http://www.bbc.co.uk/news/world-us-canada-13397306

 

 

Overweight welfare claimants in the US state of Arizona face paying $50 (£31) fines if they don't follow a dietary regime laid down by their doctor. Is that fair?

 

Just as American waistlines - like many in the Western world - continue to expand, so does the budget to meet the associated costs.

 

Medicaid, the programme which provides healthcare for the poor, costs the US federal and state governments $339bn (£209bn) a year, a figure climbing 8% annually.

 

The federal government matches state spending on the program, providing as much as $3 for every $1 spent in poorer areas.

 

Given the size of the budget, it's no surprise that Medicaid has become one of the fiscal battlegrounds in Congress.

 

President Obama's healthcare reforms would extend cover further, increasing costs to states by tens of billions of dollars. But the Republican budget proposal put forward by Congressman Paul Ryan caps the government contribution, saving an estimated $750bn (£463bn) over 10 years, but forcing states to make cuts.

 

Now the state of Arizona is proposing a radical idea. It wants to impose a $50 annual fine for overweight Medicaid recipients who don't follow a strict health regime developed with their doctor. Those with children, and people overweight due to a medical condition, would be exempt.

 

Smokers and diabetics who ignore their medical advice would also have to pay.

 

Monica Coury, assistant director at Arizona's Medicaid programme, says the aim is to change behaviour using a carrot and stick approach, in the same way that increasing cigarette taxes reduced smoking.

 

"It's undeniable that there is a link between obesity and the rising cost of healthcare in America, so we can't be afraid to discuss this issue.

 

"It's reaching a crisis level in the US and we continue to complain about the rising uncontrolled costs of care - and yet we don't drill down and test some of these concepts."

 

Rewards for those who meet slimming targets could come in the form of keep-fit videos or other kinds of incentives, says Ms Coury. People with children, and those overweight due to a medical condition will not have to pay.

 

"But if you are just an average person who is able to do something to address your weight issue, and your doctor believes you can do something about it and prescribes a regime for you and you choose not to follow it, your treatment [for heart problems in later life, for example] is costing more and we're asking you to put something back to the system."

 

Details of how the scheme, put forward by Governor Jan Brewer, would be administered have yet to be thrashed out, and would be agreed if the state gets the go-ahead from Congress.

 

Although some private companies have similar penalties in their health insurance cover, this would be the first time any state health care programme has charged people in this way for what could be deemed an unhealthy lifestyle.

 

Arizona has the second-highest proportion of Medicaid recipients in the US, and a quarter of its residents are classed as obese. Among its other plans to cut its annual $10bn (£6.2bn) Medicaid bill is to freeze enrolment for some childless adults.

 

Other states will be watching closely as they all scramble to cut costs, says Matt Salo of the National Association of Medicaid Directors.

 

"They don't know how they will survive the next two years. States are facing a $175bn (£108bn) shortfall. It's a huge amount of money and it's a time of great uncertainty.

 

"What Arizona is doing is a combination of short-term budget savings that will have a long-term change of behaviour with health outcomes.

 

"Is this the answer? I don't know, but people are looking at it closely because there are so few other options."

 

Some overweight people believe it could work. Kevin Woodman, 46, weighs 264lbs (120kg) and lives in Tucson, Arizona. He lost 161lbs (73kg) in nine months by cutting out carbohydrates and enduring a strict fitness regime.

 

"A friend offered me $1,000 to lose weight and I didn't, I gained weight," says the radio show host. "For me, it was only when I was faced with losing a limb or diabetes that I lost weight. But for those on low incomes, this could work."

 

But Arizona Senator Kyrsten Sinema thinks the tax is unfair because people like her diabetic grandmother could be penalised because there is no system to determine when a person is or isn't following a medical regime.

 

Most Americans would agree it's not fair for healthy people to subsidise unhealthy people, she says, but unhealthy people who work for the state and get state health insurance aren't subject to this proposal.

 

"This proposal targets only the working poor and elderly, and includes punishing people like my grandmother who aren't unhealthy but have a medical condition."

 

A better solution to spiralling Medicaid costs, she says, is to lift more people out of poverty by creating jobs in the state.

 

This is just another example of nanny-state social engineering, says Wes Benedict of the Libertarian Party.

 

"If you want to save the state money, which libertarians do, cut Medicaid across the board, but don't single out overweight people and smokers. I wouldn't be surprised if this programme costs 10 times more to administer than it saves."

