Governor Brewer's Controversial Smoker's Fee

Wednesday, April 06, 2011

Janet Adamy, reporter at The Wall Street Journal, and Arizona State Senator Kyrsten Sinema (D-15), talk about Arizona Governor Jan Brewer's proposal to charge $50 to Medicaid recipients who are smokers or obese and not following doctor's orders.


Janet Adamy

Comments [64]

I live in Arizona and this woman has some real screwy ideas, taxing obesity, smoking, diabetes? Though some may agree with her, think about it, isn't what she is suggesting prejudice? There are other things that cause these health problems, not smoking, but obesity and diabetes and they can not be put in any definite category as to what causes them in anyone.

Apr. 07 2011 03:00 AM
Mike from Inwood

Why not charge people for their over-sized SUVs & Hummers that pollute the air and cause lung diseases?

Apr. 07 2011 01:43 AM

Good example where universal health care, as opposed to the current model of "health insurance," would fix so many folks' problems through the "luxury" of preventative care and education.

Apr. 06 2011 01:20 PM
Ron Raphael from Flairon District of Manhattan

Rather than penalize people who, possibly, can not help having their habits changed for what ever reason, why not reward those who do? It is not easy to give up these "necessities ,"so I feel that it is more justifiable to give a discount on medicare rather than charge $50-00 per year for those who do.

Apr. 06 2011 01:16 PM

How about paying for preventive care? Or gastric bypass surgery? How about taxing millionaires and using the $ for such services? This seems to me just another example of taking from the poor. Sure smoking and obesity are dangerous, but this answer is simplistic and mean.

Apr. 06 2011 12:20 PM
Randi from NYC

Mark Victor from Queens made one of the most important points:

3.) Stop federal subsidies of corn instead of taxing the end result.

There is a direct correlation between the amount of corn produced and the obesity rates - starting in the late 70s. Corn syrup is much cheaper than natural sugar.

Also, if you want to start taxing "unhealthy" behaviors, lets start taxing employers who's employees have to work long hours. Longer working hours = less exercise, less healthy eating habits and more stress = weight gain.

Apr. 06 2011 12:19 PM
sarahkate from Maplewood

What about people who drink too much or abuse drugs (prescription or illegal substances)? Those problems are easier to hide than smoking and obesity. Or those who drive too fast and don't wear seat belts or have reckless sex lives? It is unfair to single out those whose risks are easy to see. Not to mention the Republican hypocrisy when it comes to keeping the government out of our lives.

Apr. 06 2011 12:02 PM
Mark Victor from queens

1.) There is evidence that smoking and obesity is connected with psychiatric disorders, specifically attention deficit, anxiety, and depression. Patients need to be treated for these conditions rather than penalized for something which is not within their ability to control. Poor people, many on Medicaid, may have more incidence of these conditions than people in higher economic strata.

2.) The market place, in this case, can more adequately reduce the number of people smoking. The Senator from Arizona is right; bring on the fat, sugar, alcohol (no discussion about this addictive substance??), and cigarette taxes!!

3.) Stop federal subsidies of corn instead of taxing the end result.

4.) Taxing only Medicaid recipients is discriminatory. This proposed law is probably unconstitutional, and I'm sure it will be challenged if passed.

Apr. 06 2011 12:00 PM

what a crazy conversation! "This would only affect childless, non-disabled adults"? what if i'm overweight due to injuries or illnesses that prevent me from exercising enough and do not necessarily qualify me for the state or federal definition of disabled, i.e. rhuematoid arthritis, a serious car accident, thyroid cancer, etc?

Aren't most childless, non-disabled adults senior citizens who have already retired?

What a mess this would be to enforce, the cost of which would likely be thousands of times the number of $50 checks Arizona would receive.

Apr. 06 2011 11:53 AM
Randi from NYC

As a health insurance employee, the pricing of insurance premiums are more complex than what's being stated here. Also this is about Medicaid/Medicare, which means that this is about our most vulnerable populations. And as usual, we place the onus of responsibility is placed on our poorest citizens. This plan doesn't change the habits of people on private insurance. And everyone should understand that Medicaid/Medicare will continue to feverishly increase as long as we have a private sector that doesn't hire or doesn't provide health insurance.

