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Medicaid Could Save $2.6B Within a Year If Just 1% of Recipients Quit Smoking
- nerdo 3y agoSave money now, pay more later? https://www.cbc.ca/news/science/smokers-the-obese-cheaper-to-treat-than-healthy-long-living-people-study-1.764092 https://www.cbc.ca/news/science/smokers-the-obese-cheaper-to...
- phoronixrly 3y ago> The study, paid for by the Dutch Ministry of Health, Welfare and Sports, did not take into account other potential costs of obesity and smoking, such as lost economic productivity or social costs. Emphasis mine
- nerdo 3y agoWould be so nice to have the ability to do accounting like this. This house and car are free, no money down! No need to take into account the future at all.
- dingi 3y agoSo how much tax money that 1% pay for cigarettes? I’ll bet that it’s significantly larger than $2.6B
- phoronixrly 3y agoHow about how much tax money will be gained from having alive and healthy people earning money and paying taxes? I bet it's going to be more than whatever cigarette tax will be lost...
- ComputerGuru 3y agoNot if the smoking cohort is concentrated in older, retired members of the population.
- jeffbee 3y agoIt's not. Smoking among those over 65 has always been relatively rare. It used to be that the highest rates were among those under 30 but those younger adults today don't want tobacco and the current largest cohort of smokers is middle-aged. Less than 10% of over-65 Americans smoke tobacco according to various surveys.
- phoronixrly 3y agoLook around you, do you see only old sick people smoking? Also at this study (for Spain): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813084/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813084/ > Deaths due to lung cancer represented the 28.90% and the 10.83% of all cancer-related deaths in 2017 in males and females respectively, with an increasing tendency in this last group. In addition, the YPPLL count increased in the study period among females. Lung cancer was responsible annually for 60,846 YPPLL, and productivity losses summed €13.1 billion over the 10 year period.
- lostlogin 3y agoIn New Zealand we tax tobacco heavily. It is thought that smokers save the government money - they pay a lot of tax and die early. https://www.nzherald.co.nz/nz/smokers-save-govt-cash-says-report/FYUXTPA456UAK3KNA5RFYRL62U/ https://www.nzherald.co.nz/nz/smokers-save-govt-cash-says-re...
- dingi 3y agoThis is true for my country as well. Govt taxes cigarettes around 1000%. I'm not kidding, that's a thousand percent tax. Our govt essentially runs on smokers and drinkers tax money.
- mattw2121 3y ago30 million people smoke $1.50 per pack tax (1.01 fed, giving high estimate for state taxes) 2 packs a day (high) (30,000,000 x 1%) x (1.5 x 2) x (2 x 365) = 657,000,000 You'd need 4% to quit to even out.
- photonerd 3y agoYou’d lose that bet. State and local governments collected $19 billion in revenue from tobacco taxes in 2020. Which was high. In 2022 it had dropped to a more normal level of $11.26 billion. 1% of that is $11 million. Quite a difference.
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- xyzzy4747 3y ago1% of 11 billion is $110 million. To go from a million to a billion, you multiply by 1000. Same to go from 1 to one thousand or one thousand to one million. It’s also easy to remember since the commas are every 3 decimal places. 1/1000 is equivalent to 0.1%, not 1%.
- photonerd 3y agoIndeed, a typo, my apologies. The point that it is a LOT less than 2 billion stands however
- MightyBuzzard 3y agoYour math is bad. 1% of recipients is nowhere near the same as the 1% of smokers you used.
- photonerd 3y agoIt’s assuming the 1% of smokers who are recipients are evenly distributed (statistically speaking) across the smoking population. A quite reasonable assumption. Therefore, to generally reduce the population of recipients you’d have to reduce the population of smokers. Unless you have data showing a specific population skew or sampling issue I’d say it is perfectly good math, albeit with an assumption. Now, of course, you could simply deny service to 1% of smokers who would be recipients—or other extremely skewed sampling attacks—but that is somewhat unlikely and in most cases directly against the goals of the program.
- jeffbee 3y agoThe entire tobacco tax revenue in 2022 was only $11 billion. At the margin, the proposed reduction in smoking would only reduce revenues by ~$400 million while saving $2.6 billion. That's clearly profitable.
- DaveExeter 3y agoIt is actually better if more people smoke. Smokers die sooner, needing less health care in the long run. Also, social security becomes move solvent.
- op00to 3y agoEnd of life for smokers is incredibly traumatic and expensive.
- arp242 3y agoThat is true for many people, smokers or not. You save money on things like hip replacements, care homes for people who can no longer fend for themselves, etc. etc.
