2009-07-20 15:47:54 - From President Barack Obama to major lobbying organizations, and increasingly in newspaper editorials, people are beginning to talk about incorporating personal responsibility into health care reform, but, so far, it doesn't seem to be reflected in legislative proposals despite overwhelming evidence that it is the most effective - and perhaps the only way - to substantially reduce health care costs, says a public interest lawyer who has saved billions in health care costs.

Recently Obama reminded Americans that "we've got to have the American people doing something about their own [health] care."
www.msnbc.msn.com/id/31929715/ns/health-health_care/

HHS Secretary Kathleen Sebelius repeated the refrain: "personal responsibility extends to lifestyle; that in order to have a healthier America, a more productive America, we need to make some basic changes in what we eat, how much we exercise, getting our kids

up off the couch, turning off the video games."
www.realclearpolitics.com/articles/2009/07/19/secretary_sebelius ..

At the other end of the political spectrum, Conservatives for Patients' Rights features personal responsibility in its many TV ads as one of the pillars of health care reform, saying: "Placing responsibility squarely where it belongs, on the shoulders of the patient, will encourage individuals make to make healthy lifestyle choices. Infusing personal responsibility into health care reform allows us all to maintain our cherished freedom to live our lives without government intrusion."

According to the National Association of Insurance Commissioners [NAIC], some 60% to 80% of all health care expenses are directly caused by factors over which individuals have direct control, and the biggest single factor, of course, is smoking.

Thus, making smokers accept personal responsibility for their lifestyle choices is not only fair - because otherwise the great majority of Americans who are nonsmokers are forced to pay them in bloated health insurance costs and higher taxes for Medicaid, Medicare, and other welfare programs - but also because increasing the costs of smoking will help millions to kick the habit and slash medical care costs for everyone.

Indeed, says Banzhaf, Executive Director of Action on Smoking and Health (ASH), America's first antismoking organization, charging smokers higher rates for health insurance - as a type of user fee because their actions directly increase the costs of health insurance - should be considered before higher taxes.

Requiring smokers to pay through a user fee even a portion of the unnecessary excess costs they voluntarily impose on the health system would raise as much additional revenue as many of the competing tax proposals, and do so without violating any no-new-taxes pledge or possibly reducing the incentive for investment and economic growth, argues Banzhaf, whose actions in getting antismoking messages on the air, cigarette commercials banned, and starting the modern nonsmokers' rights movement which is banning smoking in more and more places have helped persuade millions to quit smoking and thus reduce health costs.

Moreover, imposing user fees - charging smokers more than nonsmokers for health insurance - will, unlike any proposed tax increases, by itself substantially reduce health care costs by providing strong incentives to help smokers quit, and thereby slash the number of heart attacks, strokes, and cancers which must be treated. It also provides a simple way for them to avoid the added cost - quitting - something others targeted by proposed tax increases cannot do.

“America’s approximately 46 million smokers already spend over $90 billion annually on tobacco, and their choice to use such products adds almost $200 billion in totally unnecessary health-related economic expenses to our already overburdened health care system and ailing economy,” says ASH.

Requiring smokers to pay an extra $60/month for health insurance - a fraction of what they now pay simply for tobacco products on the average - would bring in about $33 billion annually; about the same as the proposed “millionaires’ tax,” also estimated to yield about $35 billion/year.

ASH also argues that a user fee for smokers would be better than new taxes on sugary beverages and alcohol because most people use these products in moderation, and therefore do not impose additional health care costs on others. But, argues Professor John Banzhaf of ASH, any amount of smoking imposes substantial risks and therefore contributes to escalating health care expenses.

Tinkering with the costs of treating diseases, or trying to impose those costs on others, does little to address the overall problem of too many very costly diseases, and too few physicians to treat them; a problem which will be exacerbated when tens of millions of newly insured people seek medical care.

But, since most smokers already want to quit, and study after study shows that making smoking more expensive provides a very strong, direct, and immediate incentive which substantially helps them to quit, a user fee would directly address the underlying problem of too many diseases which are caused by easily preventable causes.

ASH has written to all Members of Congress asking them to incorporate personal responsibility into health care reform by insuring that smokers will pay more of their fair share of the costs their personal choices cause by paying more for health insurance under any plans which emerges.

PROFESSOR JOHN F. BANZHAF III
Professor of Public Interest Law and Executive Director
Action on Smoking and Health (ASH)
2013 H Street, NW, Washington, DC 20006, USA
(202) 659-4310 // (703) 527-8418 // ash.org/