Health Care


An email I sent regarding a pending policy initiative.

To All My Senators,

This morning I received an email about HCSAC’s push to make ASU a smoke and tobacco free campus. I had attended the hearing a few weeks ago where there was a lively discussion about this initiative where many points were brought up by both sides. I was discouraged upon seeing the email that the objections had been addressed without any mention of the many responses that were given, by myself and others, when HCSAC brought up these same points in discussion. I am emailing all of you who represent me to give those responses and urge you not to support this program. Below is the original email into which I have inserted my comments.

100% Tobacco Free ASU Policy Will

  1. Create a healthier campus and learning environment for everyone.
  1. Inform students that smoking is not the social norm

I have a serious problem with this. If providing information is a goal, putting up posters that say, “only X% of students smoke” is a more accurate and less expensive way to do so. Banning smoking costs smokers something that they enjoy, and we should avoid doing so unless it is necessary (which it may be, as I address later, but clearly this is not a relevant reason). Students have the right to make their own decisions given the information they acquire; information is the game for advocacy groups, not government.

  1. Give students more control in there day to day lives by limiting the control of addiction.

It seemed to be the position of HCSAC that if a person is smoking, they are clearly addicted and want to stop, based on the number of times I had to repeat the opposite. Many students enjoy smoking, and passing rules which limit their activities certainly does not give them more control, but less. Again, if the goal is to help students quit if they want to, more advertising about the resources can do so without imposing costs on other students.

  1. Encourage and help students and faculty to take advantage of on campus smoking resources.

I go back to my previous point about advertising. How banning smoking would help take advantage of resources, which is based only on whether someone wants help or not, is beyond me.

  1. Position ASU as a leader in the state’s fight against tobacco addiction.

Statements like this do not have a place in this debate. Obviously, we could enact policies to make ASU a leader in hiring teachers without Ph.D.s or discriminating in our admissions, but these are not desirable. We must look at whether the policy leads to good or bad outcomes, not about our esteem.

Top Three Concerns

1. Smoking is a right.

  • Smoking is choice which is not guaranteed by the constitution.
  • Further, smoking is not a natural or moral right. We can exercise rights and freedoms insofar as they do not infringe upon the health, safety and rights of others. Smoking obviously does infringe on the rights of others because second hand smoke is deadly.
  • Tobacco is the cause of over 400,000 deaths annually, 50,000 of which are due to second hand smoke.  To put this in perspective, in its prime, DUI caused about 30,000 deaths annually and today that number is less than 15,000. DUI law limits where and when we can drink, yet is far less deadly than tobacco. As deadly as tobacco use is, it should most definitely be limited as well.

In the hearing, none of the opponents to smoke free ASU argued that smoking was a right. We argued simply that the “life, liberty, and pursuit of happiness” gives people the right to choose for themselves, unless it harms others (as is granted and discussed below).

Of all the points which are brought up in this email, this is the only one which provides a basis for action by government. I agree that secondhand smoke does infringe the rights of others, although it is hard to say exactly how much danger it poses to a student walking through campus. Given, though, that it does impose some cost, I am in favor of action to prevent smokers from imposing that cost on others, as I discuss in the smoke-zones section.

There are many things, from fatty foods to snowboarding, which increase risk of death for those who partake in them. Tobacco may carry an especially high risk (although, if you ask my friends who smoke, it also carries especially high pleasure), but that does not change the fact that a person is free to engage in any behavior for which he or she bears the costs- he or she decides what is worth it, not the government. DUI is different- deaths from DUI are not solely, and even not mostly in many places, the people who chose to drink and drive. Many are killed who were not part of that choice, which justifies government action, as does secondhand smoke in this case.

2. Why not smoking zones?

  • At universities that have tried both options, they report that completely tobacco free policy is much more enforceable.
  • Smoking zones send an inconsistent health message.
  • Smoking zones result in a misperception of inflated smoking rates among students which gives the impression that smoking is the social norm. This leads to increased smoking rates.
  • Smoking zones increase exposure of smokers to second hand smoke.
  • Smoking zones do not support our goal to create a healthier campus and learning environment.

