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Medicine The Almighty Buck United States News

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."
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Arizona Governor Proposes Flab Tax

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  • Tax junk food (Score:4, Insightful)

    by Anonymous Coward on Tuesday April 05, 2011 @05:17AM (#35717948)
    Just tax junk food like is done with cigarettes, alcohol, etc. Use the tax revenues to compensate the extra medical costs.
    • Junk food is the cart, not the horse.

      • Re:Tax junk food (Score:4, Insightful)

        by somersault ( 912633 ) on Tuesday April 05, 2011 @06:05AM (#35718218) Homepage Journal

        Junk is a very subjective term. I think all "low fat" food is junk.

        • Re:Tax junk food (Score:4, Insightful)

          by fbartho ( 840012 ) on Tuesday April 05, 2011 @07:08AM (#35718458) Homepage

          "Low Fat" often means "High Sugar" which is often junk from a nutritional point of view. Neither of those are what you want.

          If you're just pointing out that people have subjective opinions of this sort of thing. Well then great, but that doesn't add too much to the conversation. One person's junk is another person's gizzard salad.

          There are many quacks and quack diets out there, so I don't know quite how to establish an objective standard for diets that are tailor-made for people to avoid junk food. We have rough measures of the amount of nutrients we need to eat per day. So maybe we can point at a rough consensus from world-wide experts?

          I propose that foods that overwhelm those nutrient levels in the wrong way; Say adding too much fat, sugar, sodium/salt, etc, be labeled as "Junk Food" and taxed lightly so as to adjust the perceived price difference between fast-food and healthy food.

          It's a bad cost to society to have to support people in self-destructive patterns, it's a literal monetary cost, and we effectively incentivize the behavior that gets them free healthcare. A counterweight has to be applied to keep people at the same effective equilibrium point in health. Societal communal healthcare has it's problems, but if we don't want to just be throwing money down the drain, we have to use strong motivators to help people regain or maintain their health.

          If a person can demonstrate that they won't be a burden on the shared societal health plan, then it should be a right to opt out of the plan. But opting out should be a waiver-worthy process. If you opt out, and then at a later date get sick, you can't just opt back in. -- Avoid the free-loader tragedy of the commons.

        • by jamesh ( 87723 )

          Junk is a very subjective term. I think all "low fat" food is junk.

          Anything is subjective if you redefine it to mean whatever you want it to mean.

          You know full well what is meant by the term "junk food" though.

          • Re:Tax junk food (Score:5, Insightful)

            by DrgnDancer ( 137700 ) on Tuesday April 05, 2011 @08:31AM (#35718964) Homepage

            No, unless he's some kind of regulator empowered to make decisions about what is or isn't junk, he really isn't. Many low fat food have added sugar.. Are they diet or junk? Many natural foods are quite unhealthy for you, or quite fattening. I try to limit my sweet intake, but once a week I get an organic cookie from Earth Faire (the local Whole Foods-a-like). It's all organic with real sugar, unbleached flour, etc... It's still a cookie though. Junk or not? What about high fat (but also high nutrition) red meats? In moderation they're quite good for you... in excess they're a hug contributor to obesity. Then there's all the stuff that you wouldn't expect to be nearly as awful as it is. A Starbuck's Carmel Latte seems like a small indulgence till you realize that it has nearly as many calories as a sleeve of Oreos.

            It's really easy to point at Krispy Kremes and say "that's junk food", but like anything the Devil is in the details. For every Twinkie or bag of potato chips there's an item that is "low fat" (but high in something else), and item made from all natural ingredients (but still full of fat and carbs), an item that is good in moderation (but often eaten in excess), or an item that is just as bad as the Twinkie (but you never really realized it).

            • Re:Tax junk food (Score:5, Insightful)

              by somersault ( 912633 ) on Tuesday April 05, 2011 @09:11AM (#35719376) Homepage Journal

              Red meat is not a "huge contributor to obesity". Try looking instead at the potatoes/fries or white flour based buns that people often eat with red meat. You could eat steak every meal and not get fat. It's not high in calories at all, and fat is much more likely to pass through you undigested if your body doesn't need the energy. Stuff like potatoes and white bread is very easy to digest and absorb. I'm happy to eat steak/burgers/hot dogs any meal.

      • Re: (Score:3, Insightful)

        by mcgrew ( 92797 ) *

        Four words: High Fructose Corn Syrup.