You are ALL barking up the wrong tree here.

Apr. 06 2011 11:52 AM
Ana Maria

A latino visitor employed as a handy men, who has been living in Oklahoma for the last 5 years, stated that people get obese purposely to get government help.....

Apr. 06 2011 11:52 AM

Interesting. Blame the victims of "free market" corporate decisions. We are told by companies that old models no longer work. Medicare, national health insurance etc. But it seems to be ignored by supporters of this system when it comes to their own interests. Old models here include making money from tobacco, processed foods, and medical industrial complex.
The gov of Arizona should sue to increase income form the corporate entities that abuse her people and put that money to work to get them off cigarettes.

Apr. 06 2011 11:52 AM
jgarbuz from Queens

I fully agree with the caller about the carbs vs. fat argument. The medical establishment came out against Atkins diet long ago, and they are therefore responsible for making believe that eating fat makes you fat. I've been on the Atkins diet nearly 14 years now, and my lady doctor has always gone beserk when I tell her that I regularly eat eggs and meat, and eschew bread and most high carb foods. While I am 64, and do have some growing problems with arthiritis, I suffer no heart, high blood pressure, or obesity problems thanks to Dr. Atkins. And I quit smoking over a decade ago. Tough, but the best thing one can do to preserve health.

Apr. 06 2011 11:51 AM
FranciL from NYC

I pay my own insurance out of pocket, and I can no longer afford to be fat! So, I'm losing weight so that I don't get diabetes, osteoarthritis, foot and knee problems. I say, yes, people should pay extra if they're not willing to take respponsibility for their own health.

Apr. 06 2011 11:50 AM

if the amount of $50 was the extra amount that smokers and obese tacked onto the system we wouldn't be having this conversation.

All this does is to trick those who choose to risk their health into thinking they are finally paying their fair share into insurance.

Apr. 06 2011 11:50 AM
Tony from Canarsie

Your last caller said her family never gets sick, but then went on to say "we go to the doctor a lot." Huh?

Apr. 06 2011 11:49 AM
Edward from NJ

To be fair to Arizona, many states -- including New Jersey -- don't cover non-disabled, childless adults *at all* under Medicaid.

Apr. 06 2011 11:47 AM
Sue from NYC

Medically, there is no basis for this fee for obesity. There is no agreement on an appropriate and effective program for individual weight loss. In the medical literature, there is much data on the failure of many attempts. There is also a genetic basis for obesity that is not yet clearly identified.

The groups who would be most affected by this tax are primarily poor and minority, the very groups who are the most obese in this country, and who have fewer resources in their community to live a healthy lifestyle.

This is another way to increase the income and health disparity in this country.

Apr. 06 2011 11:46 AM
Dr. Allen from Brooklyn

This legislation is abhorrent. Smoking is a powerful behavioral AND chemical addiction, such as alcoholism, and opiate addiction Obesity , objectively defined by ones BMI index) is a very complex metabolic disorder involving many factorrs--only some of which are under a person's "voluntary" control. Should we also bulimics, cutters, people with suicidal depression for not taking up yoga or positive thinking? People who suffer from these conditions need medical help and societal support. They do not NEED to be further peripheralized and scapegoated and forced to bear the brunt of what is a social responsibility to care for our sick.

Apr. 06 2011 11:46 AM
Brian from Hoboken

Type 2 diabetes is NOT hereditary!!!!! Stop talking about your grandma being a victim of type 2 diabetes!!! quick wikipedia search data states that at the time of type 2 diabetes diagnosis, 55% of patients are obese.

Apr. 06 2011 11:45 AM
DarkSymbolist from NYC!

It's funny how right-wing conservatives talk and talk and talk about having government out of your private life, small government, etc and yet they love to propose the most intrusive, ridiculous and unfair governmental policies...

Well it would be funny if it weren't so horrifying and the cowardly MCM didn't constantly let them get away with that glaring hypocrisy.

