http://www.msnbc.msn.com/id/42383307/ns/health-health_care/

Discuss.

Is this guy a looney or a voice for the opprossed?

"Sin tax"? No, this is a reasonable attempt to recover some of the expenses imposed upon the rest of us by people who make unhealthy choices.

When I get to be King of the World, I will decree that anybody who uses tobacco shall be denied any and all health care that is provided at public expense.

Then I will locate every tobacco farmer in the country and pay him $1,000,000 as compensation for never growing another leaf of tobacco. In the long run the savings in health care costs will more than cover the million dollar payments.

I am a bit less willing to impose draconian sanctions on the obese. For many this is not a life choice but a condition predetermined by their genetic makeup. Don't punish people for things over which they have no control.

As far as feeling sorry for the poor (monetarily, not unfortunate) people who smoke... a single carton of cigarettes, perhaps a week's worth, costs as much as that $50 tax, and the price of the cigarettes is trivial compared to the true costs of smoking when you factor in health consequences, diminished life expectancy, damage to clothing and surroundings, and the antipathy and disgust that the habit incurs.

And yes, I know (not from personal experience, thankfully) that it is not easy to get over the tobacco addiction. TRUE ANECDOTE: a friend of mine used to live in Florida, and in his words he was a heavy cocaine user. One day he woke up in a motel with no idea where he was, when it was, or how he got there and he said "This stuff is gonna kill me. I quit." And he did, cold turkey, never touched it again. He moved to Alaska and when he first met the woman he subsequently married he asked her to go out with him. She told him she couldn't date someone who smoked, so he crumpled up his cigarette pack, tossed it in the trash and said "I just quit." He did, he never touched tobacco again, and he told me that "Quitting the cocaine was easy, a piece of cake, compared to quitting the tobacco. It was the hardest thing I'd ever done." This from a former Army Special Forces officer.

So, yeah, I have no problem with penalizing the people who run up my health care costs by smoking.

tanstaafl.

From another MSNBC article linked from that piece:


So, the state health agency will be tasked with reviewing paperwork to enforce these sanctions, and doctors will waste time dealing with more red tape, all in the name of collecting a chump-change fee that will do very little to defray the costs of Medicaid. Boy, for "conservative" leaders, they do sure loves them some big government healthcare bureaucracy when it means they can punish the less fortunate!

These laws are written by people to whom the very existence of a social safety net is anathema. They don't really want to make the safety net more "fair" by punishing people who make bad choices, they just want to reinforce the meme that anyone on the public dole is a lazy freeloader. So I agree with the author of the piece that this is a misguided effort that will not help actually slim down the obese or rid tobacco users of their addiction.

This has nothing to do with making people healthier, it's about trying to eliminate Medicaid altogether. Same playbook the pro-life forced-pregnancy movement has used for decades now.

Yeah, when I read the article, my initial thoughts were "Doesn't sound like such an unreasonable law to me." and "This author writes like a complete tool for a guy with a Ph.D. after his name."

Anyone feel differently?

EDIT:

One point I do agree with the author on is that there are far better ways to recover these costs. As Tony pointed out, it adds red tape and seems like it might cost more to implement than it recovers for the State.

And probably the Nazis too.

Tony -

Do you think it's equally wrong that private health insurance companies charge higher premiums for tobacco users and the obese?

Are they also trying to "reinforce a meme" or are they simply charging more for people who cost more to cover?

There are many private insurers that I can choose from, but there's only one Medicaid for the poor to choose from. I expect corporations to be amoral, but governments shouldn't be, and needn't be for something that's as much of a blatant Trojan horse as this is.

The extreme right-wing in this country needs scapegoats, and Jan Brewer has found them. In the 1980s it was "strapping young bucks with T-bone steaks", in the 1990s it was "welfare queens," and now it's fat-ass smokers (along with the usual suspects like Mexicans and Muslims.)

Incidentally, I didn't bring up the abortion issue out of the blue -- Arizona just passed a "no abortions based on the race or sex of the child" law, which is another blatant attempt to pass off the real intention of the law (ending abortion) as a humanitarian, egalitarian effort.

