substance. Kinda like you. It’s one thing to see it at cesspools like RedState & FreeRepublic, but to deal with it happening here, a crucial site where people come to to get the news that’s not in the news & to get their critical faculties sharpened is disconcerning. To say the very least.

    I’ve seen like Ashley, jacko, RKMK & people like them approach this side of the body-image debate & present their points in a polite manner & more often than not their reward is to be screeched at, branded fatbashers, concern-trolls, threatened with moderation, etc: to be buried under an avalanche of lame cop-outs. So if being polite dosen’t get the point across, maybe a little belligerence & screeching back will.

    I’m sorry, who came in here with their very first comment in the thread gibbering about “Corpulence Glamourization”? Not exactly a substantive critique or an indication that anyone’s out to sharpen their critical faculties. Ashley, RKMK and Jacko were all engaged, even if they were disagreed with. You, on the other hand, got what you brought. Try leaving a substantive comment next time.

    And, yeah, we bounce people for being hateful. Deal with it.

    Those of who take issue with obesity & those who seek to give a free pass a la these Our-Way-Or-The-Highway posturings do so because People. Die. From. This. Shit. & it’s something we wish to avoid if it’s people we admire, even more so when it’s someone close to us.

    People die from a lot of shit, but they don’t die simply from being fat (see the JAMA link above). One thing they do, however, die from is not getting proper medical treatment until it’s too late. And that happens all too frequently with fat people, because symptoms are ignored because the person is fat, or the patient is given so much shaming that she doesn’t want to go to the doctor even if something is really wrong, or she can’t even get insurance because of her weight. And people also die because stuff like insulin resistance goes undetected in people of average weight
    because thin people are presumed to be healthy — and the person only gets treatment after years of insulin resistance have left them fat and it finally turns into full-blown diabetes.

    I’d think if you were really concerned about health, you’d actually advocate a health-based rather than a weight-based approach to health care, devoid of shaming fat people simply for being fat. However, it’s clear from your comments here that you’re not, in fact, concerned about health, but you *are* concerned that anyone might get the idea that it’s okay to be fat.

  84. Sniper says:

    I’d think if you were really concerned about health, you’d actually advocate a health-based rather than a weight-based approach to health care, devoid of shaming fat people simply for being fat. However, it’s clear from your comments here that you’re not, in fact, concerned about health, but you *are* concerned that anyone might get the idea that it’s okay to be fat.

    I forget who said it first, but if there’s one thing fat people don’t need it’s more people hating them for their own good.

  85. pennylane says:

    I realize that often this is a choice between the devil and the deep blue sea, but the big difference is that you choose to participate in the limits that an insurance company sets on you, whereas you cannot choose not to participate in universal healthcare.

    I’m sorry but is this absurd libertarian theater? My mother-in-law was a self-employed realtor who was treated for breast cancer three times. During that time she wound up separating from her alcoholic husband through whom she had health insurance. She wound up being unable to divorce him in order to stay on his health insurance because she was not given a choice of which set of limits she wished because–by virtue of having had breast cancer–she was considered uninsurable. Yes, she was unable to get health insurance. How many of us actually exercise choice in our insurance plans?

    On the fat stuff, Paul Campos said it best:

    The reality is that a significant portion of the anti-fat hysteria that has gripped the culture over the past decade is driven by a desire to find any plausible excuse for not doing what every other developed nation in the world does: provide basic health care for all citizens.

  86. wriggles says:

    In a world where health resources are finite and never seem to cover all our needs. If you are perceived as taking up more than your fair share, deliberately, then you are being accused of something akin to theft. It is as serious a charge as it is wrong.

    Meowser was asking how much force people are willing to subject fat people to. Because contrary to assumption, we have tried everything that is supposed to quarantee slimness.
    Smoking was once acceptable has become increasingly less so over the decades until it’s rank unnacceptability to many today. Fat people on the other hand have always been subject to all the attention and advice currently given, we are still fat.

    I think it was Ashley that said that most people became fat whilst or through eating badly and being sedentary, even if that is true, ditto slim people that’s the rub. Quitting smoking requires you to stop smoking ceasing to be fat requires you to do that which makes you slimmer that is not fully understood, therefore it cannot be told.

  87. Smartpatrol says:

    Came back for a visit after a few months. Could only be bothered with this:

    There’s nothing funnier than a wiseguy who calls other people on their grammar, but can’t even use spellcheck correctly.

    Fair enough. & a mook who can’t distinguish between a one-off spelling whoopsie & a consistent display of shallow, affected style comes in a dead-heat, photofinishing second.

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