"Yes, Prime Minister" was made in 1986. We did, eventually, carry out all these policies and more.
Today the vast majority of the price of a cigarette is tax, about 80%; most forms of advertisement are prohibited; the packaging is required to explicitly tell you this is a bad idea (dominating the packaging, the brand name is relegated to small print since you are required to ask for the product by name so you must know what it is, displaying it is considered a form of advertising and no longer permitted in most retailers)...
We also prohibited smoking in workplaces, which includes bars and restaurants (since those are someone's workplace, even if not yours) with the notable exception of prisons (it's not as though prisoners could leave to smoke somewhere else) and oil platforms (again, it's not like you can just pop somewhere else for a smoke).
And despite this, a few people I know still smoke. The tax revenue is slowly falling though, fewer young people have decided to become addicted to cigarettes.
> The study, paid for by the Dutch Ministry of Health, Welfare and Sports, did not take into account other potential costs of obesity and smoking, such as lost economic productivity or social costs.
Would be so nice to have the ability to do accounting like this. This house and car are free, no money down! No need to take into account the future at all.
I'm so skeptical of "if just 1% of X happens, we'll all be rich!" arguments. It's like when startups say "If we just get 1% of <giant market X> we'll be worth billions." All you're really doing is emphasizing the size of the market while handwaving away how actually difficult it is to get that 1% (because hey, 1% sounds like such a small number, how hard can it be??)
When it comes to smoking, at least in the US, it has largely become an affliction of the poor and uneducated. This has definitely changed in the past 40 years or so - smoking used to be something that was very common, but now I'm actually pretty shocked when I hear someone in my social class (highly educated, upper middle class) smokes. "What's wrong with you?" is honestly my first thought.
So the main issue is that tackling smoking rates among the poor (this article was about Medicaid after all) is really about tackling many of the issues of poverty itself. When you're bored and don't have much hope in your upward mobility, smoking (and other drugs) doesn't seem like such a bad trade - a temporary little joy, when life is generally tough anyway. When you talk about tackling the root causes of poverty in the US, that's a much more difficult (and realistic) conversation than just saying "let's just get 1% of Medicaid recipients to stop smoking."
That's funny, because when I see someone from that same social class not be condescending about people's personal choices I think "What's right with you?"
> When it comes to smoking, at least in the US, it has largely become an affliction of the poor and uneducated.
We all are capable of addictions. Smoking is the one most available to the poor.
A lot of smart people get hooked on drugs -- even though they probably shouldn't. Wall street investment bankers and cocaine come to mind -- even though they are maybe some of the smartest people on the planet.
> So the main issue is that tackling smoking rates among the poor ... is really about tackling many of the issues of poverty itself.
You're right, but your cause and effect are switched: Addiction is more likely to create poverty than the reverse. Not only does it create poverty, but persistent poverty. People would rather get high than clean themselves up and own a house.
Yeeeeech, I can't handle "the poors are addicted" narrative.
Smoking was high-class fashionable awhile back. Then the lower classes caught on as disposable incomes rose and factories made tobacco products within their reach. Necessarily the high class abandoned it because it no longer distinguished them.
Your high-class grandchildren will smoke(+). It's purely cyclical fashion and health be damned. To be crude, they will have to compete to get into each others' beds somehow and what better way than eschewing 100 years of their class' ground-truth advice about far-distant medical outcomes?
(+) As they wore jeans and played guitars in the 60s. Because those were counter-cultural, low-class markers.
I wish people who smoke could be charged more, or maybe, better yet, a large national tax on tobacco.
Where I work, people are asked if they smoke, if you do, you pay higher rates. You and I know everyone, except for a small minority, will say No to that question. So that points to a national Tax.
Where I live, people travel up to 100 miles to buy tobacco products in a neighboring that has tax much less than where I am. So yes, time for a national tax I guess.
We can charge people for health insurance based on how healthily they eat, whether they consistently wear sunscreen, how much exercize they get, how dangerous their hobbies or habits are (motorcycle? skydiving? oh boy), etc etc.
