Giving us all yet another reason to fight for universal health care in the United States, a recent memo from Wal-Mart indicates that the business strategy to deal with rising health care costs is moving rapidly towards discriminating against sick people. Or, at least people who look like they must be sick like old people and fat people.
The New York Times published a report based on a leaked internal memo from Wal-Mart’s executive vice president for benefits. While it does a lot of hand ringing about fatness and long-term employees, there was no indication that any active discrimination was being advocated. The closest is a misguided attempt to introduce physical labor to positions that wouldn’t ordinarily require physical labor like cashiers. Presumably based on the false assumption that fat people are sedentary and who will flee from physical activity. Nevertheless, a memo like this will foster an environment of hostility towards fat employees as well as longer-term employees. It is likely that managers will feel pressured to avoid hiring fat applicants even if there is no overt expression of intent to discriminate. Not that an overt expression isn’t likely itself. Wal-Mart may just do a better job preventing leaks on that account. Even still, there is some thought that mandating physical labor unrelated to one’s job for the purpose of discouraging certain workers could be illegal. David Sclar makes note of an article in American Health Line that advances this argument, and it certainly seems like a valid legal concern. An issue also worth noting is where would such health discrimination stop. If fat people are fair game, what about ethnic groups who have shown higher rates of some diseases? Or women given their possibility of pregnancy. It may seem absurd to think of it, but this is the next logical step from health-justified fat discrimination. If health care dollars spent on fat people are a waste, who gets to decide when it is worth it? Ultimately, this is either an economic concern which targets everyone or a moral concern which targets those considered morally undesirable. Neither outcome is one we should be comfortable with. Most especially when its individual companies making those decisions. Increasingly, we are seeing big businesses understand that health care costs are making them less productive compared to nations where there is universal health care. The good outcome from this would be some visible support from the business community for a universal health care plan. The bad outcome would be what Wal-Mart is doing and creating a hostile environment for employees who look like they are unhealthy. Lets hope most companies fall towards the good outcome. At the same time, it is a very good reason why fat activists shouldn’t give up fighting the “common sense” that being fat is unhealthy. It is not enough to just try to combat fat discrimination. What we see with stories like this is that the “fat is unhealthy” message fuels discrimination. This is what justifies it fat hatred for so many people. Even when the bigotry is obviously cosmetically based, such as Dan Savage’s tirades against Girl Love Handles, the prejudice is always defended by pointing how unhealthy fat is. Prejudice against fat people and the prevailing assumption that fat is unhealthy go hand in hand, and Wal-Mart shows us just what is at stake.
Major Trump donors who complained of immigrant ‘invasion’ used Mexican workers illegally https://www.theguardian.com/us-news/2024/dec/20/uline-mexican-workers-trump
Erm, did it occur to you that maybe this wasn’t a misguided attempt to discriminate against fat people? Maybe it’s a non-misguided attempt to discriminate against people who are too sick or disabled to do manual labor. The article seemed to imply pretty clearly that the policy was aimed to discourage applications from people who had chronic health problems. Why do you assume that it’s really about something else?
Maybe it’s a non-misguided attempt to discriminate against people who are too sick or disabled to do manual labor.
Because discriminating against the sick and disabled is just dandy? People with “chronic health problems” need jobs too.
Oh, dear. I put that badly. That’s kind of my point. Bstu seems to think that the problem is that Wal-mart wrongly thinks that fat people can’t do manual labor. That seems to me to be a really weird way of looking at this story. The problem is that Wal-mart is discriminating against people with chronic health problems, not that fat people are wrongly assumed to be in that category. Even if we achieve fat acceptance utopia, this would still be a fucked-up policy.
So I can’t for the life of me see why this is being discussed as a fat-acceptance issue.
I had thought the article was referring more to people who are more immediately sick and/or disabled – say, someone with arthritis who needs regular medication and needs to sit down while working. That said, they may specifically be aiming the policy at “fat” people as well, and in any case it could certainly affect them.
So either way, it’s a pretty sleazy move in my opinion.