 

The $50 fine alone might not be enough to change behaviour, says fitness expert Lisa Johnson, but it could help encourage doctors to talk about weight issues with patients.

 

"A recent Harvard study said 61% don't have time to talk to patients about weight loss, so this could have a more dramatic impact on the way doctors see their patients than on the behaviour itself.

 

"If your wife is nagging at you, you roll your eyes and eat another chip, but if your doctor says you have to lose 10lbs, then you take it more seriously."

 

Why the Medicaid bill is rising

 

-Medicaid is the state health programme for people on low incomes

-In recession, more jobs are lost, incomes decline and people lose employer health cover

-This results in higher Medicaid enrolment

-At the same time, state revenues are declining

-Medicaid enrolment has increased by 6m people in last few years

-Not to be confused with Medicare, which is the state health insurance cover for over-65s

 

Source: Kaiser Commission

 

Would a fine encourage weight loss?

 

"It's a silly idea. Overweight people are motivated to lose weight but it's very hard. Only 5% of people lose weight and keep it off for five years. The state would be wiser to change the conditions driving obesity rather than penalising people that have it."

 

Kelly Brownell, Rudd Center for Food Policy and Obesity, Yale University

 

"The reason people are obese is complicated and saying 'eat less' is not enough. People don't have access to grocery stores that carry healthy foods, don't have the funds to buy them and don't have the education to know what to buy."

 

Ziporah Janowski, Camp Shane weight loss camp, Arizona

 

Ballooning budgets and waistlines

 

-Michelle Obama (above) has led an anti-obesity campaign called Let's Move

-For every dollar spent on health care, 83 cents is spent on a patient who is overweight or obese

-Annual health costs related to obesity in the US are as high as $168bn (£104bn)

-25.5% of Arizona residents are obese, which is about the US average

 

Source: Campaign to End Obesity

If it doesn't harm anyone but themselves then let them be fat...but at their own expense. Can the state really force you into this position or does this realisation have to be acquired from within?!

If it doesn't harm anyone but themselves then let them be fat...but at their own expense. Can the state really force you into this position or does this realisation have to be acquired from within?!

 

I would say it comes from within. That's how I lost my weight. Forcing people into it and victimising them can work in some cases, but it can also have very detrimental effects and I personally feel that the negative results not only outweigh the positive ones on a moral level, but also probably would on a numerical level.

I would say it comes from within. That's how I lost my weight. Forcing people into it and victimising them can work in some cases, but it can also have very detrimental effects and I personally feel that the negative results not only outweigh the positive ones on a moral level, but also probably would on a numerical level.

 

this. It can only come from withing since it needs a huge will and A LOT of discipline...and it would be a total change of lifestyle for those people we are talking about here....I don't think it would work if you don't support what you are doing

I also don't think people need to made to feel any more anger towards authority figures given the current climate, and anger would be a likely, and also legitimate response to this, in my eyes at least.

Don't think anyone should be forced for fear of financial retribution, but also don't believe tax payers should be responsible for footing the bill of welfare/Medicare/medicaid recipients who actively ignore their weight problems. Sometimes, the tax payers are also providing financial means for the subject to complicate the problem (food stamps should not cover a cartload of Tortinos Pizza Rolls and Mointain Dew - yes, I have seen this one in person). Considering obesity is becoming a health epidemic here, I also think it's idiotic to continue raising sin taxes on cigarettes and alcohol, while blatantly ignoring the fat/processed food cash cows. I work a nasty schedule, but have the fortune of constant activity at my job. I also make it a point to eat decently and limit my fast food intake. It takes initiative and persistence, but it can be done.

Fines are degrading, but intervention of some sort is needed.

I would say it comes from within. That's how I lost my weight. Forcing people into it and victimising them can work in some cases, but it can also have very detrimental effects and I personally feel that the negative results not only outweigh the positive ones on a moral level, but also probably would on a numerical level.

 

I really do agree with this.

It all comes down to education. Jamie Oliver's on the right track.;)

I am slim and don't smoke, and I don't like to eat lots of fattening food. Why should I pay for someone who does this. I don't understand how anyone could eat bags of bread boxes of ice cream. I don't know where their stomach can loads of crap, and the ones who eat big plates of nachos.

