Posts Tagged smoking

Smoking cessation benefits can save lives, money

Published: August 17, 2010 | No Comments

By Tom Hopkins

Quitting smoking today is the number one thing that Californians can do to improve their health. Not a moment goes by without a citizen of our country and the State of California suffering from the hazards of tobacco use. Tobacco use has far reaching ramifications that encompass not only health issues, but widespread economic issues.

The difficulty that physicians, patients, and health care workers face today lies in the lack of accessible resources available to treat the ills of tobacco dependence.

Today, smoking is the number one preventable cause of death in the United States, and smoking-related illnesses are among the most dominant and preventable of all health issues. The U.S. Surgeon General cites tobacco as the single greatest cause of disease and premature death in America today. In California, there are nearly 5 million current adult smokers. Nationwide, more than 48 million Americans smoke, and 70 percent admit they want to quit. Even though seven in ten California smokers wants to quit, many smokers, particularly low-income Californians, lack the tools necessary to help them succeed.

As a practicing physician who specializes in treating chronic diseases including tobacco dependence and its health consequences, I continue to be frustrated by my inability to assist patients who lack coverage for medications and counseling services that would help treat their tobacco addiction.

We as a nation and a State can no longer afford to sit back and watch people die. The health of our children will be jeopardized by a well-known health hazard. If there is a smoking gun, it is our society that is holding it!

We can no longer afford to use an economic excuse for not covering the costs for smoking cessation treatments. The figures overwhelmingly demonstrate that coverage is a smart financial investment for governments, insurance companies and employers.

Nationwide, the total economic burden of smoking is at $193 billion. Indirect costs due to lost productivity from smoking-related illnesses in California total in the billions. The average cost for the package of covered smoking cessation services – including counseling and medication – is estimated at $487.50. In contrast, one smoker costs the Medicaid program in California an additional $1,951 per year over their lifetime. If only 10 percent of smokers quit, after five years, California Medicaid would save $59 million annually. If 50 percent of smokers quit, after five years, California Medicaid would save $296 million every year on smoking-related illnesses.

California now has an opportunity to take a stand against the hazardous health consequences of tobacco use and addiction. As we embark on Federal Health Reform implementation in California, it is time that we lend support to Californians who want to quit smoking.

Federal health reform was a good start, but under that plan, many insurers won’t have to cover smoking cessation treatments for years, or even a decade, and many patients who smoke will not even know they’ve gained coverage for the benefit.

If a Californian decides to quit smoking today, the best thing that we can do for his/her health and for the economy of California is to provide access to the full suite of CDC-recognized treatment options now, and to continue to cover different treatments and the doctor and patient try to find what works.

We know that quit-smoking programs are effective, but studies have also shown that it takes five to seven attempts to quit smoking. Many health plans currently cover only one attempt to quit per lifetime of a patient.

Federal health reform legislation requires that all new health insurance plans cover smoking cessation treatment with no cost sharing for American consumers.

California can improve on that piece of the federal reform. We can define what that benefit looks like for Californians, and we can make it available sooner, as opposed to years down the road. We can also make sure that all existing health plans cover access to proven treatment options recommended by the Centers for Disease Control.

If we do this, we will save lives, and money.

Dr. Tom Hopkins is the medical director for Employee Health and Chairman of the Utilization Management Team at Sutter Medical Center in Sacramento and former Medical Director for the Tobacco Cessation Program and Bariatric Program for Sutter Medical Center.

 

Anti-smoking law would save lives, money, study says

Published: June 22, 2010 | No Comments

By Daniel Weintraub

A law to require insurance companies to cover smoking cessation services at no out-of-pocket cost to consumers would improve public health and the economy at a cost of less than $1 a month for each person covered by insurance, according to an independent analysis of the proposal.

The study was performed by the California Health Benefits Review Program, which since 2002 has analyzed the cost and potential benefit of legislative proposals to require insurance companies to provide certain services to their customers, known as “mandates.”