I think they might be talking about fat people because the Wal-mart memo specifically cites fat people as a motivation for the memo, and by implication, the recommendations in the memo. No doubt, I think their intended action would end up harming more than fat people and that is certainly a valid area of interest as David Sclar notes in the linked article at tpmcafe. Indeed, I suspect their expectation of their suggested methods being successful at “disuading” fat people from employment at Wal-Mart to be misplaced and the likely direct victims from such a course of action would be people who may have a chronic disease that would not prevent them from gainful employment had Wal-Mart not seen fit to deny it from them by placing physical demands on the position for the stated purpose of weeding out applicates for non-performance reasons.
However, any discussion of health care costs inevitably results in a discussion of health care costs for fat people, which some seem to believe are not as morally justified as health care costs for thin people. It did in the Wal-Mart memo. Now, a lot of times people like to talk in code when advancing fat discrimination and one might need to understand the coded language to realize what’s really said. Not the case here. Wal-Mart’s memo clearly identifies fat people as its villian. The Times article quotes a specific passage which specifically lays blame on fat employees for rising health care costs. Fat people being scapegoated for health care costs is most certainly a fat acceptance issue. Specifically because that kind of attitude will create workplaces hostile to fat workers.
So I can’t for the life of me see why this is being discussed as a fat-acceptance issue.
In the memo, obesity was cited twice: “particularly with obesity-related diseases” and “specifically less prevalence of obesity”. It seems reasonable to assume they are targeting fat people.
Maybe they are. But they’re definitely targeting people who can’t do manual labor, no matter what their size. If you frame this as a fat-acceptance issue and about the irrational belief that fat people are unhealthy and can’t do physical labor, where does that leave those of us who really can’t do manual labor? Where does it leave those of us whose health care really is expensive? Let’s say that Wal-mart was magically cured of its anti-fat prejudice and just went after genuinely unhealthy, expensive workers. Why would that not be a problem?
It seems to me that by framing this as a fat-acceptance issue, you tacitly endorse discrimination against people who really do consume more, and more expensive, health care.
It seems to me that by framing this as a fat-acceptance issue, you tacitly endorse discrimination against people who really do consume more, and more expensive, health care.
Well, it would be pretty difficult not to tacitly endorse that discrimination. Harder still to avoid doing it, given its eminent logic. It isn’t like non-performance-oriented discrimination against people of particular races or sexual orientations or what have you, where the discriminatory characteristic had no objective relevance to the success of the enterprise. It’s discrimination on rational, if not very warm and fuzzy, criteria.
It is non-performance oriented: they’re changing job discriptions with the specific intent of making jobs un-doable by people who are likely to have high health care costs. It makes sense because of the way we currently run the health care system. If health insurance was not tied to employment, and if employers didn’t pay higher premiums if they had employees consumed more health care, employers wouldn’t have an incentive to discriminate against competent employees with high health care costs. This story is an argument for a national health care system, as well as more evidence that the people who run Wal-mart are assholes.
But I’m curious. Do you have a solution to the problem of companies having an incentive to discriminate against competent, expensive-health-care-consuming employees?
…more evidence that the people who run Wal-mart are assholes.
I am not sure what part of “asshole” covers “being a rational optimizer”; most every human being makes similar decisions daily, but let that pass.
Do you have a solution to the problem of companies having an incentive to discriminate against competent, expensive-health-care-consuming employees?
Nope. I’m not sure it’s a “problem” in the sense that you mean it; it’s one unintended result of a long series of tradeoffs in how we fund various social goods and the economic choices we’ve made.
The issue with the employees in question is that, presumably through no fault of their own, the economic return on hiring them is lower, or perhaps negative, than the return of hiring someone else. The first generous impulse is to conclude that those costs should be shifted to a neutral party so that the economic return between two potential employees is equalized.
Unfortunately, these people are not in a particularly unique boat. There are an infinite set of variations in our individual ROIs to various potential employers, and pretty much everyone has higher or lower returns due to factors beyond their control; the only difference is that this set of people’s poor return happens to be readily identifiable, and thus a target for intelligent discrimination on the part of employers. State action to rectify this particular set of people’s problem may be justifiable (or at least justified) on humanitarian grounds, but it is not tenable for the state to equalize all unjust inequalities between working people.
So I take it that you don’t want to answer the question.
As I said, I do not have an answer to your question. I also explained why I believe your question to be somewhat misformulated, and why I believe this phenomenon to be an identifiable subset of a much broader condition, rather than a discrete situation in and of itself.
