Fat is an economic issue 9
Terry Pratchett once observed that a character of his was anorexic because every time they looked in a mirror, they saw a fat person. By that measure, I’m anorexic, though I tend to avoid mirrors. By more objective measures, I’m morbidly obese – 6’ tall, 346 pounds; the Body Mass Index calculation is never going to give a good number.
To listen to some sections of the press, I might as well be public enemy number one. A drain on the public purse, a morally bankrupt insult to the eye of the right thinking, Daily Mail reading healthy public. Apparently, I have the self control of an incontinent puppy and spend my time sat on my arse in front of the TV or looking at child porn on the internet, constantly stuffing my face with lard and chocolate.
Mmm… lard and chocolate…
Now, everyone’s entitled to their opinions of the morality of others. Catch me on another day, and I can rant for ages about the ugliness of the way diet and beauty industries stoke insecurities to sell product. Today I want to talk about the cost issue.
Fat people aren’t cheap to keep – we tend to die younger, and in the process of our dying we cost a lot of money. But dying can be an expensive business and however we go, we all do sooner or later. Fat people’s healthcare costs may well be higher than those of healthy people of the same age, but those healthy people could end up waiting ‘til they are 80 before dying of something horribly expensive like cancer, or Alzheimer’s.
When you add up the net lifetime healthcare costs of the average healthy person, and those of the average obese person, the healthy person costs more.
This is analogous to the “Long Tail” idea – the idea that the long tail of low sales of ‘specialist’ books/records/services adds up to being of greater value than the total sales of the top 100 or whatever. Obvious when you think about it, but running counter to traditional thinking in this area.
We’re really good at spotting the big things, but rather less good at spotting the slow accretion of small things. Each drop of water that falls from a stalactite to a stalagmite doesn’t appear to contribute anything. Nevertheless, the stalactite and stalagmite got there somehow.
I find this knowledge rather heartening. Okay, so as a fat git with diabetes, I’m likely to die young, but that’s my business. The pernicious idea that the broader population of tax payers is somehow suffering because of me and that because of that I should be denied access to health care isn’t just morally repugnant, it’s economically illiterate.
References
Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure from PLoS medicine. The paper describes a mathematical model rather than something which does the arithmetic on a real population, so it’s only as good as the assumptions, but it does seem compelling that the driver for high total healthcare costs over a lifetime is the length of that life. But, as I fat git, I might be expected to say that. Ho hum.
You do realise you just reworked the economic argument for smoking? Just saying.
You knew there was a BUPA gym membership ad in the banner under that post, right?
(bastards)
Oh, and I’d better mention that what the model appears to omit, concentrating on health care costs, is the economic activity of people over their lifetime; a shorter lifetime translates to less economic activity which translates to less money to fund healthcare and the non healthcare costs incurred.
And I say that as a fat bloke who smokes, who exercises and eats sensibly (and losing weight).
Reworking the economic argument for smoking: Yeah, the study linked did the maths on smoking and smokers came out even cheaper. What it didn’t factor in was the cost of secondary cancer. As a fat person I’m unlikely to infect anyone with my obesity or diabetes. If I were a smoker and smoked in public, then I could be contributing to some non smoker’s cancer.
Economic activity: Once you hit retirement, you’re essentially economically inactive anyway – living off the earnings you salted away while you were working. Peg out early and you spend less time inactive on a pension. This does rather depend on how you account for the time you spend as a kid…
I suppose the point I’m trying to make is that the issue is not as black and white as it’s often presented – the complexities of economic activity don’t make things any less blurred.
Bupa ad: Time to hit the adwords blocker again…
All this might be true, but by the same logic, teenage suicides save taxpayers money. I don’t think cutting off healthcare for the overweight is sane, the overweight face serious medical risks, I know because I had some serious medical problems related to my own weight problems. I’ve been working on losing weight for years and I really only relatively recently brought it down below the obesity threshhold.
Anyway, your argument makes a certain amount of sense, but I think the risk of cutting fat people out of the British healthcare system has got to be low. Then again when my uncle told me what they replaced British Rail with, I thought he was joking. But what I’m really saying here is that defending your right to healthcare under the British system is all well and good, but if you’re fat, the most logical response over the long term is to find some way to become not fat, especially since, as you’ve pointed out, being fat limits your life expectancy.
