Smoking is All About Poverty
by run75411
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. Exploring alternative stress-relief methods, such as biocbd+, could offer a healthier option for individuals.
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
I agree completely with Maggie Maher on this–especially since nicotine is just about the most addictive chemical there is.
“penalizing individuals for unhealthy behaviors could result in great injustice and social harm.”
This is exactly correct. It coinsides with our past few decades of “get tough” concept that is nothing more than persecution.
However, the idea that raising the cost will make people quit only goes so far. More than that, consider that the tobacco suit was based on the smoker being a victum and not at fault for their addiction and thus the settlement. To then raise the cost via taxation on such people might actually be not so legal or constitutional in that we are taxing people who are victums by the fact of the tobacco suit. But, there is no big payout for someone to take up that case, so it won’t happen.
The other perversion is that we are using it as a general revenue generator. We are hitting people while they are down and justifying it as good for them to sooth our souls. We get away with it, because socially smoking has become a moral negative so teach those smokers a lesson.
sorry folks. i don’t buy it.
let me begin, however, by trying to be clear about what is a more important point.
we are all going to get old. this is not about punishing misbehavior.
it is just more sensible to pay for your eventual health care needs in old age at an affordable rate while you are young and have an income. This is what Medicare does… even the general budget part of Medicare.
I don’t think private insurance can manage this kind of “pre pay” over a lifetime. which is why we need Medicare.
rather than charge a higher premium for smokers, i would offer a lower premium for non-smokers. and if you think this is being “cute”, you are right. but “cute” works when dealing with humans, and “punitive” does not.
but if poor people are spending 25% of their income for smoking, then they need to check into a rehab program… government run.
i think the poor liberals run off the rails … not to mention alienate the people who would naturally be on their side (workers) by feeling oh so sorry for those who just can’t help themselves.
there may be some cosmic justice in that, but down here on earth we think we should be encouraging people to take some responsibility for themselves and stop feeling like victims.
(To the tune “If I Ruled the World…”) If we were really serious, here’s what I would do to tackle the tobacco addiction problem.
1. As several of you have said, provide free rehab programs, government run, and none of your state’s rights business, either.
2. Cut the cost of tobacco products in half, at least. Remove all taxes except ordinary sales taxes.
3. At the same time, move all tobacco products out of every sales outlet EXCEPT pharmacies. People would need a prescription card to access tobacco at these much lower rates. These cards would be available only to persons over 18, with younger smokers grandfathered in if necessary for the first 10 years or so. (More than 80% of smokers began smoking before age 18, and many of these started before age 10.)
5. Underage smokers lacking a prescription card would be relieved of their smokes every time they were found with them, but would otherwise suffer no legal repercussions. However, people found supplying them would fall under child abuse or some similar law (administering a noxious substance, perhaps.)
6. I would mandate that tobacco products could contain only tobacco, none of the myriad other chemicals currently added.
7. Finally, if this is even still necessary, I would offer funding for increased research on tobacco addiction, what predisposes people to it and how it can be circumvented. Heck, lets be generous and fund research into the possible beneficial properties of nicotine, too.
Why would this work, when alcohol prohibition didn’t?
Well first, tobacco manufacture even at its crudest is actually rather difficult. You can make booze in a jam jar under your bed — not so with tobacco.
Second, addicts wouldn’t be cut off, hallelujah, they would also experience a huge drop in prices which would, God knows, be a blessing to people with too much on their plates already.
Third, the reduction of price, brand competition, taxes, etc would remove both the corporate and political profit motive from the equation, while still paying the farmers and grassroots processors as much as they have ever made — but cutting their load of guilt if that’s been bothering them.
How long would it take for smoking to go from a widespread habit to a rare, medical problem in the society at large? I would guess about 15 years.
Noni
6. I would mandate that tobacco products could contain only tobacco, none of the myriad other chemicals currently added.
That is a definate necessity if we are serious about the issue. There is some thinking that a good portion of the issue of tobacco is the processing. Kind of like a lot of what is ailing us.
coberly & Noni
Um– when poor people “check into a rehab program” who takes care of their children?
How do they find a job when they get out? (Bosses don’t hold jobs for low-income workers who “check out”)?
Noni-
I like your ideas.
But let me just add that we don’t need more research on nicotine addiction. It’s pretty straightforward, and we have very good drugs that can help smokers
stop smoking. Someone just needs to pay for them.
Alchoholism, on the other hand is more complicated. (genetics, alchohol, body chemistry, etc. etc.)
We don’t have really effective medications to help alcoholics stop drinking. AA help some –but many who succeed on AA ultimately fall off the wagon.
We also don’t have effective help for people suffering from obesity. Even if they diet and exericise under a doctor’s supervision–and are totally compliant –97% regain the weight they lose.
(This is why are tendency to blame the obese for being obsee is so cruel.
Do you know of a government-run free rehab program for smokers?
But we really could help most smokers stop smoking with free smoking cessation clincs. Some won’t make it. They’re too depressed, and just don’t have the will. But many would– and this would go a long way toward improving the heatlh of the population–and reducing health care costs.