In fact, health insurance in USA DID do things like that before the 2010 ACA -- but limited by incomplete information. With smartphone surveillance (hey, why not require smartphone surveillance to get a certain product), the amount of factors you could monitor and charge based on go up a lot.
Except the ACA prohibited this... EXCEPT for smoking, in fact. "I wish people who smoke could be charged more" for health insurance -- in fact, they CAN. It's about the only thing the ACA allows differential pricing on.
Why is smoking different to you, or to the policy-makers who decided on that in the ACA? I don't really get it.
>Why is smoking different to you, or to the policy-makers who decided on that in the ACA? I don't really get it.
Smoking became the boogeyman in the early 90s. Everyone was brainwashed that smokers are weak/evil/a drain on society/less than/low class people and should be taxed until they stop being addicted somehow.
There isn't really any positive associated with smoking, it's an industry that shouldn't exist in its current form.
If we were just talking about raw tobacco then this would be a very different discussion, but we are not.
All of the other things you are talking about while are health risks a don't carry an addictive and largely proven connection to cancer (maybe the sunscreen one but there is also a difference between making a conscious choice to do something instead of just not doing something).
There is clearly a massive societal cost associated with Smoking that I really don't think can be applied to many other things. The closest thing I can think of would be Alcohol but even that for most people is not on the same level as Smoking. At least I would not think so.
So you acknowledge something is addictive (indeed, nicotine is one of the most addictive things there is, by some measures more addictive than most any other drug) -- but think that is a reason to penalize addicts?
If something is really bad for your health but you choose to do it anyway, that's one thing -- but if we know how very very addictive it is, how very hard it is to stop doing it -- that's a special reason we should penalize addicts by charging them higher premiums?
I still don't get it.
(Presumably we should charge other kinds of addicts higher premiums too? Alcoholic? Problem with opioids? Those things will surely correlate with higher health care costs -- higher premium!)
[I haven't smoked in 47 months. It was very very hard to quit].
Wish it was that simple. Modern diets and mainstream diet guidelines are terrible for us, but going back to a hunter gatherer diet for everyone on earth isn’t all that realistic either.
Smokers get charged a hefty tax on their cigarettes this tax is federal and state taxes. They also pay more for health insurance.
When I was in college, a carton of cigarettes cost $10. Now they cost $80 last time I checked. I quit smoking 5 years ago, but smokers have been taxed enough. Every few years the government wants to squeeze more blood from that rock.
Have you been to Europe? Smoking is much less prevalent in America and has been declining for decades [0], clearly the policies we've implemented have been working. What you don't want to happen is a tax so egregious that it sends the whole industry underground.
>> I wish people who smoke could be charged more...
I wish the opposite. As it is we have private employee insurance for "healthy" people who work, and government stuff for older people who don't. I'd rather see a less judgemental system and more effort to get people to be healthier.
What you’re talking about is personal responsibility. While I agree with it, I would have to say singling out tobacco users is not right. Drinking alcohol, having high sugar or fat diet, eating processed food, having a desk job, never exercising, working in a job that exposes you constantly to carcinogens, not having enough money for preventative healthcare and a lot of other things can impact your long term health, should we also start punishing those actions?
Punishing the people who are suffering from addiction with a tax isn't ideal.
I think we might be better off with a national tax that goes towards funding the healthcare necessary to support people moving off. Want to stop smoking? Here's a clinic that will work with you to develop a plan, supply you with materials, provide the counseling and community support, all for free.
And sure, if you've got that in place, dial up the costs to onboard into smoking. Prevent new addicts through price and regulation, address existing addicts with huge outpouring of support. It's expensive up front, but gets us in a healthy state long term.
And yet we let billionaires exist with their idiotic perchance for hoarding wealth and the rest of us suffer greatly from the wealth disparity. There are consequences for their actions and the majority should not suffer for the minority's idiotic habit.
Billionaires are wealthy because the companies they own stock in are successful. What are you going to do, make them sell the stock to pay someone else’s living?
It’s a rhetorical question by the way -- your position is not very defensible.