        Soda used to come in 9, 12, and 16 oz containers. Now most machines have one litre bottles; more than twice 16 ounces. A small soda at a fats food joint is larger than a large used to be. Soda will make you fat without satisfying appetite. There's a reason there are so many more fat people than there was in my youth, and I think it's a reasonable hypothesis.

        Tax HFCS -- that is, if you LIKE regressive taxes (I don't).

        • by DrXym ( 126579 )
          I remember buying a TGI Friday's back of chips from a vending machine. The ingredients claimed it contained 6 servings. Why are they allowed to get away with shit like this? If the fat / sugar / calories sounds too high they increase the number of servings in a packet.

          If retailers were forced to separately package each serving (or perhaps be liable for a serving tax), it might make them think a bit harder about the packet size and calorie content in the first place.

      • Re:Tax junk food (Score:5, Interesting)

        by PopeRatzo ( 965947 ) * on Tuesday April 05, 2011 @08:06AM (#35718776) Journal

        Junk food is the cart, not the horse.

        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.

        • by Rufty ( 37223 )
          Right on the money. Here's the detail. []
          • by ydrol ( 626558 )

            Suggest anyone that watches that lecture also read independent critique.

            A couple of links for starters:

   [] including comments and response from Dr. Lustig

            • Re:Tax junk food (Score:5, Insightful)

              by PopeRatzo ( 965947 ) * on Tuesday April 05, 2011 @02:49PM (#35723270) Journal

              I'm not sure that anyone who looks at the people on the bus or riding their little scooters around Wal-Mart can possibly believe that a serious concern about obesity can be "alarmism".

              And it's not just that suddenly mankind has started eating more. There's never been the kind of fat that we see today.

              In 1965, a woman who was 180lbs was a fatso. Over 200lbs was unusual. Today, you can see >300lb women all over the place. And it's a qualitatively different sort of fat. It's not the fat that comes from too many cheesburgers. It's Jabba the Hutt fat, that comes from some industrial or environmental factor that was not around 40 years ago. That's not to day that it's necessarily high-fructose corn syrup, but it's definitely something besides just eating too much.

              • by pnuema ( 523776 )
                The cause is really easy to understand. No one cooks anymore.

                My wife and I are the only people we know who are not related to us that cook five or more nights a week - and by cooking I mean starting with raw ingredients, not opening a bad of noodles and vegetables (which are loaded with extra calories - if you knew how much HFCS goes into a jar of pasta sauce, you'd be floored). I'll eat a pork chop, broccoli, and roasted potatoes for dinner, and consume a few hundred calories. Meanwhile, if I go to a res
    • by Moraelin ( 679338 ) on Tuesday April 05, 2011 @06:33AM (#35718342) Journal

      Working on either solutions or explanations before knowing if there is an actual problem, is called Tooth Fairy Science. You know, the kind where you figure the market value and profits/losses per tooth type, before even knowing if there is a Tooth Fairy.

      In this case, last I've seen a study based on data from an actual health insurance company, it turned out that smokers and the obese actually cost LESS. Summary, for example, here: []

      I don't just mean on the total with pensions and all. Even just the healthcare taken separately, actually cost less. Why? Because they die earlier and need less medicine in the long run.

      The problem is that you don't need the most care when you're 30. You need the most care when you're 70, and the latter is for decades if you prolong it.

      The fat smokers need expensive chemotherapy or surgery for maybe a year, then die. That is, if they don't just keel over and die of a heart attack. If not the first time around, the second will get them. And that's that. While the guy who was fit and lean and never had any vices, if he lives to 100, will likely be on expensive anti-Alzheimer medication for two decades. Plus various other trips to the doctor as their body is barely functioning and getting worse by the year. The guys who died a horrible death in their 50's just saved you all those costs.

      So, really, the smokers and obese actually subsidize healthcare for everyone else just by biting the dust earlier. And that's in addition to paying for a pension they won't get as much of, or at all. And subsidizing the government via tobacco taxes.

      So, really, WTF? You'd think someone would at least say, "hey, thanks fatty" ;) The notion that, OMG, let's tax them some more 'cause they cost us money, is provably false, and fucking stupid too.

      But it keeps happening because it's two overlapping groups of people who already feel bad and guilty about it, and have been amply proven to be easy to guilt trip some more into paying even more.

