Arizona Governor Jan Brewer Wants to Fine............
YOU!! Yes, you read me right. Tonight ABC Nightly News reported that Arizona Governor Jan Brewer has proposed leveling a $50 fine on MedicAid participants who (1) Smoke; (2) Are obese; and/or (3) Have a chronic condition and fail to to meet the goals set by their primary care physicians. According to Phoenix ABC News 15, Governor Brewer proposed this in order to raise funds for the cash-strapped MedicAid program and to encourage people to take responsibility for their own health. The funds raised from these fines would be used to help support the organ transplant program that was pretty much shut down last year and to allow an increase in the number of people eligible for the MedicAid program.
I see a number of problems with this, not the least of which is that Arizona will be punishing people for things they may not have any control over. For instance, in 2007, the doctor I was seeing placed me on Metformin when my A1c rose to 8%. While the drug brought down my fasting numbers, it did nothing for my post-meal numbers, which were just as high as when I was not taking any medications. Was I being non-compliant? I was certainly taking my medications and following the meal plan given to me by the dietitian. My doctor tried to accuse me of being non-compliant with exercise, even though I did not have a car and had to walk every where I went! Should I be fined because the medication didn't work and because the doctor refused to run the tests that would have helped guide his decision making process? If Actos is the drug that works best at keeping your bgs down but it has also caused you to gain a substantial amount of weight, should you be fined for that, though the weight gain is a direct consequence of the medication? Is it fair to fine someone who has been following his or her program religiously, who has had good bgs for (perhaps) years, but whose body has changed and for whom the program no longer works?
IMO, it's a bad plan. It punishes the people who are least able to afford it. As it is being reported, the behaviors that trigger the fines are not well-defined. A doctor who is angry at you and who wants to "teach you a lesson" (like mine did back in 2007) may write "non-compliant" on your records though it is not the truth and cause you to be fined, for instance. Why fine obesity? For the same reason they're fining cigarettes, IMO: The governor has a misguided belief that both are due to "willful bad choices" and you have a choice in whether you're obese or not. It fails to take into account the contribution of genetics, it fails to take into account that there are some who are both fat and fit. It is unfair legislation, though with good intentions -- and we all know which road is paved with good intentions!
If you live in Arizona and you agree with this, I hope you will take a moment to write to your governor to express your thoughts and offer alternatives. I know these are difficult times but there must be a better way!
Angela
I see a number of problems with this, not the least of which is that Arizona will be punishing people for things they may not have any control over. For instance, in 2007, the doctor I was seeing placed me on Metformin when my A1c rose to 8%. While the drug brought down my fasting numbers, it did nothing for my post-meal numbers, which were just as high as when I was not taking any medications. Was I being non-compliant? I was certainly taking my medications and following the meal plan given to me by the dietitian. My doctor tried to accuse me of being non-compliant with exercise, even though I did not have a car and had to walk every where I went! Should I be fined because the medication didn't work and because the doctor refused to run the tests that would have helped guide his decision making process? If Actos is the drug that works best at keeping your bgs down but it has also caused you to gain a substantial amount of weight, should you be fined for that, though the weight gain is a direct consequence of the medication? Is it fair to fine someone who has been following his or her program religiously, who has had good bgs for (perhaps) years, but whose body has changed and for whom the program no longer works?
IMO, it's a bad plan. It punishes the people who are least able to afford it. As it is being reported, the behaviors that trigger the fines are not well-defined. A doctor who is angry at you and who wants to "teach you a lesson" (like mine did back in 2007) may write "non-compliant" on your records though it is not the truth and cause you to be fined, for instance. Why fine obesity? For the same reason they're fining cigarettes, IMO: The governor has a misguided belief that both are due to "willful bad choices" and you have a choice in whether you're obese or not. It fails to take into account the contribution of genetics, it fails to take into account that there are some who are both fat and fit. It is unfair legislation, though with good intentions -- and we all know which road is paved with good intentions!