So why don’t we do it?
Because the majority of people who smoke are low-income.
Wouldn’t it make more sense to break the poverty instead of breaking the habit that makes poverty tolerable?
Concentrate on bringing back manufacturing.
Reimpose Glass-Steagall and enforce it brutally.
Eliminate the financial sector entirely. Force investors to invest in American jobs. Shoot anyone who outsources.
Eliminate the idiotic “environmental justice” crap that prevents factories from locating where the poor people live.
When low-skilled men can support a family, they will have much less reason to smoke, less reason to commit crimes, less reason to do other drugs.
This is not theory. We know it from experience. We’ve been there before.
Keep in mind that different times had different norms. When I was growing up, smoking was the norm, and at the same time the American middle and lower classes were doing better than ever before or since. So poverty and tobacco use aren’t necessarily linked. You can easily have a country with high poverty and low tobacco use, for instance if tobacco was a luxury item rather than an ubiquitous presence. Or, you can have a low poverty country with high tobacco use, such as the US in the 50s and 60s.
But these are differences across populations. Individually, once a person has become addicted they don’t have 2% or 5% tobacco use, they have addiction level tobacco use, and making that person financially better off at that point will not effect their addiction much, except perhaps to make it worse due to greater ease of purchase.
So there are two problems — preventing the establishment of addiction in the population, but also assisting addicted individuals to reduce or eliminate the medical harm and financial burden of tobacco use. They are separate, and some of the policies used to deal with one can be ineffective or even harmful in the other sphere.
My approach, I hope, would deal effectively with both spheres at the same time.
Noni has it right. I would only add why it is that smoking cessation tools should be free.
Half of smokers quit once the effects became completely disseminated, then quitting just stalled, even for people who kept trying.
That’s because there’s a large subset for whom quitting is analogous to having a stroke: it takes years regain/retrain concentration and some of the other brain activity that affect IQ and any sense of equanimity. Some very well paid coders, celebrities, you-name-them use gum, etc. for years.
For these people, Chantix, the patch, and gum don’t work well. since they don’t mimic the peaks and valleys of nicotine’s effect on the brain. Another proof of this is that the spray, 5-10 times as expensive, works about that much better. Another example of why taking away the money of those who need the most expensive treatments is counterproductive. It’s also why electronic cigarettes are so profitable.
Maggie
being one of the poor myself, it never even occurred to me anyone would think of a “residential” rehab. That’s for rich drug addicts.
Whatever the complications, I still can’t buy the “poor poor” theory of government. I am pretty much of a liberal in regard of government programs to help the poor. But treating them like irresponsible victims does not help them.
And I don’t take a “moral” attitude toward them. I don’t regard cigarette addiction as sin.
But if you are going to smoke, you are going to have higher medical costs, and to the extent that “insurance” is a way of sharing costs whether government paid or not, it is reasonable the persons with known high risk behaviors should bear some extra cost for paying for the higher risk.
I suspect you will not believe me, or understand me, or even hear me… but I am not one of those who proposes leaving the poor, or even the addicted, to die on their own. But the opposite attitude… that they are just poor victims and “we” (usually “the rich”… that is, someone who makes more money than i do) should just take care of them no matter how self induced their degradation is… will not fly with me. Or with most of the voting public, who see that attitude among “liberals” and run away from it as fast as they can.
Find a way to help the poor if you can. But don’t advertise your complete abandonment of the concept of responsibility while you are doing it. That will make sure you can NEVER do anything effective, because people won’t trust you.
This comment has been removed by the author.
1) Health care is not a right. It can’t be.
2) Old people pay more for health insurance because in any given period, they are far more likely to need health care – and more expensive care – than younger people, including younger smokers. There is nothing unfair about it.
3) Taxing and stigmatizing smoking is not punishing the poor for being poor. It is “punishing” a behavior that a large majority of society don’t like and want to discourage. That a higher percentage of poor people engage in the behavior is irrelevant.
If they stop smoking they can go from being poor to being a lot less poor.
tobacco and alcohol are generally high cost items for those who smoke and drink in any quantity. Especially if your poor.
Oh, and Lou Bricano: Health care is a right for many people in many countries. Just not yours. I’m happy to say it is in mine.
Lou Bricano
I wish you had read my comments. Not that you don’t have a right to your opinion. But when your opinion shows that you have not even considered the other opinions offered here, it makes people feel like it isn’t worth talking to you.
Health care can be a right if we decide to make it one.
Old people can pay for their expected costs in old age while they are still young. See Medicare… or my humble comments on same.
The point about higher premiums for smoking is not to “punish behavior we don’t like.” It is to attempt to match the cost of insurance to the probability of illness resulting from that behavior.
A little like a “preexisting condition” if you will, except that most people, not extreme liberals, believe that smoking is a choice not a disability.
NO doubt some day they will discover a gene that predisposes some people to smoking, and then there will be a debate about whether we should tax people for their genes, but in the meanwhile it is still bad politics, and in my opinion bad policy, to go around saying “the poor smokers, they just can’t help themselves, and since they are poor, the rich should buy their cigarettes for them.”