Apr. 06 2011 11:45 AM
Nicholas Messitte from brooklyn

You know what else needs money? The school system. And here's how the Senator from Arizona would handle it: let's charge all children with special needs more money for public school, since they would in theory need more schooling.

Oh wait, that's a HORRIBLE idea.

So is this.

Apr. 06 2011 11:44 AM
Laura from Metro NY

This is a foolish idea. Smoking is an addiction: some people are just unable to kick it, trying to quit and starting again numerous times.

Eating well and losing weight, requires eating healthy fruits and vegetables, which are EXPENSIVE. Fast food is cheap. People would need to spend more money to lose weight, which Medicaid is not going to cover. And you're going to penalize them?

Apr. 06 2011 11:44 AM
sansha from Mtown

We are fast becoming a country of stupidly proud of our Medical system. Even after paying top dollors for insurance, everyone gets quite poor service - wait for experts, high payments, millions with no insurance. Medicad and Medicare under constant attack from the Republican and some democrats. In any case, the quality of service is so poor that raising new fees are not going to help even with insurance.

Apr. 06 2011 11:43 AM
Edward from NJ

Like one caller and a lot of posters here, I was first struck by the hypocrisy of a nanny-state-hating Republicans coming up with this idea. Then I realized that this would only effect poor people who are "on the dole" -- and it made perfect sense.

Apr. 06 2011 11:43 AM
dboy from nyc

I'm literally sick from not being able to afford health insurance, partially because the cost of other people's bad habits.

I have doubts that any of the rest of us would see any actual benefit. It would probably just end up being sucked into the insurance company profit vortex.

Amerika® should be ashamed of itself!!!

Apr. 06 2011 11:43 AM
steve from Barryville, NY

As things stand now, people with healthy lifestyles are paying a penalty to the extent they are subsidizing the health care for people with unhealthy lifestyles. Whether you charge the unhealthies a premium, or give the healthies a discount, there has to be a way of equalizing the situation. People need to be accountable for their behavior. As to where you would draw the line, or how it would be administered, is another question.

Apr. 06 2011 11:43 AM

A pack of cigarettes cost $8 or more. So we accept that it's ok for smokers on Medicaid to spend $50 a month, which would only be a pack a week, and most likely smokers spend much more than that. But God forbid we should ask them to contribute towards their healthcare

Apr. 06 2011 11:43 AM

i understand the reasoning but think medicaid may be the wrong place for this. a medicaid patient with a weight or smoking problem should get help for that problem and fee that my keep them out of a system that provide that help seems counter productive.

in agreement with previous comment, a middle ground might be to charge a fee to those with such problems who fail to avail themselves of such help for an extended period of time, but first that help has to be made available.

(in many cases medicaid is intended to be a short term emergency solution for folks who will be going on SSDI or going back to work, or have serious short term medical problems that must come first, so i'm not sure how many folks would actually be around long enough for a provision like one i just described to kick in.)

Apr. 06 2011 11:42 AM

How do you enforce this? I mean, who tattles on the Medicare recipient? If it's self-reported, how easy would it be to just lie?

Apr. 06 2011 11:41 AM
Mike from Tribeca

Too bad the outrageous Medicare cuts by Arizona didn't get this much attention.

And why the Republican panic over smoking now? Less people smoke than ever before, and the number of smokers continues to go down. "Social engineering" indeed.

Apr. 06 2011 11:41 AM
Bob from Huntington

How about a sur-charge on the fast food that contributes to so many people's weight issues? (We already have taxes on cigarettes.) Of course, that wouldn't happen because MacDonald's and company would buy congressional no votes.

Apr. 06 2011 11:41 AM
Jane from BRooklyn

While the idea does have merits, why aren't we holding alcoholics, diabetics, cardiac patients and the like responsible for their behavior?

Apr. 06 2011 11:40 AM
jmurphy from long island

1. the enforcement of this requires more bureacracy.
2. where does "vice taxing" end?
3. who gets to pick and choose what vices are most damaging to society, and those people picking, what is their motivation or benefit in choosing what they do and omitting what they don't?

I think we would be wise to heed "let he without sin cast the first stone."

