The New Thirteen

Fatties Need Not Apply August 17, 2009

Wandering around Shakesville today, I found this gem of an article: The Way We Live Now: Fat Tax.

Just from the title, I knew that this was going to be good, but it really exceeded my expectations in a wow-this-makes-me-sick kind of way.  In summary, the article focuses on the Cleavland Clinic’s policy of not hiring smokers and espouses the virtues of similarly vilifying fat people to save money.  (By the way, all of the following emphasis is mine.)

Refusing to hire smokers may be more hard-nosed than the other parts of the program. But given the social marginalization of smoking, the policy is hardly shocking. All in all, the wellness initiative seems to be a feel-good story.

Actually, I do find it shocking because I believe that what someone does with their own time and with their own body is none of my business.  While I don’t smoke, and I certainly appreciate laws prohibiting smoking in enclosed public places, it never dawned on me that I should be able to penalize someone engaging in a legal behavior that I find unacceptable.  I don’t consider myself to be a libertarian, but the idea that employers should essentially be able to police the choices you make in your life really burns my cookies.

In order to survive in this society, everyone needs money which, for most people, means you need a job.   In the United States, we already have less vacation time than most other Western countries and we work some of the longest hours too, so we sacrifice a lot of time and life to our jobs.  If employers can start discriminating against job applicants for smoking, where will what we sacrifice end?  Couldn’t they refuse to hire people who have unprotected sex, because they may catch an STD and then they would miss work and cost money by using their health benefits (if they even have them)?  What about people who drink alcohol?  There are some health risks to that.  Or people who engage in risky hobbies?  Sure that mountain-biker might improve his cardiovascular health, but what happens if he falls and breaks a leg!?  Or hell, what about people who watch TV in the evenings instead of reading?  They could be learning more if they read a book instead of watching a reality show, and this could help them in their work.  Shouldn’t employers have some say in that too?

No, they shouldn’t and I’m sure it sounds ridiculous (to most people) for me to even suggest that.  But once you give an employer the right to govern one element of your private life, other restrictions are not going to be far behind.

That’s the case at the Cleveland Clinic.  Because the Clinic’s Chief Executive, Delos M. Cosgrove, not only loves their no-smokers-allowed policy, but would love to expand it if not for those pesky legal restrictions.  Can anyone guess to whom he would like to expand this policy.  Why, to fat people of course!

“Why is it unfair?” he asked. “Has anyone ever shown the law of conservation of matter doesn’t apply?” People’s weight is a reflection of how much they eat and how active they are. The country has grown fat because it’s consuming more calories and burning fewer. Our national weight problem brings huge costs, both medical and economic. Yet our anti-obesity efforts have none of the urgency of our antismoking efforts. “We should declare obesity a disease and say we’re going to help you get over it,” Cosgrove said.

Oh, I don’t know Dr. Cosgrove, maybe it’s unfair because a person’s body size is none of your fucking business.  Even if we discount the fact that there is a genetic component to body size, the idea that you should be able to govern the size of your employee’s asses is insane.  What would you do if you hired someone, who you felt was of an acceptable weight, who later gained weight?  Suspend them until they lost weight?  Fire them if they couldn’t or didn’t want to?

The debate over health care reform has so far revolved around how insurers, drug companies, doctors, nurses and government technocrats might be persuaded to change their behavior. And for the sake of the economy and the federal budget, they do need to change their behavior. But there has been far less discussion about how the rest of us might also change our behavior. It’s as if we have little responsibility for our own health. We instead outsource it to something called the health care system.

Oh yes!  Of course, that is one of the major problems of our health care system.  It isn’t that insurance companies are using every trick in the book to avoid paying for necessary treatments or that drug companies are doing everything they can to make a huge profit off of illness and suffering.  It’s that people just don’t care enough about their health not to be fat.  Because according to a study referenced on the left side of this very article, 9.1% of the annual health care costs in the United States are “obesity related.”  Yes, that’s right: less than 10% of our health care costs go towards treating these so-called obesity related problems, including heart disease and diabetes. If not for that ten percent of costs, everything would be a fucking field of flowers; everyone would have all the health care they need, and no one would ever die.

Let’s ignore the fact that the top risk factor for heart disease is increasing age and that increased age is also a risk factor for developing diabetes.  And that our population of people over age 65 tripled from 1990-2000 and has been growing ever since.  I’m sure that an increasing older population has nothing to do with the increase in the cost of treating heart disease and diabetes; it is all those lazy fatties who clench their teeth shut when presented with a vegetable.

Not to mention that even this article acknowledges that you probably aren’t paying the costs of your fat coworkers health care:

Cosgrove mentioned to me an idea that some economists favor: charging higher health-insurance premiums to anyone with a certain body-mass index. Harsh? Yes. Fair? You can see the argument. And yet it turns out that the obese already do pay something resembling their fair share of medical costs, albeit in an indirect way. Overweight workers are paid less than similarly qualified, thinner colleagues, according to research by Jay Bhattacharya and M. Kate Bundorf of Stanford. The cause isn’t entirely clear. But the size of the wage difference is roughly similar to the size of the difference in their medical costs.

Certainly one of the causes is fairly clear to anyone with two brain cells to rub together: fat hatred.  Fat people are repeatedly categorized as being lazier, sloppier, and dumber than thin people, and it is often claimed that they cost the healthcare system more money than thin people.  Considering the widespread nature of these beleifs, are we really that suprised that employers are paying fat workers less than their thin colleagues?

But that isn’t enough for people like Cosgrove.  In spite of this study, he still wants to find a way to charge fat people more for their insurance (if he can’t avoid hiring them all together); if they are already paying their fair share do to the decrease in pay (and this assumes that the alleged increased costs of obesity are true, though as I showed above, that is also complicated), why should they also be penalized with higher health insurance premiums?

Cosgrove’s would-be approach may have its problems. The obvious one is its severity. The more important one is probably its narrowness: not even one of the nation’s most prestigious hospitals can do much to reduce obesity. The government, however, can. And that is the great virtue of Cosgrove’s idea. He is acknowledging that any effort to attack obesity will inevitably involve making value judgments and even limiting people’s choices. Most of the time, the government has no business doing such things. But there is really no other way to cure an epidemic.

Control, that’s why.  The end of this article brings me right back to my original point.  It isn’t about increased costs or keeping people healthy; this is just one more thing that those in power would like to control.  If they can keep us all worried about not being able to find a job because we are fat, than we won’t dare to worry about being overworked and undercompensated.  We won’t speak up about a stressful work environment or a lack of vacation time.  We will be too busy worrying about keeping ourselves acceptable enough to remain employed!  Someone will decide for us what is important in our lives and what we are entitled to have, and if we don’t agree, well…that will just have to be too bad.

People worry that a single-payer healthcare system would be a step on the road to the government dictating what sort of treatment we would get, punishing those they deemed unacceptable, well as you can see, that’s already possible.  When everything is about profit and cost, those things that supposedly cost the most are going to be the first things people try to cut down.  This is why we need to move towards a system that is based around caring for people, not making money by denying those who need help.