- phoronixrly 3y agoDo dead people pay taxes? Whatever is gained for the health care system by people dying early will be lost several times in tax income in general.
- ComputerGuru 3y agoI mentioned this elsewhere but if the sickest (or dead) are concentrated in the oldest segment of the population (not unreasonable as young smokers are still fairly healthy on the grand scheme of things) that isn’t working then this doesn’t hold.
- hn_throwaway_99 3y ago47% of Americans don't pay federal taxes (excluding payroll taxes). That's obviously even much higher for people of Medicare age, and retired people aren't paying any payroll taxes. Also, when people die, so does (at least most of) their social security payments. Smoking is in fact pretty well aligned if all you care about are government revenues: it minimally affects people during their prime working age when they're paying taxes, and then has it's largest effects (i.e. death) when people are older and likely to be a net negative when it comes to government expenditures anyway.
- karim79 3y agoThis reminds me of an incredible episode of 'Yes, Prime Minister'. I dug up the clip: https://www.youtube.com/watch?v=p1DviQ9mva0 https://www.youtube.com/watch?v=p1DviQ9mva0 Edit: To get straight to the point, I would suggest jumping straight to 1:50
- tialaramex 3y ago"Yes, Prime Minister" was made in 1986. We did, eventually, carry out all these policies and more. Today the vast majority of the price of a cigarette is tax, about 80%; most forms of advertisement are prohibited; the packaging is required to explicitly tell you this is a bad idea (dominating the packaging, the brand name is relegated to small print since you are required to ask for the product by name so you must know what it is, displaying it is considered a form of advertising and no longer permitted in most retailers)... We also prohibited smoking in workplaces, which includes bars and restaurants (since those are someone's workplace, even if not yours) with the notable exception of prisons (it's not as though prisoners could leave to smoke somewhere else) and oil platforms (again, it's not like you can just pop somewhere else for a smoke). And despite this, a few people I know still smoke. The tax revenue is slowly falling though, fewer young people have decided to become addicted to cigarettes.
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- sidewndr46 3y agoWasn't the Master Settlement Agreement meant to account for these costs?
- Racing0461 3y agowhat if these people then live longer due to quitting smoking?
- yamazakiwi 3y agoThey would still save money
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- jessepasley 3y agoHow much would Medicaid save if 1% were no longer obese?
- mschuster91 3y agoProbably even more, but reducing smoking rates is very cheap for a government to do than trying to combat obesity.
- throw__away7391 3y agoA lot. The US gov actually already spends more on healthcare per capita than most of the European countries with socialized medicine.
- judge2020 3y agoAre there studies that point to obesity being the main cause of this?
- qwytw 3y agoThe main cause is of course significantly higher costs in the US. In some part possibly due to more administrative inefficiency, but mainly because of much higher cost of labour. I would guess the gap between doctor salaries is even bigger than in tech (probably besides Germany and of course Switzerland).
- lostlogin 3y agoThe difference isn’t due to obesity though, though that might be part of it.
- throw__away7391 3y agoNot entirely, no. The US pays a lot more for healthcare, for identical treatment. About 80% of total revenue for medical technology comes from the US market. A lot of other countries either negotiate lower rates utilizing their state monopoly on the market or are just lower income and cannot afford the prices paid by the US. In both cases, the marginal cost is low enough that companies are willing to compromise or cost discriminate, but the end result is essentially the US footing the bill. If this were ever to change, if the US ever started negotiations like European countries do, I worry it would negatively impact medical progress. Still, the impact of obesity are quite significant. An obese person will have 6 times the healthcare costs of someone who is merely overweight. I am not sure the difference between an overweight and healthy weight person, but I imagine it is at least something. Currently 69% of Americans are overweight and 36% are obese. This is insane to me because even "healthy weight" guidelines are pretty generous IMO. My doctor has told me I'm "healthy weight" at times when I definitely needed to lose a few pounds. (After losing the weight I felt better, had more energy, mental clarity, etc.)
- jmclnx 3y agoI wish people who smoke could be charged more, or maybe, better yet, a large national tax on tobacco. Where I work, people are asked if they smoke, if you do, you pay higher rates. You and I know everyone, except for a small minority, will say No to that question. So that points to a national Tax. Where I live, people travel up to 100 miles to buy tobacco products in a neighboring that has tax much less than where I am. So yes, time for a national tax I guess.
- sergiotapia 3y agoFat people are a much larger problem (lol). I wonder how much money could be saved if 1% fat people lost weight? It's a huge problem.
- patatino 3y agoDo you know who is the biggest problem? The one with bad genetics, let's test everyone and charge them.
