Truth Be Told | Paradise misguided

Indulge me. Sit back and imagine a certain utopia.

A place where evildoers are pulled over for not quite passing the brown paper bag test. A paradise where the standards for patriotism (read: “righteousness”) are so high that simply being born on its soil isn’t enough to ensure citizenship.

This is a nirvana where guns and ammunition flow like milk and honey at political rallies, college campuses and even bars. And in your drunken bliss, you won’t be able to distinguish your cell phone holster from your pistol holster. Picture a place where poor transplant patients have the business savvy to found a Fortune 500 company to pay for their own operations.

This is the perfect world as seen by the visionary genius of Arizona Gov. Jan Brewer (R) and the state legislature, who now suggest a sublime addition — a tax on Medicaid recipients who smoke or are obese. Sheer brilliance!

By proposing to offer up the poor and the sick on the sacrificial altar to attaining a balanced budget, the Arizona lawmakers have demonstrated a glaring disregard for the complexity of nature. There’s an aggressive arrogance in their pretending to have a complete understanding of those disease processes.

The Wall Street Journal reports that a spokeswoman for the state’s Medicaid program said that the measure is a “way to reward good behavior and raise awareness that certain conditions, including obesity, raise costs throughout the system.”

But why stop at utopia when you can bring heaven to your doorstep? If overeating and smoking are risky behaviors that drive up healthcare costs, why not levy a tax on people who play football or grow up in a crime-ridden neighborhood or suntan regularly — or who live in Philadelphia?

In February, Philadelphia topped Forbes magazine’s list of America’s 10 Most Toxic Cities. Forbes cites levels of trihalomethanes, a carcinogen, to be a factor in granting Philly the worst overall water rating. Living here, then, is a relative risk over living anywhere else deemed to be less toxic.

But are such behaviors easy to separate into taxable and non-taxable? The name of the game here is reducing costs by penalizing people who engage in behaviors that raise health risks.

“To be fair, the governor can add the same tax to water-skiing, jet skiing, horseback riding, mountain biking, owning a swimming pool, paragliding, rock climbing, failing to wear a helmet while riding a motorcycle (Arizona has a very weak law) or choosing to work in roofing, mining or construction — or any other activity that carries a risk,” Arthur Caplan, director for the Penn Center of Bioethics, argued in a recent column on msnbc.com.

The deeper issue here is that these risky behaviors that Brewer cites as contributing to the healthcare problem aren’t entirely behaviors in the first place. Many view overeating and chain smoking as failures of character, a lack of will and dedication.

But this understanding isn’t taking into account the entire picture of addiction as part of a pathological process. Addictive substances, including nicotine and even high-fat foods, activate a reward system that causes an individual to become dependent with repeated usage over time.

This is a simplistic explanation, of course. Obesity and smoking have many other factors that come into play — including social, psychological and even genetic — over which the individual has little or no control. To a degree, then, Brewer’s law is better understood as a tax on simply being who you are.

This shortsighted proposal fails to take into consideration all of the implications of pointing the finger at a single subset of people. It’s simply scapegoating a vulnerable group to satisfy lawmakers’ take-no-prisoners agenda of balancing the budget. This feigned interest in improving the public health is a poor excuse for mistaking the obese poor for fat cash cows.

Mark Attiah is a first-year medical student from Dallas, Texas. His email address is attiah@theDP.com. Truth Be Told appears every other Thursday.

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