How you ask? Erect A Federal Smoking Ban.
ATLANTA (AP) — A smoking ban in one Colorado city led to a dramatic drop in heart attack hospitalizations within three years, a sign of just how serious a health threat secondhand smoke is, government researchers said Wednesday. The study, the longest-running of its kind, showed the rate of hospitalized cases dropped 41 percent in the three years after the ban of workplace smoking in Pueblo, Colo., took effect. There was no such drop in two neighboring areas, and researchers believe it's a clear sign the ban was responsible.
Addendum: The results of the study above are discussed here. (h/t to KevinMD)
It's amazing how we spent over two trillion dollars last year, the vast majority of which was spent on conditions directly attributed to smoking. Heart disease. Stroke. Emphysema. Cancer. It's all directly correlated to smoking. I think every Medicare recipient should undergo random cotinine testing and if present their rates of insurance should be automatically quadrupled. There is no excuse for their raping of America. We spend billions of dollars a year on medications trying to counteract the results of these preventable disease processes. As an internist, I am nothing more than a medication pimp.
It's looks like all we gotta do to save America is put up a federal ban on smoking in public places.
But then you have these morons in Pennsylvania
Perhaps all the smoke has gone to their heads. Perhaps all the cardiologists should move to Pennsylvania.
Or better yet, if Obama really wants to make a dent in the health care expenditures, he should, by executive decision, in the interest of National Security, sign a federal decree banning smoking in all public places. Addendum: (This recommendation was for shock value. Please don't start a riot).
It's looks like all we gotta do to save America is put up a federal ban on smoking in public places.
But then you have these morons in Pennsylvania
HARRISBURG, Pa. (AP) Slot machines in the smoking sections of Pennsylvania casinos have performed far better in the last three months than machines in nonsmoking sections...
The law took effect in September, and allows casinos to expand their smoking sections if three-month revenue numbers show greater demand for it.
Perhaps all the smoke has gone to their heads. Perhaps all the cardiologists should move to Pennsylvania.
Or better yet, if Obama really wants to make a dent in the health care expenditures, he should, by executive decision, in the interest of National Security, sign a federal decree banning smoking in all public places. Addendum: (This recommendation was for shock value. Please don't start a riot).
Talk about leadership. He would save America, I believe, with that one act. Decreased health expenditures, increased productivity, fewer sick days, no more smoke breaks.
We don't dump toxic nuclear waste in bars and restaurants. Why should be allow the tobacco companies to do the same.
Of course we still have to remember that Obama Still Smokes.
We don't dump toxic nuclear waste in bars and restaurants. Why should be allow the tobacco companies to do the same.
Of course we still have to remember that Obama Still Smokes.
31 Outbursts:
HH -- It has long been argued that smokers more than pay for themselves via taxes. In fact, smoking is cost-saving since they die sooner and accumulate fewer health care expenses than non-smokers in the long run.
I wonder if anyone has re-run these numbers since data about the health effects of second-hand smoke have become known.
Nanny-state wibble.
Obesity causes all sorts of health problems, including diabetes and joint issues. Perhaps a federal ban on junk food? Or a Big-Brother-style mandatory exercise regime for everyone, first thing in the morning?
Alcoholism causes all sorts of health issues, as well. Perhaps a federal ban on..oh, wait. Tried that already, and the results were for shite.
Cranky. This is not a federal ban on smoking. It is a federal ban on public smoking. It is not nanny state to do so. It is good public policy
It's still nanny-state wibble. You can not legislate healthful behavior. All you will do is create a new class of scofflaw.
Unless your goal is to increase revenue stream through the tickets issued, in which case it's just big-government pecksniffery.
LOL! I have a new word. Pecksniffery!
Standing next to someone in a public place and letting them punch you in the face is no different than letting them blow smoke in your face.
What about the Pole-Smokers??
Those Miracle-HIVie meds aren't cheap...
Cranky, The economic term is "externality." Per wikipedia an externality is an impact on any party not directly involved in an economic decision. An externality occurs when an economic activity causes external costs or external benefits to third party stakeholders who did not directly affect the economic transaction.
Air pollution is a common example of a negative externality, and actually, it is the government's job to protect people against things like this, even if you think that the government should only exist to protect property rights and provide good information to the public.
People who smoke in public directly harm my health. Either they should compensate me for this with $$, or they shouldn't be allowed to smoke in public places where I could be adversely affected.
They ARE compensating you with $$ -- through the taxes they pay for their cigarettes. The tobacco companies ARE compensating you with $$ -- where do you think the money for those obnoxious "Truth" ads comes from? It's not a smoker's/tobacco companies' fault that those taxes, when collected by the various governments, are not applied as they are supposed to be.