What I hear you saying, Robert, is that you think we should throw people with high health-care costs to the wolves, but that’s ok, because you’re also in favor of throwing a lot of other people to the wolves. And I don’t find that a particularly satisfying position. But thanks for clarifying that this is, in fact, about “rational” discrimination against people who consume expensive health care, instead of just being about irrational discrimination against perfectly-healthy fat people. Now maybe the people here who aren’t assholes can discuss what to do about it.
Rational discrimination is very problematic for society in general, and the general topic spawns a host of issues which are fruitful subjects for debate and discussion.
It probably isn’t helpful to your point of view to characterize awareness of the economic questions involved as being a policy of throwing people to the wolves, but the phrasing of your persuasive text is, of course, your own prerogative. (And of course, my own occasional rhetorical indiscretions, particularly in arguing with socialists, counsel against me taking too hard a line.)
In all questions economic, at some point the questions must be asked and answered: who pays for it, and how much? In the context of your (presumed) belief that the state should equalize these health care costs, thus freeing Wal-Mart of the burden of an economically straightforward but morally difficult decision, I guess I would phrase these questions as:
How much in taxes are you personally willing to pay, in order that the competent-but-sickly not be discriminated against?
Robert,
I know it was addressed to Sally, but my gimlet-eyed, cold hearted answer would be that allowing the system to prevent sick people from working so employers don’t have to pay their health care costs is unlikely to decrease your taxes. Sick people who can’t work are forced to get disability from the government, and have their health care costs covered by Medicaid. Furthermore, sick people who can’t work are unable to contribute economically to society, and don’t pay any taxes themselves. Since they still use services like roads and libraries and police just as much as they would if they were working, the tax burden on everyone else goes up. Sick people who can work, but are prevented from doing so by companies that don’t want to shoulder their health care costs, will add to your horrific tax burden.
There are two routes that can be taken to prevent sick people from being forced into the protection of the state, and from becoming such a burden on your wallet. The first one, currently in place, is to make firing people for health related reasons that don’t have to do with their ability to do their job illegal. This involves intrusive state regulation, ineffectual enforcement, etc. For most of us, it is inadequate, but for a libertarian, I would think it would be unacceptable.
The second route is to transfer health care costs from employers onto society at large. This way employers have no perverse incentives to discriminate against employees who are capable of doing their job, but are likely to be a greater financial burden on society.
There is a third route, which your arguments seem to implicitly favor (since they appear to oppose both the existing laws that make WalMart’s plan probably illegal, and the alternative solution of nationalizing health care costs): we could cast sick people out into the streets, to be cared for by either their families (until the costs leave their relatives destitute) or by random charity. Perhaps you imagine that everyone will so increase their charitable giving that universal health care can be provided purely by voluntary charity, but that seems highly unlikely. It isn’t happening now, and imagining that it would surely start if we just made the situation a bit more despairit is exactly the sort of malevolent wishful thinking (“heightening the contradictions”) for which Leninists are rightly reviled.
This third option is overwhelmingly opposed by our fellow Americans, who still understand the benefits of a government-protected safety net (forcing companies to provide the safety-net instead of providing it directly doesn’t make much sense to me, but I suppose it is the natural result of decades of twaddle about how corporations do everything more effectively than governments).
Personally, I would happily start by paying the $6000+ a year that I pay for health insurance in taxes to provide universal health insurance to everyone. I’d happily pay more, but that would be a start. Indeed, given that US health care is the most expensive in the world, and has the highest administrative costs of any in the world (largely due to the fantastic inefficiency of the private insurance system), simply diverting everyone’s existing health insurance costs would be likely to cover the entire cost of a single payer system. Since the currently uninsured would probably also be taxed, my expense for universal health insurance might easily go down (of course, it probably wouldn’t, since any system that didn’t allow the insurance industry to stay involved and taking a huge profit stands virtually no chance of passage in this country, but if we could sacrifice the profits of the insurance industry, I am confident that universal health care would be pretty much revenue nuetral).
Ug, submitted without previewing. Forgive the typos and horrible spelling.
First off, again, Wal-Mart framed this as a fat acceptance issue. I’ve just pointed that out.
