Let me first say that I have no firsthand knowledge of this actually happening any time soon if ever. Nor am I suggesting that smokers should be cut out of Medicare benefits, this is just an issue that I am looking at and with my limited scope and vision, I foresee a possibility that this could happen. Call it, "the perfect storm of nicotine addiction" and "possibility of things to come." Allow me to explain.
Smokers Need Not Apply
In part of a qualitative research class that I took last spring, I had to conduct several formal in-depth interviews with a couple of impromptu interviews. Since the focus of my research project was on smokers and smoking, I struck up an interview with a woman whom I saw smoking alone in a public place. It turned out that the woman that I approached was a nurse working for a local hospital. In the course of my short interview, she mentioned that her place of work was going to ban all smoking on the grounds of the hospital. That was surprising to me! Employees, patients, visitors were all going to be banned from smoking on the hospital grounds. While this would be a new development for this hospital in southern West Virginia, it is not a new idea in other parts of the country. According to Boston NPR Affiliate WBUR, there have been laws in place to prevent smokers from being hired by police and fire departments since 1997 in Massachusetts. A hospital association announced at the end of 2010 that if they have their way, they will not be hiring smokers for hospital positions in the future.And there are similar stories being run in other states, such as Ohio, Tennessee and Georgia. The thinking is, according to Benita Dodd of Gwinett Hospital in Atlanta, GA, ""private companies can do what they want with employees, within the law," she said. "I don't see any legal challenge" (Atlanta Journal Constitution).
A Chronic Condition
While unbeknownst to some, myself included, smoking has been classifieds as a chronic condition by the Public Health Service (PHS) since 2001. Why is this important? Because, according to a paper published last year by an anti-tobacco group, smoking is no longer considered a "bad habit" or something that can be passively treated, it is a real problem for people who want to quit. "Instead of viewing smoking
and tobacco use as a “bad habit” that can be cured with willpower, a more practical model describes smoking as a chronic relapsing condition that often requires ongoing medical and behavioral treatment" (TobaccoProgram.org). That makes smoking sound more like a disease, such as Alcoholism or drug addiction, because it requires ongoing medical care and the persons involved are likely to relapse without measures in place.
Whether you think that classifying smoking as a "chronic condition" is accurate or not, I think that we can all agree that aiding anyone who wants to quit smoking, for whatever reason is a good and reasonable action. And, the good news is that if you do want to quit, there are more options available to you than ever before. There are plenty of over-the-counter patches, gum and additives which can reduce cravings, and now, the Federal Government is willing to help you if you want to stop. SmokeFree.gov is an extensive web site with information, educational tools, a clearinghouse for information and links to local and national resources, all geared to help anyone quit smoking today. How wonderful!
A Long Time Coming
Smoking-related disease is costly on the body and the government has been taking action to stamp out smoking through incremental steps over the past 50 years. Starting with the Surgeon General's 1964 "Smoking and health" report which indicated that there was a negative association to the 2007 report which drew a clear distinction to the dangers of second hand smoke and cancer. In 2009, President Obama signed the Family Smoking Prevention and Tobacco Control Act which put cigarette manufacturing, distribution and advertising squarely under the jurisdiction of the FDA.
The question becomes then, why the federal government would be taking such large step toward helping people quit smoking?
The obvious answer is for the public good and benefit of the public. If this were true though, wouldn't there be a total ban on tobacco use and consumption in the same way that there is for marijuana? This is where my speculation comes into play. I believe that the government is attempting to make it possible to quit smoking by whatever means necessary in order make the claim that if you don't quit, that is your business, but Uncle Sam doesn't have to pay for your medical bills if you don't.
The Writing Is On the Wall
According to the 2010 U.S. Surgeon General's Executive Summary on Smoking, "cigarettes are responsible for approximately 443,000 deaths-one in every five deaths each year- in the United States." That is a staggering statistic and one that should give anyone pause who smokes. But what the Surgeon General says in this report is more interesting to me. "The chronic diseases caused by tobacco use lead the causes of death and disability in the United States and unnecessarily strain our health care system. The economic burden of cigarette use includes more than $193 billion annually in health care costs and loss of productivity." And that, I think, is the bottom line for smoking in America. If you are a smoker and collecting Medicare benefits, you might start being profiled as preventable health liability. It was reported in the Epoch Times that Arizona Governor Jan Brewer wants to place a "$50 fee on on smokers and obese people to deal with the state’s expanding Medicaid expenses" (EpochTimes.com).
Another example of what I am talking about is the news recently reported that the Medicare system will start paying to help senior citizens to stop smoking. According to The Huffington Post, if you were a senior with "tobacco related illness" then Medicare would pay for treatment to help you stop, but that coverage is apparently being expanded to cover all seniors who want to stop for any reason. "The new rules will cover up to two tobacco-cessation counseling sessions annually and as many as four individual sessions per attempt" (HuffingtonPost.com). Again, to me this sounds like the federal government loading their guns with "reasons to quit" and "we gave you the chance" bullets so that they can decisively pull the trigger on limiting benefits to seniors in the future.
I don't want to scare anyone by suggesting this. Like I said, I am merely looking into my crystal ball and procuring evidence that the smokers of today, people of my generation might be barred from collecting their full benefits come retirement age, due to their life choices now. And I am not the only one who sees a gathering storm of risk management for health benefits. Another gentleman (or group of gentlemen) wrote about a similar issue on his blog yesterday, which I would recommend reading.
I don't believe in "death panels" or that anyone is going to kill grandma. The ballooning federal budget is a real problem, particularly with Medicare and Medicaid being a good portion of what our country spends on managed care. There have already been suggestions by some politicians that soda should not be purchasable with food stamps because it has no nutritional value. Also, Kentucky H.B. 208 purposed "requiring drug tests for Medicaid and Welfare recipients," and while the bill never actually passed, other legislation has come up this year with similar aims.
While all of this might sound like a lot of "anti-tobacco hot air" it might be gaining public support. If it does, that would be the final nail in the retiring smokers cigarette pack. Escapist magazine conducted a poll of Australian citizens, as to whether they thought: "Should smokers be denied access to Medicare? (Australian Medicare)" 42% of those polled said YES while 47.2% said no with 10% undecided. This was a very small poll and not scientifically conducted, but it is possible that these numbers could be reflected by the general public if asked.
On a Personal Note
I have never been a smoker and have never had to try to quit. I have had friends and family who have smoked and successfully quit and they have all said that it was one of the toughest things that they had to do in their lives, that nicotine addiction was that strong. Harder to quit than alcohol and hard drugs, some have reported to me. Having said that, I have a degree of sympathy for anyone who has started smoking, has been smoking a long time or who must stop smoking for health reasons and still finds that they cannot.
Shortly before I wrote this tonight I talked to my Dad by phone. He is in his late 70's and has COPD. He told me that he has lost 30% of his lung capacity and that his doctor believes that this is due to his smoking as a young man. My dad hasn't had a cigarette since 1971, four years before I was born. He collects Medicare and Social Security. Given the standards which I am suggesting are coming, I don't know what would happen to him.