There are already plenty of smoke-free establishments, Smoke-free zones, et al. Frequent them! Enforce the laws that exist, rather than creating more -- useless laws (not unlike the laws created by the War on Some Drugs) that will do nothing but clog the courts system.
Alcoholics drive drunk, cause millions in infrastructure and property damage and kill thousands of people. They have myriad health issues. A FEDERAL BAN on consumption did fuck all, and was repealed for lack of effectiveness and huge costs to enforce. Hellooo, Volstead Act.
Fat people smell. They take up more than their fair share on public transport. Engines work harder to haul them, using more gas, creating more pollution. They eat more, using more food resources. They have myriad health problems. How do you propose to deal with THAT externality? I know...let's enact an unenforceable set of laws banning the public consumption of junk food! I'm SURE that will work!
Christ, have people not read Orwell? Does no one understand the slippery slope argument?
We don't need more Cardiologists in Harrisburg, what we need are intelligent people. What do you see when you go into the casino in question? Scooter people with their oxygen tanks.
Yea.. 'nuff said.
The Happy Hospitalist again wants big mommy government to make its children do what he/she thinks is right. Even when he/she has no facts to back up his/her position (Eg: You have any primary research AT ALL to back up the "smoking is as bad as getting beat in the face" claim?)
I have a question: Why does the Happy Hospitalist hate individual choice, which includes the choice to make bad decisions? Will we ever get an answer?
Must be some correlation between those who smoke and those who enjoy gambling in casinos...Illinois just finished its first year of smoke-free workplaces, restaurants, bars, and other public places. Many bars reported business was up slightly since going smoke-free. Only the casinos complained about losing business.
Some of these responses are from idiots. Do these idiots not under stand sarcasm. HH is not advocating big government. He advocates personal responsibility. People that smoke should pay more for their healthcare period. Its already done in some health plans. Money is a strong motivator, both positively but more so negatively. When give the choice of having to pay more for personal decisions, many will change their decisions. And if they don't then they pay for the consequences, literally. Why should I pay for other peoples bad decisions? Oh wait a minute, this is America, everyone is entitled to a free bailout.
do you feel those with a high bmi should also contribute more dollar to the insurance pot also?
In a government run health care system, where tax dollars are collected (your FICA) to pay for health care, I don't see any reason why a healthy, good eating, exercising, responsible person should have their taxes raised to pay for someone who sits at home on the couch, watching TV, smoking cigarettes, getting drunk.
If that is what standing in social solidarity is, then I would kindly ask to stand alone.
The social contract does not give one an excuse to avoid personal responsibility.
If you want to smoke or eat yourself to death without getting help, feel free to do it. Except don't ask that I pay for it. I will gladly pay for you to get help, not to give you an excuse to continue your destructive ways.
Smokers quit every day. Fat people lose weight every day. It is not fatalistic thinking that creates success. It is fatalistic thinking the creates failure.
fat people get lap bands and staplings no need to diet or exercise anymore...ain't life grand!!!!!
fat people get lap bands and staplings no need to diet or exercise anymore...ain't life grand!!!!!
...and they'd still overeat, popping those bands/stitches, and then we'd get to pay to treat their peritonitis.
You can not make people take responsibility/do what's right. They have to want to do it themselves.
http://www.scienceblog.com/community/older/1999/D/199903370.html
state estimates of total medical expenses attributable to cigarette smoking, 1993 by leonard miller states that 12% of 1993 health care costs were caused by smoking. Of last year's $2.1 trillion health care budget that comes to $250 billion for 18 billion packs smoked or $13/pack. Even if this estimate were off by a factor of two it would still come to $6.50 per pack which if paid by the smoker would allow for funding for other programs such as the uninsured. Higher costs of smoking would also lead to a decline of smoking which would improve the health of the former smoker.
Mandatory drug and/or nicotine testing for recipients of publicly funded health care, with steep cuts in benefits or rate increases for those testing positive?
Yeah, I could get behind that.
But more bans, of any kind, by the government?
Slippery slope there.
While your idea seems good on its face, considering the dangers of secondhand smoke, the people enacting such bans can't be trusted to stop there.
Empower them to do that, and what's next? Ban smoking in homes when the hospitalization rates don't fall enough? Ban restaurants from using trans-fats because the smoking ban didn't eliminate the problem?
Don't say it's unlikely, because that's simply what politicians do.
@Anon, 9:46:
"HH is not advocating big government. He advocates personal responsibility."
Original post:
"It's looks like all we gotta do to save America is put up a federal ban on smoking in public places."
???
I'm still looking in my Constitution for where it says the federal .gov is given the power to do this.