I am slim and don't smoke, and I don't like to eat lots of fattening food. Why should I pay for someone who does this. I don't understand how anyone could eat bags of bread boxes of ice cream. I don't know where their stomach can loads of crap, and the ones who eat big plates of nachos.

 

I know. It's all connected to the "greedy" society which has spread round the world like a disease.:dozey:

I agree with what has been said. It should be the expense of the people who are overweight. I think that a healthy lifestyle of course is best, but why should the taxpayers have to pay money for their mistakes? I understand some people might have a slow metabolism or can gain weight fast, but if you truly want to you can do it. It's also something that may be ignorant of me (especially since I've never had to worry about weight problems) and I don't want it to come off as a dickish thing to say, but I also don't understand how people can let themselves get so out of shape and be that overweight. I mean in some sense wouldn't you want to have some self-respect?

 

 

 

edit: this was my 10,000th post :awesome:

I believe it is a persons right to overeat and gain weight. We have evolved to a state where we have this luxury, if we choose to pursue it.

 

On the other hand, I, like others in this thread, think that they if they choose to live like this then they should fun it themselves. It does get hard though when they get ill as to what exactly they should pay for, because when you look at a fat person with an illness that comes on from obesity, I know I always make the assumption that it is their weight that has brought them this illness. It cannot always be the case though, because not everybody will be ill because of their weight. it affects people who are not obese as well. Obesity only usually increases the chances of getting it. Obviously there are certain things you could definitely say they should definitely pay for, for example special transportation costs, or if they needed special equipment due to their size.

 

With things like fining people for developing heart disease then you would have to fine smokers for lung trouble, people who regularly drink alcohol for liver and heart problems, and other things like that.

 

What I'm saying is that it's so hard to prove for certain that the weight has caused the issue, when it could simply have increased the chances. I think they should have to pay and other people should have to foot the bill but it's so difficult to find the right balance (it certainly wouldn't be through fines) to do it fairly.

 

In many cases I see obesity has stemmed from depression, and a lack of self respect (not all cases). When I was depressed I was fat (and likewise when I was fat it added to that depression) and I couldn't get out of it for years. Whether it was down to my own self pity, addictive junk food, or a combination of a lot of things, nothing was changing for me. Eventually it clicked and I sorted myself out. Had I not clicked I'd still be there now, more than likely bigger. Depression is something that is treated for free in this country under the NHS and it also appears obesity is too. In America, if this came into force, it would not be free for some people. I'm not for that in a fine sense, but there could be a tarriff in place. As I pointed out above though, it's so hard to gauge.

I edited my above post now I've had time to finish it.

I believe it is a persons right to overeat and gain weight. We have evolved to a state where we have this luxury, if we choose to pursue it.

 

On the other hand, I, like others in this thread, think that they if they choose to live like this then they should fun it themselves. It does get hard though when they get ill as to what exactly they should pay for, because when you look at a fat person with an illness that comes on from obesity, I know I always make the assumption that it is their weight that has brought them this illness. It cannot always be the case though, because not everybody will be ill because of their weight. it affects people who are not obese as well. Obesity only usually increases the chances of getting it. Obviously there are certain things you could definitely say they should definitely pay for, for example special transportation costs, or if they needed special equipment due to their size.

 

With things like fining people for developing heart disease then you would have to fine smokers for lung trouble, people who regularly drink alcohol for liver and heart problems, and other things like that.

 

What I'm saying is that it's so hard to prove for certain that the weight has caused the issue, when it could simply have increased the chances. I think they should have to pay and other people should have to foot the bill but it's so difficult to find the right balance (it certainly wouldn't be through fines) to do it fairly.

 

In many cases I see obesity has stemmed from depression, and a lack of self respect (not all cases). When I was depressed I was fat (and likewise when I was fat it added to that depression) and I couldn't get out of it for years. Whether it was down to my own self pity, addictive junk food, or a combination of a lot of things, nothing was changing for me. Eventually it clicked and I sorted myself out. Had I not clicked I'd still be there now, more than likely bigger. Depression is something that is treated for free in this country under the NHS and it also appears obesity is too. In America, if this came into force, it would not be free for some people. I'm not for that in a fine sense, but there could be a tarriff in place. As I pointed out above though, it's so hard to gauge.

 

Good points you made there. It would be difficult to gauge if a health problem is directly related to someones eating habits just as you mentioned lung problems for smokers and liver problems. Of course all of those have strong factors that can lead to problems.