Lou:
Healthcare is a right and should not be priced in such a manner that only the rich in income only afford it.
I assume you are at your BMI weight? If not, then why should we pay for your addiction to be 10 lbs or more overweight because you like Italian sausage or greasy burgers with bacon and cheese. Obesity caused diabetes is the growing trend and will surpass smoking as the #1 killer. This generation of children is expected to live fewer years than there parents.
Only a small % of the elderly cause the large percentage of medical expenditures. It is not fair or equitable to punish a person because they are old. A large percentage live in poverty as it is today.
This comment has been removed by the author.
No, I’m sorry, health care is not a right. There are no rights to any goods or services. There cannot be. If there were, then that would turn others into slaves: forced at gunpoint to work for others. No, absolutely there cannot be any right to any good or service. As a civilized people, we may choose not to let anyone starve to death or go without clothing or die untreated of communicable disease, but we do that as a matter of charity only, not out of respect for any rights.
As a matter of fact, I am right below the top limit for normal BMI, at 24.5. I’m 60 years old, 5’6″ tall, weigh about 152 pounds (10 pounds more than at high school graduation), have a 31 inch waist, and I can bench press a pair of 65 pound dumbbells 11 times.
Neither obesity nor smoking is a cause of death in anyone. They are risk factors for illnesses that can be the cause of death.
It simply is false that only a small percentage of elderly incur high medical care expenditures. The elderly go to the doctor more often, take far more – and more expensive – medicines, and in any given year, are far more likely to be hospitalized than the non-elderly. This is true even for elderly people who were in generally robust health when younger. A CDC study covering 1992-1996 found that mean medical expenditure in the last year of life for elderly 65+ was $37,581 versus $7,365 for non-terminal years (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464043/). It is a well established fact that smoking actually saves the government money: people who die of smoking related illnesses tend to do so both younger and faster than people who don’t smoke. There is a saving to the government both of medical and pension expenditure.
And to Coberly: no, we cannot grant rights – by no means. Rights exist independently of the existence of government or society. Rights can only be negative: statements of what others, acting either individually or in concert, may not morally do to you. We do not have a right to keep and bear arms because the Second Amendment “granted” or “conferred” such a right on us – we have that right because every man has an inherent right to self defense against the immoral depredations of others, irrespective of the existence of government and civil society.
A belief that you have a right to health care, or food, or nice housing, or a daily ration of cake and ice cream, is infantile. Children want things and wrongly think they are entitled to them. They don’t understand that someone must engage in productive endeavor in order to create and provide those things, and that it is immoral to compel anyone to do that against his will. There is no right to happiness or satisfaction. Our Declaration of Independence very properly speaks of a right to the pursuit of happiness, but you must conduct that pursuit within the limits of your own ability. As a civilized and charitable people, we may choose not to let people starve or die in the streets, but it is not based on any rights people hold – it is based solely on our innate impulse to compassion and charity. You must never lose sight of the fact that it is an act of charity, not the fulfillment of a legal obligation.
The comments in reply to this so-called article, as well as the article itself, betray an appalling ignorance of the understanding of rights and their origin. Rights establish moral obligations on people with respect to other people. There can be no inherent positive rights. Positive rights can only arise contractually: if A agrees to provide some good or service to B, then B has a right to it, or to some form of compensation if A fails to perform. Only negative rights inhere in people as a condition of existence. B has an inherent moral right to go peaceably about his business, and that creates an inherent moral obligation on A not to interfere with B, so long as B’s affairs do not interfere with A’s. That is the full extent of inherent rights. Any other natural rights are derived from that.
We see the absurdity of the notion of inherent positive rights when we examine cases of their violation, contrasted with violations of negative rights. If someone holds a right, he is morally entitled to act in immediate defense of it. First we examine a negative right violation. Suppose Joe Biden is walking down the street, minding his own business, and Sarah Palin crosses the street, walks up to him and kicks him in the shin. Clearly she has violated his right to go peaceably about his business. What must occur in order for the right violation not to occur, or to cease? Simply, Palin must not kick Biden in the shin – she must go peaceably upon her own business. Biden’s recourse, in the event she won’t stop, is to stop her from kicking him, either himself or with the assistance of others. No violation of Palin’s right to go peaceably about her business will result from preventing her from kicking Biden.
Now, suppose instead that impecunious Joe Biden wants to visit a doctor, but he has no money. He sees Sarah Palin on the street and demands that she pay for the medical care. Sarah refuses. Is Sarah violating impecunious Joe’s right? If so, what might Joe do about it? Since a person may morally act in immediate defense of his rights, might not Joe forcibly drag Sarah into the doctor’s office to pay for Joe’s medical care; or just take the money he needs for it from her? What difference does it make if Joe does it himself, or sends an IRS agent to do it?
The notion of positive rights falls to pieces. If you may not morally – and legally – act in immediate defense of your rights, then it’s not a right – it’s state-sanctioned robbery.
You cannot have a right to force others to give you things. That violates their rights to be left alone to go peaceably about their business.