- sergiotapia 3y agoAttaboy! Let's prescreen people and designated roles to them based on genetics. Terrific idea.
- skrebbel 3y agoIt’s also extremely hard to solve. I don’t know any stats but I suspect to quit overeating is way harder than to quit smoking. That or I’m projecting :-)
- TylerE 3y agoPlus smokers can switch to a vape with basically no downsides and eliminate probably 80-90% of their risk.
- xnx 3y agoWe're in the middle of finding out. GLP-1 drugs are revolutionary and are close to "curing" obesity.
- robswc 3y agoNot terribly on topic but I truly don't understand how people can smoke unless it's just a genetics thing? Smoke smells and tastes awful. I know the addiction is pretty much the answer but I don't get how people don't hate the smell/taste more than the buzz lol.
- throwanem 3y agoSmoking significantly suppresses both senses.
- Izikiel43 3y agoThey probably get used to both, and don't notice it anymore
- yamazakiwi 3y agoYou get used to it very fast and it becomes a pleasurable smell...but only your own smoke. If you smell someone else's, especially a different brand, it smells bad still. Now that I've quit for a while they all smell terrible again.
- asdff 3y agoNot me, I love the smell of second hand smoke, especially menthols. I grew up with people's parents usually smoking outside of parties, and it drums up some nostalgia I guess. It's a totally different smell than you smoking it yourself.
- yamazakiwi 3y agoI should be more specific. I smoked menthols and whenever I smelled a Marlboro red it made me gag.
- jrochkind1 3y agoSame is true of coffee at first... or alcohol!
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- hospitalJail 3y agoSince we are on the topic of Medicaid and I'm the resident whistleblower here: Medicaid could save some insane money if people had to pay some deductible or copay. I can't tell you how many Medicaid patients come through our clinic and will milk it for every drop. Our clinic likes it because its easy money and you don't need to take any payments(although payouts suck). Meanwhile BCBS patients are hyper sensitive since they pay until they hit their max out of pocket. We work with them to get their visits down from ~16 visits to, 4-6. They can do a lot of the work at home, so they are motivated to do it without the $125/hr fee. But medicaid patients would much rather have a doctor watch them, give them instruction, and do some hands on work. Its free, why not? There is a huge disparity in treatment between the lower class and middle to upper class. At the end of the day, it seems everyone gets better. The payouts are the same ~16 visits * 40$ vs 4 visits at $125.
- ctennis1 3y agoTotally, but people on medicaid are people who essentially don't have money, right? In order to qualify, you must be below certain asset and income limits.
- xyzzy4747 3y agoYou only have to be below income limits, not asset limits.
- hospitalJail 3y agoLots of our patients own gas stations and lie about their income. What they do is have 1 person own the gas stations for credit card purchases, and everyone else claim the cash purchases. We also have a few farmers/rural people who sell stuff for cash and don't report it. Definitely not everyone is doing this loophole, but I always find it a bit brazen they are telling us this.
- qwytw 3y ago> ~16 visits * 40$ vs 4 visits at $125. To be fair this seems like a bigger problem to me than Medicaid recipients "overusing" healthcare. Are services to people on Medicaid provided at a cost and effectively subsidized by others? Or are clinics just maximizing their profit margins by charging as much as they can since there are no incentives to decrease prices (insurance companies don't have that much interest in lowering overall costs since they can just raise the premiums).
- adasdasdas 3y agoPay less medicaid, pay more social security
- DontchaKnowit 3y agoI do not believe this first off. Healthcare is an endless money pit. The cost will always equal precicesly what the buyer is willing to pay
- cddotdotslash 3y agoIf you want to balance personal liberties with reducing government spending, why not implement a large(r) federal tax on cigarettes which is refunded at tax time if you’re not a Medicaid recipient?
- Clubber 3y agoMaybe we should stop building so many missiles.
- valval 3y agoSo you have any idea how small the defense budget is compared to social programs (let alone their sum) like the ones discussed in this thread? The numbers are all public, just look them up. The US doesn’t spend a particularly interesting percentage of their GDP on defense budget at a global scale.
- Clubber 3y ago>So you have any idea how small the defense budget is compared to social programs (let alone their sum) like the ones discussed in this thread? The numbers are all public, just look them up. Yes I do, it's comparable to SS and Medicaid/Medicare. Before WWI and WWII, we hardly carried a standing military. >The US doesn’t spend a particularly interesting percentage of their GDP on defense budget at a global scale. That's true but you aren't mentioning total spend. The total spend numbers paint a different picture. How much military spending at the expense of domestic wellness do we need? https://en.wikipedia.org/wiki/List_of_countries_by_military_expenditures https://en.wikipedia.org/wiki/List_of_countries_by_military_...
