New healthcare law could penalize older smokers up to $4,250 per year

[banned from Kos]

WASHINGTON (AP) — Millions of smokers could be priced out of health insurance because of tobacco penalties in President Barack Obama’s health care law, according to experts who are just now teasing out the potential impact of a little-noted provision in the massive legislation.

The Affordable Care Act — ‘‘Obamacare’’ to its detractors — allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums starting next Jan. 1.

For a 55-year-old smoker, the penalty could reach nearly $4,250 a year. A 60-year-old could wind up paying nearly $5,100 on top of premiums.

Younger smokers could be charged lower penalties under rules proposed last fall by the Obama administration. But older smokers could face a heavy hit on their household budgets at a time in life when smoking-related illnesses tend to emerge.

http://www.boston.com/lifestyle/health/2013/01/24/penalty-could-keep-smokers-out-health-overhaul/QiilPtcXnG77De9Z9UtnTI/story.html

[phleshdef]

1. As a person that smoked for 8-9 years myself, I agree with this in principle.

The 50% ceiling might be a bit excessive. But in principle, those of us who knowingly did unnecessary, unproductive things to our bodies that makes us more of a liability on the system should pay more into it.

[dogman]

4. Except it does not apply to obesity and other factors.

Who are they really trying to help?

[phleshdef]

5. I'm pretty sure obesity can drive your premiums up already.

Regardless, I don't see why, if I spent 20-30 years smoking, should expect to pay the same as someone who didn't and then wake up with emphysema, lung cancer, blood pressure problems, etc... all of my own doing and completely unnecessary.

[dogman]

7. Not under the ACA, just smoking.

We make decisions every day that adversely affect health, so far only one is penalized. Smokers already pay extra taxes on the tobacco products. If they are left without insurance coverage, they will be back in the more expensive emergency rooms.

[phleshdef]

16. Before the ACA, they could be denied insurance entirely.

[dogman]

28. For anything.

Out pricing or denial, same effect.

[Confusious]

201. That sounds familiar

"there's no health care emergency! They can just use the emergency rooms!"

The problem is paying, not access.

They could just go back to using the emergency rooms for all that it matters.

[pnwmom]

24. Obesity can be caused by genetic factors and other illnesses,

for example, those that lead to treatment with steroids.

Deciding to become a smoker is within an individual's control.

[dogman]

27. And addiction is not an illness?

No one is forcefeeding the obese. They have a problem that society should care about.

[pnwmom]

60. Not the same and you know it. Food is needed for nutrition,

but some people genetically metabolize food differently. (Some but not all obese people overeat.)

Cigarettes are of no nutritional value and no one is forced to smoke their first cigarette. (If someone does force someone to do so, it should be considered assault and prosecuted.)

[dogman]

64. That's not how it works and you know it.

People smoke for a variety of reasons, the primary being they are human. The dehumanization of smokers is easy but why do we want to see them as to low to qualify for the same healthcare? Medicare provides equally and ACA should also. Some eat to live and some live to eat and I am fine with that. I am not saying obesity should be punished, I'm saying no one should be punished.

[pnwmom]

131. It's not an instinct. There's nothing about being human that makes people need to smoke.

Addiction doesn't kick in till you've voluntarily put that first cigarette in your mouth.

This law will give better access to health insurance than smokers have now. Insurance companies won't be able to deny them due to their preexisting condition, and they'll be limited to charging them 50% more than nonsmokers (less for younger age groups.) And people on Medicaid or receiving subsidies won't pay any more.

[HiPointDem]

214. not if they have to pay an extra $4000 on top of the regular premium, it won't. first, that's

way above the average additional cost smokers SUPPOSEDLY incur (like about $3000 a year over the average).

second, it will put a lot of people who can afford it (barely) at the margin.

third, for those too poor to pay it, the public will pay. they may just as well charge the regular price & pay the bills.

fourth, THE SURPLUS WILL GO TO THE INSURANCE CORPS, WHAT DOESN;T EVERYBODY GET????

[pnwmom]

217. They do have the option of quitting, and paying the same rate as anybody else --

even people who are at high risk because of long term past cigarette use.

I had two relatives who quit 2-pack a day habits. It is possible.

We have two other relatives who didn't quit till the wife got lung cancer, and the husband got cancer in his throat, and had to have an electronic voice box installed. But under Obamacare, they would still be eligible for the same rates as anyone else once they quit smoking.

[HiPointDem]

218. then the pricing scheme makes no sense at all, since the highest rates are charged to older

smokers, presumably since they incur the highest costs (as older people do generally & older smokers even more so, presumably) -- but you say they can get 'normal' rates if they quit.

yet by the time they're older smokers, most of the damage is already done after a lifetime of smoking.

so what is the purpose of the higher rate that can be extinguished by quitting in one's old age?

it's senseless & merely punitive.

[pnwmom]

220. It makes sense to me because it encourages people to stop before it's too late,

but it doesn't penalize those who, like my critically ill relatives, didn't stop soon enough.

[HiPointDem]

221. i thought it was an insurance program, not a smoking cessation incentive. which is it?

so you acknowledge it's not about insurance risk.

[pnwmom]

222. It's both. It's an insurance program that takes smoking risk into account,

and rewards customers for stopping smoking.

[HiPointDem]

223. or neither. because you've already admitted it's allocating risk & cost incorrectly, & the

'incentive' is not an incentive but a punishment that's removed if you behave properly.

but if all the smokers quit tomorrow, precisely the same number of people would die, often with health complications before the ends of their lives.

no money is actually 'saved' because they die from one thing rather than the other.

[HiPointDem]

207. As you say, Medicare provided equally for everyone, whether they were fat, thin, drug addicts,

teetotalers, smokers, pipe smokers, chewers on non-smokers.

AND IT WORKS JUST FINE.

The insurance segmentation of ACA in my mind is a dagger aimed at turning Medicare into the SAME FOR-PROFIT CRAP.

IT WON'T LOWER COSTS. IT WON'T EVEN PROVIDE MORE HEALTH CARE FOR PEOPLE. IT'S THE SAME PUSH FOR INDIVIDUALIZATION/PRIVATIZATION/PROFIT that's happening in EVERY OTHER AREA OF PUBLIC FINANCING -- in education, in government services, and in public healthcare.

AND TOO MANY PEOPLE AT DU ARE JUST LOVING IT, cheering, doing the divide and conquer rag.

It's sickening.

[dogman]

232. I've always considered empathy to be a major difference between GOP & Dems

I guess the GOP is not the only one changing its philosophy. As they abandon their party they dilute ours. Party Id is less important. It truly is sickening.

[Special Agent Oso]

87. You left out the genetic part

Which was the main point the member made.

[dogman]

90. See post #64

I think you misunderstand my view. It is not against obese people, it is against singling out any group of people.

[dmallind]

30. There is NOTHING even close to smoking

Everybody always trots out obesity or booze or inactivity whenever these things arise.

21% smoke - 435000 deaths including 55000 nonsmokers

36% are obese - 100k deaths including zero non-obese

67% drink - 76k deaths including zero nondrinkers (traffic fatalities are indirect results of drinking and driving - badly, not an essential part of drinking like ETS is an unavoidable part of smoking)

To be comparable, obesity would have to kill 750,000 a year including over 90000 thin people. Drinking would have to kill 1.3 million and 165,000 teetotalers

[dogman]

35. So we can only concern ourselves with #1?

Statistics are interesting but selective. The nonsmoker number is a guess but given credit while traffic deaths are excluded? Whatever. How about the mental health effects and side effects of alcohol. This hurts, not helps, people which was the point of ACA.

[beaglelover]

39. Yes, but how much to smokers 'cost' the HC system vs. the obese?

I'd be interested in seeing stats on the dollars of HC costs attributed to smokers versus the obese. I'll check Google....see if any our out there. My gut tells me the obese 'cost' the system a heck of a lot more than smokers.

[Sekhmets Daughter]

53. Late honey

had COPD....was still smoking when first put on oxygen.... His Medicare expenses were astronomical. COPD eventually leads to congestive heart failure because the deformed lung(s) puts pressure on the heart. That eventually leads to pulmonary edema which is treated with 'water' pills that strain the kidneys. He had a primary care physician, a pulmonologist, a nephrologist and a cardiologist. Saw at least two of them every month and until he complained about it, they didn't coordinate their lab work, he visited the lab 2 and 3 times every month. A portable oxygen concentrator, for which he paid $5,000 in 2007, is now covered by Medicare. This is the short list of his expenses.

[phleshdef]

55. Obesity does cost the system more.

http://www.acoem.org/CostsObesityvsSmoking.aspx

However, I feel that obesity is a grayer area where a good amount of it can be attributed to genetics. Its not purely from people just eating more than whats considered the ideal amount of food.

Smoking on the other hand, is an optional activity and no genetic malfunctions forces you to smoke.