 

I don't think people should though be fined for being overweight. To be honest I feel that people should be educated to know the effects and problems overeating can occur. No one should be forced to do anything. People can be shown options and solutions but ultimately it's up to the people to have the right sense of judgement to make the right choices so long as it's not directly affecting the well being of someone elses life.

 

I think that clinics or other institutions should be made easily available for people wanting to change or battle their issue of depression or overeating.

Good points you made there. It would be difficult to gauge if a health problem is directly related to someones eating habits just as you mentioned lung problems for smokers and liver problems. Of course all of those have strong factors that can lead to problems.

 

I don't think people should though be fined for being overweight. To be honest I feel that people should be educated to know the effects and problems overeating can occur. No one should be forced to do anything. People can be shown options and solutions but ultimately it's up to the people to have the right sense of judgement to make the right choices so long as it's not directly affecting the well being of someone elses life.

 

I think that clinics or other institutions should be made easily available for people wanting to change or battle their issue of depression or overeating.

 

So how would you find a way to make people who do look after their bodies don't have to foot the bill of the people who do? That's the tricky thing.

So how would you find a way to make people who do look after their bodies don't have to foot the bill of the people who do? That's the tricky thing.

 

That is true, it is tricky. I think people who don't look after themselves should be the ones that should have to attempt to foot the bill or at least have insurance pay for it. I mean when you have people go to things like rehab to cut their addiction to drugs and alcohol they either get picked up by the insurance companies or have to pay for it themselves. Unfortunately it seems like in general you are always going to have people who have no problems support and pay for others that are less fortunate. Like for example when I get a paycheck it has to go towards Social Security to which if things don't change will go bankrupt and be obsolete in like 20 years. So essentially the money I give will be sent to help others, and I won't get anything from it.

 

However at the same time you can't turn people back that are willing to get the help they deserve. To be honest I feel that health care in general is ridiculously expensive (I got billed like $160 just for a regular checkup and an EKG), and clearly they can lower prices to help the general public.

The timing of this thread is uncanny. I started on my own journey of weight loss on Monday. I decided that instead of doing nothing all summer, I was going to accomplish some goals I made for myself before the end of the semester, and this was a big one. I've been overweight for quite some time now, and my dad getting diabetes two months ago (It's hereditary in his family, but he was also overweight) was a huge wake up call for me. I thought that the summer would be a good time to start taking better care of myself. I'm only in my third day, and it's already done so many wondrous things for me. I'm learning to have more self-control in terms of eating things that I should and not eating when I think I feel hungry. My face already feels thinner, and I get a great sense of self-accomplishment after I've finished my morning walk. It's fabulous.

 

Anyway, given my story (which is still in the works, mind you), I think this is something that people have to learn to figure out on their own. For some people like my dad, it took him a visit to the ER to figure out that he needed to take better care of himself. For me, seeing that and not wanting to end up like that is a piece of motivation. Yeah, sure, I want people to be healthy, but I agree with Greg. I don't think you should force people to do something. By doing this, you make them unwilling participants, and the consequences can be dire.

On a somewhat related note, I did hear a story on the news today about how some ob-gyn doctors are refusing to treat overweight women, for whatever reason. The report I heard on the news said something about how women over 200 pounds couldn't get treatment from these doctors. Of course, as a woman who fits into said category, this makes me angry, but even if I weren't, I don't think it's right to refuse treatment to people who want/need it.

 

Here's an online articule about the story:

 

Article

The timing of this thread is uncanny. I started on my own journey of weight loss on Monday. I decided that instead of doing nothing all summer, I was going to accomplish some goals I made for myself before the end of the semester, and this was a big one. I've been overweight for quite some time now, and my dad getting diabetes two months ago (It's hereditary in his family, but he was also overweight) was a huge wake up call for me. I thought that the summer would be a good time to start taking better care of myself. I'm only in my third day, and it's already done so many wondrous things for me. I'm learning to have more self-control in terms of eating things that I should and not eating when I think I feel hungry. My face already feels thinner, and I get a great sense of self-accomplishment after I've finished my morning walk. It's fabulous.

 

Anyway, given my story (which is still in the works, mind you), I think this is something that people have to learn to figure out on their own. For some people like my dad, it took him a visit to the ER to figure out that he needed to take better care of himself. For me, seeing that and not wanting to end up like that is a piece of motivation. Yeah, sure, I want people to be healthy, but I agree with Greg. I don't think you should force people to do something. By doing this, you make them unwilling participants, and the consequences can be dire.

