BTW, We STILL Don't Have Universal Healthcare

I am more relieved this morning that I realized I would be when I read the announcement that the US Supreme Court upheld the constitutionality of health care insurance reform passed in 2009 (commonly called "Obamacare"). I had mentally prepared for a negative decision, which I believe would have been wrong and would have set a precedent that would have had effects far greater than the measure under consideration.

The core question of whether the federal government has the right to require people to purchase something was a silly question, IMHO. The government provides tax incentives to control our behavior all the time. In fact, the tax code is so confusing because it is built around such mandates and incentives rather than any logical monetary policy. Calling the provision in Obamacare a "mandate" to do commerce was a political construction. What the law does is no different than "mandating" that homeowners upgrade their energy efficiency or that people keep their retirement money tucked away in their IRA until they are 59-1/2 years old. (The first has a reward incentive, the second a penalty.) I'm happy to see the court didn't go for the convoluted reasoning that led to that assertion.

But even though I'm relieved, I'm not celebrating. The measure passed in 2009 is no where near what we need in this country. All that really has happened is baby steps. Monumental and historical baby steps, but baby steps nonetheless.

I'm being given the "choice" to give profit to corporations that have made their billions through the deaths of individuals who could have lived full and productive lives or pay a penalty to a government in the form of taxes. This "choice" is no choice at all. I do not and will not pay premiums to a private insurance company. Ever.

If we had to compromise, I would have liked to have seen a government option for those of us who would rather pay into a government plan than to a private insurance company. I would have to preferred that these companies be put out of their misery and we go to a single-payer system.

Today's decision means that it will be an ongoing political struggle not a court decision and for that I'm grateful. A negative vote today would have set back any efforts at real reform. But let's not over-exaggerate the contribution Obamacare has made. It is impressive because it moved inches forward in a system that is pushing hard against it, but it is not really progress.

I have two basic arguments regarded universal healthcare that Obamacare did not address:

1. For-profit medical care is unsustainable economically. If you are a capitalist, you should oppose for-profit medical care on principle. A free market can only be free when sellers are in competition with each other and buyers can freely pick among them. Healthcare cannot work this way. When a patient (buyer) is ill, they do not have the freedom to shop around. In addition, a patient (buyer) cannot obtain the information needed to make a shopping decision. The sellers (doctors, hospitals, pharmaceutical companies, etc.) will always have an unfair advantage over buyers. Thus, medical care cannot never be a free market. Medical care is definitively a natural monopoly and thus should be regulated and administered for the group by the group. In our current sociopolitical world that means through government (though alternatives to this exist beyond the usually reductionist dichotomy of either government or private industry, but that is another topic for another day).

2. Healthcare is a human right and should be respected as such. Article 25 of the Universal Declaration of Human Rights states:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The current system, even under Obamacare, does not recognize this right or respect it. We got a little closer with the abolition of "pre-existing conditions" but medical care that is mostly for-profit is medical care that is classist. We do not have adequate care and in a for-profit system we cannot have universal adequate care because profit always seeks profit above all else.

I'm not really a fan of big government, but I'm even less of a fan of big business. The pharmaceutical-medical industrial complex is big business and Obamacare gave them a big gift: 30 million more customers. It wasn't unconstitutional to do so, but it still hasn't got it right.

In 2014, I will most likely be penalized for not participating in Obamacare by paying the thieves their due. I wonder if I might become a medical refugee, heading to a country with real universal healthcare. I hope that before then a viable government option, an expansion of Medicare, would emerge. In the current political climate, I'm not holding my breath, but today's decision makes it a possibility and that is better than the alternative.

What a Day--Stigma is alive and well

I wrote a little blog entry on Psychology Today yesterday and today all hell broke lose and I spent the day being attacked on a number of personal levels, including threats to my job at CSN.

As a description of the blog I wrote:

Judging character, work ethic, health or worth on the basis of how somone looks is ALWAYS prejudice. No one should be treated as "less than human" because of their body size.FATISM is a matter of cultural stigma. This blog is about cultural and social issues, not a health debate.

Talk about a prophecy. First controversy and the judgements about my character, my work ethic, my health and my worth were all over the place.

