Let The Obese And The Smokers Die?

[rubato]

There is research into food additives but that is getting somewhat away from the topic.

There is quite a lot of 'catching up' to do as well.

yrs,
rubato

[oldr_n_wsr]

New York – a state with very high cigarette taxes

NY recently received an "F" grade on its anti-smoking education campaign.
and
Years ago when NY settled with big tobacco, X amount of the settlement (I forgot the percentage) had to go toward the anti smoking campaign. Big Tobacco (maybe the US Health org) had to sue NY state to get them to use the full X amount for the campaign.

And for the record, I am a smoker.

[dgs49]

Ahem,

A few years ago, we had a discussion on this board about the societal costs of smoking, and we considered the SAVINGS in retirement and healthcare costs that are attributable to the shortened lifespans of heavy smokers. I think our conclusion was that there was a considerable savings, but it was not quite offset by the high-cost of treating the heart and lung related diseases that often bring about the demise of heavy smokers. Dang it, they weren't dying quickly enough!

I suspect the same is true of obesity. Our internal medicine protocols have come to prolong the lives of armies of obese septuagenarians and even octogenarians to well-past the time when their fat predecessors would have kicked the proverbial bucket. Anecdotally, a friend of mine recently had his mother pass away at 80 - she was over 500 lbs, and had been bedridden for years.

So the solution is to deny publicly-funded treatment to ANYONE whose acute medical problem is CLEARLY related to self-destructive lifestyle choices. And repeal the portion of Obamacare that guarantees coverage of pre-existing conditions, as it pertains to such lifestyle-related diseases and conditions.

Shall we start with smokers, porkers, and sodomites infected with the AIDS virus?

[oldr_n_wsr]

Don't forget us alcoholics and our liver diseases.

I would opt out as long as my family maintains coverage, none of whom smoke nor drink like I did (a big YET). If it's not drinking nor smoking related, I'll sign up. Of course any "vice" can, and will be, related to my lifestyle choice (even a broken bone, hell he was drunk at the time).

[Big RR]

If and when we have to ration care, these decisions will have to be made, but where do we draw the line. Do we refuse care to obese and smokers only, include dringklers, include those who engage in other dangerous activities (rock climbing, scuba diving, sky diving, skiing, etc.), exclude those in stressful jobs, exclude those who have family histories which indicate predisposition to certain diseases... It's far from easy to make these choices, even harder if you care about the freedom to make stupid or less popular choices, but it's a debate worth having. Ultimatly it does come down to what costs we are willing to bear in the name of presonal freedom (and considering all the "costs" the government has used that line to justify over the years, those coss might well be considerable).

[oldr_n_wsr]

Oh I forgot, I sky dived (plan to do so again) I have a tablesaw that I use frequently, a chainsaw and I ride a motorcycle. I also run through my house with scissors or a kitchen knife, a sharp one, not one of those wussy butter knives and have a gas propane tank for my stove and grill which make real fire.

[rubato]

Smoking is harmful to 100% of habitual smokers. It is not a probabilistic outcome or one which can be attenuated except by not doing it.

The only way to avoid harm from smoking is to not smoke.

yrs,
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[rubato]

Having reviewed some of the literature for this thread I'm surprised that no other states have yet adopted the anti-smoking programs used in California. As of 10 years ago it was plain that they worked by far the best and were very cost effective; $3.50 per capita per year to cut smoking by more than half.

Increasing tax (NY, NJ, and others) was somewhat effective by itself but far less so than the comprehensive approach. (see above links)

The public education part, tailoring the message correctly, was the most important. In the 90s the ad most effective in keeping teenagers from starting was the ad showing the tobacco executives lying in congress (naturally Pete Wilson tried to pull it). Teenagers don't like being made chumps.

By extension we need to develop public education spots about diet and nutrition which are effective.


yrs,
rubato

[rubato]

If and when we have to ration care, ... "

We have been rationing care for decades. Poor people and those with no insurance all know this already if their family has had a serious injury or illness.

yrs,
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[Scooter]

I suspect that if we denied health care to anyone who advocated denying health care to someone else, the savings would far exceed any cost of providing health care to those with so-called self-inflicted conditions, and the only people who would be denied health care would be the hypocrites, which would be precisely what they deserve.

[Scooter]

If and when we have to ration care, ... "

We have been rationing care for decades. Poor people and those with no insurance all know this already if their family has had a serious injury or illness.

yrs,
rubato

Bingo. Include those with insurance who suddenly discover that the lifetime caps that are common as dirt in health insurance policies are far too low to cover the costs of most catastrophic illnesses.

Rationing is going to happen one way or another. The only question is whether we are going to ration based on medical need, or ability to pay. Hint- only one of those options is moral and humane.

[oldr_n_wsr]

Hint- only one of those options is moral and humane.

So the other choice is what will be chosen.

[Big RR]

If and when we have to ration care, ... "

We have been rationing care for decades. Poor people and those with no insurance all know this already if their family has had a serious injury or illness.

yrs,
rubato

Bingo. Include those with insurance who suddenly discover that the lifetime caps that are common as dirt in health insurance policies are far too low to cover the costs of most catastrophic illnesses.