- tehjoker 3y agoImagine how much they could save if people would stop spreading COVID-19
- adr1an 3y agotax people who sit in front of computers too /s
- xnx 3y agoHow much could be saved if smokers switched to vaping?
- Clubber 3y agoA lot. There was a huge anti-vape crusade a few years ago because people couldn't tell the difference. Remember "popcorn lung?"
- asdff 3y agoI still can't believe how they outlawed flavored vapes. Want to quit? Try this stale awful fake tobacco smoke option, because a mango juul pod sold behind the counter with an ID check that is regularly tested by police is too tempting for the youth who are still smoking and vaping anyhow. Meanwhile you have blueberry vodka in arms reach at the grocery store. Bud light seltzer in attractive summer packaging in every fruity tutti flavor next to the 7 up at the gas station. It's all a bullshit farce and really goes to show how leveraged our lawmakers are in companies like Altria.
- xnx 3y agoIt blew my mind to see that there's an alcoholic version of SunnyD (US orange drink targeted toward children). At this point, I would no longer be surprised to see alcoholic Kool-Aid next.
- swsdsailor 3y agoI must be getting old, this argument is so tired. W could save X if just Y % stopped doing Z. Stop micromanaging people, bring freedom back. /sigh
- cosmotic 3y agoBetter title: Medicaid could cut costs by 0.45% if 1% of smokers quit smoking Absolute units like billions of dollars are meaningless in these contexts. Please use percentages.
- phoronixrly 3y agoHey, I'd take a 45% reduction of Medicaid costs if everyone stopped smoking right away. That's how the math goes, right? :)
- nerdjon 3y agoI don't think thats really a better title. It gives the impression that the reduction is less than the impact of people quitting. I get where you are going, but this doesn't communicate it well. It would be better to somehow tie it into taxes or something if we want to go down that path. Or maybe say something like "If all smokers quit it could save Medicaid 45% of its budget". Saying the same thing but I feel like putting 0.45% next to 1% leads to a gut reaction (since the savings is smaller than the amount of people stopping smoking) that does not properly communicate what is being said.
- cosmotic 3y agoI agree, it's confusing because the two percents are of different things.
- smegsicle 3y ago> if 1% of smokers quit smoking you'd think that's what they meant, but the article seems to be talking about if 1% of medicaid recipients stopped smoking, not medicaid recipients who are smokers only about a quarter are actually smokers (who therefore could conceivably stop) so if 1% of them stopped smoking, we'd be closer to 0.1% of the budget
- hn_throwaway_99 3y agoI'm so skeptical of "if just 1% of X happens, we'll all be rich!" arguments. It's like when startups say "If we just get 1% of <giant market X> we'll be worth billions." All you're really doing is emphasizing the size of the market while handwaving away how actually difficult it is to get that 1% (because hey, 1% sounds like such a small number, how hard can it be??) When it comes to smoking, at least in the US, it has largely become an affliction of the poor and uneducated. This has definitely changed in the past 40 years or so - smoking used to be something that was very common, but now I'm actually pretty shocked when I hear someone in my social class (highly educated, upper middle class) smokes. "What's wrong with you?" is honestly my first thought. So the main issue is that tackling smoking rates among the poor (this article was about Medicaid after all) is really about tackling many of the issues of poverty itself. When you're bored and don't have much hope in your upward mobility, smoking (and other drugs) doesn't seem like such a bad trade - a temporary little joy, when life is generally tough anyway. When you talk about tackling the root causes of poverty in the US, that's a much more difficult (and realistic) conversation than just saying "let's just get 1% of Medicaid recipients to stop smoking."
- RhysU 3y agoThat's funny, because when I see someone from that same social class not be condescending about people's personal choices I think "What's right with you?"
- bb88 3y ago> When it comes to smoking, at least in the US, it has largely become an affliction of the poor and uneducated. We all are capable of addictions. Smoking is the one most available to the poor. A lot of smart people get hooked on drugs -- even though they probably shouldn't. Wall street investment bankers and cocaine come to mind -- even though they are maybe some of the smartest people on the planet. > So the main issue is that tackling smoking rates among the poor ... is really about tackling many of the issues of poverty itself. You're right, but your cause and effect are switched: Addiction is more likely to create poverty than the reverse. Not only does it create poverty, but persistent poverty. People would rather get high than clean themselves up and own a house.
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- rswskg 3y agoSame with type 2 diabetes. Huge sums could be saved by simply insisting on calorie restriction.