Putting A Tax On Obesity
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?
Fat Fee
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 ($61.3bn).
Which Is The Right Way?
We are left with many questions here: Should a state have the freedom to penalize lifestyle choices and if yes, in what form? Is it more viable to penalize those that overeat or those that produce the foods that make people fat? If we have to resort to these measures, has the state failed in educating people or is that a personal responsibility?
Picture courtesy of Dominik Golenia.
46 Comments
Very interesting article. I’m not sure which side I agree with. Like you said, it makes sense that those whose health is more at risk through lifestyle choices should have to pay more, but I skateboard and being charged more for that is absurd 😛 also not to mention it’s dead easy to lie about things like skateboarding and cycling (btw skateboarding also leaves you very tanned and sun exposed!), but tanning and obesity are far more obvious
Also, where do you draw the line at who is obese? Is there some magical line that defines who is at risk and who is not?
As far as I understood it, Governor Brewer wants to use the BMI for that.
Obesity is defined as have BMI of 30 or more, which is about the 90th percentile or so. Being overweight is very different from being obese, as there is a significantly weaker correlation between BMI and health risks once BMI dips below 30. Being overweight is classified as a BMI between 25 and 30, which is still far above the norm, but not necessarily harmful to the population as a whole, nor is it such a burden on healthcare systems.
Well, obese people live with a risk of paying with their lives (so to speak) if they don’t straighten their lives out. That’s enough IMO.
Isn’t weight descrimination illegal?
That is a very interesting aspect you bring up there! IIRC, there are some jurisdictions in the US where discriminating people because of their size is against the law.
Personally, I’d like that to happen everywhere and not only 50$ but a lot more.
It’ll make people think twice before binging regularily on junk. It’s for their own good and I’m far from being against that.
I’d prefer using a carrot than a stick. In other words, a discount for people who follow guidelines and doctor’s orders instead of a penalty for those who don’t. And it “sells” better too.
this is not fair in my mind. im about as far from obese as possible but i dont like this. my distant friend weighs nearly 400 pounds to no fault of his own. his parents are the same but i eat more then this kid. he is really nice and everyone makes fun of him which is punishment enough. he even bikes to the gym everyday but he was recently struck by a vehicle for the second time trying to cross the road. hes fine now but when you know people like this its hard not to side with them. but yes, most obese people are that way for obvious reasons.
there was mention that it was not just for obese people, the tax would be for obese people who do not follow a doctor’s dietary recommendations. wouldn’t this mean that your friend could go see a doctor, maybe get some help figuring out why he’s had such crappy luck in the metabolism lottery, and not have to pay the fat tax?
I’ve always supported the idea that obese people should be taxed. Why? It costs us, the taxpayers billions every year with having to cover obesity related illness (at least in the USA). However, not everyone should be taxed, if the person has a justifiable reason to not be able to lose the weight like illness, then I say they should have the right to sneak under the radar. Also, what is considered overweight and obese is bogus IMO because those BMI charts don’t take into consideration factors like muscle, just height and weight, and even then what is considered “obese” seems a little light to me.
i think that if we used body fat percentage with respect to gender and age, then we could find a reasonable substitution for the BMI chart that would take a health-focused approach, instead of a be-like-everyone-else approach, this fat tax would work really well.
I have an idea. Abolish money. Free healthcare, free art, free food, free furniture, free houses. Contribute to the community, let community reward you. No property, you can get anything, so no thief. No governmors, go and make decision when your commune needs one, direct democracy and no representatives.
Umm, back to this world. No, that’s horrible idea. Then is it illegal for a 80 year-old to marry someone in 30s because he has increased heart attack risk?
If you’re that concerned with your taxes, think about why that fish man is smoking his cigar, sipping on gin and juice next to his pool with 3 celebrities on his lap. If any government is concerned with justice, they should question this entire system, not how people act.
What if doctor’s advice doesn’t work in the first place? How could you even know if someone is following what doctor says? By placing cameras in their houses, even bathroom? Well being governed is to get inspected but that’s too much.