It might be very difficult to get from 346 to 200, which is probably your target weight given your height, but it’s pretty easy to get from 346 to 340, and it would probably cost you as much energy as this debate, or less. If being fat diminishes your life expectancy, losing fat must increase it, so even losing just 6 pounds is worth doing. It’s not for me to tell people what to do, and there are many highly intelligent people who are overweight, but if you’re going to go on about it, let me tell you, plain and simple, there’s only one logical response when you know you’re not in a healthy condition, which is to target a healthy condition and then attain it.
I usually don’t get into this, because losing weight involves psychological matters like self-image, and most ideas on psychology are BS, but I’m trained in hypnosis and I’ll tell you, it’s easy to change your self-image. All you do is practice visualizing images and then work on visualizing images of your self. Do that often, deliberately, and after a while it becomes habit. All the stuff they BS about in the psychology industry, like what self-image “means,” it’s just time-consuming, meaningless chatter. You can disregard it as noise. To change your self-image, do visualization exercises, and visualize yourself looking different. That’s all there is to it. Use that on your weight issues and you’ll lose weight. I know because I’ve done it. At MountainWest RubyConf I was walking around holding my pants up with my hands because I had shrank, while the size of my pants had stayed constant, and I had foolishly failed to plan for this eventuality by packing a belt.
Anyway, long story short, this is my opinion: your obesity threatens your own life. Tune out anybody attacking you for it, fight to retain your healthcare, but make losing weight a priority, and do it.
“Secondary smokers” – A case could be made that there is a “social infection” route in the normalisation of obesity that could have similar effects to that of secondary smoking.
“Once you hit retirement” – that assumes that people manage to make it that far and the assumption that retirement age is a cut off for economic activity (it isn’t; retired persons are still taxed and economically active all be it at a lower rate).
And why block the BUPA ad? Wasn’t your point about personal choice?
Oh please, the only useful measure is annual healthcare costs, which as you can see from the paper, was below both smokers and the overweight regardless of age.
The worthlessness of the argument is shown when taken to its logical conclusion, which is that the best health-care bargain is to be still born.
Giles: Oh, I’m working on getting the weight down as it seems to be about the only effective way of dealing with being type II diabetic. I’m down about 7 pounds from when I was diagnosed and the trend is in the right direction, albeit slow.
Codepope: Frankly, I’m thinking of removing all the advertising from the site. It’s not like I’m earning a fortune from it and it’s depressingly inappropriate most of the time. I’m certainly not happy about carrying ads for a parasite like Bupa.
Joe: I’m not sure that cost/year is the only useful measure – it’s certainly not obvious to me that it is. As for the best bargain being still birth, well, it depends doesn’t it? What’s the average cost of counseling the parents who lose the baby? Was the fetus the result of IVF? Worst bargain probably has to be pegging out at 16.
Of course it’s ludicrous. Money is a truly shitty yardstick for measuring any person, but the people who argue for denying treatment to the obese, smokers, drinkers, junkies, AIDS sufferers and the like tend to dress up their bigotry in financial terms: “I can’t believe that my taxes are paying for…” so I see no harm in offering a financial argument in reply.
Our taxes pay for worse things than caring for everyone regardless of their circumstances. Christ knows how much Viagra, insulin, ventolin, malaria research and drugs rehabilitation therapy we could support with the money we’re pouring into Iraq.
Got a really interesting perspective on this from my brother-in-law while he was visiting us recently. He was talking about how in some countries they are thinking about calculating health costs similar to auto insurance – divining who is a “high risk” and giving them high rates to offset that risk. Overweight, smoking, bad genes, whatever translates to higher costs, and therefore should be higher insurance premiums.
At first, I was in total agreement. I mean, if you are a higher risk then you should pay a higher rate, right?
Then he exposed me for the simple-minded fool that I was, by pointing out the negative effect of singling individuals out of the community, for whatever reason. His thinking is that everyone can share the load evenly, and fairly; and overall it will not make certain people feel like they are not wanted as part of the community.
In a sense, he’s preaching tolerance and inclusion, something that this world is sorely lacking in nowadays.