If you live in Arizona and you agree with this, I hope you will take a moment to write to your governor to express your thoughts and offer alternatives. I know these are difficult times but there must be a better way!
Angela
Tags: Arizona, Cigarettes, Diabetes, Fines, Law, MedicAid, Obesity, Smoking
Replies to This Discussion
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Permalink Reply by Trudy on -
There are so many complaints about "big government". This law would make government intrude in people's everyday lives to an intolerable extent. Way way too big, yes callous and mad and without compassion and just unbelievably evil.
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Permalink Reply by Jeannie Wagner on -
I know I am a lone wolf here but these states are going broke. What happens when your state goes bankrupt and they cut your Medicaid insurance altogether. I believe people should have personal choice in their life. When I make a bad choice that affects my health I then pay the consequence. Our government makes lots of rulings that affect our choice. If we choose to speed we get a $75 dollar ticket. If we don't wear a seat belt we can get another fine. Under the new Healthcare Law if I don't pay many thousands of dollars for expensive insurance I will get a fine. If you don't pay your taxes by April 15 you get a penalty fine. I'm not saying it is easy to lose weight and I do understand certain meds and insulins may add to the problem. But I think the obesity problem in our country is out of control and costing the health care system billions of dollars. If they can reduce the amount to people going on kidney dialysis, having heart surgeries or having amputations I think they should do it. Private Insurance companies are already doing this, charging you more for behaviors that endanger your health. Now, I would like to see them offer more incentives like adding a free gym membership where if you exercise so many times a week the fee would be waived. I would also like to see informational classes on how to buy and prepare healthier meals that will let you lose weight. I have had to make a lot of changes in my diet since I was dx'd with diabetes. Do I miss bread, potatoes, rice and pasta, you betcha. But I do it because my health is very important to me.
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Permalink Reply by Gerri on -
Jeannnie,
Criminalizing behavior to impose fines is not the way to prevent health problems or to save a system from bankruptcy.
Did you ever read Jonathan Swift's "A Modest Proposal?" That was satirical. Sadly Governor Brewer's plan is not.
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Permalink Reply by Natalie ._c- on -
The worst part of the problem, as I see it, is that they are going to do it only to Medicaid recipients. Balancing the budget on the backs of those least able to afford it. Does that make any sense at all? Why not up the taxes on the wealthy who CAN afford it? They have too much already -- and some of the too much is legislative influence.
When Obama proposed raising taxes only on those who made more than $250,000 a year, the Tea Partiers got average Joes to protest it, but it wouldn't have affected them at all. So why did they fall for the propaganda machine? Are we a nation of idiots?
What ever happened to being our brothers' keepers, and charity begins at home and all the other beautiful lessons we were all taught? Have we become so totally selfish that we not only can't imagine helping those who are less fortunate, but have to actively seek ways to harm them? Last I heard, taking money from the poor for nothing never helped anyone quit smoking or lose weight!
And while you are educated enough to learn about various ideas on eating, most poor people aren't, and the doctors they see aren't, and so you can't use yourself as an example. We are fortunate to have what we do, but poor, uneducated, underserviced people cannot walk in our shoes -- we need to learn to walk in theirs.
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Permalink Reply by Anonymous Jim on -
Lets see smoking well not good for you is not against the law, so why fine people for not breaking the law. Also it can be the lesser of 2 evils, have you ever been outside of a AA or NA meeting as a recovering addict I can tell you smoking is a better choice then heroin.
Obesity I have a family member who has Proteus Syndrome and is bed ridden. Part of his weight problem is because of Proteus syndrome and I know quite a few people who are in great shape but following the BMI chart are considered obese, I have yet to meet anyone outside of pro athletes whose doctors go to the extent of putting them in a water tank to get a true BMI measurement
Uncontrolled chronic illness, I can assure anyone on here that there are people on here who listen to everything their DR tells them to do and still can't get in control.
