Monthly Archives: March 2009

Universal Healthcare and Fat

by bigliberty

On the subject of whether universal healthcare is better for fat people than the system we currently have, here are a couple of comments about fat and universal healthcare I thought especially illuminating. One is from deannacorbeil, who left it on my About page because I closed the comments for the other post ;) The others are from richie79 and osxgirl, commenting on a recent blog post on Big Fat Blog.

deannacorbeil writes:

I thought I’d write you here, as you’ve closed comments on your post on libertarianism and obesity and health care.  As a nurse who’s been working in this American system of ours for almost a quarter century (damn!  how did I get this old?), this is obviously a topic of interest to me.  I continue to be perplexed at those who think that socialized medicine might somehow  a) be free (that one always cracks me up) b) improve the quality of care and c) be fairer to those of us who, ahem, don’t “fit” into the prevailing weight standards of today.

I thought you might want to post some of the following links sometime about the problems with socialized medicine.  Most of them are from the CATO institute.  (I’m certain some will discard any of the info on that fact alone, since it is a libertarian think tank.)

1.  Five Myths of Socialized Medicine

and the more detailed policy analysis–Health Care in a Free Society: Rebutting the Myths of National Health Insurance

2.  The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World (This is a pretty recent, quite long and detailed policy analysis—definitely worth reading.)

3.  The Top Ten Myths of American Health Care

I heard one of the congressman here in Michigan (Rep. Dingell) being interviewed about this topic last week.  He flat out denied that there was any sort of problem with waiting periods for procedures/tests in Canada, and then stated that things were so expensive here because we just had too many CAT Scan and MRI machines!!!  Damn those machines, anyway!  And people think they want these idiots in charge of our health system.

Sorry if this was too long….

It wasn’t too long at all, and I think it provides an insider perspective that can be sorely lacking in some comments which blindly promote universal healthcare under the assumption that all the various abuses of the current system would magically disappear or at the very least, dissipate.

richie79, a UK citizen and close observer of the NHS policies (Britain’s universal healthcare system), begs to differ with this fantasy:

richie79 writes:

The healthcare system in the US is totally broken and our only hope is to adopt a universal care model under which all US citizens — regardless of health, age, employment, etc. — will have access to care

Oh don’t you believe it. Whilst I fundamentally believe in universal state-provided healthcare free at the point of use, the fact remains that in the UK we do have such a system (falling apart though it may be due to a population which demands European public services for US levels of taxation) and far from easing the problems of discrimination and resentment against fat people it actually amplifies them – and throws up a whole host of new ones.

The recent shift toward public health promotion and preventative medicine means that there is far more propaganda in the guise of ‘advice’ being peddled through the media, most of it from ‘respectable’ Government sources. And because the NHS at central level is a single monolitic entity with a Cabinet Minister in charge, it’s also much easier for the frankly huge number of single-issue pressure groups, misguided charities and self-styled ‘obesity experts’ to force their frequently extreme views on tackling the ‘obesity timebomb’ onto the Government.

But most importantly, because everyone pays into the system and given the way in which it’s been starved of funding over the years, there’s an increasing sense of public and media bitterness toward anyone who are accused of taking more than their fair share – smokers, drinkers and fat people.

The fact that supposedly respectable news outlets and professional organisations such as the BBC and the British Medical Journal are now blaming fat people for the resourcing crisis within the NHS is keeping the issue pinned to the top of the health agenda.

The NHS is being used as a stick with which to beat anyone who is considered not to be paying adequate attention to their health back into line, and there have even been proposals advanced to deny fat people treatment for conditions related and unrelated to their size, on the grounds that these are ‘self-inflicted’.

With socialised healthcare you add the concepts of fairness and social responsibility to the anti-fat brigade’s arsenal of weapons, and that can’t possibly be a good thing.

Right on, richie!

osxgirl also has a great comment on that same post:

…socialized medicine WON’T fix this problem. In fact, I think in many ways, it will make it worse.

Why do I say this? Well, under socialized medicine, the IDEAL is that everyone gets to go to the doctor, no matter what. And that’s true, sort of. The problem is, in order to control costs, a rationing of supply inevitably occurs. And how do “they” decide how to ration the supply?