I think the thing that interests me most as a sociologist is that I was considered "obsessed" because I have written about this. These persons were defending themselves on the basis of credentials and a body of work, but as a stigmatized person I was considered "biased," "obsessed" and "deaf to other points of view" because I, too, had a body of work.

I have never seen a more beautiful example of what Goffman meant by spoiled identity. If I wrote and researched the topic, I am obsessed. If I am uniformed and unwilling to change, I am ignorant and need help. My body was code for "stupid," "unhealthy," "lazy," and "incompetent." It makes me wonder what they would have used if I had been thin.

I have written in other places about my reluctance to be a "professional fat person." Today was a reminder of both why I became one and why I hate it.

It remains my hope, however, that having become one, I can use the example of fat stigma to end all stigma. Stigma is a horrible cultural practice and one that hurts both individuals and society.

I Take Up Space: New Blog on Psychology Today

I'm excited about kicking off a new blog at the Psychology Today website. The blog is called "I Take Up Space" and is about the consequences of fatism. The site has millions of visitors each month, so I'm hopeful that it will become an outlet for discussing Fat Studies as an emerging field and promoting sociological perspectives on these issues as well.

I write about the failure of New Year's Resolutions and the Moral Panic of the War on Obesity in my first effort.

(Please forgive my cross-posting if you read me in more than one place.)

Wendell Potter and Michael Moore on Keith Olbermann's Countdown

Since we discuss both the role of whistle blowers and the health care debate in class, I thought this might be of interest.

Interesting Article on Poverty and Aging

This supports some of the things we've talked about/will talk about in 101 classes. A very interesting read.

The Gap Between the Poverty Line and Self-Sufficiency

7 Ways Health Care Could Be Improved in the US

So after a year of debate that was full of backroom deals, posturing and ultimately the demise of anything resembling bipartisanship, we have a radical but weakly constructed Health Care Insurance reform law aptly and anemically named: The Affordable Care Act.

Okay, before I discuss what I hate about this bill, let me make some concessions to my liberal friends:

• Yes, this goes way further than anyone has gone before;
  
  
• Yes, it is good to do away with the discriminatory practices of the predatory health insurance industry such a pre-existing conditions and dropping insurance when one is sick;
  
  
• Yes, there are some immediate benefits that are helping some people; and
  
  
• Yes, this will most likely result in some improvements both in the cost and delivery of health care.

But this is a drop in the proverbial bucket and Michelle Obama's anti-childhood obesity campaign tells me all I need to know about how much this administration knows they have failed to produce real change. Just like the Clintons in 1994, blaming fat people is a great way to blow smoke and use mirrors to make the failure disappear.

So why am I profoundly disappointed in this bill?

• First, no public option other than some lame expansions of Medicaid and some temporary fixes like High Risk pools which will go away when the full non-existing condition prohibition goes in effect in 2014.
  
  
• Leaving these lame expansions in the hands of states and demanding that states provide matching funds. Nevada's a-hole of a governor (and my boss--I'm technically a state employee) Jim Gibbons had decided that it is better to sue the federal government than provide the extra medicaid and high risk pools. Thus, a beggar-thy-neighbor affect has already begun. And yes, he's acquiescing but it is really too little too late.
  
  
• No effort has been made to even begin to address social inequities inherent in medical relationships or to ask the hard questions about the money and power held by hospitals, pharmaceuticals, physicians, insurance companies and other big-time players in the system. (Like, I don't know, maybe a regulatory system that allows patient's complaints to be heard.)
  
  
• Health care coverage is still tied to work. This is a ridiculous idea and it belies the latent function of health care in America: keeping the working class compliant. This is not a natural fit at all and all the celebration of tax credits is a perfect example of politicians pretending they are doings something when they are not.
  
  
• In fact, the health care tax credits for personal income tax is essentially making school loan debt, tax debt and non-payment or being behind in child support payments a death sentence. If you don't have enough money to pay these things, you probably are not going to have enough money to buy insurance. If you get the tax credit to supposedly help pay for insurance, it goes to pay these other debts, which means you have no money to pay for the insurance the government requires. This in turn means you will owe more taxes because of the penalty and therefore you will be further in debt and the cycle continues.
  
  
• But the biggest reason I find this law to be distasteful is that millions of Americans who have been bullied and mistreated by the nation's health insurance industry are now going to be forced to buy insurance from that same group of people. You see the dirty little secret is that the insurance industry knew they were in a win-win situation.
  
