When I first heard that Arizona could be taxing the obese I thought it was an April Fool’s Day hoax. Looks like the joke’s mostly on Arizona. The very real proposal, endorsed by Governor Jan Brewer, would impose a $50 per year fee on childless adults who receive Medicaid in the state if they are obese or smokers. While not a true fat tax on the general public, the Medicaid flab fee has raised outcry, debate, and no small measure of support from various news sources in and out of Arizona. The chances of this sinner’s surcharge actually becoming policy may be slim, it would need to be approved by Medicaid administrators at the federal level and would undoubtedly face a host of lawsuits, but it raises an interesting question: how ARE we going to change our unhealthy habits? Estimated financial costs of obesity in the US are $147 billion per year (smoking adds another $193 billion), not to mention the social, physical, and emotional price paid by those grossly overweight. Something has to give, but will it be taxes, technology, or temperament that gets the job done?
The scale of the problem is large. According to the CDC, about 25.5% of Arizona adults were obese in 2009. According to surveys by the state’s Medicaid agency, about 46% of beneficiaries smoke. We’re talking about many millions of dollars spent on medical treatments that, largely, could be avoided if people took better care of their health. Add to that the general financial trouble facing Medicaid in nearly every state. Arizona has been cutting Medicaid funding in broad strokes, even holding back money needed for organ transplants. Every $50 collected could be used to offset losses in the Arizona Medicaid budget. The economic drivers behind the fat fee proposal are very strong – the money might be motivation enough. Yet that’s not all that is happening here.
You see, under most versions of the proposal, the $50 fee will only be applied if you do not make an attempt to curb your smoking or lose weight (as overseen by the Medicaid doctor). The surcharge is not a tax on your fat, it’s a prod to get you to remove it. In a recent interview with the New York Times the spokeswoman for Arizona’s Medicaid program, Monica Coury, made it clear that the state was focused on changing habits for long term health gains, not just short term budget goals:
Q. How did you arrive at the amount of $50? Would that be sufficient to offset the fund’s costs?
A. We’ve talked about $50 once a year. We haven’t done the math, but it’s not about how much we would collect. It is totally about testing the efficacy of this strategy. Obesity is costing us billions in health care costs, so our thought is, Let’s test some of these strategies.
Clearly the surcharge is as much, if not more, about curbing bad habits as it is collecting money to offset them.
That’s a mistake. Making recreational drugs illegal hasn’t stopped people using it, even with stiff fines and jail time facing them. Punishing people for their vices may make a difference, but it’s never going to be a total solution. This is evidenced by the millions of people who buy cigarettes despite the soaring taxes applied to them (it costs $11+ for a single pack of cigarettes in Manhattan, by the way). What makes us think that a $50 fee once a year, or even a greater tax, would significantly stop habits that take lifetimes to build, and that we choose in small doses everyday.
You can’t tax away everyone’s extra pounds. Not without starving them outright.
What can we do? Well the billions of dollars spent on health food, gyms, exercise equipment, and diets seems to show that the US wants to buy better health. As it always does, our society turns to technology for help with its problems. Is there an easy technological fix for obesity? Perhaps. A large part of your body shape is determined by genetics, a science that is rapidly evolving. We’re also delving deeper into the brain, maybe we’ll find some neurological means of keeping us skinny. Or there could be solution found in biochemistry, surgery, virtual reality…you get the idea.
The most promising technologies we’ve seen in the short term, however, are those that enable humans to make better choices on their own. We’ve seen a number of 24/7 health monitors come into the market in the last two years, allowing you to better record and analyze your habits. Perhaps seeing that data will help us fight the fat in the small daily doses in which it arrives. Cynthia Breazeal, one of the robot wizards working at MIT, even experimented with a robotic solution to managed weight loss – turn a machine into your diet buddy. I’ve cued up the following video to the appropriate part of her presentation at TED:
In the short term, science can’t wave a magic wand and end obesity. If it could, we would have already been waving it like a flag in a tornado. Instead, it will just help us do what we already should be doing: making better choices about our health.
Singularity Hub has always maintained that living a healthy life is relatively simple, even if it isn’t easy. We take our general philosophy from the so-called Blue Zones – those areas with high numbers of people naturally living passed 100 years in good health. The lessons here are clear: humans need daily exercise, real foods (mostly plants), and strong social bonds that help them manage stress. If most of us got those three things right, the obesity epidemic wouldn’t be upon us. It’s a simple plan…but one we clearly have trouble following.
Which means, for the time being, we’re going to keep turning to crazy alternatives. This isn’t the first fee on fat. Alabama state employees already face a surcharge on smoking and obesity. Similar programs exist inside many corporations with employee health insurance, sometimes with positive reinforcement rather than negative. Until we find the mental fortitude to form healthier habits, or until technology progresses to a point where the human body is easily altered on the cheap, we are going to be stuck with the obesity epidemic and its equally frightening cures. So take a good long look at Arizona. That flab fee would be funny, if it wasn’t so fruitless…and if it wasn’t so likely to be repeated again and again in the years ahead.
[image credits: James Heilman via WikiCommons (modified)]