I say this as a very skinny person who has a smoking history

[robinlynne]

120. I smoke. I cost the healthcare system NOTHING. have been paying for insurance for 55 years.

This argument DISGUSTS me.

what about drug addicts? what about poor people? What about being old? What about being born with any healthcare need?
Jesus!
You would deny me health care?
I dont ahve an extra 4000 per year. I barely mkae enough to pay my rent.

I have NEVER an to deny anyone else healthcare for any reason.

[Jack Sprat]

125. It disgusts me, too.

Finding ways to exclude people based on their condition is not something I envisioned in any healthcare system. This is what I assumed the ACA was trying to prevent health insurance providers from doing.

What is really disgusting is the people agreeing in charging higher premiums for smokers. Perhaps we should charge patients more for eating red meat which can lead to cancer or for eating sweets like icecream or loaded with sugar. Those things are also willfully done. If the current ACA law targets some for exclusion or subject to higher premiums, then some fix to the law is needed immediately to address the inequality.

I'm in perfect agreement with you.

[TorchTheWitch]

197. being a smoker isn't a condition

Being a smoker only makes it possible that you might become ill at some time in the future with a smoking related illness. This if FAR worse than punishing people with pre-existing conditions - it's punishing people for the POSSIBILITY that they MIGHT become ill with a smoking related condition at some time in the future.

Singling out smokers even though they HAVE no condition/s related to their smoking and charging them 50% more for their health insurance particularly now that it's MANDATED that we MUST purchase it whether we can afford it or not is unconstitutional - NO other group of people with any number of POSSIBLE future illnesses or injuries resulting from something that they do is being punished in this way. This is FAR FAR worse than hiking prices up for people that actually DO have pre-existing conditions.

Meanwhile, Obama the smoker has his health CARE paid for by our tax dollars without having to contribute one fucking dime.

[jberryhill]

51. "including zero non-obese"

I dunno about that....

http://www.kirotv.com/news/news/woman-accused-smothering-boyfriend-chest/nTwt3/

EVERETT, Wash. —

A 50-year-old Everett woman is accused of smothering her boyfriend by lying on his face.

...

Documents indicated the victim was 5 feet 7 inches tall and weighed about 175 pounds, and Lange is 5 feet 6 inches tall and weighs 192 pounds, documents said.

[Honeycombe8]

127. Where's the link to your source? Those nos. don't make sense. Also, deaths don't matter.

Obese....I am thinking that the 100k deaths don't include the millions who die younger because of obesity. You don't know any 75 year old 350 pound women do you? That's because they die younger. The cause of death isn't called "obesity." It's called "natural causes" or "heart attack." But it was because they were obese.

Smoking - You probably DO know some seniors who smoke. They die younger, too, but seem to live longer than obese people.

But to insurance companies, what matters is COST. Dying young doesn't cost a healthcare ins. co. nearly as much (if anything) as the illnesses that ensue from smoking...like obstructive pulmonary disease and emphysema.

So quoting deaths - eh....that's not what these companies are looking at.

Obesity, though, usu results in metabolic syndrome (diabetes, high blood pressure, high cholesterol, whatever).

Unless you're an alcoholic, drinking doesn't affect your health, cost-wise, as far as I know. Taht's all that ins. companies are looking at.

[laundry_queen]

136. That's usually because

many obese people lose weight as they age not just cause they all die off. Besides, obesity isn't 350 lbs, it's more like 175 lbs for an average female (who is 5'4&quot according to BMI charts that insurance companies use. 350lbs is 'super obese'.

My maternal grandmother was obese (over 220 lbs at 4'11&quot and my paternal grandfather also. They were obese for most of their adulthood until they hit about 70 or so and the weight started coming off. The last 15 years or so of their lives, they were quite slim.

My paternal grandfather wasn't just obese - he smoked too. And drank too much. Lived to be 97. Not the healthiest 97 but he still had his mind...

My ex's slim uncles died of heart attacks in their 50's from smoking. No one listed THEIR deaths as 'heart attack from smoking' either, you know. Just 'heart attack'.

Also, obesity doesn't CAUSE metabolic syndrome - it's quite the other way around and starts with insulin resistance. The excess insulin levels lead to extra hunger, extra fat, higher cholesterol and triglycerides. The added hunger makes it difficult to diet, and when you do, it's difficult to lose weight because of the high levels of insulin in the blood. So you gain more weight, and it becomes a vicious circle, yes, but the obesity is a result of, not the beginning of, metabolic syndrome.

[Honeycombe8]

171. I've never known someone morbidly obese who became slim naturally in older years.

They died is all I noticed, still obese.

Yes, obesity causes metabolic syndrome.

Causes, incidence, and risk factors

Metabolic syndrome is becoming more and more common in the United States. Researchers are not sure whether the syndrome is due to one single cause, but all of the risks for the syndrome are related to obesity.

The two most important risk factors for metabolic syndrome are:
•
Extra weight around the middle and upper parts of the body (central obesity). The body may be described as "apple-shaped."

•
Insulin resistance. The the body uses insulin less effectively than normal. Insulin is needed to help control the amount of sugar in the body. As a result, blood sugar and fat levels rise.


Other risk factors include:
•
Aging

•
Genes that make you more likely to develop this condition

•
Hormone changes

•
Lack of exercise

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004546/

I come from a morbidly obese family. That is, a family where most of the members are/were morbidly obese. You show me a morbidly obese person, I'll show you someone who gets metabolic syndrome, diabetes....and dies young.

There's no shortage of ins. cos. who blame smoking for increased healthcare costs. This discussion is about why they won't be charging more for the increased costs due to obesity and alcoholism.

[laundry_queen]

173. No need to school me about metabolic syndrome

I've done the research. In fact, there is debate in the medical community about this. Your link says there is correlation, not causation. The reason some in the medical community mistakenly believe that obesity CAUSES metabolic syndrome is because once someone with metabolic syndrome gains a bit of weight (for instance, I started out as a normal weight child and teen. As a teen I had to work HARD to keep the weight off - 2 hrs of activity/day, skipping meals, eating nothing but veggies for weeks then I gained a few pounds when I moved in with my boyfriend who hated veggies and told me he'd love me if I was fat) it does trigger the metabolic syndrome to get worse. More weight=more insulin circulating, more insulin resistance, which means more hunger, more blood sugar fluctuations which then leads to overeating because of hunger/low blood sugar, which leads to more weight gain. Can you lose the weight and reverse metabolic syndrome? partially - it can help but you will never get rid of metabolic syndrome, no matter how thin you become - and that is why it comes before the obesity. If the obesity came first, you would be able to be rid of metabolic syndrome as the weight came off. No matter how thin you are, your lab numbers will never be as 'healthy' as a 'normal' thin person. I have several thin people in my family with metabolic syndrome. All have serious problems keeping their weight off (meaning they work HARD to stay slim) and all have higher than normal triglycerides, a tendancy to gain weight in the belly, elevated BP and borderline fasting sugars.

I've never known a smoker, other than my grandfather, to grow old. I've known obese people in my family to grow old. So our stories are mostly anecdotal anyway. Also, no obese people in my family had diabetes (the obese family members are on my mother's side where there is no metabolic syndrome).

BTW, I don't think anyone should get charged more for insurance, period. American insurance companies have dehumanizing down to a science. I fucking hate insurance companies. Their actuaries can kiss my ass.

[Honeycombe8]

180. No need to school me in metabolic syndrome. I've done the research.

You are in denial.

If someone intentionally does something that causes the cost of insurance to go up, I'm okay with their premiums being higher. Why charge ME for someone else's choice to eat beef and butter and not exercise and smoke?

There are many things that cause ins. costs to go up, not the least of which is going to the doctor for every little thing. I know people who go to the dr when they get a cold, for gosh sakes. I know someone who has diabetes type 2 and uses her insulin as a way to allow her to eat junk.....eats a piece of cake, then sticks the needle in her abdomen through her clothing, so the cake won't cause her to get sick. You and I pay for her insulin. She could get off the insulin, maybe, if she changed her lifestyle.

Ins. is a business. It's only natural they'll base rates on their costs. The ACA is a start. Maybe one day we'll get rid of the ins. cos. altogether.

[laundry_queen]

195. And you lack empathy. nt

[HiPointDem]

215. Obese Workers Have Even Higher Health Costs than Smokers, Study Finds

Chicago IL — Obesity adds more to health care costs than smoking does, reports a study in the March Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

James P. Moriarty, MSc, and colleagues of the Mayo Clinic, Rochester, Minn., analyzed the incremental (additional) costs of smoking and obesity among more than 30,000 Mayo Clinic employees and retirees. All had continuous health insurance coverage between 2001 and 2007.

Both obesity and smoking were associated with excess costs for health care. Compared to nonsmokers, average health costs were $1,275 higher for smokers.

