Monday, August 10, 2009

Don't Worry about the Donut Hole, First Put Down the Donut

An article on MSNBC's website explores the idea of restricting medical coverage or charging extra taxes and fees on those people who simply refuse to take care of their bodies. Those who stubbornly maintain unhealthy practices, thus creating significant health problems for themselves in the process, it is proposed, ought not to expect to be covered by a public plan. Or, rather they ought to required to pay into the system to cover the inevitable cost of surgery or treatment when their bad habits end up costing taxpayers paying to sustain the public option. In some respects, the latter proposal exists already, as those who continue to smoke despite decades of proven research that directly correlates smoking with debilitating, and highly preventable diseases, are already forced to pay private carriers to defray the cost of expensive treatment later in life. Countries with fully socialized medical systems already tax cigarettes severely, operating under the sensible notion that if a person is going to destroy his or her body, he or she ought to have at least paid several hundred, if not thousand dollars into the kitty before they need that first oxygen tank, or for that matter, lung.

Though I personally agree with both proposals, the devil, as they say, is in the details. Determining a fee scale for fairly weighing the potential cost per person for those not inclined to be healthy would be tricky. Should one need to pay $50 a month into the system if he or she continues to remain morbidly obese and adheres to a steady regimen of fattening foods? Why not $40 instead? Why not $60? What if the person claims he or she has a medical condition that makes losing weight very difficult? If so, should we make an exception for him or her, or should he or she be scheduled for a gastric bypass, instead? Based on what specific condition or conditions should we charge and how frequent should payment be required? Each person involved in the process would probably have his or her own preferred way of handling the matter.

Also unmentioned in the MSNBC article is the element of race--or rather, what our reaction to the element of race would be if someone invoked it. Since many African-Americans still live in poverty, and since poverty frequently fosters obesity---for those who eat a poor diet and keep poor health behaviors, attempting to introduce the idea of personal responsibility into health coverage could quickly become sidetracked by an accusation (though completely groundless) of racism. It needs to be noted that the charge would not really stick because these identical risk factors exist within every demographic of low-income residents across the board, regardless of racial identity. I thought I might focus on the southeast specifically for the rest of this entry because it's a region I know best and it has the highest percentage of people who would conceivably be instructed to either pay into the system or to die sooner as a result of bad health habits.

Included in the above article is a graph pointing out the percentage of obesity in every state of the union. Three of the highest are in the southeast and the forth is a predominately white state, West Virginia. Yet, if you survey from state to state, obesity by percentage is usually only a few points off of those highs for our entire country. The South has a well-deserved reputation as the stroke belt because of its combination of those who eat a poor, unhealthy diet, a large percentage of people of all stripes living in poverty, a high percentage of residents who smoke, and a large number of residents who live sedentary lifestyles while rarely taking the time to exercise. This has been a serious issue for decades, but no one has ever seen fit to address it directly.

Indeed, while the description might well apply to many people in the United States, it is particularly applicable to the South. The region's rate of heart attack, heart disease, lung cancer, high blood pressure, stroke, and diabetes are distressingly high. Dixie is also is home to a large proportion of African-Americans whose ancestors were taken by force and pressed into slavery until the practice was finally banned at the end of the Civil War. Those who did not leave the South during the Great Migration for the promise of less white supremacy and more opportunity in the North settled very close to where their ancestors had been forcibly taken, nearly a century before, and they continue to live there today. Poverty in these places often resembles that of a third world country and in some instances, it is so extreme that indoor plumbing or electricity are often in short supply or sometimes not even present altogether, even now in the twenty-first century. I don't think it's any surprise or wonder that the health of these people suffers greatly as a result, but what is true is that these people, who are the poorest of the poor, would be obligated to either pay to maintain their bad habits or have their coverage denied if it was deemed avoidable had different lifestyle choices been taken, instead.

But, before one cries foul, take into account their neighbors of a different skin color. One only needs to travel a few miles in any direction to locate the poor whites. Their economic condition might be a bit better, but their level of health is often just as bad. Here, as before, residents adhere to a diet of fried, fatty foods, if not relying intermittently on fast food to augment an already poor diet. Cigarettes, if not snuff are the opiates of the masses. This is a culture satiated by advertising and glorified bad habits and as such they are rarely informed enough to see past the manipulative advertising tactics that freely exploit them and reinforce bad habits. Good health is one thing, but if you don't live in a place that places a premium on the practice, doesn't provide opportunities for pursuing preventative care, and you don't know what preventative care actually means, then what you have going for you is the realization that you shouldn't smoke (but you do), you ought to eat better (but you don't), and you ought to exercise (but you keep putting it off).

To back up a bit, what always gets me about charges of racism or racial bias is that they all seem to stem from the same premise--the belief that that black culture and white culture are completely dissimilar in every way and do not brush up against each other. If you took the notion at face value, you'd think both lived not just on different planets, but also on wholly different solar systems. However, it should be said that no two groups of people can ever live in close proximity to each other while engaging in frequent contact without influencing each other to a great degree. One might have noticed that the bad health habits of both poor whites and poor blacks were remarkably similar to each other, if not identical. One might have noticed or at least noted that the diet of poor people, regardless of race, tends to also be completely similar, if not almost interchangeable. It is deeply unfortunate that we don't often give credence to this fact, because if we did, we might find we had more in common then we ever did in opposition.