Apr. 06 2011 11:40 AM
Garry from Manhattan

Charge smokers? Sure. It's an expensive habit for all of us. They may be addicted, but they're still choosing to smoke. Being obese is much less of a choice, and there are a lot of things, like genetics, that can affect people's weight.

Plus leaving it to the subjective point of view of doctors is not a good way to go about things. Smokers choosing to smoke is the cause of smoking, obesity has too many causes.

Apr. 06 2011 11:40 AM
Brian from Hoboken.

Re: the Senator's grandmother:
Diabetes is a horrific disease which affects the vascular system, nervous system, and more. Her statement that "it isn't her fault" is more than likely not true. 95% of diabetes cases in the US are type 2 diabetes, which is caused by poor lifestyle (mostly diet and lack of exercise).

This country needs to do something about diabetes. Type 2 diabetes was often referred to in the past as "adult onset" diabetes, bit is no liger because of the huge numbers of fat kids. Government numbers show that 1 of 3 kids born in 2000 or later will end up with type 2 diabetes. Scary.

Apr. 06 2011 11:40 AM

So to all these people saying, "be accountable".. What do they say to the fact the working poor can often only afford the less healthy food and often can't even find good produce in their neighborhoods.

Personal responsibility!! Working poor don't have the time to work out..

How about holding Agri-Biz produce lower costing healthy food??

Apr. 06 2011 11:40 AM

This is such CRAP about "holding people accountable for their behavior." What about Wall St? What about the people who have RUINED our economy?? What about the corporate decisions that pollute our water & air?? Why aren't THEY held accountable for POOR HEALTH DECISIONS? I'm so angry I can't even see straight.

Apr. 06 2011 11:39 AM

While the idea does have merits, why aren't we holding alcoholics, diabetics, cardiac patients and the like responsible for their behavior?

Apr. 06 2011 11:39 AM

There are several objective measures of obesity which are widely accepted by the medical community. You can use BMI, although this can be skewed by muscle mass, or you can use percent body fat. There is no reason to think that obesity is a subjective issue, or that you need to worry about a specific person's metabolism. The issue should be whether you are doing what you should be to stay healthy, not what your stats are.

Apr. 06 2011 11:39 AM
Beatrice from Brooklyn

The bill should also prevent corporations from advertising fatty foods if they want to punish consumers for buying them.

Apr. 06 2011 11:39 AM
Diane from Caldwell nj

While I like the concept of individuals being responsible for themselves.

But I see some issues:
1. under the Paul Ryan proposal, states could and would implement this as they will be responsible for the 'block grants'

2. Since the poor are primarily dependent upon packaged goods and those are responsible for weight gain. why would we not change the P&G's of the world.

Apr. 06 2011 11:38 AM
Marc from Brooklyn

How about gays, or people who otherwise engage in risky sexual practices? Shouldn't they be held accountable for their conduct, as well -- or is this just another example of a politically-correct scapegoat?

Apr. 06 2011 11:38 AM
Fatty from nyc, ny

You can charge me for being fat as soon as you charge big oil for being stupid, or bank ceos for being greedy.

Apr. 06 2011 11:38 AM
RBC from FiDi

I don't like fees for "overweight" because there's no definition of what "overweight" is. If you're a bodybuilder and you're 20 lbs "overweight", do you pay extra?? Also, will we start fining people for being underweight???

Apr. 06 2011 11:38 AM
ash idnani from nj

How about incentivising and pay those who stay healthy and have no claims. This rewarding will make those high maintenance folks think twice before they light up or weight up.

Apr. 06 2011 11:38 AM
Katie Kennedy from Huntington, NY

We're attacking the problem the wrong way. How about DISCOUNTS for non-smokers and not overweight people?

Apr. 06 2011 11:36 AM
Chris from Manhattan

If a Democrat proposed imposing a charge to influence behavior, every Republican west of Newt Gingrich would be howling about “social engineering.” Why isn’t that a problem here?

Apr. 06 2011 11:36 AM

Until we have a better idea of the biological and social determinants of health it seems juvenile and punitive to blame people for their own health. Once again, Jan Brewer seems hellbent on punishing the poor.

