Punishing people for being unhealthy is certainly not a new concept. Everything from societal peer pressure and restrictions on things like where you can smoke, to calorie counts at fast food restaurants and financial hits through insurance have tried to convince people to just be healthier. And for some people, it may have worked.
But now the state of Arizona wants to take a similar “health initiative” and turn it into a money maker. Arizona’s Medicaid program is cash-strapped, so now they want to tack on a fee to all those unhealthy people who are apparently sucking the system dry. Arizona is going so far as to single out groups of people whom they think are the biggest drain: folks who smoke or are obese. PWDs and others with chronic illnesses are also being included in this “fat fee,” where they will be required to pay the fee if they don’t follow their doctor’s directions to lose weight (there’s no indication that A1c or other measures of health would be included).
Some private insurance and state governments have already implemented a simple fine for people who are overweight or smoke, but Arizona’s fee would be the first state-federal fine for low-income people.
There are so many problems with this initiative that it’s hard to know where to start, but consider… why is it OK for the rich Arizonians to remain fat?! If it were so important for the state to use punishment to motivate behavior change, why wouldn’t they charge the wealthy-unhealthy proportionately?
Since this is focused solely on low-income households on Medicaid, let’s consider how much money goes into weight loss efforts: purchasing healthy, fresh, or possibly organic food (if you can get it where you live); exercise equipment and/or gym membership; clothing and appropriate shoes for exercise; and co-pays for medications and services (which are small compared with private insurance co-pays, but they still exist). Not to mention time: time off work, time meeting with doctors and nutritionists, time driving, time waiting in line at the pharmacy, and the complete lack of time with the physician that you’re required by the law (if this AZ fee passes) to see.
Not to mention all the other factors you might not have control over, such as disability, race and genetic factors that contribute to prevalence in obesity (and diabetes). Talk about adding insult to injury!
A spokesperson for Arizona’s Medicaid, Monica Coury, says “We want to stretch our dollars as far as we can. Part of that is engaging people to take better care of themselves.”
Wha? Since when has punishment in the absence of rewards been proven an effective health engagement strategy? Since when does charging a $50 penalty do anything other than annoy people? Unless of course you are a 2-person family earning less than $15,000 per year, and possibly struggling to pay for your diabetes meds — in which case the fee becomes a large financial hardship.
We certainly agree that this country needs to address obesity and unhealthy lifestyle and eating behaviors. We’re not shrugging our shoulders at that. But there are better and more productive ways to encourage healthy living that don’t involve a fine! My suggestion: instead of charging people a nominal fee for not following directions, why not actually help prevent the reasons why 25% of Arizona’s population is obese and 46% of them smoke? Perhaps gym memberships should be reimbursed? Perhaps there should be vouchers for healthy food?
Implementing programs that make it easier for people to be healthy is what would engage and encourage people, rather than sending them a “You’re still too fat” bill every year. For diabetes in particular, some health insurers are trying incentive programs, like the one from UnitedHealthCare that provides discounted rates and no-cost office visits, lab tests, generic drugs, insulin, pen needles, syringes and lancets, as well as insulin pumps and supplies as long as members take certain proactive steps. They must “comply with diabetes and preventive care evidence-based guidelines” provided by the ADA. A tracking site collects information about the services members use, and has an automated reminder system to prompt them to get their checkups and lab tests regularly. Not a bad idea, it seems.
Meanwhile, we PWDs who are pretty engaged have been arguing with private insurance for years to pay up-front for the costs of staying healthy now, rather than waiting until serious complications set in that are vastly more expensive. Maybe instead of cutting gym class at schools or making fast food so appealing to children (Happy Meal toys anyone?), Arizona should cough up money for Weight Watchers programs and diabetes education, to name a few.
A “sin tax” does not count as helping!
I really liked the MSNBC op-ed in which contributor Dr. Art Caplan, professor of bioethics at University of Pennsylvania, writes: “And just to be fair, the governor can add the same tax to water-skiing, jet skiing, horseback riding, mountain biking, owning a swimming pool, paragliding, rock climbing, failing to wear a helmet while riding a motorcycle (Arizona has a very weak law) or choosing to work in roofing, mining or construction — or any other activity that carries a risk. Actually, if the governor really wants to make money, how about a tanning tax for those who bask in the Arizona sun and hike their risk of skin cancer?”
