What Arizona's Health Care Cost Containment System Means for Diabetes Patients
Arizona has come up with a new method to help pay for Medicaid.
They want to penalize overweight Medicare recipients for failing to lose weight.
According to an article in the New York Times, Arizona's Health Care Cost Containment System has proposed charging smokers $50 a year and applying a similar fee to diabetes patients who do not follow their doctor's orders to lose weight, said Monica Coury, a spokeswoman for the state Medicaid agency. . . .
"Ms. Coury said the cash-strapped agency would not be weighing people and slapping a fine on those carrying extra pounds. Rather, the $50 would be charged to those who were specifically urged by doctors to lose weight for health reasons, like diabetes, but failed to do so, she said.
" ‘We don't care how much you weigh,' she said. ‘We care if you are doing something you should be doing to manage your disease.' "
What these beaurocrats don't understand is that if you're overweight, it can be very difficult, short of starving yourself, to lose that weight. It is especially difficult to lose when your doctor prescribes medication that causes weight gain. And it's very difficult to lose weight when you don't have much income and are forced to buy whatever food is the cheapest.
Although one might argue that it was fair to fine people for not trying to lose weight, for example, for refusing to take part in a nutritional counseling program, it's totally unfair to fine people, especially people with limited financial resources, for failing to succeed at losing weight.
Most people who are overweight have been trying to lose weight their entire lives, and they haven't succeeded. Why? There are many reasons.
Some overweight people have metabolic differences (leptin deficiency, although it affects only a few people worldwide, is an extreme example) that make them very efficient at putting on fat. They will gain weight on a diet that would cause other people to lose.
Some overweight people have very little money for food, and so they're forced to exist on high-carbohydrate foods like bread and rice that raise blood sugar and insulin levels and favor the storage of fat. It's very well to tell people to "eat more fruit and vegetables," but if you live in an inner city neighborhood where the only fruits and vegetables at your local bodega are overripe bananas, it's difficult to do that.
Some social workers actually urge low-income people to live on fast food, because you can get more calories for your dollar with the cheap french fries and fat you get from fast food.
Some overweight people have problems with their appetite-control systems, so they're constantly hungry. Putting food in front of hungry people and not allowing them to eat is a form of torture. But some overweight people face this situation three times a day or more.
If Medicaid's Arizona organization wants every overweight person on Medicaid to lose weight, I think they should start by providing sufficient funds to allow the overweight people who have been told by their doctors to lose weight to buy good cuts of grass-fed meats and organic low-carb vegetables.
If that turns out to be too costly for the state, then the beaurocrats should set a good example. Everyone in the agency should lose 20% of their weight on a poverty-level food budget. Until they do, they should stop telling overweight poor people how easy it is.