Arizona Governor Proposes Flab Tax

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."

Comments

Tax junk food

[Anonymous Coward]

Just tax junk food like is done with cigarettes, alcohol, etc. Use the tax revenues to compensate the extra medical costs.

Re:Tax junk food

[somersault]

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

Re:Tax junk food

[fbartho]

"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.

Re:Tax junk food

[mcgrew]

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).

Re:Tax junk food

[FictionPimp]

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

Re:Tax junk food

[HangingChad]

>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.

Re:Tax junk food

[DrgnDancer]

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

[somersault]

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:Tax junk food

[PopeRatzo]

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.

Right, smokers should pay extra

[Nursie]

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...

Re:Right, smokers should pay extra

[xnpu]

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:Right, smokers should pay extra

[perrin]

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 + N years should be illegal, where N is increased every year. There is no excuse to keep that substance legal, except that it is sometimes too hard to stop for some people already hooked on it.

Re:Right, smokers should pay extra

[Nursie]

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 smokers, then the tax should be bumped up to cover it, IMHO.

Re:Right, smokers should pay extra

[zippthorne]

Because smokers and fatties are the modern untouchables. We need to have some group that we discriminate against and revile, apparently, and we can't do this based on race and sexual orientation any more, so "bad habits" will have to do. Maybe their even better, since you could always argue that someone can't choose their skin color, so these new undesirables "have only themselves to blame!"

I've always found it amusing to rail about weight issues in a population: isn't it a good thing that the leading causes of death are related to having too much food? How many societies throughout history can say that?

Beware of junk science

[mangu]

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".

Re:Beware of junk science

[daem0n1x]

And yet they still get demonized. People are running out of places to smoke

I don't have anything against smokers, but I'm very happy that they "run out of places" to smoke. Just because they're trying to give themselves a slow and painful death doesn't mean they have the right to give it to others.

Before the adoption of anti-smoking legislation in my country, that banned smoking in most closed spaces, I had to put up with stupid jerks smoking just about anywhere. I couldn't take my children anywhere without exposing them to vast amounts of smoke. The law passed a few years ago and now even smokers say they prefer it this way. In fact, I can't see how someone with even half a brain can defend stupid shit like smoking in the office.

Now I'm anxiously waiting for the law that will ban smoking in ALL closed spaces, with no exception. It should be only a couple of years away. I'll be able to go to a pub and have a beer in peace without having to spend the next day in the horrible torture of an asthma crisis.

Re:Beware of junk science

[definate]

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!"

Re:Beware of junk science

[daem0n1x]

Wrong. Specially in a permissive country like mine, where people are traditionally cautious to exert their rights. You can't stop people from smoking in the office unless there's a law for that. Otherwise the smokers will ignore the complaints and go on smoking. As to the bars and cafés, it's a race to the bottom. The owner who bans smoking will feel he's losing customers to the competition. Fortunately things are changing a bit, because mentalities are changing after the ban was created. It's usual to see coffee shops and restaurants where smoking is banned full of families, while the smoking places are full of winos and bums. Before the end of the smokers' dictatorship, people hadn't realised how good it is to breathe clean air.

Re:Beware of junk science

[Qzukk]

And as some kind of strange kickback to the democrats, for the first time ever, my job would not tell anyone what the new rates were until the middle of November

They (the insurance company) was hoping that the Republicans would win in a large enough landslide that they'd repeal everything right away and they could go back to jacking up everyone's rates 125% for no reason at all.

Since I started offering insurance at my company 10 years ago, it's been the same story every year. I don't know why Republicans have such short memories that they can't remember that their rates get jacked up year after year after year. We now pay almost 4 times as much as our original plan, and we've gone from a $500 deductible (paid 90% by the company) to $7000 (paid 50% by the company, plus a promise from the company to pay the $2000 deductible difference from last year if someone needs it, since increasing the deductible from $5000 to $7000 this year made the increase over last year only a few dollars per policy (over the year) instead of several hundred, so we're taking the risk that only one or two people will have a problem. We've had years where remaining on the same plan would have cost us twice as much the second year. We've even ended up changing insurance companies four times over the decade to chase policies that are actually affordable.

This year my job added a "discount" if you are not a smoker or are in a smoking cessation program

This is what insurance is supposed to do: measure risk and insure against that risk, with some risks being more expensive than others. Too bad the risk of needing healthcare by the time you die is 100%.

Of course, that's the dirty little secret here: since everyone gets insured through their company, if they can keep you alive and healthy long enough to be fired/quit/retire, you become someone else's risk. So keep off the smokes and stay fit! That way, when it's time for you to need serious healthcare, you'll be Medicare's problem.

Fat Irony

[ThatsNotPudding]

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!

Irony, thy name is Brewer

[Karl Cocknozzle]

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.

Re:First, is there a problem?

[Anonymous Coward]

No, you're still falling into the "how can we tax people to make their lives better" trap. Once you've agreed to the premise that you can improve people by taxing them and start negotiation about which things are best to tax, you've already conceded the argument.

Fine then lets go further

[definate]

(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.

Re:Revenge of the smokers

[mjwx]

First we came for the smokers,
then we decided to go after the people who use pointless memes to equate things that they do not like to a Hitlerian regime.

Then we had much rejoicing.

Re:Revenge of the smokers

[DJLuc1d]

Most obese people never made a choice to be obese, their lifestyle made them that way.

Really ? Because sitting around watching TV and eating larger portions and junkier food isn't a choice ? Well according to your statement, it's their lifestyle which IS a choice - or at least that aspect is. I also made a choice to go to the gym more and eat healthier - why can't obese people make the same one ? Doesn't even have to be the gym, try talking a walk outside twice a week or skipping the mid afternoon soda.