Just ONE of the problems…

I am about halfway through finally reading the full text for the proposed (and mostly already through all the hoops necessary to pass into law) Health Care Bill for the US.  I find myself thoroughly frustrated with it already.  Mostly the text has some good intentions (ie: increasing access to good nutritious food and safe areas for physical activity, addressing disparities in this access due to economics, location, race, etc); all flavored with bad policies and worrisome proposed actions which set my panic-about-the-future radar into alert.

Since I’m not a legal expert and still working through the bill (also available in full here) I’ll just for now note ONE of my issues thus far.

In the Section: Creating Healthier Communities, in the section for “COMMUNITY-BASED PREVENTION HEALTH ACTIVITIES.” there is a part about what measurements will be taken to prove progress is being made. They are:
(i) changes in weight;
(ii) changes in proper nutrition;
(iii) changes in physical activity;
(iv) changes in tobacco use prevalence;
(v) changes in emotional well-being and overall mental health;
(vi) other factors using community specific data from the Behavioral Risk Factor Surveillance Survey; and
(vii) other factors as determined by the Secretary. (Page 1186 of the Bill)

That’s right. In the efforts to increase the health of our nation, your WEIGHT carries more… weight than does your use of tobacco, your OVERALL MENTAL HEALTH and even changes in your nutrition or physical activity. Let that percolate for a moment. The number reflected by a scale; which measures only the size of the shell your health is contained within; means more to these metrics than any other measure of your healthy habits or healthy existence.

That, to me, does not bode well to the mindset behind this bill. Especially as I do not see the folks behind these measures (such as the CDC) actually finding that weight is NOT reduced with their efforts taking the time to think maybe weight isn’t the problem.  Instead I foresee FURTHER measure aimed at reducing Obesity; rather than focusing on increasing access to fresh foods, access to safe spaces, etc.

I, for one, am more than worried; though not for many of the reasons listed by the unanimously opposed Republicans or even the minority of opposed Democrats.


4 thoughts on “Just ONE of the problems…

  1. I think you’re missing the forest for the trees. You’re looking at just one tiny part of the bill, which has to do with measuring outcomes. How outcomes are measured is extremely technical and peripheral.

    What really matters is access to affordable health care, and imo, the best news for fat folks in this bill is that: 1) insurers can’t deny coverage to anyone due to pre-existing conditions (such as being fat) — this provision is known as “guaranteed issue;” and 2) insurers can’t charge you more than anyone else in your geographic area, no matter what your health status (or weight) is. This provision is known as “community rating.” The only thing they can look at is your age. The oldest customers can be charged up to four times as much as the younger customers, but no more than that.

    Look — there are definitely bad things in the bill, and I certainly agree that the idea that if people in a given community gain weight, it’s somehow a sign that their health has declined or that health care is not working, is ridiculous.

    This bill is not anywhere close to what we need in this country, and I’m disappointed in the ways it falls short, and in Obama for failing to push for reforms like a public option, drug reimportation, and removing the anti-trust exemption for insurance companies. I also don’t like the anti-immigrant and anti-choice provisions (to put it mildly!).

    But, overall, there’s significantly more good in it than bad. Insurance companies will no longer be able to drop coverage if you get sick. They won’t be allowed to impose lifetime caps on how much healthcare coverage you receive. Many, many more low-income people will qualify for Medicaid. And, as I said before, you can’t be charged more, or denied coverage, because of a pre-existing condition, two provisions that are of special importance to fat folks.

    Honestly — if you want to buy health care on the individual market, they will ask your weight, and if you’re too fat, you won’t be allowed to buy insurance at all, at any price. This is now a huge problem for many people, but once the reforms take effect, it won’t be.

    As I said, overall, there is more good than bad in this bill. And what’s bad will, I hope, be fixed over time.

    Do write more about what you’re finding in the bill. I’m familiar with the general parameters, but I haven’t read the whole thing, so I don’t know many of the details.

    • Thanks Kathy for the response! Like I said I do think there are lots of good intentions in there but some things are very worrisome (not least of which what I’ve already mentioned and what you’ve brought up on anti-immigrant/anti-choice provisions). I’ll definitely write more about what I find as I continue reading the 2,000 page bill though 🙂

  2. Being fat is not a ‘pre-existing condition’, as with some chronic illness or some such thing. It is a normal, natural, mostly genetic variation in body size. I would understand being charged more if I had a history of cancer, but it doesn’t seem fair to be charged more for being fat when I have used health care resources less & been sick much less than most people I know who are half my age &, in many cases, much thinner than I am as well. It smacks of yet more weight-based discrimination & of wanting to put the whole country on a diet. Of course, I have strongly libertarian (small l) leanings & believe that my body belongs to me & how I live in it is no one’s business but my own. I am strongly against anything which suggests that I am being ‘nannied’ by the government, any of its agencies, OR an insurance company.

  3. “It’s about diet, not diabetes. It’s going to be very, very exciting.” – Nancy Pelosi on the Health Care Bill

    One more thing: is there anything you know of federal policy and mindset that leads you to believe Kathleen Sebelius will decide that high BMI is a pre-existing condition? Or is she (or her successors) more likely to determine that weight is a “lifestyle choice”, a matter of “noncompliance with medical advice for optimal health”, and therefore not something falling within the purview of the pre-existing conditions exclusion?

    I know which way I’d bet.

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