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PostPosted: Tue Jan 29, 2013 9:03 am
 


Is it fair to penalize smokers and overeaters? Yes, say experts. Here's why

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NEW YORK, N.Y. - Faced with the high cost of caring for smokers and overeaters, experts say society must grapple with a blunt question: Instead of trying to penalize them and change their ways, why not just let these health sinners die prematurely from their unhealthy habits?

Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong lives, including surgery, chemotherapy and other measures.

But despite these rescue attempts, smokers tend to die 10 years earlier on average, and the obese die five to 12 years prematurely, according to various researchers' estimates.

And attempts to curb smoking and unhealthy eating frequently lead to backlash: Witness the current legal tussle over New York City's first-of-its-kind limits on the size of sugary beverages and the vicious fight last year in California over a ballot proposal to add a $1-per-pack cigarette tax, which was ultimately defeated.

"This is my life. I should be able to do what I want," said Sebastian Lopez, a college student from Queens, speaking last September when the New York City Board of Health approved the soda size rules.

Critics also contend that tobacco- and calorie-control measures place a disproportionately heavy burden on poor people. That's because they:

—Smoke more than the rich, and have higher obesity rates.

—Have less money so sales taxes hit them harder. One study last year found poor, nicotine-dependent smokers in New York — a state with very high cigarette taxes — spent as much as a quarter of their entire income on smokes.

—Are less likely to have a car to shop elsewhere if the corner bodega or convenience store stops stocking their vices.

Critics call these approaches unfair, and believe they have only a marginal effect. "Ultimately these things are weak tea," said Dr. Scott Gottlieb, a physician and fellow at the right-of-centrethink-tank , the American Enterprise Institute.

Gottlieb's view is debatable. There are plenty of public health researchers that can show smoking control measures have brought down smoking rates and who will argue that smoking taxes are not regressive so long as money is earmarked for programs that help poor people quit smoking.

And debate they will. There always seems to be a fight whenever this kind of public health legislation comes up. And it's a fight that can go in all sorts of directions. For example, some studies even suggest that because smokers and obese people die sooner, they may actually cost society less than healthy people who live much longer and develop chronic conditions like Alzheimer's disease.

So let's return to the original question: Why provoke a backlash? If 1 in 5 U.S. adults smoke, and 1 in 3 are obese, why not just get off their backs and let them go on with their (probably shortened) lives?

Because it's not just about them, say some health economists, bioethicists and public health researchers.

"Your freedom is likely to be someone else's harm," said Daniel Callahan, senior research scholar at a bioethics think-tank, the Hastings Center.

Smoking has the most obvious impact. Studies have increasingly shown harm to nonsmokers who are unlucky enough to work or live around heavy smokers. And several studies have shown heart attacks and asthma attack rates fell in counties or cities that adopted big smoking bans.

"When you ban smoking in public places, you're protecting everyone's health, including and especially the nonsmoker," said S. Jay Olshansky, a professor at the University of Illinois-Chicago's School of Public Health.

It can be harder to make the same argument about soda-size restrictions or other legislative attempts to discourage excessive calorie consumption, Olshansky added.

"When you eat yourself to death, you're pretty much just harming yourself," he said.

But that viewpoint doesn't factor in the burden to everyone else of paying for the diabetes care, heart surgeries and other medical expenses incurred by obese people, noted John Cawley, a health economist at Cornell University.

"If I'm obese, the health care costs are not totally borne by me. They're borne by other people in my health insurance plan and — when I'm older — by Medicare," Cawley said.

From an economist's perspective, there would be less reason to grouse about unhealthy behaviours by smokers, obese people, motorcycle riders who eschew helmets and other health sinners if they agreed to pay the financial price for their choices.

That's the rationale for a provision in the Affordable Care Act — "Obamacare" to its detractors — that starting next year allows health insurers to charge smokers buying individual policies up to 50 per cent higher premiums. A 60-year-old could wind up paying nearly $5,100 on top of premiums.

The new law doesn't allow insurers to charge more for people who are overweight, however.

It's tricky to play the insurance game with overweight people, because science is still sorting things out. While obesity is clearly linked with serious health problems and early death, the evidence is not as clear about people who are just overweight.