I contend that a lot of the rationing will be done based on how morally “deserving” you are of treatment. Accident victims get first priority. People who have diseases get higher priority. Low-ranking will be people with lung and liver cancer (alcoholics and smokers), people with drug-addict-related conditions, and fat people in general. Because, after all, we all did that to ourselves, according to “them”.

It’s what’s happening with insurance now. The reason insurance companies do it is to reduce costs. Government has NEVER been able to do anything cheaper than the private sector. So socialized medicine will be more costly than it is under the current scheme of private insurance managed by the government. (Medicare and Medicaid only come in cheaper because government mandates the prices as cheaper than the market, which is why so many doctors and hospitals will refuse Medicare/Medicaid patients when possible. When there is no market to subsidize the government anymore, the government will have to find ways to reduce costs.)

Given the current popular thinking, what do you think the government means of reducing health care costs will be? I think it will be exactly what we are seeing – set up a system where a certain amount of “blame” for the state of a person’s health is assigned to each person, and that amount of blame will determine the level of care the person receives. It won’t be stated that way, but it’s what it will boil down to.

Even then, assume the system was instituted in an ideal manner. The inherent prejudices of the doctors would not go away. I don’t think fat people would get any better care than they currently get. In fact, I think it would be worse. At least now, if I go to a doctor and that doctor won’t treat me because all he can say is “You’re fat,” I can realize he’s an idiot, and go find another doctor. Under socialized medicine, I would no longer have that choice. How am I going to shop around for help when my entry into the system insists there is no problem that weight loss wouldn’t cure, and refuses to give me a referral to a new doctor? And there’s a waiting list to even get in to see a doctor, and I’m not allowed to just pick a doctor..perhaps I’m even assigned one.

Believe me, I’m no fan of our current health care system, or of the health insurance system as it stands. But socialized health care scares me far more. ESPECIALLY as a fat person!

I also wanted to link to my Universal Healthcare category, that has several other posts where I describe in detail my position on universal healthcare and fat (so I don’t have to always repeat myself in the comments!).

I want to keep these comments open, and in order to do that and fit everything into my busy schedule I’m not sure if I’ll be able to reply to comments on this as readily as the last one. Just a head’s up!

Libertarians and Obesity, Take Two

by bigliberty

I’ve often talked about libertarianism and size issues: namely, that libertarians are the best political friend of fat people, and that nationalized healthcare (of which libertarians are the most vehement opposers) will steal away our most precious of civil rights, namely, the right to make choices for our own bodies. How does nationalized healthcare do this? By making others foot our healthcare bills, making those groups of people who are perceived to “raise” costs easy scapegoats for a healthcare model that’s doomed to fail by definition. So when it inevitably fails, it won’t be the model or the voters or the bureacrats who are held accountable, but those scapegoats.

I came across this article from 2006 that cleanly illustrates this effect:

The libertarian assumption is that we should all be free to do what we want, as far as possible, and if some people’s lifestyle choices involve snacking on deep-fried Mars bars and triple-processed cheeseburgers, other people have no business interfering, still less the government.

…

However, obesity does not concern only the obese. It concerns all of us. Obese parents produce obese children, and obesity places a crippling burden on the National Health Service, quite apart from the many personal miseries involved.

The moral of the story?

Don’t get government involved in healthcare. Don’t place private citizens in the situation where their neighbor can claim to be footing the bill for their perceived choices. It’s NOT a good idea.

UPDATE: Comments are furthermore closed. If you are interested how free markets work, and why nationalized heathcare doesn’t make economic sense, please grab texts in basic Micro and Macro, and especially Price Theory. I also recommend reading up on basic game theory, though that’s a bit more abstract. Additionally, there is a very interesting evidence-based site called The Problems with Socialized Health Care I suggest everyone who wants to comment here at least breezes through.

