It's never about health, it's always the "gap"

The USA imports working-poor people because we have trouble growing our own. Our own poor may be homeless, or mentally ill, or elderly or in fragile health--essentially, unemployable; our own social agencies don't know what to do except offer them government assistance, insurance and welfare. So we wink at the working-poor from other countries who because of language or illegal status, must live a reduced lifestyle. We have a broken, unworkable, 20 year old immigration law, and a Congress who can't figure out how to fix it without swamping our social services and education system. The primary goal of both Republicans and Democrats appears to be to log more constituents for their parties.

Even with a jump start over the border, or a generational family tradition of government assistance to replace fathers-in-the-home (the primary cause of home grown poverty in the USA is single motherhood), our poor are better off than the poor in most countries because we set the bar very low. To qualify for SCHIP, our health insurance for children of low income employed people, the family of four income eligibility is at at 250% of the poverty level, or a little over $51,000 for a family of four. I don't know about you, but that doesn't sound like poor to me--remember, income isn't wealth.

No matter, though. It's always about the GAP between the rich and poor or the poor and middle class; it's never about the poor as real people with real health problems, or even their income. Even if every poor person in this country had full health, dental, vision and cosmetic surgery insurance with pet insurance thrown in for Spot or Fluffy, if someone richer had more, could elect a higher standard of care, it would be a terrible burden to bear for the psyche of liberals.

Here's the latest gap. Help for the obese. Bariatric surgery can reduce diabetes, heart disease, hypertension, sleep apnea, osteoporosis, etc. and improve general sense of well-being. Did you know that there is a gap between white, obese women who have bariatric surgery and black and Hispanic obese, women who have it? Also, a gap between white, obese women and white, obese men? Yes, 84% of the patients who have the surgery are women and 90% of those are white. But black and Hispanic women are more likely to be obese.

However, even people who can elect to have this surgery--rich, obese white women who live in cities that have special surgery centers--often choose not to have it. 15 million people are obese enough to have the surgery, but only a tiny fraction do. I'm just guessing here, but 1) there is a fairly high morbidity and mortality rate--you can survive, loose weight, but reenter the hospital several times--that ain't fun, 2) you still have to diet, 3) you still have to exercise, 4) after all that pain and frustration and giving up the comfort food you love, there are no guarantees you will live longer or save your marriage or job, 5) some minority groups and white males do not see obesity as quite the cultural sin that wealthier, white women do and have no wish to change their behavior, 6) this surgery is usually performed on those who have the best chances to survive and comply to the lifestyle changes which significantly helps the statistics of success, and 7) you can, with persistence, gain it all back!

For more information see, "Toward the rational and equitable use of bariatric surgery," JAMA, Sept. 26, 2007, pp. 1442-1444