HEALTH CARE/Joan Retsinas

Elimination of the Poor Helps to Balance the Budget

Consider the poor! How dreadful: no choices among the lattes at Starbucks, no chance to live in a McMansion, a mountain of debts to pay for cars that break down. And the difficulty of finding a job, much less one that will pay a living wage. Wretched lives – for themselves.

And for us the taxpayers the poor are a burden. Think Medicaid. We pay for their surgeries, their immunizations, their medicines. The expense is cost effective: we need people to work the counters at Starbucks, to build the McMansions, to enrich the usurers among us. The upkeep of the poor is cost-effective, but they definitely cost.

Now consider the fat poor. Their lives are more miserable – they have a harder time finding work, mates, and enjoyment than their skinnier counterparts. The same dire statistics hold for smokers. Imagine the life of a poor, fat smoker: ineffably grim. And — no surprise — fat people are more expensive to maintain than skinnies. More incidences of a grab-bag of ailments: diabetes, arthritis, heart disease. If the fat person smokes, add a few cancers to the list. So here is a modest proposal.

We need not follow the lead of Jonathan Swift, who proposed that the English eat Irish babies (stewed, roasted, baked, or boiled) to right the economic balance. Realistically, any health-conscious American would gag on the fat or smoke-filled organs of the poor.

I am proposing that we simply let fatties and smokers, at any rate the poor ones, perish, by withdrawing health care.

Arizona has gently paved the way. To save money, Arizona is proposing a $50 surcharge on all fat or smoking Medicaid recipients. (It is not clear whether fat smokers will pay double). (Wall Street Journal, April 1.) Politicos might cloak the surcharge as a do-good incentive, presuming that it will convince fatties to slim down and smokers to quit. But if being sick (or fear of being sick) has not nudged people to change their lifestyle, a surcharge won’t do the trick. (Private insurers often apply a surcharge on smokers. Those smokers don’t quit to avoid the surcharge.)

Arizona has taken the first step towards paring taxpayers’ burden. Arizona will reap some money, since roughly one-quarter of residents are fat, and more than 40% smoke.

But $50 probably won’t reduce the state’s Medicaid rolls. Fat people are not de facto stupid. Anybody who can scrape up the extra $50 for insurance will do so, although, since these people have very little income, that $50 may be hard to scrape up.

Why not increase the surcharge dramatically, so nobody fat and nobody who smokes can afford Medicaid?

At the same time, let’s dump into the “disqualifying pot” all those lifestyle decisions that drive up the health care tab: driving without a seat belt, indolence, drugs (the illegal kind). The American ethic already embraces the “hard working, worthy” poor, who merit our alms. Let’s reserve government health insurance for the “physically fit.”

Without health insurance, many of the unhealthy poor will die. They need insurance, first, to pay for the diagnostic tests that will tell what is wrong, second, to pay for treatments. Pro bono care, or charity-driven hospitals, are passé, relics of an almost forgotten age. So we can expect this modest proposal, a la Swift’s, to lower the census of poor people.

Better yet – it will lower the census of unhealthy poor people – the kind who may not be the most productive workers, yet who put the heaviest burden on government. After this modest proposal, we will still have enough workers.

By driving some people out of Medicaid, we will ease the dreadful lives of the unhealthy poor, while at the same time easing the plight of taxpayers.

A Biblical axiom holds that “the poor you have always with you.”

Maybe not. Thank you, Arizona, for showing us the way.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, June 1, 2011

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