Will Arizona Lead the Global Anti-Obesity Revolution?

Until now, few people would have considered Arizona Governor Jan Brewer a force of progressivism and enlightenment. That is why a recent initiative of hers — to make enrollees in Medicaid programs pay a $50 annual fee for violating a doctor-prescribed anti-obesity regimen — is all the more remarkable.

You see, as much as obesity has become a national scourge, any efforts to battle this trend are quickly portrayed as efforts to rein in the “freedom” of Americans — in this case, the freedom to eat copious amounts of calorie-laden foods.

To defend their turf, a ready-made coalition of conservatives and business interests stands by, always ready to pay for TV commercials that are designed to defend Americans’ expanding waistlines.

“We don’t need the government to tell us what to eat. As a free and sovereign people, we can make our own decisions” — even if that means an ever-expanding mid-section of one’s body.

Trouble is, for all the healthcare problems the United States faces already, the obesity trend is a time bomb unlike any other. Obesity is becoming increasingly prevalent among U.S. youth, resulting in a sharp rise in Type II diabetes and other obesity-related maladies.

As these overweight youth age, their health will deteriorate much more dramatically — and their health care will become ever more costly if they remain obese.

And since obesity tends to be inversely related to personal wealth, this is fast becoming a public-spending issue since Medicaid provides health coverage for poor patients unable to afford health insurance.

Arizona’s governor has seen the writing on the wall and, in a symbolic move, now seems determined to get at the problem by penalizing poor overweight people, as well as poor smokers.

In the peculiar logic of American politics, such a measure would have long been decried on Fox News and elsewhere as a blatant case of government socialism if it had sprung from the mind of the governor of, say, New York, California or Massachusetts.

Worse, it would have next to no chance to become public policy for the nation under those circumstances.

But if such a measure is proposed by a conservative governor in a conservative state, it has a much better chance of becoming widespread and developing national traction.

That is especially true if the measure is cast as a budget-balancing matter — and one focused on poor people. Once this proposition is on the books, let’s have the U.S. Constitution work its wonders.

After all, it is discriminatory to penalize only poor people for their unwillingness to fight obesity. Under the Medicare program, which provides health insurance to all Americans above the age of 65 irrespective of income, the costs of obesity are much larger — and so are the federal budget-busting consequences.

Under any kind of equality clause, and certainly under the rules of fiscal prudence, such a regulation, once on the books, must expand to all recipients of government-sponsored health care to keep it from being discriminatory.

All of that is why Governor Brewer ought to be applauded for having overcome the political paralysis in dealing with the obesity issue. After her announcements, fighting obesity is no longer the fourth rail of American politics.

The surcharge could be considered part of a broader trend to focus more on personal responsibility and accountability. Incentivizing healthier lifestyles in this way will ultimately lower society-wide costs.

True, the governor may not yet realize the full consequences of her own actions, but the good news is that the genie is, at long last, out of the bottle.

There is no denying that fighting obesity in the United States, because of the Medicaid/Medicare link, is very much a budget — and hence public policy — issue, especially for Republicans.

Democrats ought to welcome this happy accident of history, not by fighting what’s happening in Arizona, but by showing their determination to spread the initial regulation to all other relevant circumstances.

After all, they should know that, in the current political environment in the United States, smart regulation — or so it seems — can only happen inadvertently, by virtue of entering through the back door.