The Arizona Fat Fee

The Arizona Medicaid program is in bad shape, so it’s going after clients who are in bad shape.  The Associated Press reports they’re “considering charging patients $50 a year if they smoke, have diabetes, or are overweight.” 

This would be “the first time a state-federal health care program for low-income residents has charged people for unhealthy lifestyles.”  The fee would only be assessed against adult Medicaid patients who don’t have children.  The diabetes surcharge would hit patients who failed to obey a doctor’s orders to manage their condition by losing weight.

According to Arizona Health Care Cost Containment System spokeswoman Monica Coury, this $50 fee will “engage the consumer to start having a greater awareness of how they fit into the bigger health care puzzle.”

“We want to be able to provide health care to people,” Coury added.  “And we want to stretch our dollars as far as we can. Part of that is engaging people to take better care of themselves.”

The proposal still has to be approved by the state legislature, and may run afoul of federal rules governing Medicaid fees.  It’s also provoked a lot of outrage at the heartless notion of penalizing people for their lifestyle choices.  Federal and state governments actually do that sort of thing all the time – have you checked out the taxes on a pack of cigarettes lately? – but they’re normally far more sanctimonious about it.  This is so… blunt.

Some of the opposition is plainly unreasonable.  “This would fine people with medical conditions beyond their own power and control,” Democrat State Senator Krysten Sinema thundered to the Associated Press.  “I just don’t think it’s fair to vilify someone with diabetes.”

If I’m reading the AP description of the plan correctly, it does nothing of the kind.  It penalizes diabetics who fail to obey specific medical instructions to lose weight.  The plan also provides for “a primary care physician to develop a plan to help [Medicaid clients] lose weight, and otherwise improve their health,” thus avoiding the fee.  Legislators should pay more attention to the details in these matters, and burden us with fewer hysterical over-reactions, or deliberate distortions.

I’m no fan of punitive taxes, or government interference in the life choices of free people.  However, if you’re going to make the government – and by extension, the taxpayers – responsible for the care of certain individuals, it’s not unreasonable to grant them authority as well.  Responsibility without authority is servitude.  Taxpayers should not be the helpless servants of Medicaid recipients, or any other government dependents. 

Turn the situation around, and ask why taxpayers should be expected to silently cover the additional expense of providing extra care for these deliberate, unhealthy choices.  Is that fair to other Medicaid recipients – or, more pointedly, the people who won’t get any treatment at all, after the Medicaid money runs out?

Is charging a fee for unhealthy lifestyles a form of social engineering?  Yes, but so is Medicaid, on a far larger scale.  Fury at Arizona for considering such a fee is misplaced.  If you don’t want to suffer the requirements of nosy bureaucrats, don’t expect them to cover your needs.  If you want greater freedom, don’t rely upon the benefits of compulsive taxation.  It’s pretty small thinking to fixate on this one tiny fee, in a massive system of obligations placed upon so many people.  Hate the game, not the player.