The Smoking Thing
When patients take an active role in harming their own health it becomes a very controversial topic. As physicians, we rarely ever turn away a patient. We try, as consultants, to guide him or her but we try not to judge. As we become stewards of the healthcare system, however, we need to understand the big picture of resources. In part, that is why I do this blog. In previous posts we have debated the use of CT scans to screen the lungs of smokers. We have debated whether drug testing should be done on patients who receive government healthcare. And so on and so on. Unfortunately, we still need to have these discussions.
In the real world of non-subsidized folks, the issue is often cut and dry. When you or your employer pays for health insurance, you both accept that there are rules and they are going to charge you more if you have established health problems. They will your check your urine for nicotine and make your rates go up if you have been doing bad things. Heck, even the Cleveland Clinic will NOT hire smokers! Again this is all accepted but if you take the same scenario and apply it to people who do not pay for their care then all of a sudden it becomes political and wrong. In Utah there is bill to add a surcharge for smokers on Medicaid. They would be tested for nicotine and their copayments would go up. This is the same technique used for managed care patents. All of a sudden there are tons of people ready to battle over this intrusion into their lifestyle. Where where they before? Where was the uproar when this was done for the paying customers? Crickets.
Needless to say, Utah is giving it a shot. Will it fly? Never.
All these financial calculations apply to health insurance in America, generally a short term product for people under 65. The best thing we can do for the federal deficit is take up smoking because lifetime Social Security and Medicare payments go down. Until we change the way we care for octogenarians, striving to become one is no way to save the system money.
If we take this to its logical extent -yes, please! – then I would love to see women who are on Medicaid and become pregnant get hit with severe penalties. After all, it’s their lifestyle choice for which I am paying!
Here’s another thought Re: the smoking quandry: Would it be possible for a non-smoker, living in close proximity to a smoker, to absorb enough second-hand nicotine to be tested ++ for same, w/ the result of being denied employment? I wonder…..
Lynne S Tobias, RT
Pt Pleasant, NJ
If we’re talking about nicotine addiction as a primary health problem (which it is) I would think the same policies/practices would apply as with alcoholism. Persistent noncompliance would cancel treatment for other issues. This means every primary doc would be an addiction specialist, which they should be. Before I got sober many years ago, my doc was the easiest person to fool within my sphere. I think/hope things have changed.
The Baylor health care system in Dallas, TX, will also no longer hire smokers.
Medicail treatment for Type 2 diabetes:
1. Dietary Excercise consult.
2. Smoking cessation class.
3. Glyburide, Glipizide and Metformin.
4. Insulin and NPH
5. Q60 day hemoglobin a1c’s. No further coverage for anything if you skip one until you get it done.
6. Further treatment of complications based on average A1c’s and urine nicotines. This will encourage dietary, smoking and excercise compliance. For instance:
Retinopathy – laser vs eye patch
Peripheral vasc ds – fem-pop vs amputation
Nephropathy – dialysis vs hospice
CVA – expensive rehab vs wheelchair and oatmeal.
CAD – cath, stent, CABG vs free cigs, donuts and aspirin.
E.D. – viagra vs divorce.