      • by jimicus ( 737525 ) on Tuesday April 05, 2011 @06:41AM (#35718364)

        In that case, there's one obvious solution.

        Don't tax burgers, bacon and booze. Tax oatmeal and cereal bars, fresh fruit, mineral water and anything with "whole" in the name.

      • by mangu ( 126918 ) on Tuesday April 05, 2011 @06:43AM (#35718382)

        That link you posted is very suspicious, to say the least. Look at the key sentence:

        "Van Baal and colleagues created a model to simulate lifetime health costs for three groups of 1,000 people"

        You can create a model to simulate any effect you want. That's what's called in technical language "pulling numbers out of your ass".

        • by TheLink ( 130905 ) on Tuesday April 05, 2011 @07:04AM (#35718446) Journal
          In some countries they don't need models to show that smokers cost less.

          The UK for example. They get 10-12 billion pounds per year from tobacco taxes, and they estimate that smoking related costs to the NHS are about 1.5 to 3 billion.

          So the smokers pay for themselves and help pay for other people too. :)
        • by definate ( 876684 ) on Tuesday April 05, 2011 @08:27AM (#35718944)

          Sweet, that exact same argument is an argument against the very study above.

          I do work along these lines, and all I can say is that while economic models are often wildly wrong, they are our best, most informed, attempts at finding ways to solve extremely complex problems. You think solving engineering/physics/mathematical problems are hard? Try solving people problems, on the state/country/world scale. Try solving problems where the entities (like particles) can up and change their mind, and do something else. I guess this is why we end up employing so many engineering/physics/mathematicians to work with us.

          While economics has many bad models, some are getting better over time. I've been noticing a significant shift toward Austrian models (which are softer and less about predicting the future), and Post Keynsian models (which are more about empirics and less about ideological principles). So, over time, we attempt to make the best decisions possible. Additionally, a large problem with the models is, they often aren't implemented. Politicians tend to pick the pieces they like, that agree with them, then implement those, without realizing that the WHOLE system is required. Though, they're not all to blame, as most people also aren't willing to implement the "whole" system. For a really good documentary about this, see the documentary The Trap by Adam Curtis [].

          Lastly, if your problem is models in general, then what would you have us do? Just guess? Flip a coin? Implement whatever we feel like, without regard to consequences?

          What do you think a model is?

          I must confess, this post is somewhat rehearsed, I'm used to hearing this from luddites.
          "Oh sure they're the models the 'scientists' created at the LHC show it will be fine, but they don't know for sure, and their models are often wrong!"

        • You can create a model to simulate any effect you want. That's what's called in technical language "pulling numbers out of your ass".

          I take it you are a "global warming denier"?

    • Re:Tax junk food (Score:5, Insightful)

      by FictionPimp ( 712802 ) on Tuesday April 05, 2011 @07:22AM (#35718518) Homepage

      I should pay extra for a candy bar because other jackasses can't limit themselves to just one?

    • Re:Tax junk food (Score:5, Insightful)

      by HangingChad ( 677530 ) on Tuesday April 05, 2011 @07:50AM (#35718680) Homepage

      >Just tax junk food like is done with cigarettes, alcohol, etc.

      Okay, so then fat people and smokers want to tax your motorcycle. After all, they do have a higher injury rate (though not a higher accident rate) than cars. So we can tax them and sky divers. And don't forget rock climbers, dirt bike riders, skateboarders, bicycle riders, and roller bladers.

      Almost everyone has some high risk behavior we could tax. I'm not sure AZ is a really good model for anything.

    • by definate ( 876684 ) on Tuesday April 05, 2011 @08:19AM (#35718874)

      (DISCLAIMER: I'm talking as if I live in America, I don't, I actually live in Australia, but work closely with Americans, and my family/friends are in the health care industry in Australia. There is a good chance I'll be relocating there for work soon.)

      Excellent. Well, while we're at it, I want a blue collar workers tax. My father who worked on farms, and has done sheet metal work, all his life, is perpetually at the doctors, with all sorts of ailments. Far more than any fat person, and likely, blue collar workers would collectively spend a lot more time at the doctors, especially in their old age.

      This would "reward good behavior" like studying hard and going to college, and "raise awareness that certain conditions, including" manual labour, "raise costs throughout the system. If you want to" not invest in your own education and settle for a simple life, "go for it". "But understand you're going to have to contribute something for the cost of the care of your" choice of occupation.

