"Big Tobacco"

[FoolKiller]

The drawback is it tends to affect lower income people more severely as they tend to spend a great absolute amount on these goods and certainly a greater proportion of their disposable income.

The question is: Why are they low income? Cigarettes are part of it.

I worked with this woman (she quit abouta month ago) and she always had trouble paying her electricity and water and cable, etc. I couldn't figure out what the problem was since she started at the same pay scale I did and had a husband that she claimed made more money that her. Combined this would mean they made more than my wife and I, but we make all our bills and and have free spending money after savings. I consider ourselves to be lower-middle to middle class, and so does the market and IRS. She even said that she had her electricty shut off for three days.

I couldn't figure it out until she was talking about how she and her husband both go through about three packs a day. She said they go home and eat their McDonald's (explains her weight) and just smoke non-stop while watching TV. So that is six packs between the two of them in a day so a carton every three days (rounding up). An average carton Marlboro (what she smoked) is $22. So they spend $200-$225 a month on Cigarettes.

I think I found her budget problem.

So, when you see someone living impoverished but chain smoking you know that they can probably live better. I have no sympathy, especially after you figure in the fact that many have a satellite or cable with at least HBO (can't miss Sopranos) and usually a couple other movie channels.

And her burden on the healthcare system is minimal since she refused to go to the doctor.


Of course this is just one case, but I figure there are others like her. It's just when you watch someone chain smoking and complaining about money just remember that they are smoking a chunk of their money.

 

[dbartucci]

The question is: Why are they low income? Cigarettes are part of it.

And her burden on the healthcare system is minimal since she refused to go to the doctor.

I'd consider her to be low-income if her net income after income taxes is lower than 70% of people, how she chooses to spend her money cannot determine her income status. Your example, however, did illustrate my points; that lower income people tend to spend a greater absolute amount on cigaretters and alcohol and a greater percentage of their disposible income. Which is why sin taxes "hurt" low-income groups more than high-income groups.

You and I must consider burdens on the health care system seperately as we have mandatory public health insurance, financed through transfers from the federal goverment to the provinces, taken out of general tax revenue and in some provinces also by an ear-marked tax. So everytime a smoker visits the doctor, or goes to the hospital, or has surgery, I pay for some part of it.

In America, I believe these costs are born by the insurance company, who of course increases premiums to pay, but can target their premiums to certain groups who will be at high-risk of causing a large payout. So you'll charge a smoker, or someone with a history of heart disease more because the expected payout for their health costs is greater. So while you may pay for smokers to visit the doctor, you probably don't pay as much as they do, and whether you do probably depends on the the size of the pool of insurees covered by your policy, and the kind of medical evaluations the insurer does to target premiums to certain groups.

 

[FoolKiller]

I'd consider her to be low-income if her net income after income taxes is lower than 70% of people, how she chooses to spend her money cannot determine her income status.

Let me rephrase my statement. The reason why they appear low-income may in part be because of cigarettes. She has to live in a low-income neighborhood and has trouble making her bills, yet she has the same job I do (or had before I got promoted) and made the same as I do (possibly more because she was hired on a year before me) and trust me, it is not low income. It isn't rich but there is no reason to struggle if you aren't wasteful. I would call $200+ a month on cigarettes wasteful.

It is the same as the guy you see driving the run down junker of a car and think he must be low-income, but he owns a $300,000-$500,000 home. Or the guy with the Viper and the $95,000 home.

Which is why sin taxes "hurt" low-income groups more than high-income groups.

So additional taxes on over-priced or gas guzzling vehicles doesn't equal up to a 50 cent increase on a pack of cigarettes?

The point of a sin tax is to decrease the behavior and to help support the cost that the consequences of that behavior can add to society, such as your healthcare example. I see no problem with charging low-income people an additional tax for destructive behavior so that society doesn't have to bear the burden for their bad judgement.

You and I must consider burdens on the health care system seperately as we have mandatory public health insurance, financed through transfers from the federal goverment to the provinces, taken out of general tax revenue and in some provinces also by an ear-marked tax. So everytime a smoker visits the doctor, or goes to the hospital, or has surgery, I pay for some part of it.

But since, as you are pointing out, people with less money are a large part of this group then we can see it the same as in the United States a person can not be refused treatment whether they have the money or not. We also have healthcare support programs such as Medicare. These all fall on the government's (taxpayer's) shoulders.

In America, I believe these costs are born by the insurance company, who of course increases premiums to pay, but can target their premiums to certain groups who will be at high-risk of causing a large payout.