Insurance should be allowed to charge more if you smoke (though not that much more... dying early often results in less cost to the government/insurance company, not more).
A simple solution would be to eliminate subsidies on corn, soy, and sugar -- and transfer all of that funding to subsidies on fresh produce. Basically, subsidize many small, local farms that produce real food, as opposed to subsidizing massive corporations that farm the ingredients for cheap, processed foods.
High quality produce should be cheaper than a bag of potato chips. Unfortunately, in many parts of the country, people don't even have access to fresh produce. It's a real problem. The solution is simple, though certainly not easy.
To add to that, when traveling, I can get a 16 oz can of Coke for about 2 USD, same size bottle of water, about 2.50 USD or so, give or take.
So yes, what you said should be done.
But someone I know is on Gov food assistance, if they go to a local Farm Stand, produce they buy with their card gets reimbursed, so it is free. A nice first step where I live.
I don't think thats really a better title. It gives the impression that the reduction is less than the impact of people quitting.
I get where you are going, but this doesn't communicate it well. It would be better to somehow tie it into taxes or something if we want to go down that path.
Or maybe say something like "If all smokers quit it could save Medicaid 45% of its budget". Saying the same thing but I feel like putting 0.45% next to 1% leads to a gut reaction (since the savings is smaller than the amount of people stopping smoking) that does not properly communicate what is being said.
you'd think that's what they meant, but the article seems to be talking about if 1% of medicaid recipients stopped smoking, not medicaid recipients who are smokers
only about a quarter are actually smokers (who therefore could conceivably stop) so if 1% of them stopped smoking, we'd be closer to 0.1% of the budget
Since we are on the topic of Medicaid and I'm the resident whistleblower here:
Medicaid could save some insane money if people had to pay some deductible or copay.
I can't tell you how many Medicaid patients come through our clinic and will milk it for every drop. Our clinic likes it because its easy money and you don't need to take any payments(although payouts suck).
Meanwhile BCBS patients are hyper sensitive since they pay until they hit their max out of pocket. We work with them to get their visits down from ~16 visits to, 4-6. They can do a lot of the work at home, so they are motivated to do it without the $125/hr fee.
But medicaid patients would much rather have a doctor watch them, give them instruction, and do some hands on work. Its free, why not?
There is a huge disparity in treatment between the lower class and middle to upper class. At the end of the day, it seems everyone gets better. The payouts are the same ~16 visits * 40$ vs 4 visits at $125.
To be fair this seems like a bigger problem to me than Medicaid recipients "overusing" healthcare.
Are services to people on Medicaid provided at a cost and effectively subsidized by others?
Or are clinics just maximizing their profit margins by charging as much as they can since there are no incentives to decrease prices (insurance companies don't have that much interest in lowering overall costs since they can just raise the premiums).
>Are services to people on Medicaid provided at a cost and effectively subsidized by others?
Basically, I don't think we would have started a clinic if we assumed 100% of patients would be paying $40/hr.
>are clinics just maximizing their profit margins by charging as much as they can since there are no incentives to decrease prices (insurance companies don't have that much interest in lowering overall costs since they can just raise the premiums).
Yes. We charge $250/hr, and the insurance company adjusts it to $125/hr. (Note for anyone in medical, yes these are called units and aren't per hour, but I simplified it for better understanding)
Totally, but people on medicaid are people who essentially don't have money, right? In order to qualify, you must be below certain asset and income limits.
Lots of our patients own gas stations and lie about their income. What they do is have 1 person own the gas stations for credit card purchases, and everyone else claim the cash purchases.
We also have a few farmers/rural people who sell stuff for cash and don't report it.
Definitely not everyone is doing this loophole, but I always find it a bit brazen they are telling us this.
Not entirely, no. The US pays a lot more for healthcare, for identical treatment. About 80% of total revenue for medical technology comes from the US market. A lot of other countries either negotiate lower rates utilizing their state monopoly on the market or are just lower income and cannot afford the prices paid by the US. In both cases, the marginal cost is low enough that companies are willing to compromise or cost discriminate, but the end result is essentially the US footing the bill. If this were ever to change, if the US ever started negotiations like European countries do, I worry it would negatively impact medical progress.