You really gotta give it up for these guys for cooking up schemes like this to make these policies seem sensible (provided you don't spend more than 30 seconds looking into them.)

People live too long already. It used to be the case that you'd work for 40 years, pay into a pension, and then live for maybe another 5 and then die. Now people are living for another 20 years, and wondering why their pensions are worth nothing.

Free smokes and motorbikes to the over 60s, I say.

The main point is that $50 is a big deal to the poor, but chump change for everyone else, including those trying to combat illnesses caused by obesity or smoking. So there's effectively a hefty tax if you're poor, a nominal tax if you're not, and a source of revenue that's not going to help anything.

If you're not poor, then you're not a Medicaid recipient, so there's not even a nominal tax.

If they were serious about this, they could assess this penalty as a payroll tax increase on everyone who pays into Medicaid who can't quit smoking or control their weight. This isn't a state bill to punish people who've sinned by being obese or smoking, it's a state bill to punish people who've sinned by being obese or smoking while also being poor

If the health insurance companies are really trying to help people live healthier, then why are smoking cessation drugs not covered by insurance?

I used Chantix to quit, and it's wonderful stuff, but at $300 a month it had better be! For me it was worth it, but I had the extra grand available for the 3 month program. Many smokers do not. It seems to me that the insurance companies would be far better off paying $1000 now rather than the 10's of thousands later, but hey, that's just me.

Because insurance companies don't care about long term since most people change insurance companies because of a new job.

Not to mention that for many of the poor that I work with, giving them $1000 worth of anything is like they won the lottery. It'd be sold in 20 minutes and the money would be spent on food and smokes (and alcohol, drugs and lottery tickets).

Sorry if that sounds jaded.

Which begs the question, is poverty simply of lack of money?

It often gets defined that way. I think of it as more a lack of "essentials", things like quality shelter, food, water, and health care. Plus perhaps a small measure of "disposable" income left over, for life's pleasures.

Something like that?

Oh, and I specifically _exclude_ a huge colour TV and satellite dish from that list. As soon as I see either of those, I rule out poverty.

Cheers

Unlikely, as the number of Lottery winners, now broke, is somewhat north of zero.

That problem, I expect, is that people who grew up in poverty became conditioned at an early point, because of the necessity of living paycheck-to-paycheck, to fail to think in the long term. Every dollar needed to be used immediately in order to survive. This, unfortunately, makes it harder to escape from poverty, as any windfall, be it from a lottery or newly gained liquid assets, is immediately spent, and never saved.

My point here is that poverty engenders a psychological response that feeds back into the poverty. I doubt that those born into poverty are genetically predestined to that psychology (though I will admit that it's possible), but that poverty itself causes that symptom.

That's what I was getting at. Poverty can become cultural in the sense that it can be a learned system of values, beliefs and behaviors passed on from others within the group.

I personally believe that there can be moral and spiritual components to poverty as well, but I'm sure I'm treading on areas you might violently disagree with there.

There is also the problem that those who live paycheck-to-paycheck tend to be excluded from more efficient ways to (e.g.) pay bills. For example, if you pay a bill here by direct debit (electronic transfer) you'll pay one rate. If you pay using a top-up card, or by mailing a cheque each month, you'll sometimes pay 5-10% more for the privilege. It can make the difference between having money to save and having nothing to save.

Bingo. This is another argument in favor of a single payer (government run) insurance option -- once you have an entity that needs to pay for someone's care from cradle to grave, they start to think more long term about controlling costs, not just shedding the unhealthy from their rolls.

This also has an effect on the obesity epidemic, because it's expensive to eat healthy food. We're very good at driving down the cost of fat and calorie-laden fast food and junk food, but not so good at making it cheap to eat a salad.

Or, apparently, in the short term.

The average addict smokes a pack and a half of cigarettes a day, at a direct cost of more than $8.00. How far would $3,000 a year go towards alleviating an individual's poverty?

tanstaafl.