Recent trends are to charge smokers more. A local radio station, owned by Clear Channel, was discussing their new insurance plan on the air and the forms had a section for smoking and specifically said they would have to pay higher premiums. Lying on this form was consaidered insurance fraud.

 

[Danoff]

The point of a sin tax is to decrease the behavior and to help support the cost that the consequences of that behavior can add to society, such as your healthcare example. I see no problem with charging low-income people an additional tax for destructive behavior so that society doesn't have to bear the burden for their bad judgement.

How does American society have to bear the burden of their bad judgement?

 

[Zrow]

I think it's funny that people call the tobacco industry "evil" or whatever for profitting off of a harmful, addictive product; yet, it's perfectly okay for the government to tax the hell out of, and profit from, this addictive product, and they don't even have to produce it.

 

[FoolKiller]

How does American society have to bear the burden of their bad judgement?

In referring to low-income people, who I am assuming can't afford health insurance, it would increase costs for government assisted healthcare plans such as Medicare and increase costs when they walk into an emergency room and receive care without being able to pay for it.

 

[Swift]

In referring to low-income people, who I am assuming can't afford health insurance, it would increase costs for government assisted healthcare plans such as Medicare and increase costs when they walk into an emergency room and receive care without being able to pay for it.

Yep. That's my basic stance on that issue.

 

[Danoff]

In referring to low-income people, who I am assuming can't afford health insurance, it would increase costs for government assisted healthcare plans such as Medicare and increase costs when they walk into an emergency room and receive care without being able to pay for it.

So where do you think the problem is? In the fact that these people are allowed to smoke? Or in that you're paying for their care?

 

[Swift]

So where do you think the problem is? In the fact that these people are allowed to smoke? Or in that you're paying for their care?

The fact that the majority of Emergency rooms can't turn people away even if they don't have insurance and the people that can pay get stuck with higher bills.

 

[Kylehnat]

Plus, many, many smokers rack up HUGE medical bills in their final years, due to the many illnesses that finally catch up with them. My grandpa has medical expenses like you wouldn't believe, all paid for by the good citizens of California.

 

[Swift]

Plus, many, many smokers rack up HUGE medical bills in their final years, due to the many illnesses that finally catch up with them. My grandpa has medical expenses like you wouldn't believe, all paid for by the good citizens of California.

Yep, very unfair and a socialist policy. Also, I';m sorry to hear your grandfather is sick.

 

[FoolKiller]

So where do you think the problem is? In the fact that these people are allowed to smoke? Or in that you're paying for their care?

I figured you should know my stance on this well enough.

I shouldn't pay for their care, or anyone else's for that matter. The fact that they smoke makes no difference.

If that bothered me I would call for the prohibition of tobacco and then that would put me on a slippery slope where people aren't allowed to tan or eat fattening foods or do a million other things that can increase your risk of disease.

Nope, they can do what they want, just don't ask me to pay for it.

 

[Danoff]

The fact that the majority of Emergency rooms can't turn people away even if they don't have insurance and the people that can pay get stuck with higher bills.

Right, the real problem is that you're footing their bill. You, who have chosen a healthy lifestyle, are paying for someone else who has chosen an unhealthy lifestyle. Your justice-meter goes off when it realizes that that's not fair.

And it isn't, they should take personal responsibility for their health, not leave it to society to pick up the tab.

Forcing smokers to pay higher taxes is not a good way to solve the inequity of medical uses - it only opens a can of worms and erodes freedom. Once people feel entitled to tax others based on their lifestyle, the excercize police aren't far away. Soon we would have a fast food tax, a fatty food tax, an excercize subsidy, all based around social engineering toward what most people thought was healthy. This is the same argument used in favor of seatbelt laws, and it doesn't make sense there either.

Instead the problem should be faught at its source - the fact that you're paying for other people's healthcare. One solution would be to allow hospitals to refuse service to patients.

I think that makes a lot of sense, but not if the hospital is receiving public funds. If it's receiving public funds, it has to have an obligation to the public. That doesn't mean that it can't charge its customers though.

And what if they can't pay? Ruin their credit.

What if they argue that they didn't want to be brought to the hospital in the first place and that they were dragged against their will while they were unconcious and so they shouldn't have to pay? Let them fight it in court. They might be right, they might have been dragged against their will - in which case I'd be fine with allowing taxpayers to soak up the expense. There won't be many cases.

Emergency care is a tricky issue. The guy doing the paying often doesn't have any say over whether he goes to a particular hospital or what kind of treatement gets charged to him. They don't (and sometimes can't) ask the patient before performing a service that he'll get charged for. He didn't have a chance to check out the competition.