Secondly, I do not believe that discussing the ramifications of these policies on fat people in any way endorses their use on people who may be considered sickly, whether they be fat or thin. Just because I think fat discrimination is wrong does not mean I should be presumed to think other discriminations are appropriate. I don’t see the connection that would justify that thought-process beyond a thinking that fat issues are inheriantly unworthy of discussion and automatically devalue any other related issues. Even if the belief that fat people are unhealthy is irrational does not mean it does not exist and cannot do harm to fat people. That harm is no more and no less worthy of comment than the harm done to other people seen as unhealthy and a cost burden. Anytime you decide that a person isn’t worth health care costs its an issue worth comment.
The answer to how to deal with health-care cost based discrimination is a relatively easy one. It will benefit employees and employers alike. Universal health care. We need to press more responsible employers than Wal-Mart to start publicly making a case for universal health care. This is genuinely a situation where progressives and the business community have a common cause. We just need to encourage more in the business community to not only recognize their interest in universal health care but also to advocate for it. This doesn’t have to mean higher taxes, either, for those who feel the need to use that as a boogeyman. And if the money used to pay for universal health care means someone can get a job and provide for their family who might have been denied such a chance by corporate goons practicing what you ironically call “rational” discrimination… well, I am all for that Robert.
Look, Bstu. You said:
But you’re wrong. Active discrimination was being advocated. The memo advocated active discrimination against people who couldn’t do physical labor, because they generally have higher health care costs. You just don’t think that’s very important, because you care more about fat people, whom you don’t think will be directly affected, than about the people whom this policy directly targets.
That’s great. I think that, too. But I also don’t see much evidence that it’s going to happen anytime soon, and in the meantime, I’d like to continue to have a job. We’re not moving towards universal health care; we’re moving towards the ruthlessly “rational” society that Robert advocates, where people whose health care is expensive in many cases end up losing their jobs, losing their insurance, losing access to care, and having their health collapse. Someone termed this “the death spiral,” and that’s barely an overstatement. And it scares the shit out of me that people like you can watch it happen and decide that it’s really not that important and that the real story is elsewhere.
I can’t wait until I have to give a blood sample when I apply for a new job and have the drug, enzyme and electrolyte levels and DNA workups become part of the application process. Oh boy!
I once had a boss who told me that I should be very careful about hiring black people because if it turned out that they had poor job performance, their race made it much harder to fire them.
It’s not an exact analogy, but I think the issue for Wal-Mart is not the present situation, but their anticipation of a future one. They may fear that a fat person’s ability to physically do a given job as well as someone who is not may be equal when they are hired, but will degrade with age more and/or more quickly than someone who is not fat.
twaddle about how corporations do everything more effectively than governments
Corporations do what they do more efficiently than government; privatizing government services often saves money if it’s done on a honest basis, without sweetheart contracts and bribes and such. But with something like health care, corporations’ only interests are in getting health care for their employees, not for providing it for non-employees. So if the objective is to provide health care for all Americans that is of equal quality regardless of their employment and income status, running health care as a service of employers to their employees will never work.
However, so far that’s not an objective that all Americans buy into. They tend to favor ensuring that a minimum of health care is provided to all people; this is how you can get public support for Medicare, etc. But providing equal health care to all people is apparently not something the electorate supports yet.
Corporations do what they do more efficiently than government…
Are you seriously suggesting that private Health Insurance corporations in the USA deliver quality health care more efficiently, on average, than do the governments of countries with Universal Health Care? Blue Cross/Blue Shield really delivers health care better and for less money than does Canada? Even w/ the various BCBS CEO’s bringing home $10 million/year? If you really believe that, then… wow.
What is it that you think corporations do?
Hmm. When I was fat in my early 20s, I was much more physically active, and had a parttime job involving routine lifting of 50 to 60# items (feed sacks and hay/straw bales), not a problem for me. Can’t do that now, even though I am 60# lighter (and 25 years older and working a sedentary job).
Sally, you’re still making a connection when one isn’t justified. Just because I am talking about this story from the perspective of its impact on fat people shouldn’t be presumed to mean that I’m disinterested or even hostile as you suggest towards the interests of other affected people. There are more qualified people that I to go into detail about some of the other aspects of discrimination in this area. That’s why I wanted to link to an article which discussed it primarily from the perspective of how this will effect “sick” people. That’s not my area of greatest awareness. Doesn’t mean I don’t agree with that line of consideration. Just means I wanted to explore a different and in no ways competing or contradictory line of consideration.