You mean the things that were incredibly hard for your special forces friend to kick? Yeah, they're clearly just being short sighted.

There is cheap healthy food though. I think the problem is if you are hungry and don't eat often enough which are you going to pick- brown rice and beans, or french fries?

You can get a Burger King Buck Double for, well, a buck. That's over 3 ounces of beef, a piece of cheese, pickle slices, and a bun for $1. Nutrition-wise, that's 410 calories, including 10g of saturated fat, and 740mg of sodium.

On the other hand, beans and rice. I'm not immediately aware of any fast food beans and rice, so let's assume we're cooking at home. A serving of uncooked brown rice is about 3.8 oz, which I can get at my local grocery for $0.27. A serving of beans is about 9 oz, which I can get for $0.36. So that's $0.63. But now I have to cook the rice and heat the beans, which takes money and time. There are actually going to be more calories in this meal: about 550 calories.

So, yeah, you can get beans and rice for less, if you cook it yourself. But not a whole lot less, and it takes time, which is something you don't have a lot of when commuting between your two jobs. And, say what you will about saturated fat, it does make you feel sated.

Do they have no "Mexican" food joints near you?


And that's without anything resembling a fruit, or vegetable.

Heh. I meant no big fast food chains that I could easily compare to. For one thing, I imagine that if it did exist, it wouldn't be any better for you than a burger. As it turns out, though, Taco Bell has both rice and beans as side items. So if you got one of each, that would be 113 grams of food with 290 calories, 3 grams of saturated fat, and 780 mg of sodium.

Incidentally, while we were here trying to figure out whether poor people can afford a decent meal, the GOP announced that they're going to try to take a sledgehammer to Medicaid and Medicare. Looks like the needy are going to have to make their beans and rice rations last a bit longer so they can afford their health coverage.

I'd be fine with trying to cut down Medicaid and Medicare if they also showed some sign of slimming down the defense budget. But not a mention of even a penny cut there.

Politics just has me overly frustrated these days, more so then normal.

They slimmed the growth of the Defense Budget down to almost nothing, though. On top of that, they tried to shoot projects in the face that the Pentagon doesn't want. You can thank Congress for keeping things funded that the Pentagon says they have enough of, or don't want in the first place. We are a nation run by idiots.

Why approach it from the "cutting down Medicaid and Medicare" angle when it's not the health insurance, but the actual delivery of healthcare that's driving up spending? Medicare/Medicaid are exceptionally efficient programs that pay less to doctors than private insurance due to their massive purchasing power. There's very little fat in their budgets, so cutting the programs means cutting benefits. There are many other areas of the budget where we can look for inefficiency -- why focus on one of the few things the federal government does right?


Getting the second derivative moving in the right direction doesn't change the fact that the funding levels are too high. Why should the defense budget be growing at all now that we're winding down (or trying to wind down) the wars in Iraq and Afghanistan? We threw both of those wars on the credit card, and now it's time to *shrink* the defense budget, not simply reduce the rate of growth. Saying we just need to reduce the rate of growth from the astronomical levels of growth we had during the last decade is moving the goalposts a bit too far -- and I say that as someone who gets a majority of his project funding from defense and national security budgets.

If the budget situation is as dire as the political nonsense leads us to believe, then nothing should be off the table. If one side is going to propose massive cuts into some portion of the budget like Medicaid, they need to be willing to allow similar deep cuts elsewhere. I don't personally think it's as bad as either side wants to make it out to be, but I do believe there are long term budget issues that need to be addressed soon.

I'm just mostly tired of hearing politicians squabble over very minor aspects of the budget, such as funding to PBS. We just spent 5-6 years worth of federal public broadcasting funding with the opening missile salvo into Libya. Either they argue over these very minor details for hours on end, or they come out and propose major cuts perfectly aligned with their sides ideals. Nothing is ever going to get done if both sides continue the gridlock, while avoiding actual compromises.

I'm totally sympathetic to your arguments that the political process is broken, but you lose me with your insistence that both sides are responsible for it. Do you realize how far to the right the Democrats begin in these negotiations, and how far further to the right the Tea Party has been dragging them?