The anti-smoking bill, SB 220, by Sen. Leland Yee, would require insurers to offer telephone, group or individual counseling to smokers and all medications approved by the Food and Drug Administration to help smokers quit. This would include nicotine replacement therapy and prescription drug therapies, including gum, skin patches, inhalers, nasal sprays and other forms of treatment that counter the urge to smoke.

Counseling and medications could be limited to two courses per year. No co-payment, coinsurance, or deductible could be collected from the consumer.

Most of these benefits will be required as part of federal health reform, but those provisions of the federal bill will not take effect until 2014. SB 220 would take effect next year in California if it were passed and signed into law.

The study found that an additional 118,000 California smokers would get treatment in the first year as a result of the mandate. That treatment would cost, at most, about 67 cents per month for each person with insurance. The total cost of the treatment would be about $52 million in the first year.

That cost would probably be reduced by about $1 million from because about 10 fewer low-birth weight babies would be delivered and hospitalized, thanks to pregnant mothers who would quit smoking because of the new law.

But the savings over time could be much greater,. Tobacco use, the study points out, has “both direct and indirect costs that affect individuals, employers, health plans, the government and society.”

The study estimated that about 8,000 additional Californians would quit smoking each year, adding up to 100,000 years of potential life gained annuallyr because fewer people would die prematurely from the effects of smoking.

Smoking related productivity loss, projected to be about $8.5 billion in 2004, would also decline.

“Smoking cessation treatment is cost-effective,” the study said, and probably more cost-effective than other widely accepted medical treatments currently covered by insurance.

The cost of treating high-blood pressure, for example, ranges from between $5,000 to $45,000 per life-year gained, while smoking cessation treatment costs a few hundred to a few thousand dollars per life-year gained.

To see the entire report and other studies by the benefits review program, go here.

 

Governor vetoes bill to ban smoking on state beaches

Published: May 3, 2010 | No Comments

By Daniel Weintraub

Saying he was “inherently uncomfortable” about intruding into the private lives of Californians, Gov. Arnold Schwarzenegger on Monday vetoed legislation that would have banned smoking on state beaches and in common areas of state parks.

Schwarzenegger said local governments and the state parks system already had discretion to ban smoking under certain circumstances, and he said that was enough for him.

“I believe this bill is an improper intrusion of government into people’s lives,” Schwarzenegger wrote in his message vetoing Senate Bil 4. “I have supported laws in
the past that tackle the problem of smoking indoors and smoking in cars with children. But, by mandating in state law that people may not smoke outdoors in certain areas, this bill crosses an important threshold between state power and command and local decision-making. There is something inherently uncomfortable about the idea of the state encroaching in such a broad manner on the people of California.”

Schwarzenegger said the Parks and Recreation Department had banned smoking in some places where fire hazards exist, and local government have banned smoking in parks under their control.

He acknowledged that the bill also aimed to cut down on litter from discarded cigarette butts. He said, however, that because state and local jurisdictions are contiguous, the bill would do little good.

“The purpose of the bill is undermined if the difference between legal activity and illegal activity is literally a line in the sand. As we have seen, marine debris and litter know no boundaries,” the governor wrote. “I believe a more appropriate response is to increase the fines and penalties already in law for littering in our parks and on our beaches.”

Sen. Jenny Oropeza, the bill’s author, said she was disappointed with the veto. To get the bill through the Legislature she had already agreed to limit enforcement to what the Parks Department could do with current resources, and only after signs were posted to warn visitors about the new law.

“I’m sorry the governor did not agree with this widely supported effort to increase public awareness about the environmental threats carelessly tossed cigarettes are doing to our marine life and to the great outdoors,” she said. “In addition to the clear environmental, fire safety and health reasons sought to be addressed under SB 4, the governor’s veto is in stark contrast to what is already being done at more than 100 local cities and counties statewide.”

 

Senate passes bill to ban smoking in state parks, beaches

Published: April 15, 2010 | No Comments

The state Senate has given final approval to legislation that would ban smoking at state beaches and in common areas of state parks.

The Senate passed the bill on a 21-13 vote and sent it to Gov. Arnold Schwarzenegger, who has not said whether he would sign it.

The measure’s author, Sen. Jenny Oropeza, a Democrat from Long Beach, took several amendments weakening the bill along its legislative journey in order to get the votes she needed for passage.