Ahhh, I love a healthy debate. Makes me feel…. So human.
To try to make the entire system equal and fair is futile; it just won’t happen. There are many things that are wrong with our justice system, its hard to even begin explaining how messed up it is, but certain things that need change are being taken into consideration. This is one of the many things that need to be changed and I support taxation for the obese in otherwise good health. If you can at least change one thing and make it better, why not? Changing everything is impossible
I’m not american or british, but I’ll still post my opinion.
That ‘tax’ is outrageous! If they really wanted to fix the situation, they should have little to no taxes on vegetables, fruit, and starches and have a very high tax on sweets and fast food meals. That would be fair, and would encourage a healthy lifestyle. Not having to pay an unreasonable tax isn’t a reward it’s something you have to do if you’re poor.
So you follow the idea brought forth in the UK?
if you think about it they do pay more tax already for stuff like food, more weight in car more fuel and bigger clothes.
In a way, yes, that is true 🙂
everyone should pay their own health bill. it’s not the state’s (that is, other people’s) job to do that. i mean, if some people are allowed to live on other people’s expense (and this medicaid does exactly that), a large door is left open for irresponsability: why should they even try to get richer and pay their health bills, if they can get the exactly same thing for free, by being poor? of course no one would admitt that they like being poor, but these advantages soon pile up and you discover that it’s better like this thn working and struggling for just a little more.
“If you’re high risk you should pay more”… I’m offended! how dare the government coerce people into living better and cover the expenses of obesity at the same time.. That’s why I don’t vote right there!(and I’m too lazy to register)
Making the entire system equal is futile? Let’s all obey the lion then. But don’t expect me to be naive enough to go with you and believe he’s rasping his claw to hurt us less.
I’m saying the whole taxation system is a hoax, yet we’re talking about more taxes being fair or unfair. I’d prefer to go get fat just to protest and not pay anything more than Nichole Richie does for what I eat. Oh wait, does it only apply to what I eat or other things too? Oh well.
PS: You have to crush someone off to pieces if you want to get rich. The rich constantly get richer ever since people invented money and inheritance. Like most people have equal opportunity, we’re talking about people like being poor or deciding to get rich as if they can. I see tons of irony and black humour in the comments. Let me add another: “Fat people love being fat because it is fit people who pay for their dieticians.”
Let me tell you; Us getting weaker, fatter, sicker benefits the government. Come up with one goddamn good policy to get people happier, stronger, healthier. But no, just more taxes on the fat, lock the drug abuser, castrate the rapist. Let them fool us the government wants a better society. And more taxation to support our God-bless-politicians!
Well said, comrade. I agree.
umad?
Yes, call it bipolar and extra-tax me because I’m refusing to manage it as it is recommended and making things worse 😛
Dodo, the idea of you becoming fat is rather unsettling!
A program by economists for the UK radio station BBC4 found that the biggest cost burden for self-inflicted injury on the NHS when asked whether it was smoking, alcohol, obesity or sport then the answer was SPORT. I assume for HMO’s in the USA that SPORT is also the biggest drain on their profit. So, let’s ban sport or not cover sport – much better idea.
Seriously though, serious whilst making a generalisation, obesity is a poor persons disease, also linked to poor education and a lack of social mobility. Perhaps the person who wants to tax FAT will use the tax to educate or to use their intellectual might to smight the processed food producers who use hydrogenated fats and sugar as cheap bulking agents for their products.
Exercises to increase the quality of overall health don’t really cause money. But look at how many kids are obese, it is a shame on the government and parents. Regular exercise with no money spent on government would screw up all the health, plastic surgeon industry, even cosmetics. How many people are even aware that they don’t need gyms, dieticians, even doctors to maintain a healthy life? Make things complicated and make feel people believe they’re badly in need of treatment, when people can’t get out of this complicated system, tax them more.