Tax payers can handle that so that it's available for all. It's a situation, like the military, in which government is the best way to handle the problem. There aren't many situations like that, but emergency care is one of them.

That's why I'm fine with emergency care being public. I prefer a charge for customers (and creditors going after non-paying customers) but I don't even feel that's totally necessary.

So what happens when a guy who has smoked all his life shows up for emergency care and refuses to pay? Oh well. Any time you use the government it isn't going to be totally fair. Better to let it go than to try to tax items that might send you to the ER if misused.

 

[FoolKiller]

Emergency care is a tricky issue. The guy doing the paying often doesn't have any say over whether he goes to a particular hospital or what kind of treatement gets charged to him. They don't (and sometimes can't) ask the patient before performing a service that he'll get charged for. He didn't have a chance to check out the competition.

WHy not handle it the way you do kids? Unless it is life or death someone must approve it? When I was younger my mom had all of these medical permission forms made up, notarized, and handed out to all of our family and friends so they could make the call if necessary.

Of course, this was after I got hit in the face with a tennis racquet one day and ended up bleeding profusely. The ER doctors would only apply pressure to the wound until my dad showed up.

 

[Danoff]

WHy not handle it the way you do kids? Unless it is life or death someone must approve it?

Right, I'd kindof already assumed that. Still, some people might lie and say they'd have rather died than be taken to the ER (so that they don't have to pay). In which case they'll have to bring some sort of lawsuit.

 

[FoolKiller]

Still, some people might lie and say they'd have rather died than be taken to the ER (so that they don't have to pay). In which case they'll have to bring some sort of lawsuit.

Too bad you can't repo medical care.

 

[Danoff]

The only other alternative is cut off all public funding to hospitals. In which case they would not be required to treat anyone that walks in the door. That kind of thing could lead to unnecessary deaths and get very messy. Fire departmens, police, military, emergency care - all fall under the realm of critical government services in my mind, without which things tend toward chaos. Drawing the line between what the proper role of government is and isn't is difficult, but that's the distinction that needs to be made. Whether it's essential for society.

 

[Canadian Speed]

Why not simply deal with it like a warranty? If you go into a hospital with a problem that is a known complication of smoking, it voids the warranty, so to speak. Further more, if you bring your kids into the doctors with a problem that’s a direct problem associated with second hand smoke, it applies. Apparently their well being isn’t a high enough consequence to smoking. Perhaps making their kid’s well being a consequence would help them realize just how bad it is, and just how stupid the risk really is. However, if you go in with something that isn’t a direct cause of smoking and you’re good to go. I’m from Canada and we have health care here, but I’d love to see something like this in place, as a large portion of our taxes go to pay for a lot of other people’s problems, and a large portion of them smokers. I just cringe when I see a guy outside in a wheel chair, an IV needle in his arm, and smoking through his trachea hole. These people should be euthenized or simply have their treatments stopped, as apparently they just don’t get it. I know it sounds harsh, but seriously, how bad does it have to get before people get the hint.

As for the kids thing, I know many of you are saying, “It’s not their fault”. I know that, so perhaps we have children services take them away from their homes, as it’s kind of like child abuse. In fact, they’re looking at possibly making it illegal here in Canada to smoke in your own house if you have kids under 10…

 

[Danoff]

Why not simply deal with it like a warranty? If you go into a hospital with a problem that is a known complication of smoking, it voids the warranty, so to speak.

So let's say you have a patient who is dying. Death is literally hours away. The patient is unconcious. You have no ID, no wallet, no way to know if he can pay or is willing to pay... and he's dying from complications typically (though not always) caused by smoking.

Do you turn him away?

 

[FoolKiller]

The only other alternative is cut off all public funding to hospitals. In which case they would not be required to treat anyone that walks in the door. That kind of thing could lead to unnecessary deaths and get very messy. Fire departmens, police, military, emergency care - all fall under the realm of critical government services in my mind, without which things tend toward chaos. Drawing the line between what the proper role of government is and isn't is difficult, but that's the distinction that needs to be made. Whether it's essential for society.

Just to try and get us all back on track:

What smoking related illness puts us in an emergency situation? If it is life or death then it is already too far along to cure. (An asthma attack would be an exception)

The problem here is that the system is abused when people walk in to an emergency room for a non-emergency because they know they will be treated and not have to pay. Lung cancer or any other smoking related illness should be treated by a specialist but they would have to pay for that.