The incremental costs associated with obesity were even higher: $1,850 more than for normal-weight individuals. For those with morbid obesity, the excess costs were up to $5,500 per year.

http://www.acoem.org/CostsObesityvsSmoking.aspx

NOW THINK ABOUT HOW MUCH EXTRA THEY'RE PROPOSING TO CHARGE SMOKERS FOR HEALTH CARE: OVER $4000.


Your stats are useless. 21% of the population smokes so 435K deaths are due to smoking? what? EVERYONE DIES.

Exercising and eating organic tofu won't save you from DEATH, WON'T SAVE YOU FROM DISEASE, WON'T SAVE YOU FROM DECLINE. you're gonna die regardless. IT'S GONNA COST SOME MONEY.

[bluestate10]

97. Obesity already causes higher premiums. nt

[dogman]

114. Read the link in the OP.

It says not under ACA.

[dsc]

126. actually smoking is way worse than obesity

in terms of proven health detriment. that is why smoking is tagged while obesity isn't.

[HiPointDem]

211. actually not.

http://www.acoem.org/CostsObesityvsSmoking.aspx

but when you understand how these costs are calculated, you realize that it's a big bag of crappy assumptions.

[Honeycombe8]

172. That doesn't make sense to me. I wonder why? nt

[HiPointDem]

42. It's just another tax on the poor, the economic group most likely to smoke. They're already

taxed up the butt for the product, let's tax them some more.

Stupid policy.

Under such policies, the upper-class populations most likely to be healthy are effectively taxed the least.

Just robbing the poor under the guise of 'health'.

THE PURPOSE OF INSURANCE IS TO SPREAD RISK.

Segmenting insurance markets by risk cuts across that risk-spreading benefit in the interest of profits.

And I'd bet the total effect is actually a subsidy to the upper classes.

[phleshdef]

43. If they are poor, then they qualify for Medicaid and thus this is irrelevant.

And people of all economic conditions smoke. I've not been what I would call, in poverty, since I was a college kid and I smoked for a long time well after that and so did many of my middle class friends and even upper class supervisors, etc.

[HiPointDem]

45. By 'poor' I mean the lower classes, not just the indigent. No, the lower working class are not

typically eligible for medicaid.

and since medicaid is funded about half by states, & since state taxes are notoriously regressive, it still amounts to a LARGE TAX on the poor & middle class via property taxes, tobacco taxes, sales taxes, and other regressive taxes.

[phleshdef]

48. Whatever. If people engage in giving themselves an easily preventable condition for no good reason..

...then I can't see how one can argue that they shouldn't be responsible for subsidizing the consequences. Some things, like obesity, has a lot of gray areas and everyone has to eat. But smoking is not something anything has to do. And if you do it for several decades, there will be consequences and those consequences can cost the system hundreds of thousands if not millions to treat and sometimes that's even to no avail because the consequences end up killing them anyway.

I'm certainly sympathetic to the plight of the poor and low wage working class, but that doesn't mean people should just be able to do themselves in without chipping in more.

[HiPointDem]

49. The higher your income, the longer you live & the more you use healthcare & the bigger the

healthcare costs in the last part of your life (the time when the highest percent of costs are charged).

High income people cost the system more & are subsidized by everyone else.

[phleshdef]

52. You just made that up and you are wrong.

And your math needs work.

If one person makes an average of 80k a year up until retirement and another person makes an average of 30k up until retirement, the person that made 80k a year most definitely paid more into Medicare than the person that made 30k. That's completely irrefutable.

[HiPointDem]

54. medicare isn't medicaid. low-income people die younger & collect less on medicare.

nope, i didn't make these things up.

all this 'let's charge smokers more,' 'let's charge fat people more,' etc. = segmenting of the health care 'market' for the profits of insurers -- and further destruction of the UNIVERSALITY of medicare/medicaid, also in the interest of PRIVATE INSURERS.

And the middle & upper classes JUST EAT THAT STUFF UP -- because their mindset is essentially PUNISHING & INDIVIDUALISTIC. Which is why you find them CHEERING this crap on -- *they* eat organic, don't smoke, go to the gym -- *they're* so fucking virtuous, unlike those (lazy/undisciplined/leeching) lower-class people.

They'll be crying the loudest when it comes back to bite them -- AND IT WILL.

But personally, I care less & less because they are so sunk in their self-aggrandizing illusions.

[phleshdef]

57. You are just twisting yourself in knots now.

I'm well aware of the difference between Medicare and Medicaid. I'm not an idiot.

But you said that higher income people live longer and thus cost the system more. If they are living longer, that implies they make it to the age of 65, at which point they qualify for Medicare. And they've most assuredly paid a good deal into it.

Your logic simply does not work. And you have no idea if "high income" people are a greater cost to the system. You just made that shit up. And you know it.

[HiPointDem]

76. Do I? "Smokers and the obese cheaper to care for, study shows"

LONDON — Preventing obesity and smoking can save lives, but it does not save money, according to a new report. It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.

"It was a small surprise," said Pieter van Baal, an economist at the National Institute for Public Health and the Environment in the Netherlands, who led the study. "But it also makes sense. If you live longer, then you cost the health system more."

In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers...

On average, healthy people lived 84 years. Smokers lived about 77 years and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.

Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.

The cost of care for obese people was $371,000, and for smokers, about $326,000. The results counter the common perception that preventing obesity will save health systems worldwide millions of dollars.

http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html?_r=0


and since 'health' & longevity rise step-wise with income, the more money you have, the more your health care costs society.

but it's the poor being taxed -- doubly. fancy that.

[phleshdef]

140. Misleading, dated and incorrect.

James P. Moriarty, MSc, and colleagues of the Mayo Clinic, Rochester, Minn., analyzed the incremental (additional) costs of smoking and obesity among more than 30,000 Mayo Clinic employees and retirees. All had continuous health insurance coverage between 2001 and 2007.

Both obesity and smoking were associated with excess costs for health care. Compared to nonsmokers, average health costs were $1,275 higher for smokers. The incremental costs associated with obesity were even higher: $1,850 more than for normal-weight individuals. For those with morbid obesity, the excess costs were up to $5,500 per year.

The additional costs associated with obesity appeared lower after adjustment for other accompanying health problems (comorbidity). "This may lead to underestimation of the true incremental costs, since obesity is a risk factor for developing chronic conditions," Moriarty and colleagues write.

Smoking and obesity place a growing strain on an already stretched healthcare system. Employers are evaluating wellness programs -- such as quit-smoking and fitness programs -- in an attempt to lower costs by reducing health risk factors.

Moriarty and coauthors conclude, "Simultaneous estimates of incremental costs of smoking and obesity show that these factors appear to act as independent multiplicative factors." Their study provides new insights into the long-term costs of obesity and smoking, showing that both risk factors lead to persistently higher health costs throughout a seven-year follow-up period.

http://www.sciencedaily.com/releases/2012/04/120403124252.htm

[HiPointDem]

141. lol. your 'rebuttal' study isn't about lifetime costs. and it also claims that obesity is even

*more* expensive to the system than smoking, so all you fat people, get ready to shell out *triple* what "normal" people pay (& "normal" people, i'm sure they'll soon find reasons to segment the market even more & make *you* pay too, because that's what's really driving this crap).

News flash: The fact that a study was done 1, 2, 3, 4, 5, 10, 50 years ago doesn't make it "outdated". NEW INFORMATION THAT REBUTS THE FINDINGS OR METHODOLOGY IS WHAT MAKES IT 'OUTDATED'.

You've done neither. And you don't know much about the topic, either, as it's established fact that if you look at LIFETIME costs rather than costs at a given moment in time, shorter life = lower costs.

The rich live longest, ergo they cost the most. Care for alzheimers is more expensive than care for emphysema.

Here's some studies from 2012:

Nihon Eiseigaku Zasshi. 2012 Jan;67(1):50-5.
[Lifetime medical expenditures of smokers and nonsmokers].

RESULTS:

The results showed that although smokers had generally higher annual medical expenditures than nonsmokers, the former's lifetime medical expenditure was slightly lower than the latter's because of a shorter life expectancy that resulted from a higher mortality rate. Sensitivity analyses did not reverse the order of the two lifetime medical expenditures.

CONCLUSIONS:

In conclusion, although smoking may not result in an increase in lifetime medical expenditures, it is associated with diseases, decreased life expectancy, lower quality of life (QOL), and generally higher annual medical expenditures. It is crucial to promote further tobacco control strategically by maximizing the use of available data.

BMJ Open. 2012 Dec 11;2(6). pii: e001678. doi: 10.1136/bmjopen-2012-001678. Print 2012.
The net effect of smoking on healthcare and welfare costs. A cohort study.
Tiihonen J, Ronkainen K, Kangasharju A, Kauhanen J.
Source

RESULTS:

Smoking was associated with a greater mean annual healthcare cost of €1600 per living individual during follow-up. However, due to a shorter lifespan of 8.6 years, smokers' mean total healthcare costs during the entire study period were actually €4700 lower than for non-smokers. For the same reason, each smoker missed 7.3 years (€126 850) of pension. Overall, smokers' average net contribution to the public finance balance was €133 800 greater per individual compared with non-smokers.

http://www.ncbi.nlm.nih.gov/pubmed/22449823


The more income you have, the longer you live & the more you cost the system.

