Medicaid Could Save $2.6B Within a Year If Just 1% of Recipients Quit Smoking
ucsf.edu
ucsf.edu
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
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.
Emphasis mine
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."
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.
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.
Jesus dude you made that point yourself -- but with smoking.
I'm just saying, solve the addiction problem overall, and you solve a huge problem across all of humanity.
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.
That or I’m projecting :-)
It's almost like poor people live miserable lives and flock to anything that can provide even a minor amount of pleasure
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.
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.
"The federal excise tax on cigarettes is just over $1.00 per pack."
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.
the world lacks accountability and this perspective perpetuates it
there are consequences for your actions and the majority should not suffer for the minority's idiotic habit.
It’s a rhetorical question by the way -- your position is not very defensible.
But tax?
No.
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.
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.
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.
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.
Overeating IMO has become a bigger problem than smoking, at least in the US.
It is a highly effective antidepressant for many people.
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].
He doesn't smoke.
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.
Maybe we could slap a large national tax on heroin addicts while we're at it.
Show up in the ER and test positive for heroin or fentanyl? Hey, you owe $10-20-50,000 more to the IRS at the end of the year.
Absolute units like billions of dollars are meaningless in these contexts. Please use percentages.
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
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.
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.
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).
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)
W could save X if just Y % stopped doing Z.
Stop micromanaging people, bring freedom back.
/sigh
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).
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.)
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!"
>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.
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".
The US doesn’t spend a particularly interesting percentage of their GDP on defense budget at a global scale.
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?
https://en.wikipedia.org/wiki/List_of_countries_by_military_...
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.
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.
If you never tried one you'd think it's disgusting
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.
A cigarette with coffee in the morning is untouchable.
My rule for myself when I quit was I can only smoke on vacations, so I still look forward to that combination in the future.
Unadulterated tobacco smells rich and savory, not unlike freshly ground coffee. What in the hell do they do to it to make it smell so bad?
The FDA has some materials on this, which is horrifying:
https://www.fda.gov/tobacco-products/products-ingredients-co...
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.
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.
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.
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
Addiction is a crazy bug of the mammalian brain.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813084/
> 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.
https://www.nzherald.co.nz/nz/smokers-save-govt-cash-says-re...
$1.50 per pack tax (1.01 fed, giving high estimate for state taxes)
2 packs a day (high)
(30,000,000 x 1%) x (1.5 x 2) x (2 x 365) = 657,000,000
You'd need 4% to quit to even out.
Of course if you had nearly a quarter quit you’d save even more, so…
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.
1% of that is $11 million.
Quite a difference.
To go from a million to a billion, you multiply by 1000.
Same to go from 1 to one thousand or one thousand to one million. It’s also easy to remember since the commas are every 3 decimal places.
1/1000 is equivalent to 0.1%, not 1%.
The point that it is a LOT less than 2 billion stands however
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.
Also, social security becomes move solvent.
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.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813084/
> 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.