Archive for Sunday, June 14, 2009

Breaking the habit

New federal legislation may be the important next step in reducing America’s tobacco use.

June 14, 2009


There may be a few Americans out there who really enjoy their cigarette habit, but by far the majority will tell you they wish they could quit.

It’s an expensive and often offensive habit, not to mention being the nation’s largest single cause of preventable death.

Federal legislation that went to the president Friday could make a significant dent in America’s smoking addiction. It not only would institute a number of measures aimed at preventing young people from becoming smokers but also gives the Food and Drug Administration the authority to regulate levels of tar and nicotine, the cigarette ingredients that promote addiction.

Although the connection between cigarettes and cancer has been known for decades, the new laws will require even stronger warning labels. It bans the use of words like “mild” or “light” that might lead a consumer to believe cigarettes are less harmful. It also bans flavored cigarettes and advertising that is targeted toward young people.

Perhaps even more important, it forces tobacco companies to seek approval from the FDA before marketing new products and give the FDA power to regulate cigarettes more like a drug, perhaps leading to changes in cigarette ingredients. The law goes about as far as the government can to reduce the consumption of tobacco short of simply outlawing it.

Although the bill passed both houses by large majorities, there were, of course, opponents, mostly lawmakers from tobacco-producing states. Rep. Howard Coble, a Republican from North Carolina, reportedly argued that “allowing the FDA to regulate tobacco in any capacity would lead to the FDA regulating the family farm.” That would seem to be true only if those farms were raising products that posed a serious health hazard to consumers.

Some people may think eating red meat, for instance, isn’t the most healthy choice, but it pales by comparison with the 400,000 people who die every year from tobacco-related diseases, according to government figures. Those deaths represent individual tragedies as well as a $100 billion national price tag to provide health care for people with tobacco-related illnesses.

In a nation built on individual freedom, Americans still will be free to smoke, but the legislation passed Friday may make cigarettes at least a little less attractive to smokers and especially to young people who haven’t yet decided to take up the habit.


Richard Heckler 8 years, 11 months ago

"With national health insurance ('Medicare for All'), we could provide comprehensive, lifelong coverage to all Americans for the same amount we are spending now and end the cruelty of ruining families financially when they get sick."

Illness and medical bills caused half of the 1,458,000 personal bankruptcies in 2001, according to a study published by the journal Health Affairs.

The study estimates that medical bankruptcies affect about 2 million Americans annually -- counting debtors and their dependents, including about 700,000 children.

Surprisingly, most of those bankrupted by illness had health insurance. More than three-quarters were insured at the start of the bankrupting illness. However, 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy.

Most of the medical bankruptcy filers were middle class; 56 percent owned a home and the same number had attended college. In many cases, illness forced breadwinners to take time off from work -- losing income and job-based health insurance precisely when families needed it most.

Families in bankruptcy suffered many privations -- 30 percent had a utility cut off and 61 percent went without needed medical care.

The research, carried out jointly by researchers at Harvard Law School and Harvard Medical School, is the first in-depth study of medical causes of bankruptcy. With the cooperation of bankruptcy judges in five Federal districts (in California, Illinois, Pennsylvania, Tennessee and Texas) they administered questionnaires to bankruptcy filers and reviewed their court records.

Dr. David Himmelstein, the lead author of the study and an Associate Professor of Medicine at Harvard commented: "Unless you're Bill Gates you're just one serious illness away from bankruptcy. Most of the medically bankrupt were average Americans who happened to get sick."

Today's health insurance policies -- with high deductibles, co-pays, and many exclusions -- offer little protection during a serious illness. Uncovered medical bills averaged $13,460 for those with private insurance at the start of their illness. People with cancer had average medical debts of $35,878.

"The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every health care dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured" said Dr. Quentin Young, national coordinator of Physicians for a National Health Program.

"With national health insurance ('Medicare for All'), we could provide comprehensive, lifelong coverage to all Americans for the same amount we are spending now and end the cruelty of ruining families financially when they get sick."

Read more:

Richard Heckler 8 years, 11 months ago

Paying through the Taxman

The U.S. health care system is typically characterized as a largely private-sector system, so it may come as a surprise that more than 60% of the $2 trillion annual U.S. health care bill is paid through taxes, according to a 2002 analysis published in Health Affairs by Harvard Medical School associate professors Steffie Woolhandler and David Himmelstein.

Tax dollars pay for Medicare and Medicaid, for the Veterans Administration and the Indian Health Service. Tax dollars pay for health coverage for federal, state, and municipal government employees and their families, as well as for many employees of private companies working on government contracts.

Less visible but no less important, the tax deduction for employer-paid health insurance, along with other health care-related tax deductions, also represents a form of government spending on health care. It makes little difference whether the government gives taxpayers (or their employers) a deduction for their health care spending, on the one hand, or collects their taxes then pays for their health care, either directly or via a voucher, on the other.

Moreover, tax dollars also pay for critical elements of the health care system apart from direct care—Medicare funds much of the expensive equipment hospitals use, for instance, along with all medical residencies.

All told, then, tax dollars already pay for at least $1.2 trillion in annual U.S. health care expenses. Since federal, state, and local governments collected approximately $3.5 trillion in taxes of all kinds—income, sales, property, corporate—in 2006, that means that more than one third of the aggregate tax revenues collected in the United States that year went to pay for health care. (See Addendum below for information about how this estimate was calculated.)

Beyond their direct payments to health care providers and health insurance companies, then, Americans already make a sizeable annual payment into the health care system via taxes. How much does a typical household contribute to the country’s health care system altogether? Of course, households pay varying amounts in taxes depending on income and many other factors.

Moreover, some households have no health insurance coverage; others do have coverage for which they may pay some or all of the premium cost. What I aim to do here is to estimate the average size of the health care cost burden for households at different income levels, both those with job-based health coverage and those with no coverage.

Richard Heckler 8 years, 11 months ago

Getting What We’ve Already Paid For

Americans spend more than anyone else in the world on health care. Each health insurer adds its bureaucracy, profits, high corporate salaries, advertising, and sales commissions to the actual cost of providing care. Not only is this money lost to health care, but it pays for a system that often makes it more difficult and complicated to receive the care we’ve already paid for.

Shareholders are the primary clients of for-profit insurance companies, not patients.

Moreover, households’ actual costs as a percentage of their incomes are far higher today than most imagine. Even families with no health insurance contribute substantially to our health care system through taxes.

Recognizing these hidden costs that U.S. households pay for health care today makes it far easier to see how a universal single-payer system—with all of its obvious advantages—can cost most Americans less than the one we have today.

Joel A. Harrison, PhD, MPH, lives in San Diego, where he does consulting in epidemiology and research design. He has worked in the areas of preventive medicine, infectious diseases, medical outcomes research, and evidence-based clinical practice guidelines. He has lived and studied in both Canada and Sweden.

Leslie Swearingen 8 years, 11 months ago

Oh, come on people! There are far more people involved in the tobacco industry than the CEO's. There are the farmers who raise the tobacco. What would they do if their crops were abruptly outlawed? They support their families on this, and some have done so for generations. What of the people who work in the factories making the cigarettes? Can they immediately find new jobs? The truckers who haul the product. How easy can they find new jobs? There is a lot more at stake here than someones dislike of smoking.

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