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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.
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".
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?
(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.