As but one example, John Boehner's opening bid in FY2011 budget negotiations was around $33 billion in cuts to a list of programs that Republicans didn't like, including the preposterous riders that would defund NPR, EPA, Planned Parenthood, etc. that offer no measurable cost savings, but make wingnut voters happy. The White House countered with an offer that, instead of meeting the opening bid halfway, gave the GOP the full amount of cuts they wanted, but refused the absurd riders about NPR and Planned Parenthood.

Boehner then went back to his caucus, and not only did they not accept the White House's offer, despite it giving them the full amount of cuts they wanted, but they insisted the riders remain in, and then *increased* the amount of cuts they required to $61 billion.

Imagine you're bidding on a house that's listed at $300,000. You place an opening bid of $250k, and require the seller to leave all of their possessions behind, including the appliances, the family dog, and their first-born son. Instead of laughing in your face and walking away, they come back and say they'll give you the house and the appliances for $250k, but they want to keep the dog, and little Johnny is off the table completely. You respond by saying no deal unless Johnny and the dog are included, and, by the way, you want it for $200k now.

Somehow, the Democrats are still negotiating under these very circumstances.

If you pay any attention to congress these days, this "Bad Cop, Insane Cop" approach has served the GOP well, with Democrats generally kowtowing to whatever the most extreme elements of the GOP ask for. To my surprise, Democrats have shown at least a bit of a backbone by not caving to these demands, but the GOP will likely get more in cuts than they initially opened negotiations with.

How can you claim this is a "both sides" problem?

I'm not claiming both sides caused the problem. I'm saying both sides need to address the problem in a way that reflects more then just one sides wishes. Your recent example was something I was unaware of, and continues to irritate me since it is clear the GOP only wants it their way, even when they only hold power in one of two houses of congress, and lack the executive branch. It shows the Democrats are at least trying to find some sort of middle ground (or in this case, well past middle ground and much closer to GOP land), but the GOP doesn't want to budge at all. Hence my initial point about wanting defense spending on the table if the GOP wants Medicare on the table.

Yeah, defense is a real problem because so few in congress actually understand where the money goes, but they all understand how much of the money goes to their districts to create jobs. The contractors and subcontractors spread their operations out across hundreds of congressional districts so that everyone loses something if programs are canceled -- even ones like the completely unnecessary F-35 alternate engine that the military doesn't want but Congress refuses to cancel because it creates a few jobs. We may as well just pay those people to dig a hole and then fill it up when they're done.

I understand the distinction you're making about both sides being responsible for fixing the problem, not necessarily that both sides caused it. But I think it's important to tell the story accurately that Democrats really are trying to meet the Republicans way more than halfway, but if you give these guys an inch, they take a mile. And now they're cheering on the prospect of a government shutdown.

Which might be fine when it's a defense procurement, may or may not be fine if it's an earmark, and is certainly dubious if it's a "stimulus."

Digging more into the current budget situation, why wasn't one passed last year when the Democrats had control of both the House and Senate? I'm finding only vague hints of what happened, as most of the searching I am doing is turning up recent articles, and nothing really specific from last year. Was it one of the many issues the Republicans filibustered on? If so, makes me think this was their game plan all along, to force a shutdown.

I'd love to hang the failure to pass a FY11 budget on the Republicans, and certainly their routine and unprecedented use of the filibuster was a factor, but as best as I can tell, there was plenty of blame to go around.

Budget bills can't be filibustered, so they can be passed with just 51 votes. Unfortunately, Democrats seeking re-election in competitive states didn't want to be on record voting for a budget that increased the deficit by about $1 trillion, so most observers didn't think they'd be able to get to 51 with ConservaDems defecting. With the prospect of the budget passing the senate in doubt, Pelosi punted, choosing to push legislation piecemeal rather than enter a drawn-out fight over the budget that might chew up months of time and end without agreement anyway.

The wisdom of that choice is certainly questionable now, and was predicted then.

And, really, how hard could it be to negotiate with such a reasonable counterparty?