But no problem, let's tax smokers 4 times the cost of the product, and then double their medical insurance costs -- TO SUBSIDIZE EVERYBODY ELSE, especially the stupid upper-middle-class nazis who fancy themselves exemplars of 'health' & look down their noses at people who don't eat as the nazis think they should.

The well-off are very happy to PUNISH their supposed 'inferiors' to (supposedly) save themselves money, even to the degree of DOUBLING COSTS for the supposedly defective, but the fact is that THEY are the biggest consumers of health care & the biggest cost to the system.

In the same way that they cheer drug war policy for the poor & dark while puffing their designer marijuana in their living rooms.

Petty, hypocritical, useless morons.

[phleshdef]

198. Its about annual costs, which is more palpable than life expectancy speculation.

And yes, I already said in this very thread that obesity is a bit higher. And I also said that I view obesity differently because for a lot of obese people, genetics are at work. Genetics do not make you pick up smoking.

"especially the stupid upper-middle-class nazis who fancy themselves exemplars of 'health' & look down their noses at people who don't eat as the nazis think they should. "

^^ You should be banned for this BIGOTED bullshit right here. Seriously. I'm not even going to bother arguing anymore with someone who clearly has such class based hatred for others. I mean, seriously, tax the SHIT out of the rich, I'm all for it. But do it because its the practical thing to do, not because you are a bigot with a vendetta. And for the record, I lived the first 25 years of my life either in poverty or riding just above the line. And I've lived only the last 6-7 in the middle class. And I'm still well below 6 figures between myself and my wife. So I don't even fit the criteria you are throwing out there (which seems like it was intended to be directed at me).

[HiPointDem]

200. it's not *palpable* at all, as for *bigoted bullshit,* i've had a crawful of bigoted bullshit from

narrow-minded upper-class twits who routinely denigrate smokers, fat people, people without teeth, according to their narrow self-righteous, class-bound visions. they are completely blind to their own arrogance & punishing mindset.

[phleshdef]

203. Income has NOTHING to do with that kind of denigration.

People are assholes at all income levels.

And I completely disagree. Life expectancy is an educated speculation, whereas comparing real annual costs are more concrete in terms of numerical evidence.

[HiPointDem]

205. The life expectancy differences are AN ACTUARIAL CERTAINTY, proven statistically in multiple

studies, in multiple countries, over multiple years, and demonstrated in the historical record as well. It's a fact well-known to anyone in the field.

Also, if you actually had familiarity with the literature on smoking, obesity, and health statistics generally, rather than just the media brainwashing about how much fat people & smokers supposedly *cost* everyone else, you'd know that the basis for those statistics is highly suspect & even then, the cost differentials are small until INFLATED with bogus crap like assigning a "cost" to "quality of life" (a cost, incidentally, which is mainly borne by the smoker or fat person, but which for some reason is put in the "cost to society" column).

Smokers, and fat people, are minorities which tend to be *poorer* than the general population and denigrated by the general population, both of which make them easy targets for self-righteous attacks on their persons & pocketbooks by the self-righteously 'healthy,' who are generally better-off. They can't see the class aspect or their own ignorance because their superiority complexes blind them to everything but their own vision of life -- a profoundly narrow, judgemental & punishing one.

[phleshdef]

208. Its a certainty until its not a certainty. That "certainty" can easily change.

Especially if you are talking about the conditions that usually kill the groups of people you are talking about and the medical advances that are keeping them alive longer than it use to. We've increased the survival time over what it was a few decades ago for cancers, heart conditions, diabetes, etc. So no, the argument that "they are gonna die sooner, therefore they will cost us less" is not a valid argument at all when considering future costs to the system. As a matter of fact, I imagine the likelihood that even more effective medical advances are going to be available for all of these conditions is going to also increase the cost a bit more. And eventually, we are going to cure some of these ailments entirely. That means that not only will some of these folks end up creating a cost for the treatment and cure of their condition, but they will also go on living a lot longer after the fact. That's why I consider a year to year analysis a more credible measure to look at, because it offers the most certainty.

Your view of obesity vs income levels is also not entirely incorrect.

"According to 2005-2008 national data, obesity rates tended to increase with decreased income among women, but this trend was only significant for White women (not Black or Mexican-American women) (Ogden et al., 2010b). Among men, obesity rates were fairly similar across income groups, although they tended to be slightly higher at higher levels of income. In fact, among Black and Mexican-American men, those with higher income were significantly more likely to be obese than those with low-income."

http://frac.org/initiatives/hunger-and-obesity/are-low-income-people-at-greater-risk-for-overweight-or-obesity/

And though it is true that smoking is higher among people with a lower income, alcoholism is actually higher among those with a higher income. Both are habits that I could see justifying paying more into the system for.

[HiPointDem]

212. i'm talking about the *actuarial certainty* that low-income people as a *class* die younger.

Pooling national data from more than 30 years, White and Black women consistently experienced higher BMI at lower income levels, although this association was more modest at some time points than others (Chang & Lauderdale, 2005).

[robinlynne]

175. Thank-you!

[robinlynne]

121. You are high and mighty. You would remove my health care?

[phleshdef]

138. No. Where the hell did I say that?

[robinlynne]

142. my income is 15,000. exactly enough for rent and health insurance, without food. I am

using my retirement savings for everything else. If you stick with me 4,000 ion fines I will have to lose health insurance.
I used to be middle class, until THIS recession. worked and save my whole life, ran a successful small business with 7 employees.


I do not bitch about people drinking, taking drugs, being overweight unless they hurt other people. I have never hurt anyone, not even an ant.

Thanks and go to hell.
yes I smoke. I dont care what you think of it. I am not the person bringing down the health care system in my country.

[phleshdef]

154. You obviously didn't read the stuff I actually posted.

For one, I am a former smoker.

For two, I said I agree with the principle of charging more for smokers but I also said that I thought the ceiling on how much they can charge additionally was excessive.

[robinlynne]

179. You said I should pay more for health insurance because I smoke. I cant pay a penny more.

Do I tell you what to drink? Do I try to have you pay more for healthier because you wear blue?

Step down off the high horse. I'm sure there is something you do that I do not like. That doe snot give me the right to treat you as ales of a person. Get that.
Saying that I should pay extra for health care is saying I am a subhuman because I smoke. drug addicts do a lot worse for the health care system and for society. as do alcoholics. We are all equals. That is the idea.

If someone is born with a weak heart should I begrudge them healthcare? What if a baby is born small? Pay more for healthcare because you use more? Really? Charge the babies. Charge the people who need transplants.

or we are all human, and we all deserve equal treatment.

[phleshdef]

199. Christ. Calm yourself. Getting all fumey doesn't help your argument at all.

And I don't know how much more clear I have to make. I've been a smoker. And I still use alternative nicotine products. So this crap about me "treating smokers as less of a person" has no legs to stand on. I shared the same god damn addiction and for a number of years, the same god damn habit. I don't look down on people for it. I understand the appeal of it. I understand the stress relief it offers. I understand everything there is to understand about it. I've been there. So get over yourself. I'm ALLOWED to have this opinion and there isn't anything you can do about it.

And the comparison to someone with a weak heart or a premature child is just stupid. You aren't born with a pack of camel lights in your back pocket. I don't believe in charging excessive additional costs for genetic factors and other things that a person just can't help. But addiction to body destroying substances is something a person CAN help. AND AS A PERSON WHO HAS HAD MY SHARE OF BODY DESTROYING SUBSTANCES, I'M STILL ENOUGH OF A FUCKING ADULT TO ADMIT THIS.

Its not unequal treatment to pay a little more into the system to cover your own unnecessary risks if EVERYONE has to pay the same amount more in whenever those people willfully introduce long term, unnecessary risks into their lifestyle. That IS equality. Everyone following the same rules and everyone paying their fair share.

And like I said, I think paying 50% more is too much. That doesn't change the fact that I agree with the principle of saying "ok, I'm gonna smoke, so I'm gonna pay more into my health insurance to cover it if it comes back to burn me in a few decades".

[HiPointDem]

216. It's actually paying MORE THAN THREE TIMES what the supposed 'extra cost' is (about $1200K/year, on

average.

[robinlynne]

231. Everyone who willfully introduces longterm lifestyle risks does not have to pay more.

It would be discrimination. Poor people would need to pay more because their diets don't contain enough vegetables and proteins.
etc. etc. Overweight people would need to pay more. People who are too thin would need to pay more. People who eat sugar, drink alcohol, or take drugs would need to pay more. It would be impossible to do this. it would also be unfair to do this. What if a woman takes crack and has a baby. how much should that baby pay for health insurance?

What about people who cross the street against the light? They are much more likely to be hit by cars than I am.