Ideas such as this are as bad as say lets drug test all people on welfare. Guess what everyone is on some form of welfare, don't believe me did you go to public school thats welfare, drive on public roads, welfare, Student Loans welfare, Live in a flood plane welfare. The list goes on. In this day and age of Tea Party types scream pseudo Libertarian ideas it makes me sick because they are pragmatic and only look at things that affect them directly, scream small government but god forbid if they don't like something then the government need to do something about it.(Look at the support I got from the Teaparty council members in my town over my property rights and the city banning chickens). You can't have it both ways either the government stays out of your business or they are in it. What next fine people who work outside because of increased chances of skin cancer.
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Permalink Reply by Robert G on -
I live in AZ, work at a nationally known hospital, I am a diabetic (1.5) but was treated as a Type 2 for many years. Until I went on insulin, nothing worked for me at all. I had a Dr tell me I was the “Worst diabetic he has ever seen” at age 21. I tried like hell to be in control but looking at food made me spike.. I guess I was “Out of Control” that bothers me a little bit that I would have to pay because I “was not following Dr. orders and deemed “Non-Compliant”… my mom, is a long time Type-2 that has lost a few toes and heel to bone infection, has no feeling in her feet, problems with her stomach, heart, eyes all due to high BS over the years.. To add to it she is mentally ill, an addict, and is on Medicaid lives on less then $700 a month.. should she have to pay more for her care.. haven’t she paid enough? Her glasses, specialty shoes and podiatry are no longer covered.. she gets to see a psychiatrist 2 times a month but that is it..
A band-aid is not going to fix this issue.. IMHO, Government stay out of it, allow the medical staff to give the medical treatment needed.. in my moms case, a team approach, Mental, Medical, Ancillary a family all need to be involved in her care.. and the up most.. she need to ‘buy-in” to her care.
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Permalink Reply by Manny Hernandez on -
@Robert G:
Reading your comment about getting misdiagnosed brings back SO many memories... I was living in Arizona back in 2002 when I was MIS-diagnosed with type 2 diabetes. I was lucky to be seeing a doctor that wasn't too stubborn to accept that he had run out of options to help me manage my diabetes, b/c he ended up referring me to an endo after 5-6 months of trying to help me out without success. It turned out that, like you, I had type 1.5 (LADA) diabetes, so I was being treated for the wrong disease and, no matter how much Metformin I took, I was not gonna be able to control my BGs properly...
The medical system in the US (and in many other places) is not knowledgeable enough about all the causes underlying people's inability to manage their conditions, to be able to act on it and/or much less penalize them because of it.
The other irony in this whole situation is that I can totally recall how, when I lived in Arizona, I used to literally risk my life to bike to work in the morning, because of the complete lack of bike lanes and, in many places, sidewalks. THAT is something we know to be healthy for people and a means for people to exercise. THAT is something that governments can help fix (you don't need to be an endocrine expert to know that), yet the focus is being put on the people missing out the environmental component.
Anyway... my two (personal) cents.
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Permalink Reply by Kelly WPA on -
Manny, you hit the nail on the head with the medical system not being knowledgeable enough about the causes! I have gastroparesis and no one was able to help me. Even though they knew I had it, they still treated me like I was causing the problems. I was in the hospital for a week and the doctor said my BS baffled him – he didn’t help but he was the first one that believed me. I knew someone that went to the Mayo Clinic & was told she would never get her A1c below 7 with gastroparesis. I know that isn’t true! The DOC saved me!
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Permalink Reply by Kathyann on -
Isn't this the same governor who wants the police to stop all people of color and ask them for your documentation to live in the US? I Think you need to recall this governor. She's a nutcase!
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Permalink Reply by Sareln Pupkies on
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What you said is not accurate. The police CANNOT just stop as you put it "all people of color" and ask to see their documentation. Police can only ask those who have been stopped for other reasons and have reason to believe they might be in this country illegally.