Rationing is going to happen one way or another. The only question is whether we are going to ration based on medical need, or ability to pay. Hint- only one of those options is moral and humane.

I agree scooter, denail of care basedd on ability to pay is not rationing--rationisg has some semblance of logic behind it.

[Long Run]

We'll see on the first post of this topic since allowing much higher insurance rates for smokers is part of Healthcare Reform. Insurance companies are going to make smokers pay up to 50% more in premiums for coverage. I doubt any of the insurers are going to go after that market, especially the older groups who have a much higher incidence of expensive medical care. Combine that with the situation that the lower income groups have a much higher percentage of smokers, and there is no subsidy in the law for smokers, and viola, a lot of low-income people will still go without insurance. Which means, they won't pay until they have to show up at the ER and all of our rates will still be higher to reflect that.

[rubato]

If all states adopted smoking cessation programs like California's it would cost you almost nothing, $3.50 per resident per year, and your problem would rapidly fade away.

So why don't you do that?


yrs,
rubato

[Big RR]

Probably because what works in California will not work in all states; comnitions and people are different. I've been to California and have seen HOV lanes work; when we had them in NJ the other lanes woukld never let the drivers cut in to exit the highway; the state eventually gave them up. There are many other examples.

[rubato]

Probably because what works in California will not work in all states; comnitions and people are different. I've been to California and have seen HOV lanes work; when we had them in NJ the other lanes woukld never let the drivers cut in to exit the highway; the state eventually gave them up. There are many other examples.

California had exactly the same smoking rate as the country as a whole. All demographic groups have cut smoking There is no reason to think they are different.

yrs,
rubato

[Big RR]

And no reason to think they're the same either; Californiansseem to be a lot more willing to conform than those in other states. They were one of the first states to ban smoking in restaurants, e.g., and it worked well. not so in a lot of other states where the people fought it tooth and nail. People acepted mandatory seat belt laws a lot easier in CA as well. Bandwagon approaches work there.

[rubato]

You are asserting that it will not work without even trying it. That's stupid.

The only place it has been tried it has worked. And it's cheap.

Intelligent advertising which targets the right communities works. We proved it in a highly diverse population of 36 million people:

___________________________________________-

Did You Know?
Quitting Takes Practice, a CTCP television ad produced in 1990, has aired continuously for over 20 years in several states and foreign countries.
Working to Inspire Social Change
Kurtz

Since 1990, the California Tobacco Control Program (CTCP) has been producing hard-hitting educational ads that have contributed to a significant decrease in the number of Californians who smoke by changing the social acceptance of tobacco use.

California's ads have successfully worked to:

Reduce secondhand smoke exposure.
Counter the tobacco industry's deceptive marketing efforts to hook new users.
Motivate tobacco users to quit and promote free services to help them succeed.
Educate on the harmful effects toxic tobacco waste has on the environment.

The CTCP Media Campaign includes television, radio, print and billboard ads, as well as online efforts in several languages, including English, Spanish, Mandarin, Cantonese, Korean and Vietnamese. Additional efforts have also been crafted for the state's military personnel; college-aged youth; lesbian, gay, bisexual and transgender (LGBT) populations; as well as Filipino, Japanese, Hmong, Laotian, Thai, Cambodian and Native American communities.

California's diverse populations are affected by tobacco differently; therefore, it is essential to reach each group with culturally-appropriate messages.
African American


African Americans were seen as a "new market" for the tobacco industry in the early 20th century because they smoked far less than others. The tobacco industry studied every facet of the African American community and used the findings to successfully market their deadly products, especially menthol cigarettes. This community's smoking rate (18 men and 15 women out of every 100 smoke) 1 is higher than the general population, and has the highest lung cancer and death rates in California. 2
Asian


While many Asian women in California have very low smoking rates (for example, only 1 out of every 100 Vietnamese women smoke),3 many Asian men smoke at very high rates, including Korean men (36 out of every 100)4 and Vietnamese men (31 out of every 100).4 This shows that it is critical to continue to educate on the harmful effects of secondhand smoke, the benefits of quitting tobacco and how Asian communities are targeted by the tobacco industry.

Latinos

Among Latinos in California, twice as many men smoke (17 out of every 100 smoke) as women (6 out of every 100), and secondhand smoke exposure continues to be a serious concern.1 The tobacco industry's deceptive practices include financially supporting scholarship programs and sponsoring cultural events in Latino communities.
LGBT


It is estimated that there are more than one million LGBT adults in California, representing almost 5 percent of the state's adult population, and 43 out of every 100 LGBT adults smoke.5 That's twice the rate of the general population. LGBT Californians have fought hard to be a recognized community. The tobacco industry has taken notice and is aware of the important and profitable opportunities in this large and influential community, which is why they openly target gays and lesbians.

Native Americans

For tribes throughout North America, the use of traditional tobacco plants for spiritual, ceremonial and medicinal purposes goes back thousands of years. However, commercial tobacco causes addiction and disease. Lung cancer is the leading cause of death among American Indians and Native Alaskans. 6

http://www.tobaccofreeca.com/ads/about/
_________________________________
But I'm not a fatalist loser.


yrs,
rubato

[rubato]

"... Bandwagon approaches work there.

Appeals to intelligence work here. They work everywhere else, too.

yrs,
rubato