[Sekhmets Daughter]

58. Segmenting insurance markets by risk cuts across that risk-spreading benefit in the interest of prof

Absolutely correct.

[still_one]

105. I don't agree, and I am not a smoker. This is discrimination pure and simple. What if this was

About foods that are not good for you?

This is wrong and having people who because of this habit which the government for decades gave a free pass to, now hurts those who are hooked

Medicare doesn't do that and neither should this

[still_one]

106. It is very unfair. They do not do it for Medicare. Also, I am not a

Smoker, but this sucks

[dogman]

2. So patients will be required to lie to their healthcare providers

or lose their insurance. Odd way to expand coverage.

[cthulu2016]

6. Are those the only two options?

[Downwinder]

8. Death

[dogman]

11. If they continue to smoke.

20% of adult Americans do.

[Freddie Stubbs]

92. You don't expect people to actually quit smoking, do you?

[No Vested Interest]

128. Don't many quit smoking when the price gets too high?

What's "too high" for one person may not be so for another, but with each additional price point the price get too high for some.

[kestrel91316]

17. They'll lie to their insurance providers, and that's fraud.

They are free to tell the truth. AND they are free to cease smoking. No one is stopping them.

[dogman]

19. Sounds like the GOP healthcare plan.

Drop Dead.

[CreekDog]

73. Actually, Obamacare is an improvement for smokers and offers more protections for them

agree with it or not, the surcharges for smokers are lower than what is allowed under current law.

also, smokers cannot be denied coverage because they smoke. under current law, an insurer can deny them any coverage, based on their smoking.

if you want the cost to be even, that's not what's in the law, but it is more even than previously and it gives smokers more options than legally they'd have without Obamacare.

[dogman]

81. Except there are a large number of people who are not currently denied.

Their cost will be going up.

[CreekDog]

84. you don't know their costs will be going up

the law isn't perfect, but please stop being dishonest about it.

first, anyone covered now, is not required to pay more because they smoke. but they can be charged any amount more NOW, than a non smoker and they can be outright denied ANY coverage due to their smoking.

second, if the health insurer is not currently charging them more for being a smoker, nothing in the new law requires them to be charged more once it goes into effect. and under current law tomorrow their premiums could go up markedly for being a smoker, Obamacare limits the amounts they can rise.

please stop misrepresenting the law.


and when i point out that you're misrepresenting the law, don't tell a bigger lie to make your argument stronger.

you aren't convincing anyone else in the thread when we debunk what you're saying.

[dogman]

88. I guess it is all an assumption.

Anything can happen anytime. But I do know that a law that singles out 20% of the population for a higher premium is bullshit.

[CreekDog]

89. it doesn't single out anybody

quit smoking.

then you save money on cigarettes and health insurance.

very simple. and you probably live longer.

and those people exposed to your smoke will be healthier.

[dogman]

91. For someone who wrote about my posts, it is obvious you

haven't read them or have a comprehension problem, I do not smoke. I don't think smokers are less than human, that's all.

[CreekDog]

93. they aren't less than human

it would be great if they were charged the same, but there is one way to guarantee they will be!

stop smoking! and it's the best thing they could do for themselves.

[dogman]

95. nt

nt

[CreekDog]

100. that's a lie and you know it because you stated the opposite just a couple posts ago

the law doesn't require premiums to go up because of smoking.

current law allows any increase based on smoking, a huge amount, potentially.

you *may* be charged more for smoking, but the amount you can be charged is limited, currently, it is not limited.

apparently you now have decided you can't win this argument by telling the truth about the law.

[CreekDog]

103. LOL I see you edited your post --because you said something ridiculous

Obamacare means that those with preexisting conditions pay the same amount for coverage than people without them.

and you can stop smoking.

you often can't stop having a preexisting condition.

[TheKentuckian]

230. No bullshit, if the game is fuck you to the "undesirables"

Then why do I give a damn about your preexisting condition? It is in my interest not to be in your pool.

If you want trust to do important and large scale initiatives, the social engineering shit has to go or folks would rather take their chances and fend for themselves.

[dogman]

96. All it guarantees is that they pay more.

Maybe their should be genetic screening and just throw out the less than perfect. What is the purpose of Obamacare? To change behavior?

[CreekDog]

104. you are lying about the law again

the law doesn't guarantee that they pay more (your words).

[dogman]

109. The fact that it is left to the insurance companies tells me it does.

I could be wrong, maybe they will be nice to people.

[creeksneakers2]

182. Would quiting solve the problem?

Maybe they'll do a chest x-ray or something and hit you if you EVER smoked.

[CreekDog]

184. why are you spreading falsehoods about Obamacare?

the law allows for charging smokers.

not charging people who don't smoke now, but may have in the past.

there is a law about what can be charged for and what can't.

prior to Obamacare you could be denied coverage as a current or former smoker and could be charged ANY AMOUNT, 1000% surcharge for smoking or a 500% surcharge for smoking, ANYTHING.

now there is not.

please stop making up things about a law you can't be bothered to read before talking about.

[creeksneakers2]

186. I read the article

and the comments. It doesn't say anything about getting a break if you quit, except that group policies offer smoking cessation policies as an alternative. Even then they say it costs an extra $75 a month.

I'm not spreading falsehoods. I was asking a question. I'd be happy if you could answer it with specific information, rather than some hyper defense of Obamacare and an attack on me, when I'm not attacking Obamacare at all.

Perhaps you should read first.

[CreekDog]

187. if you quit you're not a smoker, get it?

tell the truth about Obamacare.

[creeksneakers2]

188. Somebody downthread said the

companies require a year now. Where are you getting your information from?

[CreekDog]

190. the law is here:

http://housedocs.house.gov/energycommerce/ppacacon.pdf

[CreekDog]

189. the rules don't say they can charge former smokers more

the rules are saying smokers may be charged more (but they aren't required to be charged more).

if you're getting at a detail about how often your rate can be changed, like for example, if you quit one month when are you going to be charged the new lower rate? i don't know whether that would happen immediately, or at the next rating or renewal period (usually the open seasons are once per year).

but if you quit, if you're paying more for insurance because of that, your insurance rates will be going down.

[loyalsister]

178. They won't have to lie

Having repeated bouts of bronchitis and having to finally tell the Dr. will show up the same way countless tickets and fender benders betray the reckless driver who winds up paying more.

[BigDemVoter]

23. Oh wait. . . . Those insurers have insidious little ways of finding out if one is lying. . .

They check for nicotine in blood tests. . . . You see it all the time with life insurance policies. . . .

[dogman]

31. I was not refering to insurers.

My post mentions providers, like doctors and nurses. Most group health plans aren't there yet. It seems like this may change that. Of course illegal drugs and misused OTC drugs could come in to play. In Chicago the city is cracking down on high caffeine drinks. Maybe that will be another substance to test for.

[Mariana]

41. As if the only way to get nicotine is to smoke.

Nowadays, with the various ways to take nicotine without smoking, a positive nicotine test shouldn't be considered evidence of smoking.

[HiPointDem]

46. how much do you want to bet that people will be tested for nicotine just as they are tested

for drugs -- often without their knowledge?

anytime they draw blood they can test for anything they like, extract genetic profiles, or whatever.

[Sekhmets Daughter]

56. They test for nicotine for life insurance policies.

[HiPointDem]

69. i'm pretty sure they already test for nicotine, period.

[Sekhmets Daughter]

71. You could be correct...

another way to increase lab fees.

[robinlynne]

143. which would not tell you if someone smokes or not. only if they did.

[HiPointDem]

147. 'if they did' when the blood was drawn is basically 'that they do'. the percent of people who have

an idle puff now & again is passingly small.

finding evidence of tobacco use in the blood is enough for the system to say "you are a tobacco user," just as evidence of any drug in the blood is evidence enough.

[robinlynne]

150. nictoine patches, nicotine gum, e-cigs are everywhere. non smokers all.

[HiPointDem]

152. it really doesn't matter, does it? fairness is beside the point. The point is to discipline and

punish and produce profits for insurance companies.

and no, they're not 'everywhere'. only about 20% of the population smokes; the percent using gum, etc is a small fraction of that.

[robinlynne]

176. My point is nicotine does not a smoker make. Almost all ex smokers use nicotine.

[GeorgeGist]

3. Another reason to quit.

Chantix worked for me.

[Earth_First]

10. Indeed.

Sucessful Chantix user here, too.

1 year in April.

Best thing I've ever done in my life...

[dogman]

12. Great for you.

I wonder about the suicide mentioned in their commercials.

[Earth_First]

13. I spoke at great lengths about the possible side effects wih my prescribing physician..

I was specifically directed to moinitor changes in my health very closely and to stop taking the prescription and consult my physician immediately.

I took the information and proceeded with caution, fortunately aside from the lucid dreams, I had zero negative side effects.

If course that is not common, and many experiences will differ. I believe I remember my physician stating Chantix has a 40% success rate.