      Also, we need a sportsmen tax. When I used to play ice hockey, I was always getting fucked up knees, ankles, shins, shoulders, etc. I was always going to see the doctor, and a few times I took a puck in the wrong place, and had to get some serious attention. My lower leg once filled up with blood, due to a really good slap shot, that cut a muscle internally by pushing the muscle against a bone. These days that leg still gives me trouble, all the time.

      This would "reward good behavior" like not playing rough sports, and "raise awareness that certain conditions, including" physical sports, "raise costs throughout the system. If you want to" play rough sports, "go for it". "But understand you're going to have to contribute something for the cost of the care of your" choice of leisure.

      Oh, also, some of my family are vegans and keep having problems with balancing their iron needs and some other vitamin stuff (can't remember exactly), so we need a tax on that.

      This is absolutely absurd, and extremely counter productive. Especially since, things like this are the reason the people on the right fear increasing the scope of medicaid. This sort of thing, and the scrutiny over different forms of treatment, are what is wrong with public health care. In Australia, doctors are limited via their treatment options, because the public system won't pay for various sorts of treatments (might be contingent on some variables being met), and the private system won't pay for them, because the public system pays more than what normal people can afford to the providers, while attempting cost cutting measures (such as quota limits, and more scrutinzation of patients, etc). This results in driving up the price, and creating an oligopoly type situation.

      That's just the start of the sort of problems you have with things like this. They are complex systems, where everyone has a say, many different parties hold influence, resulting in absolutely intractable problems, that will result in higher costs, and less benefits.

      Also, the BMI is fucking ridiculous. I've got friend who did/do body building, and they'll tell you that they're actually obese, based on the BMI that is. It's at this point that people say "but but but there's other measures you use in combination", the looser the legal policy is, the more useless this bill is (in fact, it will just add administrative overhead). The tighter it is, the more you're going to be victimizing these other people.

      Oh, it should also be noted, that these body building types often put a higher burden on the health care system. They push their bodies to extreme limits, such that they require regular check ups, and can easily end up in a bad situation. Ever seen someone cut weight before? It's pretty fucked.

  • "Brewer says the proposal is a way to reward good behavior and raise awareness that certain conditions, including obesity, raise costs throughout the system."

    Where's the reward? If you're on Medicaid and already fit, then the reward of the $50 is not a reward at all since you never received the punishment to begin with. Negative reinforcement only works if you're taking away something negative to begin with. Want to give me a reward, how about you tax the fatties more for FICA and give me a break since I wo

    • by xnpu ( 963139 )

      Indeed. I'm all for making the willingly unhealthy pay for their own care, but it doesn't seem like those who are healthy or pursue a healthy lifestyle to their best abilities are in any way relieved here. If money is not somehow earmarked, it's just going to end up in the wrong pockets at no benefit to us.

      • If we pay less FICA for Medicaid we will benefit. Fatties are the ones whom would pay more. We get more take home pay, they get future health care cost paid for being unwilling to eat a salad every now and then.

        • If we pay less FICA for Medicaid we will benefit. Fatties are the ones whom would pay more. We get more take home pay, they get future health care cost paid for being unwilling to eat a salad every now and then.

          I don't know if you've noticed, but obesity is often a symptom of poverty. You're not going to get any more taxes out of someone who's already on welfare, and you haven't fixed the problem that a home-made sandwich costs 3 times as much as a McDonalds cheeseburger.

          • If we pay less FICA for Medicaid we will benefit. Fatties are the ones whom would pay more. We get more take home pay, they get future health care cost paid for being unwilling to eat a salad every now and then.

            I don't know if you've noticed, but obesity is often a symptom of poverty. You're not going to get any more taxes out of someone who's already on welfare, and you haven't fixed the problem that a home-made sandwich costs 3 times as much as a McDonalds cheeseburger.

            ding ding ding, we have a winner. Just try going on a natural food "cleansing diet" for any length of time where you eat no meat, no sugar, NO HFCS(!), no nasty preservatives, no caffeine.... Yet still eat to satisfied and don't hate life.

            Doable, just a hassle with reading labels, and DEFINITELY more expensive. High fructose corn syrup is in many things, and having done a diet like that even for just 3 weeks - the results are astonishing. Much higher energy levels, much lost weight, body just WORKS much be

      • by lanner ( 107308 )

        Ding ding ding! We have a winner.

