The US state of Arizona wants to introduce a $50 tax for obese enrollees of the public health care program “Medicaid”, that aids people with low incomes and resources. Is this the right idea to stem the tide of rising health care costs and obesity or does it limit individual freedom?
What the Wall Street Journal now called a “fat fee” was Arizona governor Jan Brewer’s idea: $50 extra, per year, for those that are obese and don’t follow a diet plan monitored by a doctor. Extra surcharges would also apply to smokers and people with chronic illnesses that don’t manage them as directed. Governor Brewer believes that this would help Medicaid’s dire budget and also reward people for leading healthy lifestyles.
It would also mark the first time that the state-federal health-care program would charge people for their individual behavior. Applying different rates according to health status is a common practice among private insurers, but Medicaid is a program specifically designed for the poor and has to accept everyone that meets the requirements.
Fair Or Not?
At first glance it seems fair: Those that engage in risky behavior, and smoking and being obese no doubt threaten your health, should pay extra, because they also cost the system extra.
But where do we end this? If you often go skateboarding, you are at an increased risk for bone fractures. If you regularly sun yourself on the beach, your chance of developing skin cancer will be higher than for those wo don’t. If you regularly ride a bike, you are more likely to be injured in a traffic accident than a car driver. Should these behaviors also be taxed then?
Meanwhile In The UK
What as well stands out is that Governor Brewer exclusively targets people with low incomes – the recipients of Medicaid care. This could send out the signal that it is quite alright to be obese and a smoker, as long as you can afford it.
She could also target those whose products make people fat in the first place. Junk food is cheap, very cheap and therefore mostly bought by people who can’t afford organic produce and most likely also never were properly educated about how healthy nutrition works – Medicaid enrollees probably fit into this group very well.
In contrast we might consider a proposal recently brought up in the UK by Sir Nicholas Wald, an epidemiologist: Putting taxes on salt, sugar, saturated fats and alcohol, the four food ingredients playing the biggest role in rising obesity rates and coincidentally also the major ingredients of junks foods.
The aim to lighten the financial burden on public health care is the same as in Arizona, but it wouldn’t directly penalize the poor – cash-strapped people would simply be discouraged by the higher prices of junk foods and the money would come from the producers responsible for those cheap nutritional choices. The taxes this would bring in are estimated to amount to £38bn ($61.3bn).
Which Is The Right Way?
We are left with many questions here: Should a state have the freedom to penalize lifestyle choices and if yes, in what form? Is it more viable to penalize those that overeat or those that produce the foods that make people fat? If we have to resort to these measures, has the state failed in educating people or is that a personal responsibility?
Picture courtesy of Dominik Golenia.