  OOH, if reform failed, their unbridled profiteering at the expense of our health and well-being would continue unimpeded. OTOH, if reform passed without a public option, then a whole new group of people would be forced to buy insurance. Not that wonderful group they hate -- the sick, but that wonderful group they love -- the young folk who rarely get sick.
  
  Now let me make this clear -- for a universal system to work, mandatory insurance has to be a part of it. The whole concept is that everyone buys in whether they are sick or not, then the cost for all is lowered and the protection for all is in place. But that is only valid IF everyone receives the same protection. This bill leaves in place all sorts of stratification, meaning that young people and their parents (till they are 26) are going to get the short end of the stick, or in other words, the stick is going to be stuck someplace where the sun don't shine.

If I believed that people in Washington really saw this as a first step towards true reform, I'd be more excited. But as near as I can tell they are all celebrating the victory or mouthing off about repeal and no one is discussing the next move.

The fact is no one has really faced some fundamental truths about for-profit health care systems, and as long as lobbying and corporate money flows unimpeded, they are probably not going to face those facts. As Upton Sinclair once said, "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"

So not ever wanting to be simply "anti" anything, I offer some specific Ways to Improve Health Care in the United States. Some of these are shifts in perspectives, while others are downright practical:

1. True reform must begin with understanding the collective nature of health care. Germs do not care which bodies they infect. The water, soil, air and environment surround us all. Our well-being is collective and pretending this is an individual's business only is costing us. All health care is public health care. This basic fact is radical because it is the crux of the whole debate. When other countries debated how to achieve universal health care they took this as a given and then discussed reform. Americans are still pretending that they are in total control of their lives and it is costing them their health, their well-being and their livelihoods. This paradigm shift has to happen or we will never achieve good health care that is sustainable.
   
   
2. We must eliminate the primacy and monopoly that allopathic medicine and the physicians who practice it have on our health. What little regulation through licensing and academic accreditation that we have gives a virtual monopoly on this form of medicine and it is to our peril. The reason chronic illnesses are on the rise in the United States is that practitioners who have methods to address these conditions are systematically pushed aside in favor of the "magic pill" form of medicine. I love what surgery and pharmaceuticals can do. I'm alive because of advances in these areas, but I am, along with millions of others, in daily pain and disabled because these are the only advances that have been encouraged. Any reform that does not get rid of the monopoly of the allopathic doctor and overblown reward that monopoly affords him or her is going to fail. We need multiple modalities and we need to be rewarding these modalities and allowing them flourish.
   
   
3. We need to allow more locally based systems in the practice of medicine while finding ways to use economies of scale in the acquisition of resources. In other words, local communities should have more control over their clinics and practitioners but acquisition and distribution of equipment and medicines should be organized in such a way that lowers costs. Such organizational schemes are not without precedent but they are often defeated by monied interests. There should be no reason we cannot have medical boards in a community that oversee the practices of health care providers locally and still have vaccinations, medical supplies and equipment bought on a national scale and distributed according to local needs.
   
   
4. We need to divorce health care from wage slavery. This is not a natural marriage. It has a specific and sordid history and if we really want to have health care for all, this marriage must die. As long as health care is connected to employment we are enslaved by both systems. It's just that simple.
   
   
5. We need to recognize that it IS NOT and it NEVER CAN BE a level playing field between health care provider and sick person. This means it should never be "for-profit." The provider is always going to have far more information than the sick person. The sick person is in desperate straights when ill and therefore does not have time or ability to seek out good information and shop for the best price, best service and so forth. Thus, the opportunity for price gouging and fraud is always present. It cannot help but be corrupted and therefore it can never be a free market. Pretending that the patient is a "client" is ridiculous. In our current system, we cannot trust our providers. How do we know they have our best interest at heart? We cannot truly know if a doctor is prescribing a drug because we need it or because he owns stock in the company that produces it. We cannot know if the procedure the doctor suggests is because it is the best thing for us or if he just needs to pay for his daughter's tuition this month. We think we trust our doctors, but how can we know the purity of their motives when they make more money when we are sick than when we are well?
   