Apr. 06 2011 11:35 AM
john from office

I am tired of seeing the person in a scooter smoking, the person who is obese, smoking. I see it all the time. No self control

Apr. 06 2011 11:35 AM

Why not offer an inventive for weight loss and those who quit smoking instead of punishing them? Adding more stress won't help people quit smoking or stop comfort eating.

Apr. 06 2011 11:35 AM
dboy from nyc



Apr. 06 2011 11:33 AM
carolita from nyc

hey, health insurers already charge you extra for being a woman or for being old, don't they? so why not? I say if you willfully abuse your health, you should pay extra. You cost everyone more.

Apr. 06 2011 11:33 AM
marcus from NYC

Sounds like yet another way to keep the poor, poor.

Apr. 06 2011 11:33 AM

Re. "smokers who smoke would pay an extras $50 fee". They already are! It's called "cigarette tax"!

Apr. 06 2011 11:32 AM
Tony Bruguier

One of your colleagues discussed this already:

It seems that very unhealthy people are good budget-wise because they die early. Does your guest agree with it? What are the moral implications if true?

Apr. 06 2011 11:32 AM
Bobby G from East Village

The cigarette companies should pay the $50 fee because they are the ones that get these poor people addicted!

Apr. 06 2011 11:30 AM
Stronger than u

Fine is funny but irrelevant. Just levy the actual financial impact by obese on our infrastructure, health insurance, and our eyes and lungs.

Apr. 06 2011 11:30 AM
Brian from Hoboken

@ hjs11211
The bill is aimed at Medicaid patients, who do have access to doctors paid for by the taxpayers (federal and matching state tax revenue pay for Medicaid). I wonder why I pay the same health insurance premium as a 35 year old marathon runner that some of my work colleagues do who are obese smokers. If a patient is given access to a doctor and registered dietician, and enrolls in a healthy eating and quit smoking program, then they should not pay anything. If these free services are offered to smokers or obese patients and they don't take advantage of them, then charge them more. If you are a lousy driver, you pay higher car insurance premiums. Same thing. I work in the health care field in a poor urban area. These patients need more than a helping hand to improve their health- they need a strong push.

ALL THAT SAID, I find the hypocrisy of the Republicans sickening. They want government out of their personal lives, unless it is to keep their gay neighbors from marrying, intruding into our bedrooms (there are plenty of old sodomy laws on the books kept alive by these Republicans), etc.

Apr. 06 2011 11:21 AM
jmurphy from long island

I really love when Republicans are all for "cracking down" on other people's "sins". I have yet to see a Republican take a hard line against white collar crime which is actually what costs our economy the most money. It was, after all, corporate greed that originally made "vices" like smoking and drinking a huge part of our popular culture.

Republicans' constant finger wagging is more like big brother than any federal program of the moment that they happen to be against.

Apr. 06 2011 11:06 AM

If alcohol, firearms, and petroleum were taxed at the rate that tobacco is, there'd be a budget surplus. But no: instead we're more than happy to milk the cash cow from out of addicts' wallets.

We need smokers to keep smoking so that everyone can afford to be healthy. What hypocrisy.

Apr. 06 2011 11:06 AM
a g from n j

this is absurd-it is sort of like saying health is a deficiency of nicotine and carbon-monoxide in the brain.

again-the society of "no" and "don't" instead of ecouraging and rewarding the good and healthy. it should not be by gov't decree however.

all of this, says so much about how screwed up we are. it's infantile...

Apr. 06 2011 10:57 AM
a g from n j

is it even remotely possible to have a system that rewards people who eat right,and exercise,instead of, a punitive calvanist doctrinal finger wagging in our faces. or is that just too "brave new world'ish". i've never understood why people are less bothered by such a mediocre and intrusive notion of health that punishes "bad" behavior. if there is intrusion,why not use a positive incentive instead.

Apr. 06 2011 10:43 AM

GREAT idea!
but what if u don't have a doctor, because you are among the working poor?

maybe better to just tax cigs and sugar and oil also (maybe more people would walk)

Apr. 06 2011 10:27 AM

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