That said, public health officials shouldn't shy away from tough anti-obesity efforts, said Callahan, the bioethicist. Callahan caused a public stir this week with a paper that called for a more aggressive public health campaign that tries to shame and stigmatize overeaters the way past public health campaigns have shamed and stigmatized smokers.

National obesity rates are essentially static, and public health campaigns that gently try to educate people about the benefits of exercise and healthy eating just aren't working, Callahan argued. We need to get obese people to change their behaviour. If they are angry or hurt by it, so be it, he said.

"Emotions are what really count in this world," he said.


http://www.edmontonjournal.com/health/A ... story.html


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PostPosted: Tue Jan 29, 2013 9:21 am
 


Before we go after people who are apparently politically acceptable to hate and discriminate against, how about we first end all food and tobacco subsidies and let market forces assist in reducing both of these problems without needing to marginalize anyone? :idea:


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PostPosted: Tue Jan 29, 2013 9:28 am
 


No problem here, as long as we throw all the drug addicts under the bus too. No more feeling sorry for them or covering them under the public health system as they deliberately and willingly destroy themselves. Same with drunks. Same with anyone who ever, for any reason, exceeds the speed limit in a motor vehicle. Same with all the super-healthy, oh-so-wonderful jocks who crash their mountain bikes or fall off of cliffs while rock climbing or take a header while they're rollerblading. Or are they, being the beautiful people that they obviously are, exempt from this ridiculous philosophy that they, and they alone, not responsible for paying the full cost by themselves when their own decisions and choices have a negative outcome?

The best option would be to stop writing stories altogether about these shithead ideas that come out of think tanks. Right or left, think tanks are nothing but single-issue moral abattoirs populated by sociopaths as far as I'm concerned.


Last edited by Thanos on Tue Jan 29, 2013 9:32 am, edited 1 time in total.

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PostPosted: Tue Jan 29, 2013 9:30 am
 


Thanos wrote:
No problem here, as long as we throw all the drug addicts under the bus too. No more feeling sorry for them or covering them under the public health system as they deliberately and willingly destroy themselves. Same with drunks. Same with anyone who ever, for any reason, exceeds the speed limit in a motor vehicle.

Either that or stop writing stories about these shithead ideas that come out of think tanks. Right or left, think tanks are nothing but single-issue moral abattoirs populated by sociopaths as far as I'm concerned.


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PostPosted: Tue Jan 29, 2013 9:33 am
 


Edited above for more patented Thanos-brand awesomeness!


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PostPosted: Tue Jan 29, 2013 9:34 am
 


Health care costs for smokers are not $96 billion. Not even close. What these high figures fail to account for is the fact that smokers die earlier--on average about ten years, if studies are to be believed. So in fact, what you get is the smokers checking out soon after their productivity has ceased. So if you compare lifetime productivity and paying into the systemn, versus lifetime taking out of the system, it comes out, according to some studies I've seen, as a wash.

Probably the same is true for obesity.

Immigrants proibably cost more too. Wonder if they'll be contempltaing punishing them.

If you really want a better system, simply privaitize health care, create a comeptitive market for private insurers, and let the market quantify the risk of teh various acrtivities people engage in.


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PostPosted: Tue Jan 29, 2013 9:50 am
 


The only problem with that approach is a private market does little to nothing for people who simply fall ill for other causes without insurance.

I'm sorry but I'm very proud to know that Canada has a system where if a homeless man breaks his leg on the street he will be looked after without going through a huge barrage of paperwork and nonsense.

I'm also proud to be part of a society that allows people to have the freedom to make their own choices. If the science all comes back showing a clear and concise loss on taxes vs care for smokers and the obese I'll accept that maybe we need to put more taxes on smokes or chips and pop but I think the evidence should be very clear cut before we ever consider taking actions that limit anyone's freedom.


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PostPosted: Tue Jan 29, 2013 10:09 am
 


Thanos wrote:
No problem here, as long as we throw all the drug addicts under the bus too. No more feeling sorry for them or covering them under the public health system as they deliberately and willingly destroy themselves. Same with drunks. Same with anyone who ever, for any reason, exceeds the speed limit in a motor vehicle. Same with all the super-healthy, oh-so-wonderful jocks who crash their mountain bikes or fall off of cliffs while rock climbing or take a header while they're rollerblading. Or are they, being the beautiful people that they obviously are, exempt from this ridiculous philosophy that they, and they alone, not responsible for paying the full cost by themselves when their own decisions and choices have a negative outcome?