        Even if the funds were earmarked, they would still use them for something else. Arizona republicans think the law only applies to them other guys. They have already raided several funds that had specific uses. They don't care.

        Photo unit snaps GOP party chief speeding 109 mph []

        Arizona: Judge Throws Out Political Arrest Based on Photo Ticket
        http://www.t []

        • Re: (Score:3, Informative)

          by Anonymous Coward

          Hold on, I RTFA'd the links and find that the judge did not toss this because he was republican, but because he feels photo radar is unconstitutional. The judge also noted that most people who get caught cannot afford the legal fees to fight the unconstitutionality of the arrest. Over 1000 tickets were overturned by the judge regarding photo radar cases. That does not seem like special favors.

          I am all for equal justice and it boils my blood when I read see who rich (Paris) and famous (Lindsey, Charlie) a

    • by DamienRBlack ( 1165691 ) on Tuesday April 05, 2011 @05:51AM (#35718164)

      Obesity does have strong correlations to health problem, but your insensitive stereotypes are rude and unfounded. Making such demeaning caricatures out of heavier individuals is simply not helping the issues. Yes, many people would reap many health benefits from losing weight, but almost as many underweight people would reap similar benefits from gaining weight.

      It is always important to remember that the #1 health risk to the obese is not heart problems or diabetes, it is misdiagnosis. So many people and even doctor assume that if you're heavy, all your health problems are caused by that, and so they often miss obvious symptoms of other real, life threatening conditions. It is also important to remember that an unstable weight correlates to health problems even more strongly than obesity. Many heavier individuals are pressured by peers and doctors to lose weight, and they often attempt to do so with unhealthy means, such as various eating disorders. This often leads to fluctuating weight and other problems. If you have to choose between fluctuating weight and obesity, obesity is statistically much safer.

      Not to beat a dead horse, but another thing to keep in mind is that correlation is not causation. Many instances in the statistics of obesity can be shown to involve the correlation of "I am sick, and it is making me heavy". When these cases are weeded out, the correlations become much weaker, and it becomes even more obvious that the underweight or inactive are at just as much risk as the obese.

      In conclusion, you can decide, if you wish, that obesity is not a responsible way to live. I would accuse you of insensitivity but nothing more. But ridiculing and stereotyping the obese as moronic imbeciles that are out of control and grossly irresponsible is crossing the line. I wouldn't call you quite as bad as a racist, but you would be quickly approaching it. The fact of the matter is that very few of the people who are obese would live up to any of those demeaning stereotypes, and probably just as many (per capita) "normal" individuals would live up to them if you simply looked. But you aren't looking, because you are singling out the obese and deciding to throw your vile at them, when they simply don't deserve it anymore than anyone else.

      • Yeah, yeah, we're all being insensitive, and there's absolutely no behavioral issues that correlate with the massive increase (no pun intended) in obesity over the past few decades. We've all just come down with other conditions that happen to make us fat. And even if there are behavioral contributors, that's only the case for *someone else*, never the obese person in question. Please forgive our collective insensitivity to this as-yet unidentified cause of people getting fat that is not related to eatin

  • by Nursie ( 632944 ) on Tuesday April 05, 2011 @05:25AM (#35717982)

    Which they do, through tobacco taxes.

    I never understand why they required to pay extra again by some people. Either the tobacco tax is a premier example of taxation without representation, or smokers have already paid in. Probably more than they'll ever get out in terms of medical care.

    And that's if they even cost the medical system more. They tend to die off...

    • 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.

      • by Nursie ( 632944 ) on Tuesday April 05, 2011 @05:33AM (#35718042)

        "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."


        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.

    • by xnpu ( 963139 ) on Tuesday April 05, 2011 @05:32AM (#35718030)

      The issue is that this money just disappears in a big black hole. If it were properly tracked, accounted and appropriated towards medical care, we would at least know what we're talking about. Now we have no clue, making these kind of discussions much less useful.

    • Re: (Score:2, Insightful)

      by perrin ( 891 )

      Dying from smoking tends to be very expensive. It is not like dying from a car accident or bungee jumping, where you either die or cost a fortunate in medical expenses due to long rehabilitation, but you die and it costs a fortunate to keep you hospitalised while you cough your lungs out or wither away to chemo/radiation therapy. I was in a lung ward for two weeks and saw enough of that stuff to be permanently immunized to the idea of taking up smoking for whatever reason.

