Arizona's Republican governor, Jan Brewer, has proposed charging obese Medicaid patients a $50-a-year fee if they don't follow a doctor-supervised plan to slim down. The "fat fee" would also apply to smokers and diabetics. Officials say the fee would give people a reason to get healthy, and that it's a crucial part of a plan to save $500 million a year in Medicaid spending. Critics say the new tax would punish patients for conditions they can't always control. Is this plan unfair, or is it a creative way to fix the state's cash-strapped Medicaid program?

This is downright mean: If Arizona really wanted to reduce costs, it would invest in preventive care, says Lindsay Beyerstein at Big Think, instead of declaring a "class war" on poor people who need Medicaid. This "cruel and regressive tax" isn't about saving money or improving public health — it's about making government assistance "as degrading" as possible. "What's next, pillory stocks?"

"Fat as class war in Arizona"

What is unfair is making others pay for your unhealthy habits: "If you want to smoke, go for it," says Arizona Medicaid spokeswoman Monica Coury, as quoted in The Wall Street Journal. But the reality is that by making unhealthy choices — such as smoking or failing to exercise and trim down — you are damaging your health. Treating the ailments that result from your decisions costs money, so you're just "going to have to contribute something" so others don't have to foot the bill.

"Arizona proposes Medicaid fat fee"

Like it or not, Medicaid changes are coming: Arizona would be the first state to punish Medicaid recipients for "unhealthy habits," says Katy Steinmetz in TIME, but it isn't the first to consider a fat tax. In 2008, Alabama, which has consistently high obesity rates, slapped a $25 surcharge on obese government employees who failed to lose weight. The bottom line is that a quarter of Arizonans are obese, and obesity leads to expensive health problems. With a $1.1 billion Medicaid budget shortfall, it's something Arizona can't ignore.

"Arizona's flab tax"