The best option would be to stop writing stories altogether about these shithead ideas that come out of think tanks. Right or left, think tanks are nothing but single-issue moral abattoirs populated by sociopaths as far as I'm concerned.


Agreed. All sorts of behaviors out there that cost the medical system and society. What about anger addicts - that's bad for their health and their victims too. All sorts of states of mind that people should change - it's been shown that if you're happy you have far fewer health problems - so penalize everybody who't blissed out all the time.

Also, poverty has been shown to have a severe impact on health. Time to penalize those poor people.


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PostPosted: Tue Jan 29, 2013 10:10 am
 


Zipperfish wrote:

If you really want a better system, simply privaitize health care, create a comeptitive market for private insurers, and let the market quantify the risk of teh various acrtivities people engage in.


This article was written about the US system. I thought the had both privatized care and privatized insurance. Working out real well for them, huh?


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PostPosted: Tue Jan 29, 2013 10:18 am
 


Thanos wrote:
No problem here, as long as we throw all the drug addicts under the bus too. No more feeling sorry for them or covering them under the public health system as they deliberately and willingly destroy themselves. Same with drunks. Same with anyone who ever, for any reason, exceeds the speed limit in a motor vehicle. Same with all the super-healthy, oh-so-wonderful jocks who crash their mountain bikes or fall off of cliffs while rock climbing or take a header while they're rollerblading. Or are they, being the beautiful people that they obviously are, exempt from this ridiculous philosophy that they, and they alone, not responsible for paying the full cost by themselves when their own decisions and choices have a negative outcome?

The best option would be to stop writing stories altogether about these shithead ideas that come out of think tanks. Right or left, think tanks are nothing but single-issue moral abattoirs populated by sociopaths as far as I'm concerned.

Ahhhh, Thanos :) This made my day :P


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PostPosted: Tue Jan 29, 2013 10:28 am
 


CanadianJeff wrote:
The only problem with that approach is a private market does little to nothing for people who simply fall ill for other causes without insurance.

I'm sorry but I'm very proud to know that Canada has a system where if a homeless man breaks his leg on the street he will be looked after without going through a huge barrage of paperwork and nonsense.


So am I. But that all falls apart when the public health system becomes an agent for the nanny state.


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PostPosted: Tue Jan 29, 2013 10:51 am
 


Smokers are already paying extra.

Government revenue from smokers (taxes on tobacco products): $7,538,367,182
Estimated number of smokers in Canada: 5,967,000

Estimated burden (above normal healthcare) by smokers: $1,000,000,000

I believe the government owes me a refund.


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PostPosted: Tue Jan 29, 2013 10:56 am
 


andyt wrote:
Zipperfish wrote:

If you really want a better system, simply privaitize health care, create a comeptitive market for private insurers, and let the market quantify the risk of teh various acrtivities people engage in.


This article was written about the US system. I thought the had both privatized care and privatized insurance. Working out real well for them, huh?


In advance of the implementation of Obamacare it has suddenly become fashionable for think tanks and so-called 'health advocates' to promote slashing services to various groups and ending routine tests and routine physicals.

Apparently, the keystone of Obamacare is to control costs by demonizing certain groups and letting them die.

Seriously, my wife who survived breast cancer would be dead under Obamacare because the preventive screening that caught her cancer is being eliminated under the plan.


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PostPosted: Tue Jan 29, 2013 11:09 am
 


Zipperfish wrote:
CanadianJeff wrote:
The only problem with that approach is a private market does little to nothing for people who simply fall ill for other causes without insurance.

I'm sorry but I'm very proud to know that Canada has a system where if a homeless man breaks his leg on the street he will be looked after without going through a huge barrage of paperwork and nonsense.


So am I. But that all falls apart when the public health system becomes an agent for the nanny state.


I think your very correct. It's a hard balance.


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PostPosted: Tue Jan 29, 2013 11:23 am
 


I agree with Thanos on this one. 8O

If sych a plan was ever implemented it would surely spiral out of control as per Thanos post when "do-gooder nanny state assholes" figure they can cut cost even further by not covering anything beyond breathing, and they would probably eliminate that coverage for people living in cities with smog and pollution issues.


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