      Selling smoke to people under 18 +

      • Yep, 18 year-olds generally haven't got a clue about anything much so they don't see the bad side of smoking.

        Conversely, very few people start smoking in their mid-20s (or later). Smoking seems to me like a good place for the law to protect people from their own stupidity/ignorance.

    • Which they do, through tobacco taxes.

      I never understand why they required to pay extra again by some people. Either the tobacco tax is a premier example of taxation without representation, or smokers have already paid in. Probably more than they'll ever get out in terms of medical care.

      And the surcharges we all pay on concert tickets? How about the extra tax we pay in certain states for the "convenience" of buying fast food? The point is higher taxes on products in high demand isn't something new or unique to the tobacco industry. And remember, much like my other examples, it's a luxury tax. People choose to smoke, and can live without tobacco. It's rather hard to compare that to the expense of having medical insurance for yourself and your family, which isn't so much an "optional" e

      • Re: (Score:3, Insightful)

        by Nursie ( 632944 )

        It's not a luxury tax, it's a sin tax. And when said sin tax outweighs (as it does in some countries, no idea about the US), the tax burden from the activity, I think it's pretty damned rich to demand even more from those people who have been paying it.

        S'all I'm saying.

        People do choose to smoke, and can live without tobacco. Charging them extra for state healthcare when that habit has benefited the state more than enough to offset their costs, it's just wrong. And if the state is genuinely out of pocket on

  • It seems like Arizona could solve most of their budget woes by taxing stupidity.
  • by Sycraft-fu ( 314770 ) on Tuesday April 05, 2011 @05:33AM (#35718036)

    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.

    • by orzetto ( 545509 )

      You don't want to start up with a system of "Everything wrong with you costs more."

      What about "Everything wrong with you, which is a culpable result of your own choices, costs more"? It would cover also other self-destructive behaviour, like reckless driving resulting in accidents, smoking, drugs, and leave out people with real medical conditions resulting in obesity, such as Prader-Willi syndrome, or non-culpable reckless behaviour (e.g. dementia or insanity).

      • You like to rock climb or something? That carries a higher risk of injury than someone who doesn't. You choose to live in an area that snows and has slippery roads? Higher chance of injury than someone who lives in an arid climate (due to car accidents mostly).

        You can see where this goes. There are a lot of things that increase your risk of injury, and that you can choose not to do. However is that where we want to head? Do we want to try and force everyone to live one type of life, with severely restricte

      • It can also be logically taken to the extent of "everyone pays what they get" which is the OPPOSITE of a public health care system. When you scrutinize more, and charge more for some, you inevitably approach a limit where it becomes a private health care system.

        Though, without any of the benefits of the private health care system. So the worst of both worlds.

  • by ThorGod ( 456163 ) on Tuesday April 05, 2011 @05:33AM (#35718040) Journal

    How about an idiot governor tax?

    For all the idiot governors out there. Can't tax their IQ, so we'll have to find something better to tax.

  • Jan must not be a fattie. So whats next? Tax people because their paraplegics or handicapped in some way. Just think of the billions that could be saved if these type people started paying a "Your physically handicapped" tax. But I would like to see a POLITICIAN tax of %50 of their income (all inclusive) and the tax should be called; I have my head up my ass tax.
  • There are numerous ways that people harm themselves. How about fines for people who fail to exercise? Or fines for those that work too much or work at desk jobs which encourages diseases? How about fines for people who eat bacon? Or how about fines for people with serial, sexual partners who tend to be the ones who get AIDS? How about fines for sky divers or motorcyclists as they tend to sustain injuries in those activities?

  • In one story you read we are heading for a pensions crisis as we will all live too long and in the next story we are all to fat and will die too young. Make up your mind!

    The thing I take from all the fat stories in the press is I know for a fact that we can expand world population by another few billion people. There are enough calories for everyone in the system. Some people just need to learn how to share. Also Canada will not survive a war to protect its fresh water; but that is for another post.
  • Their joint problems and accidents are going to cost medicaid just as much.
  • I guess CowboyNeal won't be going to Arizona any time soon.
  • I'm guessing that she isn't gunning for the title of "small government Republican" here?
  • From TFA:

    Ms. Brewer's surcharge would apply only to only certain childless adults:Those who are obese or chronically ill, and those who smoke.

