Smoking is All About Poverty
I raised the issue of why the elderly pay more than smokers for healthcare insurance since growing old is a natural occurrence and smoking and its associated disorders is self-inflicted. I raised it after STR said smokers are being robbed and I pointed out the elderly non-smokers and smokers pay 3 times the lowest cost insuree as determined by the MLR. Coberly believes there should be Medicare for all. The idea is a great one once we get a Congress who will support it. Even with a Senate majority of Democrats and faux Democrats, any alternatives to the PPACA went nowhere. For now and until Congress gets more sympathetic to its constituency, we have the best which can be conjured up today. With her reply, my fellow healthcare writer and expert in healthcare answered my post to one of her articles:
Me: I am crying crocodile tears for smokers paying 50% more than the lowest cost insuree. This is a tough pill to swallow for smokers who self-inflict this damage to themselves. The 50% premium for smokers pales in comparison to the 300% above the lowest cost insure, the elderly will pay for just being old a condition which is unavoidable. Come on Louise, you can not be serious.
Maggie Mahar: Most people don’t know the vast majority of adult smokers in the U.S. are low-income, didn’t complete high school, and leading very stressful lives. This is why they smoke. As a recent study of smokers in New Orleans and Memphis quotes one of the research subjects:
“”So many things fill your mind and you go through so much, you need your cigarette to smoke to calm down and get things off your mind,” says one of the participants, quoted in an article about the study in the March/April issue of the American Journal of Health Promotion.
“In our study, cigarette use was defined as a ‘buffer’ for dealing with multiple demands, financial insecurity and daily hassles,” say Bettina M. Beech, Dr. P.H., M.P.H., of the University of Memphis, Department of Psychology and colleague.
More affluent better-educated Americans are far more likely to quit smoking than low-income very poor Americans for several reasons.
1) they have a reason to want to live. If you’re a black male who can’t find work, can’t put enough food on the table to feed your kids, and worry about what’s going to happen to them on the street, you’re angry, depressed and stressed. You are far more likely to engage in self-destructive behaviors –smoking, drinking, drugs. No matter how hard you try, chances are slim that your life is going to improve.
2) if you’re poor you cannot afford the nicotine patches and other drugs that making stopping so much easier for more affluent people. You probably also don’t have a doctor to prescribe these things. Louise is right– we need free smoking cessation clinics. The VA and Kaiser have both shown that they work. Of course poor people would like to quit smoking. A recent study in New York state shows that they spend 25% of their income on cigarettes. So why don’t they save up that money and buy a nicotine patch? Depression and stress sap a person’s will–and their ability to hope. Even if they stop smoking, they know that their lives are not going to suddenly get better. As the U. of Santa Clara points out on its Ethics home page:
“penalizing individuals for unhealthy behaviors could result in great injustice and social harm.”
While 18 percent of U.S. citizens with incomes above the poverty line smoke, the figure almost doubles to 33 percent for those with incomes below the poverty line. A one-dollar cigarette tax would have a strongly regressive effect on the low incomes these individuals receive. Consider the added problem of tobacco addiction and the probable result of a tax is not less smoking or lower health care costs, but fewer dollars spent on nutritional food and other essentials – conceivably leading to more illness and higher health care costs.”
By charging smokers more for insurance, you increase the chances that they won’t be able to afford it. Given the choice between cigarettes– which they are addicted to and which they associate with relief of stress–and insurance, they’ll choose the cigarettes. Bottom line, when we blame smokers for smoking, we are blaming the poor for being poor. Tobacco companies know why people smoke.
Consider this confidential internal Philip Morris report:
”Lower class panelists smoke more and are much more likely to be smokers than upper class panelists…”
It also found that lower class people tend to smoke non-filtered cigarettes (tend to “avoid health filters”) and that they also tend to avoid 100 millimeter-length brands. The writers also observe that lower class people have more incidence of poor mental health, hypothesizing that people use smoking as a “strategy” to combat the stress of low class status as well as poor mental health:
“…the incidence of poor mental health is greatest among the lower class…To the extent that smoking is one of the available strategies people can adopt to combat stress, we therefore would expect greater incidence of smoking among the lower social classes.”
This is why in recent years, tobacco ads have targeted low-income people and African Americans. (Btw–they’re right, smoking is also associated with mental health problems.)
Me: I had to reconsider my stance on smokers being let off easy given the weight of the evidence presented on why smokers should not pay more. http://www.healthbeatblog.com/2013/01/the-newest-health-wonk-review-on-health-affairs/#comment-17887 “Health Wonk” Health Beat blog