The state Parks Department would enforce the ban, but could use only existing funds to do so. And the ban could not be enforced unless the department had first posted signs warning about the potential violations. The ban would apply on state beaches but not in camping areas next to them.

Citations for violating the ban would come with a maximum $100 fine.

The bill is supported by a number of California cities and the state firefighters union. It was opposed by the tobacco industry.

See the full text of Senate Bill 4 and staff analyses here.

 

Ban on smoking at beaches, parks nears final vote

Published: April 8, 2010 | No Comments

Sen. Jenny Oropeza is expected to push for a final vote as soon as today on her bill to ban smoking on state beaches and in common areas of the state park system.

The measure, Senate Bill 4, would slap fines of up to $100 on offenders. But to get her bill this far, Oropeza has had to accept amendments that would allow the parks system to enforce the ban only with funds it now has available. And it could not be enforced until after signs were posted warning patrons about the potential infraction.

The bill is backed by many coastal cities, including Los Angeles and Long Beach, as well as firefighter unions and many environmental groups. Many cities and counties have their own smoking bans already on their locally managed beaches. The first was adopted in Solana Beach, in San Diego County, in 2003.

 

Assembly passes ban on smoking at state beaches, parks

Published: March 23, 2010 | No Comments

California’s Legislature is one step away from banning smoking at most state beaches and parts of the state’s 278 parks. The Assembly passed the ban on Monday and sent it to the state Senate, which is also expected to approve it. Gov. Arnold Schwarzenegger has not said whether he will sign it into law.

The proposal, Senate Bill 4, would prohibit smoking at state beaches and parks, except at campsites and parking lots. It would impose a $100 fine, but that fine would be enforced after visitors were notified of the ban through signs posted in the area. No new state resources could be used to enforce the law.

The bill is sponsored by Sen. Jenny Oropeza, a Democrat who represents the coast of south Los Angeles County. It is supported by the cities of Los Angeles, Long Beach, Manhattan Beach and Torrance, plus a stwate firefighters association and the Sierra Club.

“Unfortunately, many beach visitors are irresponsible with their smoking habit,” Oropeza said in a statement. “Our majestic beaches and parks have been marred by cigarette butts for far too long.”

The proposal is believed to be the most far-reaching statewide ban on smoking in public recreation areas in the country.

Photo from Smart Destinations.

 

SF not liberal when it comes to smoking

Published: March 10, 2010 | 1 Comment

The San Francisco Board of Supervisors has voted to ban smoking at sidewalk cafes, restaurant patios, movie and ATM lines, bingo halls and the common areas of housing complexes. San Franciscans will also be prohibited from smoking near the doorways and windows of offices, shops and restaurants.

From the San Francisco Chronicle:

The dangers of secondhand smoke have been documented in studies that found exposure increases the risk of asthma, heart disease, emphysema and lung cancer.

“Those communities that have adopted ordinances like this have actually seen decreases in the numbers of death … so by passing this ordinance you are all saving lives, and I can’t think of a higher calling than that,” San Francisco’s public health chief, Dr. Mitch Katz, told the supervisors prior to their vote.

While San Francisco was at the forefront of the nation’s anti-smoking laws more than a decade ago, the city has slipped behind other jurisdictions and even with the new controls, it doesn’t go as far as some places. In the Bay Area, for example, Richmond and Belmont have tighter restrictions on smoking in housing, and Berkeley has tougher limits on lighting up in outdoor commercial areas, said Licavoli-Farnkopf.

See the whole story here.

