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.