Sunday, February 12, 2006

IN MY VIEW: ASH Calling on Taxpayers to Shoulder the Health Care Burden of Smoking

In prior posts (post 1; post 2; post 3; post 4; post 5; post 6; post 7), I have argued against ASH's call for employers to fire smokers and to not hire smokers in order to save money and reduce the burden on nonsmokers of subsidizing health care for smokers based on my contention that such policies are unjustified, inappropriate, and improper.

Here, I argue that such policies would not even be effective in doing what ASH purports they will do: reduce the burden on nonsmokers of subsidizing health care costs for smokers.

The Rest of the Story

The rest of the story is that what ASH apparently fails to see is that when smokers are fired from their jobs, they not only lose their jobs. They also lose something else: health insurance.

Now somebody else has to pay for the health care costs that smokers are going to face. And if it's not going to be insurance companies, then who is it going to be? The answer is: taxpayers.

Because we do not (yet) deny medical treatment to smokers, the overall health costs to society are not going to be drastically reduced. What the policy that ASH is calling for would do, then, is to simply shift the burden of paying these costs from one place to the other.

Essentially, what ASH's recommended policy would do is shift the costs from health insurance companies to taxpayers. Because smokers whose health insurance is taken away will largely need to be covered by Medicaid or by free care, the costs will be borne by taxpayers and to some extent, by overall increases in medical care for everyone because of the need to compensate hospitals for free care.

ASH's thinking, in addition to being uncompassionate and cruel, is quite short-sighted. True, employers would not be burdened with the costs of medical treatment for smokers. But somebody would - and that somebody is the taxpayers.

If 20% of our population was suddenly (or even gradually) unemployed, it would create a huge burden on government-provided health insurance. Being the single largest source of government expenditures, this would harm state budgets and create a need for increased taxes to offset the expenditures. In addition, since insurance companies would be paying less of the costs to treat smokers, citizens would have to shoulder more of this burden. Likely, health care costs would rise.

The one group that stands to benefit most from ASH's proposed policy is the insurance companies. They could only dream of such a wonderful proposal. Get all smokers off of their backs by denying them health insurance. The companies could never get away with such a disgusting action. But they don't have to: ASH is attempting to accomplish this for them.

While some have suggested that there is a huge difference between policies that deny smokers employment, and policies that deny smokers health care, I really don't think the difference is as large as many think.

Ultimately, denying employment to smokers is tantamount to denying health insurance to smokers, since most insurance in this country is employer-provided and unemployed smokers will almost certainly not be able to afford private insurance.

If what is really going on here is that we are denying health insurance to smokers, then it is only one small step from there to deny medical care to smokers. Because if we don't deny them medical care, then the benefits of taking away their health insurance will not be realized (they will simply be covered under the government's health insurance or under free care).

And when it is the already strapped-for-cash taxpayers who are shouldering the burden of medical care for smokers, rather than the insurance companies, you can bet that the climate which resulted in a quick rejection of Senator Teck's proposal to deny medical care to smokers will quickly change.

The rest of the story is that ASH's claim that denying employment to smokers will help ease the burden on nonsmokers of subsidizing the health care costs of smokers is wrong. What it will really do is simply shift the burden of paying for treatment of smokers from insurance companies to taxpayers. Personally, I'd rather have the insurance companies pay.

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