 

Designing our health

Published: March 7, 2010 | No Comments
ashby wolfe

Ashby Wolfe MD, MPP, MPH

By Ashby Wolfe

Ashby Wolfe is a resident physician in the Department of Family and Community Medicine at the UC Davis Medical Center in Sacramento. She holds an MD as well as masters degrees in public policy and public health. She blogs at www.ashbywolfe.com and is a guest blogger for HealthyCal.org on issues of family medicine and community health. Her opinions are her own and do not necessarily represent the views of UC Davis or HealthyCal.org

As our Congressional representatives and Senators continue to negotiate and compromise in order to draft a universal piece of health reform legislation, I am reminded of a statement paraphrasing Virchow:

“Medicine, if it is to improve the health of the public, must attend at one and the same time to its biologic and its social underpinnings. It is paradoxic that at the very moment when the scientific progress of medicine has reached unprecedented heights, our neglect of the social roots cripples our effectiveness.” (Eisenberg 1984)

These words could not have rung more true than in a recent visit with one of my new patients. For purposes of the example, let us call him Mr. Smith. He is a 40-something gentleman, a 2 pack-a-day smoker, who has never needed to visit a doctor in his adult life until two weeks ago when he could not catch his breath and was running a high fever. Mr. Smith was seen in the emergency room, treated, and told to “follow up with his regular doctor” for further management of his severe obstructive lung disease – likely a consequence of his 30 year smoking history. Fortunately, he had health insurance and the fact that he didn’t have a regular doctor was not lost on him.

So he ambled into my office for the first time last week for a check-up. At first glance Mr. Smith was slightly out of breath but an otherwise healthy-looking gentleman, with an athletic physique. As I talked with him, it became clear that he was struggling at his construction job primarily because he could not catch his breath; and his single inhaler was not relieving his symptoms. He told me that he didn’t want to quit his job because he would lose his health insurance, but that he was worried that he would get fired if he could not do his duties as a result of his current state of health. He also informed me that he was running out of his medication, but could not afford the $30 co-pay at the pharmacy to pick up his remaining refill. “Doc,” he said, “I have to put food on the table and pay the rent, you know.”

This is a situation many of us have heard before – either spoken by a politician stumping for votes, or by community members advocating for a better system of care. It is a different feeling entirely when you in a position having a direct effect on another person’s health. As I talked with Mr. Smith, I felt that his future held one of two outcomes that I could predict with cold certainty: (1) that he begin to use a (cheap, generic, available) medication which I wanted to prescribe that day, even if that meant sacrificing some other purchase this month, and would therefore receive the treatment he needed; or (2) that he not obtain his medications which would undoubtedly result in another expensive trip to the emergency room.

Some of you may be thinking “I bet those cigarettes cost money – couldn’t he choose between medicine and cigarettes instead?” The answer, of course, is yes. But does the visit end there? Could I say that to this patient and believe – really believe – that would be enough? That I would have done everything I could for my patient? Yes, it is true that his lung condition is likely due to cigarettes. Yes, he probably could afford the medication if he quit smoking. And yes, I do believe that my patient has a responsibility to himself to make that decision to quit…and I want to help him quit as part of his overall health care plan. But quitting smoking takes time, discipline and – let’s face it – hard work. So what to do in the meantime while he works on quitting completely?

The above example is just one of many stories health professionals collect on a daily basis – and it demonstrates just how interconnected our well-being is to all aspects of our society including the health system. In reviewing the national health reform bills with the above story in mind, it occurred to me that our current health system is perfectly designed – to result in the current health outcomes that we see every day:

(1) most health insurance is linked to employee status; so if one gets sick or loses a job, it becomes very difficult and expensive get care, see a regular doctor, or obtain basic health services

(2) as a society we value advances in medical technology that provide quick relief or immediate treatment, so our care is often expensive and less sustainable than cheaper, long-term alternatives

(3) our environment and lifestyles often do not promote our making healthy choices

So, what do we do about it? Do we lose hope in the current process? Do we shrug and say “well, health reform would have been nice, but you can’t win ‘em all”? The reality is that we must make difficult decisions about how we will use available resources to improve our health. This is the very essence of why national health reform is so important and essential to our welfare. Is it really the best use of our time, energy and money if some of us can afford all kinds of extra health care, and others of us must choose between an office visit with a $40 co-pay and dinner? The fact is that despite what special interests in Washington DC will tell you, most people in our country support health reform once they are made aware of the specifics contained in the legislation (Kaiser Family Foundation 2010). For those of us who have been in a room with someone like Mr. Smith, that fact alone makes all the difference in our hope for a system designed to improve our health.