Last I checked, we live in a Republic where the government isn't allowed to do just anything it wants, even if there are possible health benefits.
'Course, we could just trash the whole "republic idea," and empower the Great Nanny-Stalin to do whatever he/she thinks is best for us. Gotta tell you, though, the dangers of secondhand smoke pale compared to the dangers of a Gulag.
Perhaps we need 50 state laws that ban smoking in neonatal intensive care units. Perhaps the smoke in the State of Virginia is less toxic to newborns than the smoke in California.
You want to battle an ideology while common sense kills your neighbor.
Oh wait, you don't care about your neighbor. Or wait. Maybe only the state has a right to care about your neighbor
Fine. You live in your authoritarian state, where the government can do anything it wants so long as some "it will be good for us" rationale can be plausibly maintained.
I prefer to live in a nation of laws, where the powers of government are circumscribed.
It's not just ideology. Look at the history of the 20th century. Governments have killed a lot more people than smoking has.
So, yes, I am much more concerned about having a heavily-regulated government than I am about having heavily-regulated smoking for gosh sakes.
...and while we're at it, do you really think we need a federal ban on smoking in NICUs? I've worked in perinatal medicine since 1996 and I have never yet seen anyone smoking in a NICU.
Is there anything you think is desirable, but nonetheless do NOT think should be policed by the Feds?
I think I am finally understanding the anger here.
It's OK to ban smoking in public places as long as it's done by state governments, not the big bad scary Feds with their big bad scary guns.
Is that what I'm hearing here? Not that the ban is bad, just that the feds shouldn't do it?
If that's really what you're saying, then I don't really care who does it. Once the states see a remarkable decrease in their health care funding obligation from smoking related illness, every state in the country, except perhaps the ones where all the smoke has gone to their heads, will be banning smoking in public places.
Smokers have no sense of social contract when it comes to smoking around non smokers. They view their right to smoke as trumping a nonsmokers right not to breath it in. Since smokers can't police themselves, perhaps a fine and court costs while change their mind.
I really don't care whether it is state driven or federal driven. The end point is the same. And that is not exposing the public to a smokers whim.
"big, bad, scary."
Yes, I do find it frightening that you, and hundreds of thousands more like you, do not care one whit for our constitutional form of government. You just want your pet policy enacted, even if by the decree of a dictator (which is precisely the office you are promoting Obama to when you entreat him to enact a smoking ban by executive decree).
Franklin said something about people who would trade their liberty for security.
You, apparently, would trade all our liberties away to be free from "big bad scary" second hand smoke. It's very disturbing.
I happen to agree with you as a matter of policy - I generally favor smoking bans - when they are instituted within a legal framework.
Again, look at the last 100 years or so of history. Look around the world, and contemplate the nature of the vast majority of governments out there. This is not a trivial matter.
You mock me for being concerned about the dangers unlimited government power, as if that is some trivial, far-fetched matter. I believe my concerns about the role of government and limitations thereupon compare rather favorably to your your concerns about second-hand smoke.
"Cranky. This is not a federal ban on smoking. It is a federal ban on public smoking. It is not nanny state to do so. It is good public policy."
Wait, wait, wait, HH!!
Haven't you heard the dreaded results on THIRD hand smoke? Please don't let me down. You have surely heard of this! Some head-way is finally being made to ban smoking in personally owned vehicles, and homes, and some apartments!(Granted a lessor has that option, I have an option not to rent from them.) And homes, especially if you have children. Please don't let us down by going to the "dark side"...yeah I know they have cookies, but dayum, ya gotta get on the Nanny State Bandwaggon, ya know? We NEED a total ban on smoking of anykind...and alcahol too! Oh...wait...ok...drugs...yeah...drugs of ALLLLLLLLLL kinds...yeah...that should cover the basis...don't ya think? Obamasia?..where were you when WE really needed YOU??
good lawd, the world has gone mad!
J.W.
HH: If possible, could we discuss this federal anti-public smoking ban proposal of yours without your straw-man arguments of HIV infected needles, nuclear waste, or lighting a fag in the NCIU ward coming into the picture? Thanks in advance.
I think the problem that I, as well as plenty of others apparently, have with your proposal is that what you are suggesting is illegal, unconstitutional, and yes, anti-American.
You suggest that the president of the United States, without due process of the voters or our representatives, make a decision that will affect millions of citizens. For that to happen, you willingly recuse yourself from any further decisions in how your government operates and give the government full and total power over how a citizen can choose to conduct his life and lifestyle.
I understand that your focus is based on what you perceive as a public health matter. Honestly, I do. If you think that smoking in public is a public health issue that should be addressed, fine. But perhaps in your enthusiasm for your cause you have failed to realize that the METHOD you chose to accomplish this is flawed.