Take the Alito nomination, for example. It is understandable that NARAL would focus on his rulings on abortion when advocating against his appointment to the Supreme Court. Does this mean that they agree with his positions on civil rights, personal freedoms, or legislative power? No. It means that they are taking up the aspect of the greater issue that they are most equipped to take up.
My problem isn’t that you focused on the implications of this story for fat people, BStu. It’s true that fat people, including healthy fat people, are likely to be hurt by policies designed to discriminate against unhealthy folks. My problem is that you suggested that Wal-mart’s stated goal of discriminating against consumers of costly health care is just a smokescreen for an anti-fat agenda. You also suggested that there’s no “active discrimination” going on, ignoring the active discrimination against people who actually can’t do physical labor. It’s fine to focus on one aspect of a story, but it’s not ok to distort the story and render invisible forms of exploitatioin that don’t interest you. At least I don’t think it is.
Meanwhile, Congress is debating slashing Medicaid.. This will be great for all the people who are going to lose their jobs for consuming too much health care. And just wait until Alito gets his hands on the Americans With Disabilities Act.
It’s been a crappy news week. And it’s just Wednesday.
Are you seriously suggesting that private Health Insurance corporations in the USA deliver quality health care more efficiently, on average, than do the governments of countries with Universal Health Care?
I don’t know how efficiently health care in countries with UHC works, so I can’t be sure. If you re-read my quote, you’ll see that my statement was arguing against the concept that considering private organizations to be more efficient than governments in general is twaddle. In general, I consider that private concerns tend to be more efficient than public ones. But there can be specific exceptions.
Also, there are certain functions that our system of government is charged with at least supervising, if not performing directly. For example, we expect our city/town/village to deal with trash disposal. Whether the garbagemen work for the town or for a private contractor is immaterial from the viewpoint of the town being ultimately responsible for it, but many governments are finding that it’s more efficient to hire a contractor.
As far as health care in particular goes, remember that a corporation’s mission is not to provide universal health care; it’s to provide health care to it’s employees and it’s dependents. I apologize for this, but I’ll turn the question around; do you think that a corporation’s health care provides lower quality and less efficient health care for it’s employees than those employees would get under UHC? Including elective procedures, etc.?
To measure efficiency, you’d have to compare the current Medicare/Medicade taxes + health insurance premiums that employees currently pay against the overall allocation of taxes for UHC plus any supplemental insurance that the employees would pay (if any) to make their UHC coverage equal that which they had been getting under private insurance, and then also compare the quality/quantity of health care they’d get under UHC with that under the present private insurance plans.
The current health care bureaucracy is likely bloated, but such things don’t usually improve when switching from a private bureaucracy to a governmental one, so I’m going to consider that to likely be a wash at best.
Going to UHC should be more efficient in making a minimal level of health care available to everyone. But UHC won’t come to the U.S. until you can sell the concept that it will improve the quality, quantity and cost of health care for people who currently have a corporate health care plan to those very people.
Well, folks, if Alito is going to bring the Court closer to the right or center (depending on your political viewpoint), it’s time to bang on your Representative and your Senator. If the Court isn’t going to legislate anymore, then you better work on your legislators.
I have found that I get my best response when I fax them my views. They don’t read their e-mail at all from what I hear (how much spam do you think a Congresscreature gets?), and letters sit around until someone decides they don’t have anthrax spores in them (and if some fool puts baby powder in an envelope as a joke, the whole bin may get thrown out). Faxes, though, get through and read the quickest. A friendly tip.
If Wal-Mart is trying to frame this as a physical performance issue, I’m wondering just what physical tasks are generally part of a Wal-Mart employees’ duties. I only shop at Wal-Mart once or twice a year; I find the local store dirty and crowded and it’s very hard to find assistance if you have a question. But I do shop at Sam’s Club, and those cashiers have to be able to handle 50-lb bags of water conditioner salt or dog food on a regular basis, to say nothing of cases of pop/beer. I’ve been afraid for a couple of the smaller cashiers I’ve seen.
If Wal-Mart is putting in a physical performance test that can’t be related to the duties the applicant would have to perform, then I think this is actionable. But if they are putting in a test that the applicant would be expected to do once hired, I think that there’d be much less basis for a suit, regardless of their motive.