I even think there is a reason media promotes grains and vegetable oil so much, while average citizen can’t even define what protein is. While it is crucial for a strong community, meat industry is under the control of the fast food industry which also kills millions of people and animals (Which is not even the number one reason for obesity if you ask me, but one of the major problems).
Yep, if the money generated by this goes at least into educating people about fitness and nutrition, that at least would make it a bit more positive.
This is kindof off-topic, but a few weeks ago I had to pay an extra $55 to put put my hand luggage (which was 2 kilos over the limit) into the plane check in luggage.
What about all the fat people on the plane huh? Why do I have to cough up? From the stupid land of Australia where I come from, everyone is fucking fat. There should be some BMI test to see who is too heavy for a plane.
BMI is a terrible method of determining obesity, which is also the problem with a tax like this.
What determines obesity? I think putting tax on things like cigarettes is far easier than on a group of people or food products(talks here of putting a ‘fat tax’ on certain foods, which has the problem of determining what foods are unhealthy, even saturated fats, sugar, salt and alcohol are healthy to an extent).
At least with cigarettes you know you are putting tax on something that is unhealthy, no arguments can really be made against that.
I think obesity really shows that the economic ”crisis” in developed countries really isn’t that bad, when you consider people die from hunger everyday in other countries.
Dude I know what you mean. Fat people on planes should be charged 2xs because those damn things are sooo small plus an obese guy sitting next to you makes the trip horrendous when you have his fat reaching over halfway to your seat, disgusting.
What about designing planes differently? They can’t do that? Ever been to business class part of a plane? I have. Seats are plenty big there. Squeeze the goddamn poor inside, but a businessman’s butt needs more air.
Guys, more tax means the government hates you more. A governor who gives a damn about people could come up with a hundred better solutions, trust me. Looking for a good intention behind a tax is like believing a racist dictator enslaves the minority because he wants to employ them for their good.
I think it is a good idea in essence, but nigh on impossible to implement. It makes great sense to be honest. Bigger people eat more, use the hospital more (generally) and are more likely to be jobless.
Bigger people don’t necessarily eat more. I doubt many obese people could force down what Michael Phelps eats on a daily basis. I ate 2-3x as much as I do now, yet I weighed 30 lbs less.
Maybe they should have an exercise tax since it leads to increased food consumption and a larger carbon footprint?
Jobless people eat more? Wow. More tax to jobless people? Wow. Eating more doesn’t mean more tax already? Wow.
The problem is that Jan Brewer, as 99% of republicans on 99% of the issues, isn’t an honest actor.
She cut funding for a program for troubled families to get therapy. Yes, on paper she saves money, the problem is every dollar they put into that program they get more back due to easing the burden of police officers, child services, etc.
The GOP don’t give a damn about fixing the budget. I mean they want to cut the budget of the IRS. For every dollar they invest in the IRS they get 10 back because the IRS prosecutes those who cheat on their taxes.
Not only are they dishonest about wanting to fix the budget, but what happened to the “government getting between you and your doctor” stuff? What happened to being outraged about the tax on soda when liberals propose it?
They serve big business, and agriculture is HUGE. We’re talking about the party whos current house speaker was caught handing out checks on the floor before they voted on the industry the checks came from.
http://www.examiner.com/progressive-in-charlotte/did-john-boehner-really-pass-out-tobacco-bribe-checks-on-the-house-floor
The party who raves against earmarks when they take a huge amount themselves. The party that raves about how the poor minorities are stealing from the hard-working REAL americans, when in fact the red states get more federal dollars than they pay, and blue states pay more than they get, because the red states are a socioeconomic clusterf*.
The GOP don’t balance budgets, they don’t care about the health of the population, all they care about is the money on the side. The democrats are pretty much the same, only they’re paid to loose, but unlike the republicans, they actually have some people who fight for what’s right.
Either way, the US needs a 3rd party that isn’t bought to take over, because although the US is screwed up, it’s so screwed up that fixing it is easy. The first step that’s really the only one that counts:
Campaign finance reform &/removing corporate personhood.