I wonder if maybe your premise is flawed also. That the government, any government, should be allowed to dictate to its citizens (not ‘subjects’ in this country, but citizens of a republic) what, where, when, and with whom that citizen is allowed to participate in a legal activity. You make the suggestion that smoking in public is paramount to assault on any non-smoker. However, you fail to take into account that there are millions of other people in this country who may find that the smell of curry is offensive, or that are allergic to peanut butter or bees. If we allow the President to create law that affects one group, a group that you as an individual do not care for, what keeps the President from later deciding that the damn curry cookers are next. Or the beekeepers. This is precisely why what you propose is morally and legally wrong. No one member of our government should have the kind of power you propose. Our Constitution kind of lays that out.
Now, if you could get a majority of our hirelings in D.C. to decide that your proposal of a total public smoking ban is a good idea, (despite the fact that tobacco is a legal crop to grow, despite the fact that local, state, and federal levels of government receive taxes from the sales of tobacco products, and despite the fact that the definition of “public” is still a matter of some debate) and get it passed up to the office of the President, and if the President would sign it, then and only then could the ban you envision be enforced. That is basic “Civics” for you. Of course, the court battles, state court injunctions, and lack of enforcement could make it a mute point.
I think that you might be well served by re-thinking your position. If what you want is just to get attention, you have certainly done that. But if you are actually serious, despite the hyperbole that you have spouted, you seriously need to drop a little bit of attitude, find your emotional center, and decide if what you are proposing is good for the country at large, or just for your own personal interest group. Once you decide that, feel free to tell rest of us so we will know if your body of work is simply a façade around your true feelings or whether you just allowed yourself to get caught up in the moment of having fun arguing on the internet..
MLG, the comment about Obama signing an edict was not serious. I posted elsewhere that it was meant for shock value. And if you have a chance to read any other stuff here, it is a common
I don't care if it's a federal law or a state law or Bernie's township law, I really don't. Details. Details. Details. I could care less. If the sensitive constitutional folks feel deplored by my words, I think the best way to get smoking out of public venues without agitating the constitutionalists is to have the feds withhold state medicaid funds if the states don't have their own comprehensive state ban in public venues passed.
Perhaps that's the best way to go about it. Same difference. The feds hold the power, er, my tax money to make states comply. It's done every. Everyday. In many parts of state government.
So it's a state law mandated by withholding federal tax dollars. Same difference. And the constitutional folks can raise the flag of freedom once again and shoot their AK47s with delight.
The end result is the same. A federally enforced bribery for a public smoking ban. But nobody gets their feelings hurt
You said: "In a government run health care system, where tax dollars are collected (your FICA) to pay for health care, I don't see any reason why a healthy, good eating, exercising, responsible person should have their taxes raised to pay for someone who sits at home on the couch, watching TV, smoking cigarettes, getting drunk."
I say perhaps I should be entitled to MORE healthcare if I sit on the couch, drink, and smoke. Hell I have already paid for it in SIN taxes.
-Sarah
Details. Details. Details.
Yah. Pretty much:
Dr. Alsever and colleagues could not determine the extent to which the observed decline resulted from smokers who quit, as opposed to reduced exposure to second-hand smoke.
But don't let details like a plausible alternate explanation for the findings, an attempt at actually reading the study or perhaps reviewing an expert, critical overview slow you down or anything.
No. The CDC has spoken, perhaps in error but not in doubt. There is no further need for evaluation. What we need now is action, at any level, be it local, State or Federal.
What we also need, incidentally, is an immediate, forceful response to America's Public Health Crisis.
I therefore stipulate and propose the following:
Whereas:
Physicians are among the most highly-paid and affluent members of society,
And, that they earn their high fees by the exercise of license granted by the several States,
And, that they are mandated by their licensure to act in the Public Interest, including matters of public health,
And further, that there are tens of millions of Americans who cannot afford even basic medical care,
Be It Resolved:
That all medical licensees be mandated immediately, under Federal Law to help resolve America's Public Health Crisis by providing no less than 30% of their services, pro bono to the less fortunate and affluent members of society.
See how simple that is? All you have to do is accept a small reduction in you reimbursement for the State-granted privilege of practicing medicine and nearly all of our problems with uninsured patients will go away. We didn't even need to trot out some half-baked conclusions from a flawed study or a nebulous "social contract"... it's right there under the mandates of your license. If you can call for mandatory public behavior on the part of patients in the name of public health, you should surely mandate for-profit behavior on the part of licensees for the same.
Enjoy what little autonomy and freedom you may yet enjoy in the practice of medicine. If it won't last for patients, it won't last for the profession.
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