My MIL cannot take it as it causes wild emotional swings in her day to day life.

[Journeyman]

15. If it makes you feel better, Kurt Vonnegut described smoking as. . .

"The only reasonably certain, socially acceptable form of suicide there is."

Now, that was in the early '70s. Just a few years before his death in 2007 (from injuries sustained in a fall), he was threatening to sue the cigarette makers for false advertising, since he'd been using their product for years and hadn't died yet.


So, all that said, I suspect the causes of suicide would need to be weighed against each other and a decision made on which is most likely, and which would be the least painful. The choices suck, but then, that's what smoking is all about.

[dogman]

22. I quit around 40 years ago.

Cold turkey, but I had only been smoking off and on for about 5 years. My concern is for the 20% of adults who smoke and could be excluded from healthcare because of that fact. Smokers pay extra tax already when they purchase cigarettes. There are many states that have used that money to fund things beyond healthcare for smokers.

[LanternWaste]

50. We will pay the penalty or we will quit smoking

"My concern is for the 20% of adults who smoke and could be excluded from healthcare because of that fact.,,:


We will pay the penalty or we will quit smoking. I'm certainly no rocket scientist, but it seems rather obvious to me...

Good a time as any to quit my little addiction...

[laundry_queen]

137. This is where single payer makes SO much more sense.

No one pays different premiums - everyone - fat, thin, smoker, extreme sport enthusiast - has the same amount every month that goes to premiums. Smokers here pay a very high tax (ETA on a package of cigarettes, that is), but studies show the tax they pay makes up for the additional health care costs incurred by smokers. So their tax dollars are being directly alloted for their care should they need it. The health care system also funds many programs to help people stop smoking (usually for free), but doesn't penalize them if they do. Negative reinforcement rarely works anyhow.

[robinlynne]

145. Depending on income, it would remove our chance of having health care.

[Incitatus]

72. My doctor refused to give prescribe it, citing potential side effects.

He insisted I go cold turkey. I am on medication for ADHD, but have no issues besides that.

[robinlynne]

144. exactly.

[SouthernDonkey]

193. I quit on Chantix as well in 2007

My wife quit cold turkey and I quit on Chantix! I only took it for two weeks. I was 46 and had been a 2 to 3 pack a day smoker for 31 years! I LOVED em.... I could eat em like candy! If it were good for you I'd still be smoking them. But it's not, and quitting was the absolute best thing we ever did. And while it's hard, the honest to god truth is, it just isn't THAT hard.

They don't have to test your blood to tell if you're a smoker, they can smell it on you. You probably don't think so, but they can. If you smoke you STINK like a dirty ashtray. My daughter told me that for years. I didn't believe her until I quit.

I was a rabid smoker as well. NOBODY was gonna take my cigs or tell me I couldn't smoke. I don't mind them now so much if someone else is smoking, but my wife is one of those rabid EX smokers. She can't stand em anymore.

My opinion, if you smoke you should pay more. There is no question smokers are a bigger drain on the health care system. Quitting smoking won't just save you on health insurance, it will save you tenfold what it costs you to smoke when you consider everything and the improvement on your health. We bought a 30' camper 2 years after we quit with the money we'd saved!

Whether you know it or not, we all pay higher premiums now because insurance companies spread the risk among us all. Non smokers are already paying more to subsidize the higher cost of care for smokers. Is that fair?

Look at it from my point of view. I no longer get to enjoy what you get to enjoy because I quit to save money on my health insurance. So....why should I have to pay to subsidize your health insurance when I no longer get to enjoy my cigarettes?

*edited to add: Proud to say I'm still a non smoker and have been since August 15, 2007!

[HiPointDem]

47. it gave my neighbor heart/lung problems.

[Incitatus]

70. I quit about 2 years ago cold turkey and I feel a hell of a lot better.

It took several tries and at times I could feel extreme rage over trivial things that would normally be just barely a minor irritation. The rising costs of smokes was one factor in my decision to quit. If they hadn't been so cheap when I started or if the prices rose faster than it did, I probably would have quit a lot sooner.

[bluestate10]

99. Exactly. nt

[shill baby shill...]

183. OMG.

Sure you're not a paid shill?

Ever heard of a slippery slope? This is a nightmare!

[datasuspect]

9. it's like a thousand little nails

at some point i might just stop paying everything, live life and wait for the authorities.

[DogPawsBiscuitsNGrav]

18. You wouldn't be alone. A lot of people starting to think the same way. Unfortunately we

can't just move to the country and escape. We'll be hunted down like dogs, our doors will be kicked in and we'll be lucky if we're not shot. Smokes are already highly taxed and now they want another 4000 a year! As an ex smoker I'm furious! This will be coming to the obese next.

The thousand little nails are getting sharper everyday.

[Ikonoklast]

14. And under the provisions of the ACA, individual states have the right to lower or change that number

There was no provision, law, or regulation BEFORE the ACA was enacted to keep health insurance providers from charging smokers whatever premium they wanted to, or to exclude offering smokers insurance at all.

[RandiFan1290]

20. Smoking is expensive in Europe and Canada too

[msongs]

21. tough choice, spend $$ on your drug addiction or health care nt

[dogman]

26. Are smokers there excluded from healthcare?

Or is the tax on products used to offset costs?

[RandiFan1290]

32. They are not excluded

I will have to yield to someone that knows more about the system than I do but I know they pay a lot more for cigs, gas, and fast food.

[laundry_queen]

139. Yes

taxes on cigs are high - and studies show the taxes pretty much take care of the health care costs. Smokers here do not pay higher premiums for provincial health care plans, nor are they discriminated against on access to care.

And yeah, 'fast food' or 'convenience' food is subject to a sales tax that normal 'grocery store' food (unless packaged in less than 6 servings like a ready-made sandwich in the deli) isn't. Unfortunately, it also applies to ready-made single serving salads from your grocery store.

[pnwmom]

25. Smokers have always been charged higher premiums. This puts a cap on that. n/t

[dogman]

33. What does a cap do for a poor person?

Poor people also tend to smoke more.

[ProSense]

34. The health care law

"What does a cap do for a poor person?"

...expands Medicaid.

The health care law is still the biggest expansion of the safety net since Medicare
http://www.democraticunderground.com/10022159929

[dogman]

36. Good

More will qualify when their funds are depleted. We just saw Jindal attempt to remove hospice care from medicaid.

[pnwmom]

37. Medicaid has been expanded for poor people

and other low income people will get subsidies to limit the costs to a certain percentage of their income.

[geek tragedy]

78. That's their fault. nt

[dogman]

85. Your right, we should only help perfect people.

Seems Paul Ryan ran on that and lost.

[geek tragedy]

86. No. Charging smokers more is perfectly logical.

It's a necessity for insurers--any insurer that didn't charge more for smokers would go out of business.

Smoking is a personal decision, and those who choose to smoke should not expect everyone else to subsidize that choice.

[dogman]

94. Does Medicare charge smokers more?

And I think you might be over concerned with the insurance business. There are a number of unhealthy items insurers could charge for. Do you have a high powered vehicle, firearms, and so on. These people are an easy target, look at your empathy level for them for instance.

[geek tragedy]

115. Smoking is different. It is (a) 100% voluntary and (b) 100% guaranteed to lead to higher

health care costs.

If people want the freedom to smoke they need to be willing to bear the costs of exercising that freedom.

[dogman]

116. So smokers are the only evil people seeking healthcare?

Interesting.

[geek tragedy]

119. Never said that. Only that they choose to make themselves less healthy and more expensive

to treat.

Smokers can't be both libertarians and socialists on the issue.

[dogman]

122. Wasn't thinking of the smoker's politics.

I was thinking of the Country's. The Democratic Party tends to be empathetic, that's how you can tell the difference.

[geek tragedy]

123. Empathetic is one thing. Terrible public policy is another.

The burden should be in the only people who can prevent smoking-related illness.

[dogman]

124. The tobacco industry is not interested in stopping smoking

unless they can switch you to smokeless.

[creeksneakers2]

185. Its not that voluntary

when you are addicted to it.

[robinlynne]

146. what about people who drink? what about people who take drugs?

and what about people who eat bacon and eggs?

[geek tragedy]

163. The causal link is nowhere near as strong. nt

[robinlynne]

181. what?

[okaawhatever]

29. What about all the money the states got from tobacco companies to offset the cost of healthcare?

It was supposed to go to medical care and stop smoking awareness. They friggin' used it to pay for everything else. That's also the reason why cigarettes are taxed so heavy, to offset the negative externality they pose to society. And BTW, smokers die younger and are less of a burden to the social security system, so i would say they should have to prove the actual cost. I'm sure in pot smoking states, they will come after that next. Alcohol meanwhile still has a strong lobby so no worries there.

[pnwmom]

38. Alcohol is more complicated because there are some health benefits

for low and moderate drinking for some people.

Cigarettes, not so much.