So the question is, should I be paying for them to be admitted through the emergency room where they are then a hospital patient for an extended period of time?

 

[Canadian Speed]

/\/\/\ Angina, heart attack, stokes, seizures (petit mals), asthma… All could be related to smoking, all of which could land you in emergency…

 

[Danoff]

/\/\/\ Angina, heart attack, stokes, seizures (petit mals), asthma… All could be related to smoking, all of which could land you in emergency…

...and none of which is specific to smoking.

 

[FoolKiller]

/\/\/\ Angina, heart attack, stokes, seizures (petit mals), asthma… All could be related to smoking, all of which could land you in emergency…

During a heart surgery, when I was 14, I had a stroke which led to eight seizures (two gran mal) and I have exercise induced asthma. I don't smoke.

Super health freaks can have any of these.

EDIT: In short, what danoff said.

 

[Canadian Speed]

So let's say you have a patient who is dying. Death is literally hours away. The patient is unconcious. You have no ID, no wallet, no way to know if he can pay or is willing to pay... and he's dying from complications typically (though not always) caused by smoking.

Do you turn him away?

Not turn them away, but make them pay for the treatment they received. Also, don't dismiss him until you find out who he is...

...and none of which is specific to smoking.

I'm sorry... Smoking doesn't raise the risk of heart attack and stroke? That's news to me... Seizures can't be triggered by lack of blood flow to the brain? Again, news to me... Asthma... Come on. They aren't smoking specific, but if you knew who they were and were heavy smokers, you could then decide if it was a factor in any of these problems...

 

[Danoff]

I'm sorry... Smoking doesn't raise the risk of heart attack and stroke? That's news to me... Seizures can't be triggered by lack of blood flow to the brain? Again, news to me... Asthma... Come on. They aren't smoking specific, but if you knew who they were and were heavy smokers, you could then decide if it was a factor in any of these problems...

I think you misunderstood...

I'm pointing out that when a patient comes to you in need of emergency care, you can't necessarily "void his warranty" based on symptoms because you don't know what caused those symptoms.

 

[FoolKiller]

Not turn them away, but make them pay for the treatment they received. Also, don't dismiss him until you find out who he is...



I'm sorry... Smoking doesn't raise the risk of heart attack and stroke? That's news to me... Seizures can't be triggered by lack of blood flow to the brain? Again, news to me... Asthma... Come on. They aren't smoking specific, but if you knew who they were and were heavy smokers, you could then decide if it was a factor in any of these problems...

A lot of this can be caused by diet or a pre-existing condition (known or unknown). If the guy comes in with a cardiac event is it the double-quarter pounder he eats everyday, the pot of coffee he has every morning, or the half a pack he smokes everyday?

 

[Swift]

A lot of this can be caused by diet or a pre-existing condition (known or unknown). If the guy comes in with a cardiac event is it the double-quarter pounder he eats everyday, the pot of coffee he has every morning, or the half a pack he smokes everyday?

Or the genetic condition that's not his fault.

I hate to say it, but that actually happens. So, while I dispise paying for others healthcare, I'd rather see them alive then dead out on the street.

 

[FoolKiller]

Or the genetic condition that's not his fault.

If you are too lazy to bust out the "Gene Splicing at Home (r)" kit that isn't my fault. At a minimum you could ask Famine to do it for you.

I hate to say it, but that actually happens. So, while I dispise paying for others healthcare, I'd rather see them alive then dead out on the street.

I agree.

 

[Canadian Speed]

Guys... It can be determined once the patient is identified... Cause for any of the problems I mentioned can be found and determined... Perhaps the wording in my first post was misleading. Basicaly, there can be many causes to the symptoms I posted. However, all of the symptoms can be related to smoking. If it is determined that a person's smoking was the cause or partialy at fault, they should be made to pay for their treatments... It's that simple.

 

[Swift]

Guys... It can be determined once the patient is identified... Cause for any of the problems I mentioned can be found and determined... Perhaps the wording in my first post was misleading. Basicaly, there can be many causes to the symptoms I posted. However, all of the symptoms can be related to smoking. If it is determined that a person's smoking was the cause or partialy at fault, they should be made to pay for their treatments... It's that simple.

Actually, that's not simple at all. So, a person is admitted into the hospital after they go through the ER for say, a heart attack. It's later determined that they smoke and have a genetic problem with one of the valves on the left side of the heart. How do you decide that?

Also, where do we draw the line at voiding the warranty? Eating too much fast food, no exercise, stress, rough childhood, the list could be almost endless.

So, you see it's not quite as simple as you put it.