Remember when I demanded human respect and equal health coverage for all humans, despite my status as a smoking fatty? (Smoking hot for sure, but mostly in reference to my fondness for ingesting delicious tobacco-stuffed tubes of burning paper through my lungs.)
The social dialogue that surrounded these issues at the time was worrying, though not surprising. Fatness and smoking habits were being conflated in the media as reasons to increase premiums under the impending new healthcare laws, and I failed to find the logic in that reasoning.
I was concerned about people being priced out of healthcare coverage altogether, similar to the way preexisting health conditions used to be damning. I felt that paying more for health insurance as a smoker made sense to some extent, but should be carefully considered and based on income level, or funded via an increase in cigarette taxes per purchase (not unlike the way the UK functions.)
I was also concerned that penalizing fat people for their "lifestyle habits" by demanding higher premiums would be counterintuitive, because contrary to popular belief, fatness does NOT automatically imply poor health and should not be a discriminating factor to consider when supplying a person with insurance anyway.
A lot has changed, both in our government's healthcare policies and in my personal life, since I wrote that initial article 10 months ago. And yet many things have stayed the same.
The hoopla that was the Affordable Care Act happened. The pitfalls of developing a dysfunctional website that was central to the new program became the punchline of late-night monologues for weeks.
Considering all the hands that were in the proverbial kitchen trying to launch that thing from the beginning, I was not surprised by the resulting chaos. Although Obama took full responsibility in the press, the mayhem going on behind the scenes was hard to ignore.
Developing such a specialized, intensive, and important governmental website should have been made a small team effort that could be more easily managed. Instead, responsibilities and blame was continually shifted onto the shoulders of many.
Now that the initial impact of a faulty system has worn off and some of the website kinks have been smoothed out, people are finally getting coverage and we are starting to realize the facets of this plan that might make it worthwhile.
Take for example Marilyn Wann, a 47-year-old fat activist from CA who has been granted health coverage for the first time in her adult life. I have to imagine the same is true for a lot of patients like her that were denied coverage in the past due to the state of their BMI (a lovely indicator of physical body mass, but an absolute bullshit way to determine individual health and wellness.)
This is a positive sign and I am happy that these distinctions are being recognized on some level.
But while the new laws may appear to be more generally inclusive or accepting, there are still incentives in place that could make the cost even higher for people of size -- especially smokers.
"Starting January 1, 2014, the Affordable Care Act will dramatically expand the ability of companies to penalize employees for lifestyle issues, including being overweight or smoking, in the name of "wellness incentives." Overweight and obese employees may now face staggering financial penalties of up to 30% of the cost of their health plan, and up to 50% of the cost of their health plan if they smoke."
And so, we come back to where we were last year -- with the possibility of facing mounting penalties for two separate circumstances that are not always 100% controllable, but are socially enforced and accepted as such.
My personal smoking habits have taken a huge hit. I went from smoking a pack a day in college, to a half pack a day by graduation, to 5 a day, to just 1-3 in the evenings with sporadic increases on the weekends.
Camel No. 9's were my jam: So smooth. So pretty in pink. So not good for my body.
As my mental health began to stabilize and I worked more with my psychiatrist and therapist to find a medication and a treatment plan that finally started to make a difference in my life, the allure of those pink and white ciggies occurred to me to be not so bright and shiny anymore.
My inclination toward the novelty and convenience of electronic cigarettes coupled with a desire not to freeze my ass off smoking half-cigs outside in the harsh winter months meant that my smoking habits came to a near complete halt without any real conscious effort.
Don't attempt to understand my logic, for I have no real grasp on it myself.
My fiancé just asked me, "So why HAVE you quit smoking?" and I exclaimed "I DON'T KNOW!" in return, because I totally really want a real cigarette for the first time all day but I'm actually sitting with my discomfort and not letting it own me for once.
Instead, I've been reaching for my disposable mini e-Flings to quell my cravings and planning a trip to my local vape shop to invest in a refillable e-cig mod of my very own.
I quite enjoy inhaling and exhaling vapor without the consequences that come with the analog alternative -- but I will admit to sneaking a real smoke now and again, usually in non-sober states.
While my smoking habits have dwindled, my opinion on the matter of healthcare coverage remains the same: All people (smokers, non-smokers, fatties, non-fatties) deserve the same access to healthcare resources without the threat of financially debilitating incentives and penalties.
And hey, how about let's not continue to conflate smoking habits with umbrella statements about "fat lifestyle habits" while we're at it? No two fatties are the same. We actually do not all live by the same standards, so you know, let's stop thinking that way.
Moderate increases where necessary are totally legitimate, but 30-50 percent increase in healthcare costs are NOT moderate. They are unnecessary.
Not to mention, the American Lung Association wrote a letter which greatly opposed the impending surcharges, stating that higher insurance rates for tobacco users “are an unproven theory to improve public health.”
Thankfully, not all insurers are guaranteed to be embracing this approach -- states like California, New York, New Jersey, and Massachusetts have banned the practice.
With the evidence at hand, let us recognize that this may not be the best solution in favor of creating more reasonable options for American citizens to get the care they so deserve. Let us keep pushing for alternative methods and remember to be mindful of different lifestyles and experiences without defaulting to discrimination.
In my mind, affordable healthcare should be a right for EVERYONE -- no ifs, ands, fat asses, or cigarette butts about it.
That is where I stand, but where is your mind on these matters? Let us discuss in the comments over a cup of tea and an e-cig -- or an analog, if you're nasty. No shame.