Still, the impact of obesity are quite significant. An obese person will have 6 times the healthcare costs of someone who is merely overweight. I am not sure the difference between an overweight and healthy weight person, but I imagine it is at least something. Currently 69% of Americans are overweight and 36% are obese.
This is insane to me because even "healthy weight" guidelines are pretty generous IMO. My doctor has told me I'm "healthy weight" at times when I definitely needed to lose a few pounds. (After losing the weight I felt better, had more energy, mental clarity, etc.)
The main cause is of course significantly higher costs in the US.
In some part possibly due to more administrative inefficiency, but mainly because of much higher cost of labour. I would guess the gap between doctor salaries is even bigger than in tech (probably besides Germany and of course Switzerland).
Maybe you should recommend realistic treatment for their obesity. Mental and physical health. List what foods/ingredients aren't filled with sugar. Do you do that or just bitch about them still being fat every year?
We can acknowledge that many Doctors have mismanaged Obesity in the past (and still do). Shame is not a valid treatment option.
But if social media is any indication (and thats a big if, I don't personally know any doctors to confirm or deny if this is really the case) than there is also a disturbing trend of people not wanting to talk about this with their doctor. Of it being noted in their records to not talk about their weight.
Which I don't understand, do I love it when I go to the doctor and and I am told they would like me to loose some weight? No. At least at the doctor I am at that actually leads into a discussion about diet, activity, etc.
But to ignore it is doing me a disservice. Like I can't imagine any other thing about my health telling my doctor, I don't want to talk about that and let's ignore it. At best if there are multiple things we need to talk about, we put a pin in it and say we will make a future appointment for it.
Also... Health, diet, etc are all complex things and it isn't as simple as "filled with sugar".
Most fat people know they are fat, and know that "fixing" it means eating less and exercising more. Why waste what precious moments you can afford to see your doctor with talk that you both know is unproductive? Until doctors develop better strategies around helping someone manage their problematic relationship with food, which is better handled by therapy, fat people don't benefit from a yearly reminder that they are fat and unhealthy.
Do you honestly believe, in today's day and age, that the primary driver of obesity is lack of knowledge?
I've known plenty of overweight people, and literally zero percent of them thought "Gosh, if only I'd known doughnuts were bad for me I wouldn't be so fat!"
The "diet" industry is a $76 billion industry. You'd think with that many sales, there wouldn't be an obesity epidemic. Seems like most of the products are a big sham. It'd be nice for a doctor to assist someone rather than just bitching that they're still fat year after year. Health advise is kinda what we're paying them for ya know.
>I've known plenty of overweight people, and literally zero percent of them thought "Gosh, if only I'd known doughnuts were bad for me I wouldn't be so fat!"
If you think the strategy to get someone to cut 200 pounds safely and permanently is as simple as to stop eating doughnuts, it's obvious you are lacking quite a bit of knowledge on the topic yourself.
If you want to balance personal liberties with reducing government spending, why not implement a large(r) federal tax on cigarettes which is refunded at tax time if you’re not a Medicaid recipient?
So you have any idea how small the defense budget is compared to social programs (let alone their sum) like the ones discussed in this thread? The numbers are all public, just look them up.
The US doesn’t spend a particularly interesting percentage of their GDP on defense budget at a global scale.
>So you have any idea how small the defense budget is compared to social programs (let alone their sum) like the ones discussed in this thread? The numbers are all public, just look them up.
Yes I do, it's comparable to SS and Medicaid/Medicare. Before WWI and WWII, we hardly carried a standing military.
>The US doesn’t spend a particularly interesting percentage of their GDP on defense budget at a global scale.
That's true but you aren't mentioning total spend. The total spend numbers paint a different picture. How much military spending at the expense of domestic wellness do we need?
