Plan B Forum

Overweight welfare claimants in the US state of Arizona face paying $50 (£31) fines if they don't follow a dietary regime laid down by their doctor. Is that fair?

Just as American waistlines - like many in the Western world - continue to expand, so does the budget to meet the associated costs.

Medicaid, the programme which provides healthcare for the poor, costs the US federal and state governments $339bn (£209bn) a year, a figure climbing 8% annually.

The federal government matches state spending on the program, providing as much as $3 for every $1 spent in poorer areas.

Given the size of the budget, it's no surprise that Medicaid has become one of the fiscal battlegrounds in Congress.

Now the state of Arizona is proposing a radical idea. It wants to impose a $50 annual fine for overweight Medicaid recipients who don't follow a strict health regime developed with their doctor. Those with children, and people overweight due to a medical condition, would be exempt.

Smokers and diabetics who ignore their medical advice would also have to pay.

Monica Coury, assistant director at Arizona's Medicaid programme, says the aim is to change behaviour using a carrot and stick approach, in the same way that increasing cigarette taxes reduced smoking.

"It's undeniable that there is a link between obesity and the rising cost of healthcare in America, so we can't be afraid to discuss this issue.

"It's reaching a crisis level in the US and we continue to complain about the rising uncontrolled costs of care - and yet we don't drill down and test some of these concepts."

Although some private companies have similar penalties in their health insurance cover, this would be the first time any state health care programme has charged people in this way for what could be deemed an unhealthy lifestyle.

Arizona has the second-highest proportion of Medicaid recipients in the US, and a quarter of its residents are classed as obese. Among its other plans to cut its annual $10bn (£6.2bn) Medicaid bill is to freeze enrolment for some childless adults.

Other states will be watching closely as they all scramble to cut costs, says Matt Salo of the National Association of Medicaid Directors.

"They don't know how they will survive the next two years. States are facing a $175bn (£108bn) shortfall. It's a huge amount of money and it's a time of great uncertainty.

much more information here in this BBC article.