Does it matter how these taxed individuals remove the obesity label? Liposuction, fasting, drugs, ‘junk food diet’, etc. What if they follow a “healthy” lifestyle, but still are obese? Getting someone from a BMI of 50-25 is not likely. What if their only risk factor is size? No evidence of CVD, diabetes, metabolic syndrome, cancer, etc. – should they be taxed?
Thus, is our target correct? Should weight/size be the target, or the behaviors? If size, why not just allow liposuction every 2-3 yrs as part of their health plan, right?
What are the issues with other gov’t efforts (food stamps, WIC, etc) where ‘energy’ is provided to consumers? Should obesity be a factor regulating the amount of food stamp support some receive? Btw, I was fed, in part, via the food stamp program many moons ago.
Great discourse as always, cheers — Mark
What if they follow a “healthy” lifestyle, but still are obese?
depends what you mean by healthy. You can healthily eat and still consume far more calories than you need, and the body still turns healthy food in large quantities into fat.
Data are pretty clear that excess fat, by itself, does not lead to morbidity/mortality (Gregg 2003 Arch Int Med; Lissner Ob Res 2001) . There are even data illustrating fat is protective (Obesity Paradox, Dr. Paul McAuley’s VA data as well as others). So, turning fuel into fat does not = unhealthy, at least from a morbidity/mortality perspective. Since obesity is not a disease, my functional definition of healthy is not presenting with a disease and living a healthy lifestyle as deemed by experts within the respective fields (nutrition, exercise sci, psychology, sociology, theology, others?). Thus, I think there is more to health than diet and exercise. Genetics plays a role as well given the “fit & fat” data.
Going further down that path, should underweight and normal be taxed the same as obese since overweight is the BMI region with the lowest mortality risk (Flegal CDC-P data)?
Good stuff and great postings, cheers — Mark
“my functional definition of healthy is not presenting with a disease and living a healthy lifestyle as deemed by experts within the respective fields (nutrition, exercise sci, pychology, sociology, theology, others?). ” mark
Are there no studies that fit your criteria, ie that someone eating a calorific intake suited to their active ifestyle but are still overweight?
http://www.youtube.com/watch?v=bXFXwlNAbME – this video series does address some of your observations. Particluarly the actress who believed she had a slow metabolism. (slow metabolism being the evergreen excuse for being overweight)
Good to hear from you again, Mark!
And you put in a perspective that so far didn’t occur to me – if we take governor Brewer’s train of thought to the bitter end, we might indeed end up with accepting state-funded liposuction treatments as a logical outcome.
Well, I’m overweight, thefore it’s abit suspicious I’m talking but I don’t think this is far. First off, the people who are obese are either obese because:
1) disease;
2) They “want” to be obese.
If they are adults, why are they being treated as “criminals”? It would be much smarter to put extra costs on buying fast food and un”healthy” food, or stop paying for medical care(if the visit is caused by being overweight, of course if I have a flu or something, it shouldn’t count) when it’s about voluntary obesity(as in, you’re only obese because you don’t exercise/eat well(there’s people who are obese due to diseases)which could probably lead to a better life for people overall, not only obese. But then, again, people who own those companies would probably not “allow”(yes, they do own the world) for this to happen. Also, 50$? Are you kidding me? That’s not really that much, only about 4.15$ a month. This is pure discrimination. Let’s put a tax in everything there’s in the world that is classified as “bad”, make world healthy…/NOT.
Let people live their lifes they way they want. They will end up realising being overweight/obese is not the way of living, maybe it will be late but I don’t think paying 50$ a year is the solution.
Thanks for your comment! I agree that people producing cheap fast food would not be very interested in any measures that directly affects them. And they have a much stronger lobby than Medicaid recipients.
Rather than taxing people for burdening our healthcare system, we should abolish public healthcare. No stealing from the state coffers. Fuck the system!!