Saturday, November 14, 2009

Fighting the Smoking Plague

Despite much more consumer knowledge about the high risks and required cigarette pack health warnings, each year in the U. S. smoking still kills more people than AIDS, alcohol, other drug abuse, car crashes, murders, suicides, and fires - combined! Causing more than 430,000 deaths annually, it's the leading preventable cause of death, reflected in statistics for those dying from heart disease, cancer and stroke, and direct medical costs are estimated at as much as $50 billion annually, according to the U. S. Center for Disease Control.

It's noteworthy that the estimated cost of implementing the healthcare reform bill approved by the U. S. House of Representatives a week ago is $1.2 trillion over the next ten years, broadly criticized by many as much more than we can really afford, even though that's on average a relatively almost acceptable $120 billion annually. The $50 billion direct medical costs from smoking is nearly 42% of that number. My guess is that after the Senate provides their input, we'll end up with final bill approved by the Congress at a lower ten year cost between $950 billion and $1.0 trillion, increasing the smoking associated 42% number to 50% or more.

Smoking is a societal plague for several reasons, aside from the high medical costs for the nation grappling with our high national debt, large budget deficits and near record unemployment, and the high number of fatalities caused by this source. As individual smokers know, it's a very expensive habit at a time when a great many Americans are needing to hunker down financially, including most likely a high percentage of those 46 million U. S. adults over 18 who were smokers in 2008. At a national average cost of roughly $5 a pack and smoking at a rate of 1 1/2 packs a day, the annual cost is more than $2,700. At two packs a day it's $3,650 annually. This is, of course, aside from any medical costs to be incurred treating diseases caused or contributed to by smoking, costs for trying to contain or eliminate the addiction to tobacco, and the costs of dry-cleaning clothes and cleaning the air in homes fouled by the nasty habit.

Another very troubling fact is that so many teenagers are smoking, fully 28% of high schoolers in this country, and at least 4.5 million are addicted users of cigarettes. Furthermore, 6,000 teenagers under 18 reportedly are picking up the habit every single day and nearly one third of these are expected to become regular adult smokers. Finally, for this post, a further significant concern, as far as I'm concerned, is the completely unnecessary and unacceptable littering done by smokers with their cigarettes and cigars and the concomitant fire danger this can pose.

What can and should be done to better fight this plague? The answers are fairly obvious for the most part, but they still bear repeating:

1. Make sure that no smoking is allowed in any of our schools funded by taxpayer dollars and that there is strict enforcement and sanctions for any violations, for both student violators and uncooperative school officials.
2. More effective teaching of the dangers of smoking beginning in the 7th or 8th grades and through high school.
3. High school sports coaches should be encouraged by school officials, if not done so already, to exclude smokers from their teams and to support efforts of smoking athletes to break the habit.
3. Since smoking rates are in general higher for the less well educated, continue current efforts to improve our education system with higher high school graduation rates and more students going on to college.
4. Increase the cost of tobacco products by even higher federal and state tax levels. It's noteworthy that there's a very substantial difference among state sales tax levels. In New York the state has a sales tax of $2.75 per pack, while in South Carolina it's only $0.07 per pack and in Missouri it's just $0.17 per pack. Interestingly, but not surprisingly, South Carolina and Missouri are among the states with relatively high numbers for percentage of smokers.
5. In the final healthcare reform bill to be approved by Congress, make sure there are adequate provisions to financially incent people to stop smoking or at least to reduce their level of smoking, as well as discouraging people to start. Concerned citizens should immediately contact their senators and representatives to pass on their point of view.
6. Insurance companies providing coverage for health, home and autos should be incented by Congress and/or market competition to establish or increase more meaningful discounts for non-smokers.
7. Fines and community service terms for tobacco product litterers should be increased significantly with appropriate publicity in local newspapers and TV news programs.

Monday, November 9, 2009

Healthcare Reform Update

This past Saturday the U. S. House of Representatives finally passed their massive healthcare plan by a very close vote of 220 to 215, with only one Republican supporting it and 39 conservative Democrats voting against the plan. It is now the U. S. Senate's turn to come up with a bill their chamber can approve. President Obama has for many months been hoping he can sign into law before the end of the year a final bill approved by the Congress, but it's very possible the legislative process will drag into January or February, given the strident opposition and filibustering opportunities available to the Republicans in the Senate.

I mentioned in my post on Healthcare Reform in June that I was confident reform legislation would be approved by Congress and signed into law by the end of the year. I'm still confident, but possibly I may have been a little too optimistic on the timing. I also mentioned in June that I was hopeful the legislation would be the product of genuine bipartisan debate and consensus. Unfortunately it's clear this didn't happen. Looked at narrowly, the approval in the House was a victory for President Obama and the Democratic leadership and a loss for Republicans. However, the result in my opinion was not in the best interest of the American people. A bipartisan bill incorporating the best ideas of Democrats, Republicans, as well as Independents, in a more balanced manner would have been much better.

In fact, the bill could most probably have been significantly improved if it also took into account some of the best features of the health care systems employed in several of the other advanced democracies in Europe and Asia, as covered in Frontline's recent TV presentation, "Sick Around the World." Primary among those countries, as I perceived it, were Japan, Taiwan, the U. K., the Scandinavian countries, Germany and Switzerland. Taiwan used this very approach in effectively reforming their apparently very successful system. Some of the main features highlighted in their broad survey were a generally high degree of patient satisfaction with the systems, good quality care, no medical bills for patients, no bankruptcies of patients resulting from high medical bills, limited and improving waiting times for patients, and much lower administrative costs to operate their systems. In the U. S. administrative costs reportedly were about 16% of total healthcare costs versus an average of about 5-6% in these other countries.

Clearly, huge savings in healthcare costs could be achieved if we could learn from the experiences of these other countries and follow their leads in substantially reducing administrative expenses. Has this been seriously explored by politicians and medical experts advising them? Or have both groups essentially been dissuaded by the private sector healthcare industry and their lobbyists?

It's not too late, but I'm not optimistic about a good bill coming out of the Senate within a reasonable timeframe. I'm afraid serious ideological differences, as well as motivation by Republican leaders to do what they can to deter President Obama from achieving a major legislative victory on a high priority issue, will make it unlikely the Senate will come up with a sensible, pragmatic and bipartisan result that best serves the great majority of the American people. Another obstacle will be the impact of expected campaign contributions for the approaching congressional elections. I hope I'm wrong and that these points can be overcome.