The Conservative Nanny State

Arizona Gov. Jan Brewer has a plan to save the state’s cash-strapped Medicaid program: Charge $50 to obese people on the plan who fail to make improvements under a weight-loss regimen, and smokers. The proposal is a nice case study in conservative policy-making. Via The Wall Street Journal:

Republican Gov. Jan Brewer proposed the idea as part of a broader plan to raise money that would allow the state to offset recent cuts she engineered to its Medicaid program. If ratified, the measure would revive coverage of organ transplants, which Arizona limited last year as a way to save money. It would also reduce the number of childless adults disqualified from Medicaid to 135,000, compared with the original proposal of 250,000.

Conservatives are uneasy with the idea of Medicaid, a program in which everyone pays for the health care of those who can’t afford it themselves. So Brewer’s solution is to make cuts to the program by reducing the funding from taxpayers and then partially filling that gap by charging the poor people who rely on it. The governor says the point is to reward good behavior and raise awareness of how costly obesity and smoking are. Giving people a personal weight-loss plan is important, but in general, Brewer’s plan embodies the conservative approach to social problems: monetary carrots and sticks.

What the plan is missing, at least from a liberal point of view, is an acknowledgment of the conditions that create the problem. In 2006, 46 percent of the state’s Medicaid enrollees smoked, but according to Arizona Health Matters, only 18 percent of adult Arizonans were smokers. The same goes for obesity, which is more prevalent among Medicaid recipients because it is largely a result of socioeconomic status. Remember, eating well and exercising require money and time. Brewer’s solution doesn’t really attack the root of the problem, which stems more from systemic conditions than individual choices.

The more you invest in education, exercise, and affordable food programs, the less Medicaid – and health care in general – costs in the long-term. I doubt a $50 fee is enough to inspire slow, painful lifestyle changes, which makes this a short-term fix funded by poor people nonsensical. It’s probably the most Brewer can do, though, before straying into programs that incentivize healthy behavior and really reach the poor; what conservatives would call Michelle Obama-style nanny-state socialism.

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