I still can't believe how they outlawed flavored vapes. Want to quit? Try this stale awful fake tobacco smoke option, because a mango juul pod sold behind the counter with an ID check that is regularly tested by police is too tempting for the youth who are still smoking and vaping anyhow. Meanwhile you have blueberry vodka in arms reach at the grocery store. Bud light seltzer in attractive summer packaging in every fruity tutti flavor next to the 7 up at the gas station. It's all a bullshit farce and really goes to show how leveraged our lawmakers are in companies like Altria.
It blew my mind to see that there's an alcoholic version of SunnyD (US orange drink targeted toward children). At this point, I would no longer be surprised to see alcoholic Kool-Aid next.
Not terribly on topic but I truly don't understand how people can smoke unless it's just a genetics thing?
Smoke smells and tastes awful. I know the addiction is pretty much the answer but I don't get how people don't hate the smell/taste more than the buzz lol.
Oh smokers hate so much about their habit. If you have close friends who smoke, they might be honest enough to tell you. No one really likes to smoke, they won't tell you because they are ashamed.
Dopamine makes your brain believe the hassle is not too bad. But who likes having smelly fingers, getting ash or sparks on your clothes, getting your teeth cleaned professionally way more often, smoker breath, receding gums, harder to keep up mouth hygiene, lighting 10k a year on fire, running out of nicotine in your bloodstream, running out of cigarettes, getting ripped of by the last working cigarette machine in the area at 3 in the morning, getting wet smoking outside, and and and
You get used to it very fast and it becomes a pleasurable smell...but only your own smoke. If you smell someone else's, especially a different brand, it smells bad still. Now that I've quit for a while they all smell terrible again.
Not me, I love the smell of second hand smoke, especially menthols. I grew up with people's parents usually smoking outside of parties, and it drums up some nostalgia I guess. It's a totally different smell than you smoking it yourself.
It's a nasty habit for sure and even nastier of you don't smoke. But a smoker actually enjoys it and acquires/develops a taste for it. They can tell the difference in tobacco brands, etc. My Grandfather smoked for about 75 years and he rolled his own or smoked a pipe or both (at once sometimes). As a kid he always had that smell of tobacco that was kinda of pleasing to be honest. I ended up smoking as a teen and young adult but eventually quit so I can speak from experience. I look back now and think of how stupid it was and how it makes me sick when I smell it now but, that's not how you feel as a smoker.
Father who also smoked use to joke that it was the Indians revenge on the white man. We ruined them with liquor and they destroyed us with smoking. Best advice is to quit if you smoke or don't even start if you don't.
There's a huge difference between the odor of cigarettes and that of tobacco in any other form. Pipe smoke smells lovely, and I don't mind cigars unless they're the cheapest of the cheap. But, six years now after leaving them behind, there's very few circumstances in which I don't find the smell of cigarettes and cigarette smoke objectionable.
There are things that when you are used to it, it just doesn't "taste" as bad as others experience it.
To you and me, we associate smoking with health problems so subconsciously we hate it a lot. We also never feel the "good parts" of smoking so our minds are entirely biased into the negative aspects of it. Meanwhile, a smoker grew up without caring about the health damages and they consider it fine to smoke and the cost is acceptable for the "good" a cigarette can provide.
In a way, this is similar to how I eat some very unhealthy foods a few times a week. They taste good but to some people those things are smelly and unappetizing and definitely too much oil and cholesterol in them to be called a balanced meal. I still eat them because to me, they taste good and I am willing to trade a bit of my health for that kind of enjoyment.
>To you and me, we associate smoking with health problems so subconsciously we hate it a lot. We also never feel the "good parts" of smoking so our minds are entirely biased into the negative aspects of it.
No one feels the good parts of smoking before they start and most people find the smell unappealing.
>Meanwhile, a smoker grew up without caring about the health damages and they consider it fine to smoke and the cost is acceptable for the "good" a cigarette can provide.
I'm not saying you're alluding to this but just to be clear, this is who a smoker develops into, the person was not some sort of pre-smoker who's dispositioned to like things that are bad for their health which would allow them to tolerate the smell. The tolerance is built.