Good for you! Best of luck! :)

 

 

For me I'm trying to do the same. I mean I don't have a weight issue, but I feel I need to be more healthy. Like in the past I tend to get really tired easily when exercising. But it was a wakeup call when I got bloodwork back to find out I have high cholesterol. I've always wanted to get healthier, but like mentioned it's usually some wakeup call to push people because honestly it's very easy to stay content and not change.

On a somewhat related note, I did hear a story on the news today about how some ob-gyn doctors are refusing to treat overweight women, for whatever reason. The report I heard on the news said something about how women over 200 pounds couldn't get treatment from these doctors. Of course, as a woman who fits into said category, this makes me angry, but even if I weren't, I don't think it's right to refuse treatment to people who want/need it.

 

Here's an online articule about the story:

 

Article

 

Fucking ridiculous and surely against the Hippocratic Oath? Especially with regards to the ones who specifically said it was because they are patients where complications could arise.

 

On a more positive note good luck! It really is rewarding. If you feel hungry, fill up on healthier things like fruit. Eat regularly (3 meals a day to keep your stomach working - starving yourself isn't healthy and doesn't work in the long run), and if you do need to snack just have something healthy. Go for things that aren't processed and things that your stomach has to actually work to break down, like seeded bread. This keeps your stomach continually working and it should shift the excess weight/inches whilst not leaving you feeling hungry. Exercise regularly, but as long as you keep to a good diet you don't actually have to do all that much. The more you do the better of course.

Good for you! Best of luck! :)

 

 

For me I'm trying to do the same. I mean I don't have a weight issue, but I feel I need to be more healthy. Like in the past I tend to get really tired easily when exercising. But it was a wakeup call when I got bloodwork back to find out I have high cholesterol. I've always wanted to get healthier, but like mentioned it's usually some wakeup call to push people because honestly it's very easy to stay content and not change.

 

Thank you, Mike. :smiley:

 

I'm sorry to hear about your cholesterol problem. :\ I'm sure that if you do your best to take better care of yourself, that will fix itself in time. Best wishes to you!

 

Fucking ridiculous and surely against the Hippocratic Oath? Especially with regards to the ones who specifically said it was because they are patients where complications could arise.

 

On a more positive note good luck! It really is rewarding. If you feel hungry, fill up on healthier things like fruit. Eat regularly (3 meals a day to keep your stomach working - starving yourself isn't healthy and doesn't work in the long run), and if you do need to snack just have something healthy. Go for things that aren't processed and things that your stomach has to actually work to break down, like seeded bread. This keeps your stomach continually working and it should shift the excess weight/inches whilst not leaving you feeling hungry. Exercise regularly, but as long as you keep to a good diet you don't actually have to do all that much. The more you do the better of course.

 

Yeah, that's what I thought. I thought it was their duty to help people out in times like that. Really, guys? :|

 

Thanks, Greg. I've indeed started eating regularly. Until now, I've never been much of a breakfast person, but now I have a serving of healthy cereal and a piece of fruit. I read somewhere you're supposed to take up to 30% of your daily calories for breakfast. I also walk every morning up and down my driveway 20 times (which equates to 4,000 yards, a little over 2 1/4 miles). I'm sure this will increase over time, but this seems to work. The big thing with me is actually remaining active. I ate too much and did too little, which is really the exact opposite of what you should do. I also find that it helps to drink water when you feel hungry. I read somewhere that your mind sometimes gets confused between signals of hunger and thirst when it's sent to your brain, so when your brain is telling you you're thirsty, you interpret that as, "Oh, I'm hungry, I should eat something." That's another big change I've made; I'm not drinking anything outside of water and Crystal Light. I'm definitely not having soda, and so far, I've been able to stay away from tea. (Given how much I love iced sweet tea, I've had to try a bit harder to resist the temptation.) Thanks for the advice, especially about the seeded bread; I didn't know about that. :smiley:

No worries. Keep up the good work. It's great when you start noticing the changes. It really spurs you on.

What is it with Arizona? Are they trying to get everyone to move outta there?

 

I certainly would never move there. It is a stupid place.

I've got the answer.

Since fat people have an excess they don't want, and skinny people in the developing world need fat, then it's a simple matter of free trade! :P