Posted by Pattie on 8/03/2009 09:47:00 AM

I've been amused and frustrated at the discussion about last week's Paul Campos interview over at Alas, a Blog and I've thought about several responses.

I could get in on the discussion about the politics of fatness. Personally, I don't think any mainstream political perspective is doing right by fat people. Liberals blame so-called "Big Agriculture" or "Big Food" for fatness, which is essentially painting fat people as mega-consumers, who mindlessly obey their mental and physical impulses. This paternalistic attitude fundamentally sees fatness as an illness, or at least, a social ill. The fact that they don't directly blame fat people is irrelevant. We are still stigmatized and flawed for being fat. That is not fat acceptance. Conservatives are perfectly happy to ignore the health and well-being of fat people while using us to support opposition to the liberals, specifically, staying in the pockets of Big Ag, Big Food, Big Pharm and Big Insurance, by suggesting that our being fat is all our fault -- "personal responsibility versus public interest." So fat people will cost too much for the health care system, so let's not reform health care. Libertarians have questioned some of the methodologies for demonizing fat and have even provided forums for fat acceptance writers to share their points of view, but in the end, the stance of the Libertarian is not usually fat acceptance but rather that the government has no business telling us to not be fat. They still mark fat people as being flawed, they just support our right to be flawed.

I could join in the discussion about what is and isn't fat acceptance. Personally, I believe fat acceptance is fundamentally the belief that people come in diverse sizes and that fat, in and of itself, is not a sign of illness, mental deficiency, moral deficiency or lack of fortitude (will-power). Fat is fat. Some human beings have more than others. It is a physical characteristic and shouldn't be debated or discussed any more than we would if we were talking about eye color. Fat should not be the basis for discrimination as much as any other physical characteristic should not be the basis. Just treatment of people involves not judging on the basis of the how they look, period. Thus, deciding that whether people who look one way will cost the system more than "beautiful people" is a basically unjust discussion.

But I haven't posted these thoughts there because I can't get past one little aspect of the whole discussion: Debating costs is a smoke screen.

While we continue to debate the questions of cost, we continue to pretend that cost is immutable, fixed objectively without any room for scrutiny. That it is just is. After all, people in the medical system have to be paid, don't they?

The BILL for my little surgery in June has grown to around $4500. This is what I'm being BILLED, NOT what it COST. Why was the hospital emergency room the only place this could be addressed? Why did I have to see several doctors to have it addressed? Why did I have to come back to the hospital to have the bandages changed and see a burn unit nurse twice? Why did my just stepping into a hospital mean I was going to be billed over $1000?

When we have discussions about health care costs, we keep confusing billings with cost. Right now hospitals bill whatever they want (as do clinics, doctors, pharmaceutical companies, laboratories, testing centers, and so forth). They often do not get what they bill because the HMO, insurance company or government program says, this is what it should cost and pay only that. Then the hospital tries to get the difference from the patient. Sometimes they do, more often they do not. That is part of the why the bill is so high in the first place.

You people who have health care coverage think you are paying for your own care only? You are already paying for all the people who can't afford it and you are doing it in a system that allows the medical provider to decide how much they want to charge in the first place. You already subsidize others, you are just doing it in the most inefficient and costly way possible and making the health care oligopoly rich in the meantime.

Let's be clear. No market forces are going on in health care. A market requires the ability for consumers to walk away. When you or your loved ones are sick, you cannot shop around. You aren't able to pick and choose. You can't decide to delay purchase until later. You can't buy low. If you can't get the health care that you need at a doctor's office or clinic, you head down to the emergency room where you know that you most likely will not be turned away. The hospital knows this as well and that is why they charge $4500 to lance an infection. They know that I'm there because I have no where else to go. This is a decided advantage of which they take are only too happy to take. In any other economic circumstances, we would label this "price gouging" and make it illegal. This is why traditionally health care providers have only been too happy to have a number us not have access to funding. We are the reason they can price gouge. We are desperate enough that they can charge what they want.

I heard someone say one intelligent thing the other day in the health care "debate": In all other instances in the Western world where health care reform has occurred, it historically had to be done in spite of the cost. Once it was done, the costs were reduced BECAUSE of the reform. There used to be a time in this country when government or public control of natural monopolies was a good thing. Health care is a natural monopoly and it can and should be regulated just like electricity, gas and water used to be.

But one part of the health care reform debate to remember is that discussions of "costs" always have to be tempered with the knowledge that what we call "costs" are essentially price gouging. The best way to reduce those costs is to regulate the market so that those who are in a position to gouge will not be allowed to do so.


gabfly1 said...

Yes, I agree with you. I'm not sure when we decided that multi-million-dollar corporations are more efficient than the government or not in need of regulation. Just the example of Enron should give us pause. We need a pithy saying, and perhaps we don't want to use it. But, I've been taking to saying, "Obese profits are the problem." It applies to the pharmaceutical companies, the for-profit HMOs and insurance companies, the physician's, especially specialists, the hospitals owned by the same doctors who order the tests, etc.

Pattie said...

I am generally a support of capitalism. That usually doesn't come across often because I don't really believe that our current economic system is capitalist. Health care (and other natural monopolies) are not good going to ever be run well under capitalism because capitalism requires equality in the market place: equality of knowledge, equality of choice, equality of competition. When there is no way to achieve this equality, our collective organizations have to make it more equal. At the moment we have monopolies and oligopolies that control a great deal of our markets. These are bureaucratic organizations that not only act to sustain themselves before they do anything else, but do so inefficiently. This is just another form of powerful ruling over others. Big, centralized business is just as bad as big, centralized government, except big government has to account to the people (at least theoretically) and big business has to account to their stockholders (again, at least theoretically).