Though I am biased because I was born in the South, I think that the reason the South by turns such an interesting, maddening, fascinating, and frustrating part of the country is because there was this cross-pollination and interplay between blacks and whites. It continues today, though Hispanic immigration has muddied the dynamic and added a brand new flavor to the old ways. And before we make snap judgments about who lives and who dies, or who pays what, when, and how much, we would be wise to examine the bigger picture. I'm in favor of giving people a financial incentive to stay healthy, if for no reason that I don't delight in seeing people suffer in pain and in sickness when a better strategy would spare them of it. But I also know that if we are quick to throw loaded terms like racism or discrimination around when a sober discussion of the facts would be much better served, then we rarely accomplish more than acting like children. When we throw these terms around these days, we take our time-honored positions and begin lobbing grenades at each other, but rarely do we ever reach a "teachable" moment. We don't really know how to listen. We just know how to be outraged.


Utah Savage said...

I have lived as if my life was worth nothing. I took every risk in the book, and since I was taught to smoke at five, why not take risks. I have tried to knock myself of a few times with pills or gas, getting better at it but never quite mastering the art of killing myself. I've alway loved anything covered in mayonnaise and accompanied by chips. I've had high blood pressure since my blood pressure was first taken in my late teens as part of a physical for college. It is a genetic trait as is vascular dementia and heart attack on both sides of my family. So is the bipolar disorder which, along with crazy parents has been the catalyst for my suicide attempts. I have tried the fast method for death and the slow method. But I seem fairly indestructible.

My girlfriend, who claims to have been raised by the perfect parents, had a happy childhood and has lived the clean pure life of the lifelong vegetarian, who uses no drugs nor smoked has lung cancer and is very close to losing her life, in part because until early this year turned 65 and is now on Medicare and so is able to get the chemo and radiation necessary to save her life.

Healthy living does not necessarily lead to a healthy life. And all the talk about rationing and euthanasia is insane nonsense designed to scare the ignorant into pressuring the politicians to vote against a public option. Oh the cost! they scream. However will we pay for it? We will tax the rich at a very high rate like the rest of the world. We will also tax corporations who would have had to pay for healthcare for all employees but have been dropping coverage and hiring part time workers to avoid paying a living wage and providing benefits.

It is not possible to say who will get sick and who will not. Do we refuse treatment to people with genetic illnesses because they cost a lot. MS costs a lot. So does Lou Gehrig's disease. The real questions seems to me to be "How crazy and irrational are we as a country, and do we deserve to survive as a nation, if we are unwilling to provide healthcare to all our citizens even if they live in the Southern states?"

lisahgolden said...

I really enjoyed this post for its coverage of the way we think about things. You're very right in your assertion that in the south there is a greater mixing of the races in ways those of us who live in the north don't acknowledge.

Eating healthy is costly. There is no doubt about it. And it's no accident that we have a huge problem with things like high fructose corn sugar - something that is very much subsidized by our gov't and thus found in all kinds of foods.

Comrade Kevin said...


You raise many interesting points, as always. The most pertinent one is that preventative methods are not necessarily the way to avoid to keep from being stricken with something awful. Still, living more healthy will greatly cut down on the odds and until we have a better understanding of disease and genetics, odds are really all we have to play with right now.

Whatever we mandated would have to be fully proven before I would go along with it.

The conclusion I was trying to draw from this is that taxing the benefits of those who were the unhealthiest according to one definition would end up with the poorest residents footing most of the bill. And not only that, most of them would be from the south.

But it wouldn't just be folks from south. It'd be poor, largely uneducated people from all over the country who'd pay this tax. You and I both know that if it came down to a strictly cost-effective matter, bipolar might be considered too costly for coverage. Since the brain is poorly understood, bipolar id a very difficult illness to effectively treat. So that discriminates against people with illnesses too complicated for medicine to easily understand.


Thank you for your encouraging comment, as always. :) The south is a paradoxical region shot through with a strange combination of irony and tragedy, and it's a wonder any of us who grow up here can maintain any semblance of sanity.

Utah Savage said...

Yes, Kevin, you and I would be deemed too expensive to cover. And that is exactly what happened to me under a very costly private insurance company, United Healthcare (the company who was sued successfully for not covering patients at the going rate). the minute I got the bipolar diagnosis they doubled my already exorbitant premium and challenged every charge. On medicare, every charge is paid and no challenges to treatment or choice of doctor has ever been made. Why is this so hard for most Americans to understand? It's cheaper to administer since it just pays. It doesn't require the hiring of thousands of bean-counters to micro manage all charges from legitimate doctors prescribing reasonable treatment.

The healthcare debate has made it crystal clear to me that we are a nation of idiots. "I don't want SOCIALIZED MEDICINE, and don't mess with my Medicare!" This statement is being made over and over by the too dumb to live set. Thank god I'm a recluse and don't actually have to try to talk to morons like that. But if this crap goes unchallenged, then they win, and we go another 30 years bankrupting the nation even more. If this thing doesn't pass with a public option, I don't think I'll be able to continue living in a country this stupid and backward. Oh Canada, here I come.

Comrade Kevin said...


If you intend to immigrate to Canada, I recommend you start the process now. It's going to take you years and lots of hoops to jump through along the way. I wish you luck. I'm not being sarcastic here, just truthful.

But as for the people opposing this plan, they are letting their short-sighted fear of big government get in the way of the great benefit they could receive in response. It's a kind of defeatist mentality that says "I'm not happy with what I have, but I'd rather keep it than take a chance on something that might be worse".

I don't think we're a nation of idiots. I think we're a nation of cowards, frankly.

Anonymous said...
This comment has been removed by a blog administrator.