Behavior Modification with Surcharge?

[Manicsleep]

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http://online.wsj.com/article/SB10001424052748704530204576235151262336300.html

Do you smoke, are you fat etc? Are you on medicaid? You may have to pay a surcharge of 50 bones in AZ if this bill passes.

There are some legal worries but I wanted ask psychiatrist what they thought about their patients. Lets say you have a schizoaffective-bipolar patient on zyprexa and depakote and they are a smoker. Do you think its *fair* for them.

At the end of the day however, I have to say its a step in the right direction. Especially with the smoking. The question is will it work? These people are paying 5 bucks a pack, often daily or more. 50 bucks a year is not going to stop them right?

 

[Ibid]

Do you smoke, are you fat etc? Are you on medicaid? You may have to pay a surcharge of 50 bones in AZ if this bill passes.


At the end of the day however, I have to say its a step in the right direction. Especially with the smoking. The question is will it work? These people are paying 5 bucks a pack, often daily or more. 50 bucks a year is not going to stop them right?

Well meaning but attacking the problem from the wrong direction. The ciggs are to cheap, thats the real problem. Tax the ciggs more and you will have a huge surplus to spend on medicaid and you incentivise the whole population into the bargain. Fair to everyone. Call it socialism.

$10.00 for a pack in my minds eye.

 

[OldPsychDoc]

Well meaning but attacking the problem from the wrong direction. The ciggs are to cheap, thats the real problem. Tax the ciggs more and you will have a huge surplus to spend on medicaid and you incentivise the whole population into the bargain. Fair to everyone. Call it socialism.

$10.00 for a pack in my minds eye.

A TAX INCREASE!!!? 😱😱😱
Government takeover! 🙄

 

[Therapist4Chnge]

Well meaning but attacking the problem from the wrong direction. The ciggs are to cheap, thats the real problem. Tax the ciggs more and you will have a huge surplus to spend on medicaid and you incentivise the whole population into the bargain. Fair to everyone. Call it socialism.

$10.00 for a pack in my minds eye.

Drugs, violent crime, alcohol, tobacco, etc...all have been "taxed" in one way or another, yet the users all find ways to continue their use. I'd love to charge $50/pack and push all of the related medical costs squarely on smokers, but it won't solve the consumption problem. I still think the gov't and insurance companies should charge more for 'at-risk' and often non-compliant people, though the vast majority of non-compliant people will continue to suckle from the teet of responsible people/tax payers.

 

[Ibid]

A TAX INCREASE!!!? 😱😱😱
Government takeover! 🙄

Only a little itty bitty consumption tax....no one will even notice it after a while...🙂

Drugs, violent crime, alcohol, tobacco, etc...all have been "taxed" in one way or another, yet the users all find ways to continue their use. I'd love to charge $50/pack and push all of the related medical costs squarely on smokers, but it won't solve the consumption problem. I still think the gov't and insurance companies should charge more for 'at-risk' and often non-compliant people, though the vast majority of non-compliant people will continue to suckle from the teet of responsible people/tax payers.

Yes, but this legislation is not about consumption. It is not rational joined up policy making, far from it. It is a quick political fix to raise cash for organ transplants which became a political hot potato when they were cut. This bash the poor solution just raises the cash in a way that appeals to the core republican vote.

As you mention it though, prohibition doesn’t work either. By raising the tax burden on personal consumption you make the polluter pay so to speak. No one would be forced to pay this tax but it would raise more than enough to pay for itself.

Its always the same with the right, when a poor person receives a benefit its because their stupid but when a “responsible” tax payer gets a benefit/tax break to nudge them in a responsible direction (all paid for by borrowing and adding to national debt) that’s not because they are to stupid to do the right thing. Oh no that’s called being clever and smart. Oh no, tax breaks for the middle class that’s not teet sucking. Give me a break.

Everyone drinks at the public trough eventually. Everyone. Just ask a banker.

 

[kugel]

Suppose we did the opposite, and PAY people for pro-health behaviors?

Let's say we INCREASE the avg. private insurance premium by $200 per month per person covered over the age of 12.
Then we Pay that money back for pro-health behaviors:

- $20/month for Negative test for serum cotinine/nicotine.

- $5 per day (up to $100/mo) for every 30 min on a treadmill or bike or in the lap lane of the pool at "registered" healthclubs. Healthclubs would be flocking to "register" and install the card readers into which you put your insur card while on the machine or in the pool. Or you could hand out GPS wrist transponders that show 30 min walking/running - and you go download your GPS transponder once/month.
(Yes, there are ways to cheat, but it's a start. How many people do you think would walk/run/swim for me for 30 minutes for just $5?)

- $100/month for keeping your BMI below some arbitrary number.
(I'm not a big believer in BMI and similar numbers, but lots of people are.)

- $200 for negative drug test of the hair every 3 months

- Isn't there some test for past alcohol use, carboxylated hemoglobin or something?

- Insurance company gives out discounts on fruits and vegetables. You swipe your Blue Cross card just like your ValueCard. I think grocery stores would JUMP at the chance to bring in those customers and give them a big "Thank you for using your Blue Cross discount at Safeway. It's good for you and for your wallet!" Stores might give out big prizes for random Blue Cross card customers. Some stores would probably give "double value" to those discounts, just to get you in the door, and then fruits and vegetables become really cheap.

Anyway, you get the idea.
REWARD pro-health behaviors with a rather immediate, salient stimulus, and you might be able to combat the immediate and salient rewards of the poor-health behaviors.

 

[Ibid]

Kugel

Excellent! What about gym membership on prescription? or books or singing even, whatever works.

http://www.medicalnewstoday.com/articles/176316.php

 

[Manicsleep]

Well meaning but attacking the problem from the wrong direction. The ciggs are to cheap, thats the real problem. Tax the ciggs more and you will have a huge surplus to spend on medicaid and you incentivise the whole population into the bargain. Fair to everyone. Call it socialism.

$10.00 for a pack in my minds eye.

The increase of pack prices, the increase in advertising regarding the dangers of smoking as well as the general agreement that smoking will kill you has lead to a dramatic decrease in smoking.

Smoking is an excellent example of positive and negative reinforcement as well as punishment impacting behavior on both sides of the lines.

I agree that 10 dollars per pack would help. It would be great if they raised it slowly and advertised it heavily so people understood the impact on their wallets. It would also help if they actually used the money they got from the money raised from taxes, settlement to fight tobacco use.

 

[kugel]

Kugel

Excellent! What about gym membership on prescription? or books or singing even, whatever works.

http://www.medicalnewstoday.com/articles/176316.php

The trick is to pay for actual behaviors, not just getting a membership. And the rewards need to be pretty immediate.

Also, no one who has ever heard me sing would think it's good for anyone's health!

 

[notdeadyet]

The increase of pack prices, the increase in advertising regarding the dangers of smoking as well as the general agreement that smoking will kill you has lead to a dramatic decrease in smoking.

Agree with this ^^^.

Folks always seem to jump on "raising prices of cigarettes doesn't get people to quit" but it actually does. They did some massive studies on cigarette use in California when they jacked the prices up and found that smoking was reduced each time they did. Price increases will never stamp out cigarette smoking, but it will reduce it.

I agree that 10 dollars per pack would help.

It's already about $10 a pack in some cities. If I'm not mistaken, it's about that in Chicago.

 

[IAmAUser]

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