Yes, I’m a Total Geek – DBS and Obesity

by bigliberty

So Sandy has a great post today about the DBS human experimentation. As a short summary, DBS (deep brain stimulation) is electrodes surgically connected to a certain area of the brain, and a pacemaker implanted in the chest, in order to then give doctors the ability to send electrical shocks to that area of the brain. The idea is that the brain is sending the “wrong” signals on its own, and it needs surgery to be “fixed” so that the “right” signals are sent.

DBS has found a place in anti-obesity medicine, as a possible method to make fat people permanently thin.

Naturally, brain surgery to make fat people thinner would make the creators of this method, and brain surgeons, dazzlingly rich. This is of course because there has been no weight loss method thus far that has been shown to be generally effective post five years.

Needless to say, in this day and age of many popular prescription medications going generic, the success – or dare I say it, perceived success – of this method would be a boon.

And indeed, as Sandy so well details, the very basis of the methodology behind this surgery is faulty. The assumption is made that fatness is caused by an addiction to food or some other kind of neuropsychological food disorder. The shocks are directed on a portion of the brain that has been suggested in animal studies to reduce hunger.

As those who have had eating disorders know, it is a disconnect with the impulses of hunger that is cultivated during the disorder (not that this disconnect is the cause, of course). In order to most successfully starve oneself, one desires to unhook the natural hunger impulse as much as possible. During a binge, the hunger impulse is also ignored, as one gorges far past the point of fullness (note: for those who are unacquainted with binge eating disorder, it doesn’t mean simply having seconds of a meal or snacking when one is not hungry, or having that second bowl of ice cream on an especially stressful night).

All that aside, there is an especially important quote from Sandy’s article that I think deserves emphasis:

At a meeting of the American Neuropsychiatric Association, Dr. Lozano also described a troubling complication observed when stimulation spread to the hypothalamus, which is the target for DBS:

[T]here have been reports of aggressive behavior induced by intraoperative stimulation in the vicinity of the subthalamic nucleus, thought to be related to the spread of the current to the hypothalamus. There have also been acute depression and anxiety induced by stimulation in the vicinity of the substantia nigra pars reticulata; there have also been reports of euphoria and laughter… by stimulation in the subthalamic nucleus. Because the subthalamic nucleus is rather small… it’s quite difficult to only be in the motor territory without having some spillover into the cognitive and limbic territory, so we often, if the current is too high, or if the electrodes are misplaced, get some of these collateral effects.

Which brings me to the title of this post. You see, I’m a total geek. I love Star Trek, Star Wars, Firefly, Battlestar Galactica, and other good sci fi. I’m a science fiction writer, myself. And since the lead researcher of this experiment himself compares it to borderline science fiction, I think it’s apt to reflect a great piece of writing from the movie, Serenity.

The character Mal from the movie Serenity

The character Mal from the movie Serenity

In this movie, the crew of the starship Serenity discover a human experiment on a massive scale. The planet Miranda had been terraformed by the Alliance government, and a general call had been sent out for individuals to become part of a new civilization on Miranda. What they hadn’t been told is that the Alliance government, in partnership with its government healthcare researchers (as far as I can tell in the Firefly series, off of which Serenity is based,  healthcare is nationalized), have developed an airborne drug called Pax.

Pax was supposed to be a “civilizing” drug – meant to weed out aggression amongst the population. However, it had horrible side effects. It worked, in the sense that along with aggression ambition, and even the simple will to live was weeded out, causing many of the population to just allow themselves to die. However, in a small number of cases Pax had the opposite effect – it caused extreme aggression. Those individuals so warped by the drug were to become a permanent threat to the Galaxy at large.

Sure, it’s an exaggerated, geeky example. However, the point is when we start abandoning the idea of rigorous science and studies based on fact with real outcomes, and start marketing anything and everything because there is a population steeped in fear about a particular “malady” (here it is obesity, in the Serenity movie it was aggression), we bear the brunt of unexpected side effects.

Perhaps DBS-surgered obese people won’t become monsters who want to kill their fellow man, but even if they are in the very least bit not just worse off after the surgery than they were before, but the same, it is a violation of the Hippocratic Oath: “First, do no harm.” I consider cutting into healthy brain tissue harm. I consider even cutting into the skin of a person for a reason that is not shown to improve their health harm.

What do you think?