Arizona Governor Proposes Flab Tax 978
Hugh Pickens writes "The WSJ reports that Arizona governor Jan Brewer has proposed levying a $50 fee on some enrollees in the state's cash-starved Medicaid program, including obese people who don't follow a doctor-supervised slimming regimen and smokers. Brewer says the proposal is a way to reward good behavior and raise awareness that certain conditions, including obesity, raise costs throughout the system. 'If you want to smoke, go for it,' says Monica Coury, spokeswoman for Arizona's Medicaid program. 'But understand you're going to have to contribute something for the cost of the care of your smoking.' Coury says Arizona officials hadn't yet finalized how they would determine whether a person was obese or had sufficiently followed a wellness plan, but that measures such as body-mass index could provide some guidance. Estimates for the costs of obesity in America range from about $150 billion to $270 billion a year. According to the latest CDC statistics, from 2009, 25.5% of Arizonans are obese, about 1.7 million people."
I'm kinda split on stuff like this (Score:5, Interesting)
On the one hand I do appreciate that people who take more risks need to bear more burden for the costs of those risks. We see that in other kinds of insurance all the time. The amount a life insurance policy costs varies with the kind of work you do, the amount a car insurance policy costs varies with your driving record and so on. It makes sense to look in to things like this for health insurance as well. If you want to live a more risky lifestyle, ok, but then you need to be willing to contribute more to your likely higher costs. Basic actuary science and all that.
On the other hand I worry about two things:
1) How do you define some of the things like obese? That one is really problematic because the value for it keeps sliding down, what used to be normal is now overweight and so on, and because it generally uses a very bad measure (BMI is extremely stupid). So I worry that this will end up with a system that pushes skinny past the point of reason, that people who are perfectly healthy will be told "You have to pay more because you are too fat," and that people who are underweight (which is far more serious medically) will be left alone.
2) Where does it end? You do have to keep an eye on the whole slippery slope thing when it comes to health insurance. You don't want to start up with a system of "Everything wrong with you costs more." Otherwise you'll end up with a system more or less where the people who can afford it won't need it because they have nothing wrong or likely to be wrong and the people who need it won't be able to afford it because it'll be so expensive. Insurance works when you spread the risk over a lot of people. Now you can limit it to only things people have control over, like what they eat or what drugs they do and so on, but you do run the risk of the government dictating what kind of lifestyle you are allowed to lead.
I also have to wonder about the particular choices. There are an awful lot of things that people do voluntarily that increase their health risks. Why is obesity such a target? I understand that a lot of people are heavy, but you need to run the costs of that against the costs of other choices people make. A lot of people drink heavily too (as much as 10%), and that causes some serious health issues, yet does not seem to get discussed.
I'm not 100% opposed to an idea like this, despite being overweight myself. I just think it needs to be very carefully examined and limited beforehand.
As an example of a problem take using BMI for weight. When I was 18 I worked as a surveyor's assistant for the summer before university. It was physical labour outside for 8-9 hours a day, 5 days a week. Of course being 18, my metabolism was high. I weighed about 185 then, which according to the current BMI scales is "borderline overweight". Still within the normal range, but right at the top. Maintaining that would be essentially impossible as I aged, and you'd have a hard time finding anyone who would argue that I wasn't in good shape, however it was only barely good enough, despite having age on my side.
It is real easy to just start categorizing things without thinking it through and where there's money involved, the pressure becomes all the greater. If more money can be mode with more people being "overweight" then there is an incentive to lower what qualifies, even if there's no medical reason.
Re:Right, smokers should pay extra (Score:5, Interesting)
"It only would apply to smokers who expect taxpayers to foot the bill for their healthcare. Your argument doesn't make sense in that context."
Eh?
But smokers who expect the taxpayer to foot the bill have been paying a lot of extra tax, that's the argument.
In countries like the UK the estimated extra burden on taxpayer funded services is around half the tobacco tax revenue. And STILL people say that smokers ought to be denied care or be made to pay for their care. It doesn't make sense to me.
I don't smoke (any more) but it's hard for me to see this as anything other than taxation as moral punishment, and denial of services paid for by that taxation as further moral punishment.
Re:Tax junk food (Score:5, Interesting)
I wonder about that.
Sometimes I'm not sure if junk food is a symptom or if it's a dangerous substance that should be regulated like heroin.
Man, sometimes I ride the subway and I think "nobody wants to look like that". "Obese" today is not the obese of 25 years ago. When I was growing up there were not people as vast as today. There's something else going on. This isn't the kind of fat that you get from having too much pasta at dinner. This is an industrial disaster.
Re:Tax junk food (Score:2, Interesting)
You're right. Sometimes, even though we know we are eating bad stuff, we don't really put it into perspective. Imagine how popular Coke would be, if we had to pour in 3/4 of a cup of sugar, yet people ingest that much sugar with every drink. Just eating 1/2 cup of plain sugar suddenly seems like a diet snack.
Re:Beware of junk science (Score:5, Interesting)
Well for one, because in Scotland a democratically elected parliament voted in favour of the ban, which has broad public support.
And you think you're being fucked over because you have to go outside for a smoke? Cry me a fucking river. You don't think non-smokers are being fucked over every time a smoker decides to light up and pollute the air for everyone?
Smokers can still smoke in the comfort of their own home. They can still go out to the pub and drink, as long as they take it outside. They're hardly being 'fucked over'.
Re:Beware of junk science (Score:5, Interesting)
I'm a free-market conservative but make an exception for things like this precisely because I think it's a very clear and easily-defined exception that isn't the start of a slippery slope.
A public place of business ought to be free to do largely whatever it likes so long as that freedom doesn't directly harm others. 'But you're free not to show up,' you rightly point out, and yes, that's true, but completely impractical. Figuring out where you draw that line -- at what point does your individual behavior affect other people so much so that the state needs to step in? -- is a very difficult question.
But secondhand smoke isn't an annoyance or an inconvenience. It's a direct harm to the medical well-being of everyone in proximity to it. This hasn't been in question for a long time.
And what about the employees? 'They can just get a job elsewhere.' Also not a reasonable expectation. Maybe if you paid extra for your employees' health care, regular check-ups, limited shifts, you could equalize the picture a little more, but that's tricky.
The general conservative view of government non-interference in our daily lives absolutely depends on acknowledging the cases where it is necessary for the state to put its bloated, debt-ridden foot down.
Re:Beware of junk science (Score:5, Interesting)
It's a bad idea to ban smoking in closed spaces. You lose potential tax revenue and you reduce freedom.
Where is my freedom when I'm forced to sit in an office all day with smoking co-workers?
In my country civil servants get pensions for as long as they live. Many of them smoke. So more of them smoking and thus dying not too long after retirement is good for the country's economics.
Check this [wikipedia.org]. The amount of taxes paid in cigarettes covers only a tiny fraction of the problems caused by smoke. Smokers don't only die earlier, they live decades with very debilitating chronic diseases that cost fortunes in treatment and lost productivity. And they cause the same problems to the unfortunate around them. Want an example? Before the ban I would always have 3 or 4 days a year of sick leave, because of second-hand smoke. And this was only when I couldn't even speak or breathe. I used to have periods when I just coughed the whole day for weeks and weeks. Measure your productivity when you can't stop coughing until your whole body hurts, just to preserve the "freedom" of the smokestacks around you.
Yes you should educate and discourage people from smoking - it is bad for them. But there are zillions of things which are bad for us that we like doing. If people insist on "helping" the country why ban them from doing so? ;)
Read my lips: I don't give a fuck if people want to kill themselves slowly and painfully. I object that they want to take me and my family with them. I thought I made it pretty explicit before.