    So it's OK to be fat and smoke, if you have children. Ms. Brewer is thinking of the children!


    They would need to work with a primary-care physician to develop a plan to help them lose weight and otherwise improve their health. Patients who don't meet specified goals would be required to pay the $50, under terms of the proposal.

    So already overworked physicians will be tasked with yet more paper work, for filing out exemptions forms. Who is going to process all this? The state will need a Department of Fat, Smoking and Do-You-Have-Children. Any savings from the surcharge will be burned up in the processing bureaucracy.

    Oh, I'm skinny, don't smoke and I don't live in Arizona.

  • It just occurred to me: this is in violation of the Americans with Disabilities Act. It's a fine on being obese and smoking, but it only applies to the obese and/or smokers who are sick and thus drawing Medicaid support. That would be interesting to see in court.
  • by Doc Ruby ( 173196 ) on Tuesday April 05, 2011 @07:26AM (#35718540) Homepage Journal

    Republicans vote for "Conservatives" like Jan Brewer when they promise things like "less intrusive government". Then the "Conservatives" get power and force the government's clutches right into your digestive tract.

  • Fat Irony (Score:3, Insightful)

    by ThatsNotPudding ( 1045640 ) on Tuesday April 05, 2011 @07:36AM (#35718606)
    The moralistic folks chastising the 'weak-willed' for being fat (and even worse: poor) are the very same who have no problem with corporatized, industrialized everything - including food. Fat Poor: No!. Fat Cats: Yes!
  • by Karl Cocknozzle ( 514413 ) <> on Tuesday April 05, 2011 @08:03AM (#35718768) Homepage

    Wasn't one of the sideshow arguments promulgated by the right-wing that "Obamacare would lead to Democrats imposing extra taxes on fat people!!!!"

    Pretty funny, actually.

  • by thesandtiger ( 819476 ) on Tuesday April 05, 2011 @08:06AM (#35718780)

    Brewer's plan is an incredibly bad approach for one very simple reason: Overweight is not always caused by poor choices. Everyone has a different biological configuration, so some people who make really lousy food choices are still going to be normal weight, while some people who make fantastic food choices will still be overweight. Further, taxing a potential, fairly weakly correlated in many cases, outcome is ridiculously indirect.

    What would be better, if you really wanted to change people's behavior, would be to directly tax the behaviors you want to change. Put a tax on snacks with no food value - candy and soda are, purely, luxury items in the sense that they have literally no nutritional value and are eaten only as a treat. Tax fattier cuts of meat. Tax highly processed stuff. Then shout it from the rafters that there is a tax on these things, and that the reason for the tax is that these things are bad for your health, and eating them regularly should cost you more because you'll cost the system more. Then tell people if they want a sweet treat to have an apple instead since there's no tax on that and it's healthier.

    You can also do other things to promote healthier choices - it takes multiple avenues to make a systemic change like this, but I'm just mentioning the tax on shitty "food" here.

    With smoking this approach seems to have worked in a lot of places - in Chicago, where I live, it seems that taxes going WAY up on cigarettes (a pack here now costs about 10 USD) combined with smoking being banned from restaurants and bars, combined with requiring smokers to stay outside and 20 feet from the entrance to buildings has greatly reduced the number of people I have seen smoking over the last 10 years.

    Now, I am not saying that these things SHOULD be done - I don't know that it's necessarily government's role to try and shape our behavior in this way. What I am saying is that if you DO want to shape people's behavior, Brewer's plan is not the way to go about doing it.

    • The vast majority of people do not actually have the "problems" ascribed to them. While it is true that person A and person B can eat the same foods in the same quantity and perform the same exercises with wildly different results, I do not see this as a problem as much as I see it as cause for the fatter of the two to adjust according to his own body. It is said that people who are obese are actually enjoying a much more "efficient" metabolism and they are simply consuming too much while those who are no

      • That's kind of my point - if you tax the unhealthy stuff it is no longer cheaper than the healthy stuff, and makes price no longer a factor in deciding where to eat.

        You also bring up a good point about the workplace issues - I used to work in an area where there were tons of chains but nothing particularly healthy was available unless you brought it from home, so most of the busy people there just wound up eating convenient but unhealthy lunches.

        What I'd like to see is employers getting into the act and off

Thus spake the master programmer: "When a program is being tested, it is too late to make design changes." -- Geoffrey James, "The Tao of Programming"