smoking kills

Monday, January 16, 2012

This is a milestone year. In 1965, Congress mandated that all cigarette packages distributed in the United States carry a health warning. Celebrating a 47th anniversary is usually not that momentous, but this year marks the first time that people enrolling for Medicare will have known for their whole adult life that smoking is dangerous. Before the first Surgeon General’s report that linked smoking to cancer, people might be forgiven in not knowing the dangers of tobacco use, but pleading ignorance was no longer an option.

People listened to what the government had to say. Gallup polls in 1958 found that only 44 percent of people thought that cancer and smoking were related. That number increased to 78 percent in 1968. However, the full health cost of smoking wasn’t related just to cancer. Smoking increased the risk of heart attack, stroke and peripheral artery disease. Women who smoked during pregnancy gave birth to babies who weighed less. Respiratory diseases like chronic bronchitis, asthma and allergies occurred with greater frequency and severity. The Surgeon General’s committee looked at all the literature and found that the more a person would smoke, the risk for disease increased as did the severity of disease. If they stopped smoking, the risks started to go away.

From 1965 onwards, a smoker would be confronted with increasingly graphic and aggressive warnings. For some people it worked. In 1965, more than 50% of the US population smoked; in 2011, it decreased to 19%. But those smokers enter the Medicare program today without a screening medical exam and without pre-existing condition exemptions and then expect the system to pick up the cost of their increasingly expensive care. In 1965, knowing what it knew, Congress declared the badness of tobacco, but then failed to address the consequences of smoking. Tobacco taxes could have been put away to pay for the expected future costs that would burden Medicare, but that would have required foresight and fortitude. While that smoker who turned 18 in 1965 continued to light up every year, the government failed every year to account for the cost of that behavior.

Government redemption needs to occur since, sadly, new smokers continue to be created. Almost 20 percent of middle and high school students smoke cigarettes but that number is too vague to tell the story. According to the American Lung Association, 3,900 kids will try their first cigarette today and 950 will become regular smokers. Of those, half will die prematurely (http://www.lungusa.org/stop-smoking/about-smoking/facts-figures/children-teens-and-tobacco.html#1) The United States isn’t a world leader when it comes to smoking rates and that’s a good thing. More than 60 percent of people in China smoke, the same percentage as in the Ukraine. Japan chimes in at 44% while France and England are in a dead heat at 36%.

This election year, when the debates occur and the talk turns to how runaway medical costs need to be controlled, the suggested solutions will likely focus on providing more efficient medical care. It’s too bad, because controlling demand should be the top priority. One can debate whether health care is a right or a privilege but it is certain that prevention saves money. The individual needs to take responsibility for their behavior and deliver as healthy a body as possible to Medicare. For the past 47 years, smokers have chosen to ignore daily warnings that the product they use kills. Perhaps they have delivered bodies that cost too much to repair. Their option may be comfort instead of cure.

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