I quit smoking years ago but I always liked the taste and smell, still do. If it weren't for the obvious health reasons I'd smoke for enjoyment. Which people have done for thousands of years, it may be one of our oldest cultural practices.
It's also a good social ritual and icebreaker that's not actually easy to replace. Just sharing a cigarette with a stranger and talking for five minutes is nice and these little interactions we don't seem to have a lot of any more.
A smoke and a coffee is delicious! At my peak I've only ever smoke about 10 cigarettes a week during college. These days I smoke socially or when my brother comes over during our long walks. Two cigs.
I recommend you try a cigarette and a black coffee sometime. Obviously don't overdo it like a dummy and smoke a pack a day.
State and local governments collected $19 billion in revenue from tobacco taxes in 2020. Which was high. In 2022 it had dropped to a more normal level of $11.26 billion.
It’s assuming the 1% of smokers who are recipients are evenly distributed (statistically speaking) across the smoking population. A quite reasonable assumption.
Therefore, to generally reduce the population of recipients you’d have to reduce the population of smokers.
Unless you have data showing a specific population skew or sampling issue I’d say it is perfectly good math, albeit with an assumption.
Now, of course, you could simply deny service to 1% of smokers who would be recipients—or other extremely skewed sampling attacks—but that is somewhat unlikely and in most cases directly against the goals of the program.
How about how much tax money will be gained from having alive and healthy people earning money and paying taxes? I bet it's going to be more than whatever cigarette tax will be lost...
This is true for my country as well. Govt taxes cigarettes around 1000%. I'm not kidding, that's a thousand percent tax. Our govt essentially runs on smokers and drinkers tax money.
It's not. Smoking among those over 65 has always been relatively rare. It used to be that the highest rates were among those under 30 but those younger adults today don't want tobacco and the current largest cohort of smokers is middle-aged. Less than 10% of over-65 Americans smoke tobacco according to various surveys.
> Deaths due to lung cancer represented the 28.90% and the 10.83% of all cancer-related deaths in 2017 in males and females respectively, with an increasing tendency in this last group. In addition, the YPPLL count increased in the study period among females. Lung cancer was responsible annually for 60,846 YPPLL, and productivity losses summed €13.1 billion over the 10 year period.
The entire tobacco tax revenue in 2022 was only $11 billion. At the margin, the proposed reduction in smoking would only reduce revenues by ~$400 million while saving $2.6 billion. That's clearly profitable.
To add onto this (given the actual numbers of ~11 billion collected) you’d actually need 23.63% to quit to lose the same revenue as you’d save with just 1% quitting.
Of course if you had nearly a quarter quit you’d save even more, so…
That is true for many people, smokers or not. You save money on things like hip replacements, care homes for people who can no longer fend for themselves, etc. etc.
It would be if it were socially acceptable for all of the smokers in question to have the option of assisted suicide when diagnosed with the almost inevitable terminal cancer. As it stands, end of life for a chronic smoker who develops cancer is typically prolonged, painful, and extremely expensive.
47% of Americans don't pay federal taxes (excluding payroll taxes). That's obviously even much higher for people of Medicare age, and retired people aren't paying any payroll taxes. Also, when people die, so does (at least most of) their social security payments.
Smoking is in fact pretty well aligned if all you care about are government revenues: it minimally affects people during their prime working age when they're paying taxes, and then has it's largest effects (i.e. death) when people are older and likely to be a net negative when it comes to government expenditures anyway.
> Deaths due to lung cancer represented the 28.90% and the 10.83% of all cancer-related deaths in 2017 in males and females respectively, with an increasing tendency in this last group. In addition, the YPPLL count increased in the study period among females. Lung cancer was responsible annually for 60,846 YPPLL, and productivity losses summed €13.1 billion over the 10 year period.
I mentioned this elsewhere but if the sickest (or dead) are concentrated in the oldest segment of the population (not unreasonable as young smokers are still fairly healthy on the grand scheme of things) that isn’t working then this doesn’t hold.
I dug up the clip: https://www.youtube.com/watch?v=p1DviQ9mva0
Edit: To get straight to the point, I would suggest jumping straight to 1:50