On Healthcare and Personal Responsibility.

By | September 21, 2009


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I read comment threads on news articles. I do this, and invariably then I’ll sigh and mourn the death of human intelligence, and wish I hadn’t bothered. But then I do it again, anyway. It’s an opportunity to get a sense of what some folk are thinking; what they wouldn’t say out loud to an open room but feel entirely safe saying in text as a stranger among strangers.

Right now, the US is in the midst of a vigorous debate over healthcare reform, which has been by degrees depressing and maddening, and unsurprisingly this has been a popular subject on all forms of the news- and commentary-driven media. The comment threads to many of these articles provide a wild diversity of approaches and opinions, but always, there seems to be at least one person who opines the great injustice that is their potentially having to help pay for some fat person’s healthcare. Combine this with the growing support for implementing some kind of “fat tax” (which, sorry folks, won’t affect this fat person’s wallet, as I never drink soda, nor do I eat snack cakes) and you have a small but vocal minority of folks who think fat people just aren’t punished enough when it comes to healthcare, and that the fat should be forced to either pay more or be shut out altogether. I’m not going to link to any particular comment thread here, but read through the responses to almost any article on the fat-tax or the “obesity epidemic” and you’ll find some guy who thinks he’s a fucking genius for having come up with this idea.

And you know, the reality is, health care costs are skyrocketing out of control. It’s probably not unreasonable, in a logistical sense, to punish the folks more likely to go and be sick (but not to up and die, as they are relatively cheap healthcare recipients) by making them pay more for their coverage (if they’re allowed to have coverage at all). In fact, I have a better idea, one that would likewise save the industry quite a bit of money in healthcare costs.

Let’s just punish all sick people.

It cuts out the middleman. After all, it’s the sick people of all walks of life who are costing the US billions in taxpayer dollars that could be better spent blowing people up halfway around the world. So, henceforth, I propose that anyone who gets sick immediately has their coverage slashed and their premiums raised to pay for all the coverage their stupid sick selves will inevitably require. You’re diagnosed with lung cancer? Tough luck, you irresponsible oxygen-breather. You get critically injured by a drunk driver on your way home from work? Better have your checkbook on you when you get airlifted to the hospital.

Obviously, I’m being glib. It’s a preposterous suggestion. The truth is that this is how insurance works: we all pay, so that the some of us who require healthcare at any given time can access it. That is the purpose of insurance, to pay into a collective system that we can then draw on if we require it. This means some of us will pay in more than we take out, and some of us will take out far more than we put in. But that’s how insurance operates and how it always has. There’s a term for putting money into a system that only you can access, and only when you want to: it’s called a savings account.

Now, if you want to punish the fat because you truly believe that all fat people are necessarily and irredeemably ill at all times, even though I disagree with you, we should think about that proposition. Because ultimately, if that’s what you believe, you’re talking about punishing sick people for using health insurance for the purpose for which it is intended: to pay for medical treatment.

Let’s just mull that over for a minute here.

The money you pay into health insurance helps to pay for the healthcare of countless individuals whose life choices you may not agree with. You may help to pay for the HIV medication for someone who contracted the disease by having irresponsible sex. You may help to pay for chemotherapy for a person who developed throat cancer as a result of smoking cigarettes. You may dislike this; you may think these people are stupid for making mistakes that impacted their health. But you also probably realize that not everyone who engages in these behaviors will end up with these illnesses, just like not every fat person gets diabetes. It’s a roll of the dice. You still don’t get to say, “I don’t want my insurance premiums to pay for so-and-so’s healthcare because I disagree with their choices.”

The trouble with focusing on personal responsibility in regards to health is the reality that not everyone who gets sick is personally responsible for it. Not even fat people. There are plenty of folks who maintain totally “unhealthy” lifestyles by current standards, smoking and drinking with gusto, cooking everything in lard, and still persisting into their eighties and nineties. And there are also a great many people who are obsessively meticulous about the things they eat, and the exercise they get, and the environment in which they live, yet who still wind up dying too young from some unthinkable accident or some unpredictable disease.

Should healthcare only be made available to the virtuous and conventionally-attractive among us? Or to people who aren’t poor and who can therefore afford such things as quality food and gym memberships? Would you argue that only people who are well-educated, or people who are Christian, or people who are able-bodied should get full insurance coverage? Should healthcare only be offered to people who have never failed to report a symptom that resulted in a late diagnosis of a treatable disease? Is healthcare only for people who get themselves screened for breast cancer or colon cancer or prostate cancer at the appropriate ages and as often as recommended?

Is healthcare only for the physically perfect and morally pure?

These questions are a natural extension of the suggestion to restrict the coverage and punish the millions of Americans who qualify as being under that questionable umbrella of “obesity”, for having no self control or discipline, because this argument’s proponents also tend to accept the fallacy that fatness is easily enough managed with a little motivation. And what the “charge fat people more!” comments really come down to, in plain English, is people expressing that they don’t want to pay for certain people’s healthcare because they just don’t like those people. But that’s not how the system works, and arguably it shouldn’t work that way, because that would set a precedent for anybody who didn’t want to contribute to the healthcare of a particular group of people (people who are gay, for example, or people who are legal immigrants, or people who have a history of drug or alcohol abuse, and so on) to make a case against it.

For all the protestations of “fairness” and “equity” on the part of those who feel cheated by fat people allegedly soaking up all the precious healthcare, that’s an awfully unjust way of thinking.


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