I know that what I am about to say is going to really tick alot of people off, but frankly, I don't give a d##n! I am tired of trying to be "politically correct.!" On the surface I don't think I totally agree with the Gov. about the proposed fines, but living in So. Calif. in an area where illegals make their way into this country I agree with Gov. Brewer that the cost of illegals in this country is seriously hurting the financial viability of our states. I worked in a county hospital for many years and I have seen how illegals have taxed the resources of our state governments. Do you honestly think it is right for an illegal to come into our country and receive free health care, while those of us who have a right to be here have to fight for every thing we get? I have done many mission trips to Mexico and I have seen first hand and somewhat experienced the living conditions there. Quite honestly, if I lived in Mexico I would do everything and anything I could to make my way into the U.S.
Like I said, I know I have riled up everyone's dander, but if we really want things to change for the better, we really need to look at what is driving some of the things that are being offered by our State governors and ask why? and what can I do to change it or make it better.
Our Gov., Jerry Brown, wants to increase our sales tax and vehicle registration tax. How do you think this is going to affect us "poor folk?" And yes, I am poor and I live below the poverty level!
I am a Reagan Conservative, so I am not going to get into the political issues that have been brought up, but ask yourself if you really want our country to become a Nanny State, and why do you think it is fair to expect that those who make a good deal more money than we do, to turn it over to the government? Yes, there are inequaties, like GE who paid absolutely no income taxes (makes me want to throw up!!!!). So, close tax loop holes like the ones GE took advantage of, but don't assume that someone making $200,000/yr. rich, because they are not! Definitely richer than me, but not rich by any stretch of the imagination.
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Permalink Reply by acidrock23 on -
People act as if there's no cost to exercise has cost me quite a bit of $$ over the years, probably about $3-4K for martial arts classes, about $9-1200 in running shoes (I try to rotate a pair in about every 200-300 miles so that's a new pair every 2-3 months at 20-30 miles/ week?) , $250-300 for various running clothes, oh wait, I forgot about the jacket, make it $350-400, $3500 for new teeth after the last major bike accident, a few ER/ prompt care visits for rolled ankles, a torn hamstring and a few other things, maybe $5-6000 in medical costs? While the medical stuff was largely covered by insurance, the other stuff has all been on me.
Perhaps tax deductions for exercise stuff could work but it could also be taken advantage of by affluent people who have the resouces to log health club memberships, personal trainers, etc. Perhaps there could be an income cap on those deductions so anyone making oh I dunno, < $50K/ year or families <$75K can claim those deductions but more affluent folks should lose access to the deduction? All of that would be workable but would require effort and I dont see a politician doing anything that requires effort. A big thing for me and exercise has also been living in two communities with access to first rate running stores, with treadmills and knowledgeable staff to help choose shoes correctly.
When I hit 275#, I got some walking shoes with ankle support and walked 3 miles regularly for a while as I was getting more active in martial arts. A couple years later, I was down to maybe 225 lbs and decided to see if I could run. I was able to run 4 miles, farther than I'd ever run, right out of the gate but the shin splints from the worn out support/stability shoes were BRUTALLY painful!! Back to the store "you need new shoes" so I ran on the treadmill through different combos of shoes and found a great pair that took me to 7th/ 53 in my age group in my first 5K and supported a lot of training up through my black belt and first 1/2 marathon last year. It is very helpful to have access to a store like that but a lot of people will naturally be shy about going to a running store person (most of whom have, in my experience been ectomorphic runners...) and saying "let me put 10 pairs of shoes through their paces on the treadmill". Whether you are walking or running, this should be a very important part of the program for anyone to get set up for success but, a lot of people simply can't or won't do this. This could easily be publicized and running shoe vendors should get some support/ assistance if, all of a sudden, 100 million of us come knocking on their doors? I have found these resources in two different communities but I am not sure that my experience is translatable or not? It seems like it might help people but the political dialogue is hamstrung by it's need to stupidify analysis like Governor Brewer.
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Permalink Reply by Anonymous Jim on
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I feel this just boils down to another tax on the poor. Eating healthy is not cheap, smoking well not cheap is more of a vise of the working class, good healthcare even with insurance is also not cheap. There are so many more useful ways to implement this like encouraging community gardens, less tax on small local providers and the big one making big business truly carry their tax burden.
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