Wal-Mart is definitely looking to discriminate here. Whether this particular kind of discrimination is illegal or unjustifiable is something that will eventually end up in court, I’d bet. Are there any laws that forbid discrimination on the basis of weight? Or is it simply that an employer has to demonstrate that they can justify such discrimination? Wal-Mart could argue that being fat affects the ability to do their jobs; I don’t know how successful that’d be. They probably figure that fat people’s health is more likely to degrade over time than people who aren’t fat, but that opens up a whole can of worms if they try to justify that; like I say, then a DNA analysis and all kinds of tests could be required prior to employment.
Yes, I do. Take a look at what has happened to health insurance over the last decade or more. Premiums have skyrocketed, deductibles have gone way up, covered procedures have been reduced, Rx coverage has shrunk to almost nothing. Currently, I have one of the better health plans around. And it is more expensive and covers less than the plan I had in 1991.
I believe that corporations would get a better return on their healthcare dollar under a universal plan. I believe that the numbers back that up – although it is difficult to wade through them all and figure out which are valid.
From what we’ve seen of the memo, job performance does not seem to be a factor. The extent to which it is mentioned is in pointing out that longer-term employees are as productive as recent hires. The concern primarily is with costs of health care, real and perceived. The performance tests seem to involve redefining positions to incorporate physical labor that is not currently involved. I believe collecting shopping carts is mentioned. When I worked at Target, they had employees who rounded up shopping carts and employees who work the registers. It sounds like Wal-Mart wants to make the shopping cart work part of the cashiers job for the express purpose of discouraging unhealthy workers. Not because that division of labor makes any productivity sense.
The question of what protection fat people have from discrimination is an open one. Only one state specifically forbids it: Michigan. Some cities also have some protections, notably San Francisco which was the cite of the most recent high-profile case of size discrimination. There is the question of whether fat people are protected by the ADA and that offers no clear answer. The Justice Department has tried to insist no, but courts have generally found that the ADA’s protections do extend to at least some fat people. The nature of the law however means that the person must be of a size where they would be considered disabled. It most certainly does happen, but there may be hesitation towards protecting, say, a 250lb woman. The open issue does have a deterant effect to some degree, but there has been ample indication that fat people are widely disadvantaged in seeking employment and many individuals who do hiring express their personal hostility towards fat people by refusing to offer them jobs.
Studies have been done which show the Americans are generally dissatisfied with their health care. This is in stark contrast to high levels of satisfaction in countries with UHC. While perhaps not enough to justify change in its own rights, companies, too, are frustrated with unpredictable costs from the insurance industry. Even if they still had to pay for health care through taxation, there can be a considerable benefit just by making the costs more consistant. They’d also be more fairly applied throughout the industry, eliminating an incentive to deny health care for employees. There are a lot of ways we can enact a working plan for Universal Health Care that benefits individuals and companies. I’m no expert so I would hestitate to make a proposal myself, but I’ve seen a lot of good ideas out there. The problem is getting people to consider the issue at all.
This, to me, gets to the heart of the problem. The company’s mission isn’t to provide universal health care, and it isn’t to provide health care to its employees and their dependents. It’s to make money for shareholders. Period. If it makes economic sense to deprive employees of health care or only to employ people who don’t need expensive care, and it often does, then companies are going to do that, because their ultimate responsibility is not to employees or the society. And I think it’s worth asking whether we want to organize society so that the people running the health care system are not responsible to the people using it and often have a strong incentive to withhold care. I’m not necessarily adverse to a universal system in which the government paid private companies to provide care and evaluated the companies on how well they were serving the public. But the way we run things now seems to me to be calculated to fail people who need expensive care.
The problem with Alito is that he has a history of defining anti-discrimination statutes, including statutes outlawing discrimination against disabled people, so narrowly that the laws become meaningless. It’s no good getting laws passed if the judges make it impossible to prove that they’ve been violated.
Not true. The memo says that utilization of healthcare was negatively correlated with productivity, and that the healthiest, most productive employees were least satisfied with Wal-Mart’s benefits package.
I responded to this post over at Catallarchy, but our trackbacks don’t seem to be working. Consider this a poor man’s trackback.