[4Q2u2]

40. What about other highly addictive substances

It has been noted in many places that nicotine is harder to quit than a lot of other drugs. Will people be asked about Heroin addiction or Cocaine, or even Prescription Drug addictions. Or are they just not done with smokers yet, and will move on to the next group when they are.

[Wind Dancer]

74. Excellent question!

[4Q2u2]

98. Thank You

I also thought that pre-existing conditions were not punishable. If there is an angle the insurance companies will find it.

[dkf]

204. Who would admit to illegal drug use?

That is crazy.

[Aristus]

44. I have done everything I can to create for my patients a disincentive for smoking.

Obviously, appealing to the need for improved health doesn't work. There's no one alive today who doesn't know smoking is bad for them. Maybe the fiduciary angle might be more effective. Hope this works...

[dogman]

61. Are you not more concerned that your patients are incentivised to lie to you?

They are being taxed when they purchase tobacco and I have already seen a charge for smoking cessation on a patient bill. They get no respect so they are easy prey.

[Aristus]

63. Most of my patients who smoke are pretty up-front about it.

Kind of a "yeah, I know I shouldn't" attitude. And even if they did lie to me, nicotine stains on the fingers, and a perpetual aura of tobacco odor don't.

[dogman]

65. If they say they don't, does that mean you will indicate otherwise?

Will their health records indicate they are lying?

[Aristus]

66. Medical charts include spaces for subjective information, i.e.: "I don't smoke", as well

as for objective information: "Patient smelled strongly of tobacco smoke, had moderately severe halitosis, and brownish-yellow stains on the fingers of his dominant hand. Coarse breath sounds noted on auscultation."

[dogman]

79. Seems like this could be a pain for you if this issue blows up.

I suppose it depends on how the insurance companies decide to implement it.

[Aristus]

82. I'll roll with it.

I'm used to having to arm-wrestle the insurance companies best two-out-of-three just to get my patients an MRI or whatever. This new thing won't affect my day that much...

[MrSlayer]

59. You know, there might have been something to all the bitching the right was doing.

What with all these businesses cutting people's hours and these other ridiculous rules fucking people and the corporate giveaway that is the mandate, perhaps there was something to all that complaining on the right other than political oppourtunity.

We should have gone with Medicare for all, we should have at least gotten the public option. But the sellouts in "our" party wouldn't go against their corporate masters and we end up with this Republican monstrosity.

There are some good things in there of course but you wonder if they outweigh the bad.

[Skip Intro]

130. I think you might be right.

I have a feeling that by the time the law fully goes into effect, a lot of people are going to be saying "wtf?"

[flamingdem]

62. This is reality: the choices made by smokers are expensive for the society

and they have to pay for that.

[robinlynne]

148. oh really? We are the reason health care costs so much/ And yet europeans smoke more and health care

is better and cheaper. How does that work?

[flamingdem]

157. Second hand smoke alone is hurting more than just the smoker

Do you deny people can get cancer from that?

Europeans might smoke less contaminated cigarettes or in general have better health but it is proven as you know that cigarettes contribute HUGELY to healthcare costs in this country.

I like cigarettes myself and will go to smoke filled venues and have friends who smoke but I think most of the are totally BS and say blah blah they'll never quit. Okay but I don't want to pay for that self destructive decision.

[robinlynne]

174. changing the subject? Yes I deny it. my stepfather was the oncology researcher who

worked on the theory that second hand smoke might cause any sort of cancer. it absolutely can not.
Even if you were locked into a closet sized closed space for years, it still would not cause cancer.

[RedCappedBandit]

67. Stop smoking.

You're supporting a vile, corrupt industry anyway.

[RagAss]

68. No baby, I love the way your ass drags across the floor !

[bluestater1966fgs]

75. This is a good idea IMO

Smoking is extremely detrimental to a person's health. This penalty would give many people who have difficulty quitting smoking an incentive to do so. Also, to be honest, I never really understood the appeal of smoking in general.

[geek tragedy]

77. Good. Why should we subsidize their self-pollution? Nt

[spedtr90]

80. Not new at all

From Health insurance FAQ's:

Can I get individual health insurance if I smoke?

You can find health insurance if you smoke, but your plan will most likely be more expensive than non-smokers. Obviously, you should consider kicking the habit for your health, but also to save money. Many plans require you to be smoke-free for a year to get non-smoker rates.

[OneTenthofOnePercent]

83. Good. If you wanna fill everyone else's nose with your smoke...

you're going to pay through the nose to do it!

[mike_c]

102. I'm all for it if it discourages tobacco addiction....

eom

[dogman]

111. If only.

Just doesn't seem likely that teens are concerned about the cost of healthcare. I think by that time it's a habit.

[Yavin4]

107. I have an answer: Impose a National Sales Tax on Cigarettes

Use that money to supplement Medicaid and older smokers.

High sales taxes on cigarettes here in NYC has greatly reduced the number of smokers here. I stopped smoking when a pack reached $14.00.

[Thinkingabout]

112. The price of cigarettes in Texas is around $50 a carton and one carton a week is $2600 a year.

Two cartons a week is $5200 a year. I guess the cost of smoking will influence some the cost is too high.

[dogman]

117. Then NY taxes them.

Where is that Money?

[Yavin4]

132. States can impose their own sales taxes if they want

and do anything they want with the money. Thus, a pack of smokes in NYC would be $20.

[Revanchist]

108. Is this just for tobacco products

or all types of nicotine delivery systems? I went from cigarettes to e-cigs a year ago and am trying to give these up for good also.

[Mariana]

135. I made the point upthread that simply testing for nicotine

which some life insurance companies apparently do, proves nothing. You can't determine whether or not someone smokes by the presence of nicotine in the body, since there are various other ways to take nicotine.

I didn't get any response. No one seems to want to consider nicotine users who don't smoke.

[OneTenthofOnePercent]

160. Well, then the smokers better grow some will power and quit cold-turkey.

Because if they fail a nicotine test with an insurance co. and said they didn't use tobacco products, it's gonna take WAY more follow through fighting their system for benefits.

[Mariana]

169. What smokers are you talking about?

This subthread was very specifically about people who do not smoke.

[JoeyT]

191. Thank you for proving

that for many this isn't about health, or costs, or even health costs to society. It's just another fucking moral crusade.

"We don't give a shit if you quit or not, you better not have devil nicotine in your system!"

Three cheers for authoritarianism!

[riverbendviewgal]

110. we don't have this craziness

Up my way. There is encouragement to quit. Travel health insurance and life insurance does cost substantially more for smokers.

[libdem4life]

113. Cheaper life and health policies for non-smokers are enforceable. If the health problem or death

is linked to or a result of smoking, they are not obliged to pay out. My auto policy has offered this option for years. Lung cancer and the like are not a medical mystery.

Health coverage I could tell, but I never was clear how this affected my auto policy rates.

[robinlynne]

149. This is idffernt LOWer premiums for some people, as opposed to raising premiums for others.

That would not bother me at all. but raising my costs because I smoke is WRONG. Smoking is not illegal. I cause harm to NOONE.

[libdem4life]

151. Like I said, I could understand health, but apparently smokers have some relevance to auto insurance

They certainly don't lower our costs for no reason.

[Mariana]

156. Weird, I haven't heard of it with auto insurance.

Certainly no one has ever asked me whether I smoked when I've applied for auto insurance. I wonder if it's your particular insurer doing it for some reason like maybe they hope you'll buy other types of policies from them, ones where whether or not you smoke really is relevant.

[libdem4life]

159. I've had AAA for years and use their Road Service, but nothing else.

[alcibiades_mystery]

118. I smoked 22 years...this is a reasonable thing

People are being asked to pay (a small part of the) costs that they are - by their own choice - putting on the system as a whole.

That's called responsibility. I have no problem with this.

Anyone can quit smoking. Indeed, it isn't even that hard to do.

[SouthernDonkey]

194. Amen! +1000

over 5 years smoke free!

[TransitJohn]

129. This is not about decreasing smoking, but protecting profits. eom

n/t

[BlueCheese]

133. Strange.

I've never smoked, and wish nobody would. I live in a state that has very strict laws on smoking, and practically reel when I go someplace where people are smoking. The smell is terrible and the health costs are huge.

But, it is legal, and I'm not sure why smoking is the one behavior singled out for punishment under the ACA. I thought the whole point of the ACA was that everyone could buy in regardless of individual conditions? As others have said, why aren't people who eat unhealthily, leading to heart disease and diabetes, also charged more? Not that I want them to be, but why is smoking so special?

[Yavin4]

134. The Future of Healthcare Will Be About Prevention

I am all for preventing illnesses than paying huge sums for treatment and care. There's a post upstream about a smoker with COPD, and the array of healthcare services that he needs to live.

The more illnesses that we can prevent, the cheaper health care services will become.

[HiPointDem]

153. death is not preventable. if one thing doesn't get you, the other thing will. it's actually

cheaper not to prevent any illnesses at all, if "cheap" is your goal.