   
6. We need to recognize that social ills create much of our personal ills. If we really wanted to lower our health care costs we would be working towards the end of poverty, we would be working towards a better ecological balance and we would be working towards the end of war and violence. Corruption, pollution, violence and lack of access to care are the leading causes of ill health. We will not be serious about improving our health and well-being until we are seriously trying to change these things.
   
   
7. Finally, related to #6, but not quite the same thing, is we need to end stigma and the medicalization of prejudices. Far from improving our collective well-being, the unintended consequences of many public health programs is to reinforce stereotypes, prop up bullying and paternalistic behaviors of bigots and mark people as less than human because of who they are or who they associate with. There is beginning to be ample evidence to support the notion that stigma leads to ill-health. Creating programs that continue to stigmatize, even if it is "unintended" will make true health care reform impossible.

Yeah, I know, if you made it this far, you are probably saying, "Yeah, but..." Well, reform is supposed to be change. Reform is supposed to be something radical. The so-called reform we have to date is just same ole, ahem, well you know. If we really want change, if we really want reform, we are going to change our core values. Right now we care more about profit than people, we care more about ideology than truth and we care more about getting our way and not having to make any sacrifices than we do about life and the future. There is a price to be paid for everything we believe that is not true. The price this time might be our lives, our children's lives, our civilization, and our planet. We cannot afford anything but reform.

Talking about Sociology on the Radio this morning

I rarely cross-post from my other blogs, but I wanted to tell as many people as possible about a great show I did this morning with Verria Kelly, the Good Health Coach.

This was a rare chance to discuss how understanding Social Roles can improve your life, specifically your health.

Check out the details on Ample Ramblings.

7 Reasons Why UNIVERSAL Health Care does NOT EQUAL SUPPLEMENTING THE SICK

My outspoken stances on universal health care coupled with the size of my body, the disabilities I live with, and my unapologetic attitude have led to some flaming of me personally on the net. I'm not too worried about it and while the hatred saddens me somewhat, I generally ignore it and almost never respond to direct flames. I've been around the net long enough to know that arguing with such people basically just fans those flames and doesn't accomplish anything but an ashy mess.

I received one such flame this weekend, however, that I do want to address, though not directly. Basically I was told in not-so-nice terms that I was for healthcare reform so I could sponge off my  healthier peers. The belief that universal health care is some plot for sick people to lay back, do nothing at the cost of the healthy is, I believe, at the heart of the health care debate. It is a belief that has been exploited by insurance companies for decades.

The irony is that the basis of insurance is exactly the same basis of universal coverage: insurance is based on the principle that if everyone pays a little when they do not need whatever the insurance is covering, then when something happens and they do need it, the fund will be there to help. If the group is big enough and has enough diversity, the bet is that it will be unlikely that the fund will be depleted because only a small percentage of those paying will need help at any given time. Of course, there is a certain understanding that each member of the group has to pay enough to cover that expected collective need for a given time, but for the most part the amount paid to the fund is supposed to be significantly less than any individual's need if it arises (making it more appealing to pay into the fund rather than just save for a rainy day). 

Of course, one of the reasons for last years collapse in the credit market is that large companies offered "insurance" against default on debts without adhering to the basic principles of size and contribution and the system collapsed.  But the idea behind insurance is an old and tested one and when done soundly it is not a bad idea. It is, in fact, one of the benefits of collectivity.

So why has the idea that the public option would be something new and different been so easy to sell to a good percentage of the American public? I believe it is because of the fear of collectivity and the cult of individualism that pervades our culture. It is this knee-jerk reaction to anything that smacks of collectivity that has made it possible for this current system of cutting off the access to good care for as many people as possible to exist.  Because Americans accept the cult of individualism we are willing:

• to blame individuals for their illnesses;
• to understand when doctors get richer because we are ill (after all each person is obviously responsible for their own illness);
  
• to buy into the lifestyle myths that eating and exercise means we can live forever (thus leading us to buy billions of dollars in diet and exercise products);
• to stand by when insurance companies and HMOs discriminate against sick people by refusing to sell coverage to people with pre-existing conditions, by denying coverage to sick people, even when they have paid premiums, and by canceling their coverage when they get sick;
• to support pharmaceutical companies even though they continue to make obscene profits by selling their medications to Americans at extreme prices to make up for the reasonable limits on their profits in other countries;
  
• to yell "socialism" when any remedy to this racket is suggested.