In addition to passing the Republican state legislature, this new bill would also need federal approval, because Medicaid is a federal program, so there’s a good chance it won’t pass. Still, if you live in Arizona, this is a great time to put on your Diabetes Advocate hat.
Finally, if this more about a state budget crisis than a health initiative (as seems to be the case), I’m sure we can all figure out ways to get the biggest bang for the buck that will actually ease the budget and help people be healthier. Right?
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I remember when the company I used to work for heard that other companies were beginning to charge unhealthy people extra if they were overweight or smoked.
My company decided to pay for a drug to help people quit smoking and gave them a few free “how to quit” sessions. Then they held a health fair where people got their blood sugar and blood pressure and cholesterol tested for free at work. And then they turned an office room into a gym with a TV. I lost 20 pounds that year in that gym and was so ever grateful they took a nice and effective approach to helping people.
Taxing people in the middle of a personal health crisis is just plain wrong.
Great article!
People with Diabetes have always been punished by the insurance world, both life and health.
What I found was that there are life insurance companies that do not ask questions about Diabetes and, therefore, do not rate higher for life insurance for diabetics. This is key. There are only a very small handful of life insurance companies for diabetics, but it’s important to find an agent that specializes in this type of insurance.
As Diabetes is impacting more and more people, having this information out there is critically important. Most everyone is denied, right off the bat, for life insurance through their traditional life insurance agent. This is not the end of the story!
My employer has just started a program that includes insane premium and co-pay hikes if you don’t “get healthier”
Sadly, it’s all about the best employer health insurance I could get……
As you point out Allison, punishment doesn’t work. Helping people get healthier by making it easier does. The Finns have done that. They have the largest population of type 1, and a growing population of type 2, and they’ve turned Helsinki around to make it easy to walk and bike, and easier to get healthy food. Punishment, like fear, is not motivating, and not for long. I wrote about a similar fear tactic in NYC recently trying to scare people into giving up their sodas and frapuccinos: http://www.huffingtonpost.com/riva-greenberg/nyc-public-service-announ_b_821658.html
They’re already charging extra for things like smoking with extra taxes I assume? I am not up to date on the details in arizona, but I assume that as in many other places tabacco and related items are taxed heavier then other convenience items.
As far as I know, despite the prevalence of heavy taxing of tobacco there is still alot of smoking going on. This should be a clue to people that it’s not just a money issue and that by taxing or fining certain undesired behaviour it doesn’t go away.
As far as I’m concerned, smoking as such already has an extra tax, something extra you pay (tho again, maybe not in arizona). And I am not against this with smoking, by adding taxes to the item itself you make people who smoke more also pay more (as they buy more). Which would be way harder with the fine system I assume (beyond it being hard to find out how much one smokes, how would you exactly plan to check if people smoke…ask them? Cause people always respond well if you ask them if they want a fine).
But being overweight is not nearly as simple as smoking, it just sounds like a system that would need to incoproate so many variabeles and adminsitration that beyond the lunacy of thinking you can make such a complex system work and factor everything in, it’s prolly gonna cost more then it will net you and it will *still* not ever be a fair system for all the reasons you mention.
Punishing people for being unhealthy? Good luck with making that work! Though I definitely see the rationale, I seriously doubt that it would work to get people healthier. It comes down to a personal choice.
CNA, in the case of obesity, it’s not EVEN a personal choice. Obesity is extremely complex, and no one has all the answers at this time. Fining ONLY the obese poor on Medicaid is the height of unfairness, or actually downright mean-ness. If the budget needs to be balanced, take it from the rich, who can afford it, even though they LOVE their money so much that it really HURTS them to part with a little. But Republicans are not big in the compassion department, and too stupid or willfully ignorant to understand what life in poverty is. Heaven forbid they should only take home enough money every year to buy 26 jetliners rather than the 27 they can currently afford!
How about doubling the corporate tax rate for companies whose products are enablers of unhealthy behavior…smoking, drinking, fast-food, etc and using those funds for education purposes to promote healthier life styles instead of picking on the people who have been hurt worse by the lifestyles???? Oh wait, while sensible that would be way to big-brother for most of corporate america…..never mind.
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As a patient advocate for diabetes among many conditions, I always try to encourage my friends of the importance of exercise to keep their diabetes under control. However, many people do not understand the benefits of exercise. Also, what do you think the best ways are to motivate diabetics to maintain a consist exercise regimen?
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