[Yavin4]

158. Highly Unhealthy Lifestyles Costs A Lot of Money to Treat

Affordable health care begins with prevention.

[HiPointDem]

161. hmm, how to prevent old age....?

[Yavin4]

164. You're Being Obtuse n/t

[HiPointDem]

165. actually not, since the bulk of medical costs are incurred in the last couple years of life. Of

*everyone's* life, not just the lives of fat smokers.

it's the health nazis that are obtuse. They imagine that we lower health care costs by surveilling, disciplining, and scapegoating supposedly "unhealthy" sub-groups (almost all of which, incidentally, have incomes below the median).

Smoking rates are lower than they've *ever* been in the US -- and health care costs just keep on growing. and they will keep on growing, for two reasons: the dominance of for-profit medicine and insurance & its concentration into a smaller and smaller set of hands, and the reduction of income of the bottom half of the population (since low income is the factor most strongly correlated with all 'unhealthy' behavior).

The geniuses designing our health policy, like the geniuses designing our education (they're the same people) think punishment and fines are the best way to get better results. Take more from the poor, give it to the upper classes, that'll work great. Give it to the people who are "living right'.

Or maybe they don't. Maybe they understand very clearly that it's just the way to get higher profits despite worse results.

[Yavin4]

166. Healt Care Costs Are Skyrocketing Because People Seek Last Minute Treatment

for ailments that lifelong prevention could have addressed far more cost effectively, and they seek this treatment in emergency rooms.

If the poor smoke, they are already injuring themselves and in this instance, deterrence does indeed work. The first step is to lower the rate of smoking, and the next step is seeing that people get regular exams to prevent diseases from reaching the critical stage.

Prevention of major illness is simple common sense.

Now, you're right about end of life care. Health care providers do indeed take advantage of patients in the final years of their lives. and we have to determine if the care being proscribed is actually effective.

[HiPointDem]

168. baloney. smoking rates peaked for men in the 40s/50s, with 67 percent of men smoking. for women,

it peaked in the 60s. The 60s were 50 years ago.

the percent of the population who smokes or has ever smoked is lower than it's ever been IN MODERN US HISTORY -- where are the fucking savings? where are they?

health care costs just keep going up, & they're not going up because people smoke more or are fatter.

it's nonsense, but there are lots of fools buying it.

[robinlynne]

177. Thank-you. As a smoker, I doubt I will ever need a transplant. THAT is expensive!

shall we punish those people? I will probaly use much LESS healthcare because I smoke, if you want to really look at that.
Now I want my discount for smoking!

[customerserviceguy]

155. I don't smoke, I never have

And I truly wish so many people wouldn't do it.

But, I have to look at this as the slippery slope. Yes, we can all agree today that tobacco is bad, but what happens when a preponderance of people consider other lifestyle choices as being just as bad? I see this moving from smoking, to drinking wine or beer, to vegetarianism, and anything else some majority is persuaded to decide is bad for me.

It's funny, I guess I don't remember the tobacco penalties being discussed when ACA was being debated in Congress. I suppose I won't find out about the other condemnation of lifestyle choices until it's too late, either.

[HiPointDem]

162. yes, & yes. it's a very slippery slope & it's so weird to see all the democrats lining up to cheer.

"Yeah, tax those nasty smokers! double, triple, i don't care! everyone *knows* they cost bazillions to treat, the entire system is floundering because of stinky, nasty smokers!!!"

health nazis, every bit as creepy as real ones.

[leftstreet]

167. I suspect a lot of them are ex-smokers

Pissed off and hateful to smokers

They need to try a joint now and then

[HiPointDem]

170. marijuana causes lung disease & increases health care costs. just off yourself now & decrease

the burden on the "good" people.

on the declining percentage of the population the PTB deem "good", that is.

[laundry_queen]

196. I agree, but it's also the money

this is where a percentage of people on the left turn out to act just like right wingers. They don't want THEIR money going to help someone who isn't 'helping themselves' ('helping themselves' usually = eating a pristine diet, working out 2 hours/day, not smoking, not drinking, no meat, and so on). That is their attitude - that people who don't live up to THEIR moral high bar don't deserve the same treatment they figure they themselves deserve. It's selfishness, and that superiority mindset where they think everything they have in life they have it because they deserve it, and that the next person who doesn't have as much, or needs help and doesn't live up to their 'standards' is that way because they are <insert moral failing here>.

Right wingers say, "Poor people are poor because they are lazy. They need to help themselves. I don't want my tax money going to help them."
People in this thread say, "smokers (fat people, meat eaters, etc) are (fat, sick etc) because they are lazy. They need to help themselves. I don't want my insurance premiums going to help them."

Same thing, IMO.

[customerserviceguy]

206. Great observation

I find a lot of hypocrisy on both sides of just about every issue. You've nailed it.

[mrmpa]

192. I asked my Doctor for a prescription for Chantix.............his answer

No! Reasoning was I take too many medicines. I'm 56 and I take a statin, a medication for high blood pressure and 2 medications for diabetes. So no help for me trying to quit.

[TheBlackAdder]

202. The 6-figure medical bill my mom racked up from Emphysema justifies it.

Yet, she continued to smoke up until her death, developing upper respiratory infections. As she aged, her memory got worse and the carbon monoxide and hypoxia from smoking didn't help.

And, let's not talk about the old Nova show, back in the 1980's that showed lung cancer can be caused by the released Polonium 210 isotope that exists in all organic life forms. It bounces off of our skin when in nature, but when you smoke, the burning of the tobacco leaf and paper releases the isotope into the body, where it cannot escape... crashing its way through the body until it strikes something that causes permanent damage.

That show said that a person who smokes a pack and a half of cigarettes a day gets the equivalent of 200 chest x-rays of radiation in a year!

[HiPointDem]

219. considering that a simple broken leg can rack up a five-figure bill and that there are plenty of

conditions not related to smoking that can also rack up a 6 or 7 figure bill, i don't see it.

a friend is currently recovering from her *third* bout with cancer in her 40s. good christian, teetotal, never smoked or used drugs, normal weight, healthy eater, etc. just had major surgery involving the removal of lots of bone, reconstruction of blood and lymph systems, etc. third bout with this, first was in her thirties.

i'm sure her combined bill is getting close to a million.

meanwhile, my neighbor who smoked and drank most of his life is out building chickencoops at 80. his wife who was teetotal non-smoker died of cancer in her 60s.

the fact that some individual smoker had a high medical bill is no more relevant than the fact that my uncle doesn't have a high medical bill and my friend with cancer does.

[TheBlackAdder]

224. Perhaps his habits contributed to his wifes death?

Folks always bring up things like that... just like the not wearing seat belt thing... until the guy I knew got in a minor accident and was airlifted in critical condition while the smaller Hyundai he hit's driver was unhurt.

[HiPointDem]

225. i doubt it. colon cancer, & she didn't allow smoking in the house.

[TheBlackAdder]

227. We have no idea what really went on in that household. nt

[HiPointDem]

228. uh, I have a very good idea what went on, since i knew them.

[sylvi]

209. Jesus H. Tapdancing Christ

When did all the fucking Rethuglican/Libertarian economic attitudes creep into this place? "Pay your own way!" Pull yourself up by your bootstraps!" "Why should I have to pay for x?"

It reminds me of all the conservative asswipes pointing to someone buying snacks or a t-bone steak with food stamps and shrieking, "See? See? Think of all the money we could save if we cut their entitlement by that amount! They're abusing the system!" Republicans hate poor people and can't stand to see them have a little pleasure. Smoke Nazis seem to have the same sentiment towards smokers.

Is there anyone more self-righteous than a nonsmoker on their soapbox? I thought we were about socializing the costs of health care. If paying in a few more dollars a year for that socialization chaps your ass that much, try demanding some profit limits on the insurance gangs or health care industry, or tax the 1% to make up for it. Stop fucking with the common citizen.

[HiPointDem]

213. Thank you. If this is any indication, we're well on our way to 100% individualized, for profit

health care and the destruction of medicare and medicaid.

WHY IS ACA TURNING INTO AN INSURANCE SCAM, COMPLETE WITH INDIVIDUALIZED 'RISK' CATEGORIES?

Bullshit, & BULLSHIT on all the saps who keep saying "it's just a stop on the way to universal health care..."

NO, IT'S NOT. IT'S A BIG STEP *AWAY* FROM UNIVERSAL HEALTH CARE.

[Yavin4]

226. So, People Shouldn't be Forced to Wear Seat Belts or Motorcycle Helmets Either?

Just like seat belts and helmet laws, it's in society's best interest to discourage overly reckless behavior.

No, wearing seat belts, helmets, and curtailing smoking alone won't bring down health care costs, but it will somewhat lessen its exponential rise.

[xoom]

210. Good!

[Romulox]

229. This is how INSURANCE works--"actuarial principles". We should've enacted HEALTHCARE, instead. nt