The reason that these companies can do what they do is because the majority of people in the United States are sold on this idea that they are in control of their health and anyone who gets sick is "obviously" at fault. So why would it be shocking when someone takes advantage of the sick? It is not "my problem." Even more basic, most Americans believe they can control risk and that a risk-free environment is fundamentally their birthright.

So I propose another way to look at all this.  I suggest that life is risky and that any one of us could get sick, disabled or incapacitated just by living a normal, every day existence, no matter how "good" we are or how much "care" we take. Life is risky, but we can face these risks and these troubles better together than apart.

So here are seven reasons to consider why one should not view universal health care as supplementing the sick, but rather as a basic right that each individual should have guaranteed under our law, as our founding documents suggest:

1.  All people can get ill no matter how "healthy" their behavior.

Yes it is true that eating enough nutrients and moving often seems to help create a healthier life. But this does NOT equate to A GUARANTEE that one will never be sick. Health and illness is complex with genetics, environment, behavior and just plain germs all calculating into the mix.  Many of the illnesses that people experience have no apparent cause and have little understanding by the medical community at this point. So deciding that one "is healthy" means that one will "stay healthy" is a costly naivety.

2.  The Healthy/Sick Dichotomy Does NOT Exist.

Health is not a binary function where it is obvious that one is either healthy or sick. Health is a continuum at least and probably more like a web structure. One can have a chronic illness but live a fairly fulfilled and active life. One can have something affects one's body but leaves one's mind sharp or vice versa. One can believe they are healthy for months or even years before a symptom of problem shows up. The belief that the healthy would be supplementing the sick is based upon a false dichotomy that cannot be worked out in the real world. All of us are dying from the moment we were born. So in a sense, we are all sick.

3. Many diseases are contagious and germs do NOT discriminate.

A really fundamental reason to work towards collective health is that the less people carrying germs around, the less chance other people will carry germs around and the benefit grows exponentially. We have a public health system in the United States right now. Universal coverage will enhance this system by ensuring that it is not a matter of money that people get immunized.

4. The question of "health care costs" is complex.

The concept of supplementation is based upon all these "cost" figures bouncing around. Costs are basically arbitrary and negotiable since most of what is involved in health care is service not raw materials. Because of economies of scale and because early intervention will help prevent more involved treatments, coupled with the power of the collective to negotiate prices and simplify administration, the overall cost of health care will get lower. This lowering of costs has been shown to occur in every country that has adopted universal health care and it has not been taken into account by those who are estimating the costs of various programs because it is hard to predict when and how much such reductions will occur. Thus, as with good insurance practices, the size of the pool and the sufficiency of the contribution will help reduce the costs for every individual and be there for each of us when we need it.


5. Public Health approaches can lead to cures and preventative measures that individual health care misses.

One of the big advantages other countries have over the United States is the ability to see big pictures when it comes to health because there is a collective understanding of data collection and analysis. Understanding epidemics, environmental factors and other kinds of risk factors comes from big picture analysis. Thus, universal coverage will make it possible to know what the health of the population is and to see patterns and gain information that will lift up the health of us all.


6. All people have the potential to make contributions that will enrich our lives and illness does not discriminate among the best and worst.

By keeping people in sickness, we may be wasting human resources that would make our lives better. Equality of access is something that has been recognized as important to the strength of our country by many of our founders and leaders. Discrimination on the basis of illness is one more wasted result of xenophobia.


7. Justice demands it.

You may consider this trite but universal health care is JUST in the most fundamental sense of the term.  Rawl's basic principle of justice calls on us to imagine a world that we would want to exist if we had no idea who we would be when we were born into it. If we didn't know whether we'd be dark or light skin, a just world would treat people the same no matter what color their skin.  If we didn't know whether we would be male or female, a just world would not discriminate on the basis of gender. If we didn't know whether we'd be rich or poor, a just world would not discriminate against the "have-nots."  So, if you imagine yourself to be one of the "healthy" and do not want to "supplement the sick," I ask you to consider how such an attitude is any different than racism, sexism or classism.

Universal Health Care is a basic human right that has been recognized by others around the world for hundreds of years. It is time Americans join the free world and put an end to discrimination against the sick.