Wednesday, April 6, 2011

Fat Grandma Beats the System

According to Chronicle News Services, Arizona’s cash-strapped Medicaid program is considering charging patients $50 per year if they smoke, have diabetes, or are overweight. They say the tax is intended to push patients to take better care of themselves. The fee would apply only to childless adults.

Not sure how far down the line of “consideration” those folks are…so let’s just process the concept for ourselves. The State Health Care Cost Containment System, the ones who are floating this idea, presumably has records of potential tax-ees already. They already know who reported himself to be a smoker, or who, during his last office visit, tipped in with a bulbous Body Mass Index. They surely can sort out who they’re treating for diabetes.

But do their records reflect childless adults? Really? No, I didn’t think so. Folks will have to respond to a questionnaire to get themselves in line for the dun. That’s sure to go well. A lot of folks will raise their hands and step forward. “Tax me! Tax me!”

The Cost Containment folks must compile the responses to their surveys and scan their records in search of offending parties. OK. Here’s a list of overweight, smoking, sick, empty nesters receiving Medicaid --- because they’re also poor. Let’s go ahead and send them a bill.

Now, will that be $50 per offending condition? Or will there be a two- or three-for-one sale? If I’m a diabetic smoker, for example, do I get a deal? Seems like a fleet discount might be in order except that the enforcers are of a mind to make some dough, er, my mistake - they’re encouraging these folks to take good care.

We can’t deny there could be some logic to this. When I get a ticket for a faulty muffler, it encourages me to get my muffler fixed. If I pay my taxes late, the penalty encourages me to pay them on time next year. But if I’m already spending, let’s say conservatively, $2 a day to the nicotine monkey, totaling $730 a year for an addiction some say is as relentless as a heroin addiction, I’m not sure I wouldn’t just pony up the added 14 cents per day the proposed fine represents.

(I knew a woman once who paid herself $3 a day for every day she didn’t smoke after she corralled the compulsion. Bought herself a diamond ring. Now that’s encouragement.)

Could this tax help make a person thinner? We’d have to look at the cost per calorie index for our amortization of this effect. Let’s see, here it is: If a person needed to lose 20 pounds to exit the “This is for Your Own Good” penalty box within the first year of paying said penalty, he would need to eliminate about 192 calories per day for an annual reduction of 70,000 calories. So, he’d need to lay off his daily box of Junior Mints, or take a brisk two-mile walk each day, every day, for 365 days to burn those calories. Either that, or of course, he’d have to pay that onerous 14cents instead.

The one that really gets me is the diabetic. Arizona would penalize, oops, sorry, encourage the diabetic with this $50 tax. But what exactly can a diabetic do to improve his lot? Can he behave his way out of diabetes? Once you have it, doesn’t it have you? You control it or contain it, but it doesn’t go away just ‘cause somebody says, “Do better.”

But of course! Here’s the giant loophole that will put the kybosh on the whole shebang: No one has to be childless. Even my favorite relative, known affectionately among the Okies back home as “Fat Grandma,” can have kids in the house. Heck, in today’s economy, it’s not uncommon at all to have kids at home, underfoot, and in the fridge until you’re underfoot yourself. Be gone Medicaid penalty!

What truly grates is the condescending deception used to package the proposal. Just tell the truth. The underlying problem in Arizona and the rest of our country is the cost of providing health care to the poor. But Arizona swaddles its proposal in a false premise: encouragement.

In fact, it may not be unrealistic or unfair to charge a smoker more than a non-smoker for services. After all, he costs the system more. So do diabetics and heavyweights. Maybe we should just call it what it is.

If I were a stout smoker, I might not like the extra charge, but I’d be less able to argue with it.