Here's a bad idea that didn't make it into the Missouri HealthNet bill a "rewards debit card":
The idea was to give recipients rewards for healthy choices that could be used to purchase additional services. Shields points out that while the idea didn't make it into the bill, it isn't dead. He says the Department of Social Services could still consider the idea when it works on the details of MO Health Net.
If this debit card becomes part of the program, it will result in a lot of waste. First, most healthy choices are not easily monitered. How will the state know if someone chooses to exercise more or doesn't smoke cigarettes? The debit card would encourage people to use more of the easily monitored services, such as exams or medical tests, in order to get rewards. That wouldn't necessarily make anyone healthier, and it could eliminate the efficiency gains some people anticipate from the program.
Second, what's healthy for one person might not be healthy for someone else. And there's a lot of disagreement about which choices are ever healthy, as is evidenced by the proliferation of diets and exercise plans. Some people might just throw up their hands and conclude that everything is healthy. For example, you can find the American Heart Association seal on just about any food at a grocery store other than potato chips.
It's a better idea to let people make their own choices, without rewards or punishments from the state. If people are responsible for some routine health care costs, such as through a health savings account, they'll have an incentive to make the choices that are healthy for them.