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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."
Just tax junk food like is done with cigarettes, alcohol, etc. Use the tax revenues to compensate the extra medical costs.
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...
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.
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.
PS: I don't reply to ACs.
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
http://findarticles.com/p/news-articles/arizona-capitol-times/mi_8079/is_20090508/arizona-dps-photo-unit-snaps/ai_n51711437/
Arizona: Judge Throws Out Political Arrest Based on Photo Ticket
http://www.thenewspaper.com/news/28/2801.asp
Republican hu? Yea, you're free to go. I like how that last article puts it up to being a "political arrest" over the fact that he had committed a felony.
(stupid /. HTML)
I've seen reports that state £2b is spent by the NHS on smokers each year in the UK, and £10b is generate by taxing smokers.
I see no one is mentioning drinking. I beleive it causes more ill health among the population.
Fact checking is down to the reader :)
This post contains benzene, nitrosamines, formaldehyde and hydrogen cyanide.
Yep, all those simplistic charts and tables that politicians and pencil pushers can comprehend are about as accurate in determining health as eviscerated chicken guts are for predicting hurricanes.
Way back when I used to be in the military. Their chart added the same amount of pounds for every extra inch above the base height. Virtually everyone on the planet 6' or taller was obese by that chart. (The idiots that made it apparently assumed an increase in height didn't have an increase in the other 2 dimensions. Something that can only be achieved if you are taffy and not an actual human.)
Just before I got out, they switched over to a different voodoo formula that used your neck diameter and height to make the calculation. Many tall thin people were labeled obese by that, yet ironically, the short fat guy that wobbled when he walked got listed as acceptable weight because his neck was so fat we all called him 'no-neck'.
There are scientific ways that can accurately determine if you are overweight or not (excluding the obvious extreme cases), but those methods will never be used by those idiots wanting to punish fat people. Those jerks just want something fast and easy with which to vilify one segment of the populace, and rack up cash quick.
Medicaid != Retirement distribution, so while it may save the Federal retirement trust in the long run, it doesn't do anything for the Medicaid program administered by the state of Arizona. Also, I think you're not taking into account the people whose weight problems don't kill them immediately. Chronic heart disease, diabetes, operators waiting to take their call so they can bill Medicaid for Hoverounds...
The only surefire protection against Microsoft infections is abstinence. - The Onion
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.
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: http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html
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.
A polar bear is a cartesian bear after a coordinate transform.
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".
so would an ASSHOLE tax. You'd have to take a 2nd job.
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) and powerful (pick your wall street banker) get a tap when the plebiscite gets the hammer. Had the DA prosecuted this like a normal case and not tried to embarrass or take to extreme the case, Mr. Mecum may have wound up paying a fine and having to explain his poor driving habits. Now he's a poster boy for a judge's stance on the constitution. Call em out...yes! Cry wolf when it's just a dog...no.
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.
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make install -not war
Is there a market for fat Arizonans? Seems to me that if the market is the god of all things you portray it as, then it's the reason so many Arizonans are so fat.
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make install -not war
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!
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 restricted activities, just because it is safer?
Also please remember there is the problem that the economic incentives would be to increasingly categorize things as risky. Since people pay more money if they do risky things, the more things that are risky the more money made. As such it is in the interests of either the insurance companies or the government (whichever is in charge) to get as much categorized as risky and requiring extra payment, regardless of real risk.
Then of course there's the question as to if it really results in savings. If you delve in to healthcare costs (warning: tons n' tons of data to sift through) you discover that the real big ones are quite often end of life stuff. Someone doesn't die of anything particular, they just keep getting older and more goes wrong, requiring more and more care. Mental diseases and general degradation are a big one. You can get someone who requires 24 hour care, yet has nothing acutely wrong and lives for many years that way. My grandma is headed down that road. She's in quite good health for her age (88) but has fairly quickly developing Alzheimer's. She'll need full time care soon and may live that way for 5-10 years.
That is expensive as hell.
While acute injuries due to risky behaviours or shorter chronic problems (like heart disease) may well increase cost earlier in life, they can cause overall lower costs if the person doesn't live long enough to get to the "Mind goes and body slowly starts breaking down," phase.
Now I'm not suggesting people shouldn't be encouraged to live as long as they can, but if cost is the issue perhaps we are going about it the wrong way. The people who are looking at living longer may well be the ones who need to pay extra, the ones likely to die younger may cost less.
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.
Who did what now?
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.
Since I can't tell them apart, I treat all ACs as the same person.
(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.
This is my footer. There are many like it, but this one is mine.
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.
Calling someone a "hater" only means you can not rationally rebut their argument.
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.
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.
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 better. You can eat well too, once you figure it out.
Flappinbooger isn't my real name
As plenty of people have found, if you reduce your energy intake from carbohydrates (to less than 10% of your energy intake) and eat fat meats, cream, eggs and vegetables instead, you lose your excess weight pretty damn quickly. It forces your body to burn your fat for energy instead of running on glycogen from the carbohydrates you eat.
Of course, you'd have to throw out all bread, pasta, rice, potatoes, beer et cetera - things which a modern human consumes tons of.
The fat you eat only sticks to your fat cells if you also eat carbohydrates. The blood sugar from carbohydrates is a signal for the body to start collecting stock piles. So then, what would you tax? The fatty food? Or the carbohydrates? You can eat plenty of carbohydrates if you burn them with exercise. You'd have to have a very intrusive diet/lifestyle inspector in order to be able to tax 'fairly'.
Please note that it's the Republicans in this case. It'll be the Democrats next time.
No it won't. This attack is exactly the sort of 'welfare queen' attack the Republicans have been doing forever.
The Democrats, meanwhile, just last year passed a bill making it illegal for insurance companies to discriminate based on the existing health of a person, including their weight.
I know the right claims the Democrats will do something like this, but people should realize that is what psychologists call 'projection'. Restricting government services so 'undesirable' people can't use them is almost solely a Republican habit, especially when those services are aimed at the poor.
In the rare cases that Democrats go after undesirable behavior, like smoking, they just go after the behavior, making it harder to do. Whether or not they should be going after smoking is a separate issue, but they actually ban it in certain areas and whatnot. For the poor and the rich.
Whereas Republicans always step in with a 'tax', so it's only poor people who can't afford that bad behavior. Because, in the end, it's not the smokers, or the obese, or drug dealers(1), or whatever that are the 'undesirables'...it's those damn poor people.
1) Remember the whole 'deny student loans to people with drug convictions'? Aka, 'deny college to poor people with drug convictions, but not rich people with drug convictions'?
If corporations are people, aren't stockholders guilty of slavery?
The entire NHL are overweight to obese, at least according to their BMI
Actually, any private health or life insurance company does this already. Insurance is based on risks. You choose the risks. Why should the "Free" coverage from any Government isolate you, me or anyone from risks? In a more perfect Government there would be a very very limited medicaid system at the Government level. But it will take a long time to get there with so many people screaming for more "Free" stuff from Government,
However, I also believe that it's a lie that smoking and being overweight are the causes of rising health care costs. Typically unhealthy people die sooner in life. The costs of so called healthy living people are sky rocketing as they keep aging and slowly watch their health fail needing more and more life prolonging health care. This is an observation based on my own extended family. The so-called healthy ones lived longer, needed nursing homes and advanced health care for a much longer time than those that lived the "unhealthy" life. Those family members typically just died suddenly and did not have the need to all these life prolonging health services.
We all die. That is the first fact of being born. I plan to enjoy that life fully even if others claim it's not healthy. It's not as if there's a chance I'll never die.
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 eating too much and exercising too little.
https://www.eff.org/https-everywhere