This is an absolutely unacceptable argument and the main reason why I do not support this initiative in its current form. Smoke-free zones solve the problem of secondhand smoke while allowing students to make their own decisions about smoking. Basically, in refusing to consider smoking zones for this reason, we are saying, “It may be the right thing to do, but it’s too hard, so forget it.” In a moral email filled with points about protecting people from themselves and others this clearly has no place. If smoking zones are the right thing to do (which I believe they are), we should be willing to put up signs and encourage non-smokers to speak up about non-compliance.

Mandating people’s health choices is NOT a proper role of government. An ad campaign about the rates of smoking and its dangers, which already happens on campus, makes the university’s position on smoking perfectly clear without trampling liberty.

Again, this can easily be countered by distributing information about the true rates of smoking, assuming this statement is true. I’m not at all sure that seeing people smoking in a restricted zone would convince me to smoke.

This is true, but a smoker entering that zone knows what it entails and chooses it for him or herself. It is a way to restrict smoking harm only to those who choose to bear it, which means once again they are deciding for themselves.

This is another improper role of government. Taking away liberty simply to say we are progressive is a deplorably selfish encroachment into other people’s lives.

3. If the current 25’ policy is not enforced, how can we expect a 100% tobacco free policy to be enforced?

  • A 25’ rule is simply difficult to enforce. No one is going out with yard sticks to measure. Are smokers 10’, 20’ or 25’ feet away? Is this distance from the building entrance, windows or vents? In the case of 100% tobacco free policy, it is very clear when someone is in violation, resulting in greater enforceability.

I’ll accept this point, but the clear boundaries to a smoking zone make it just as obvious as the clear boundaries of campus. Make specific definitions and this problem would be gone.

  • Currently, there is no cross departmental collaboration for enforcement of existing policy. RHA, Residential Life, Campus Security, ASU Police, Human Resources, etc., do not work together to enforce the policy. When 100% tobacco free policy is implemented, enforcement will become a priority and as a necessary result so will collaboration among these various groups. ASU will finally start working together to enforce tobacco policy.

This is blatant misdirection. Why couldn’t enforcement be a priority now? Enforcement priority has nothing to do with this policy.

For those of you still reading this far down, I complement you on your dedication to making the right decision for the constituency you represent. Hopefully you see that secondhand smoke is the only thing that warrants action, and that smoking zones are a perfectly good way to address this without taking away a freedom that people enjoy. If a measure can be taken to implement these instead, you would have my support.

I realize that many people still feel a need to take care of those making different choices like smoking, evidenced by many of the points in the email I received, and that I might not be able to convince them otherwise solely through logic. I’ll end with a quote from Gandhi, who carries more of the moral weight that many value so highly:

“Freedom is not worth having if it does not include the freedom to make mistakes. It escapes my comprehension how human beings, be they ever so experienced and able, can delight in depriving other humans of that precious right.”

If you have any questions about my position or wish to talk further, my email address is bjmorin@asu.edu. Thank you for reading.

-Ben Morin

As reported in the WSJ, the Credit Card Accountability, Responsibility and Disclosure Act will cost the credit card industry approximately $12 billion a year. I’m all for the provision requiring companies to tell consumers how long it will take to pay off balances, but handicapping actual contracts is going too far. This is what I really dislike about the Obama administration- they see a problem and jump on it, thinking that if they just tell people not to do thing they dislike everything will be fine. I especially enjoy the irony that they gave $800 billion in stimulus to help banks and now are tying their hands from making a recovery. Instead, why wasn’t the stimulus $12 billion less, and that difference could be made up by the taxpayers who act within their contracts instead of everyone who had nothing to do with any of this. Not to mention, of course, that private spending ensures that both parties are better off than they would have been otherwise. Government spending carries no such guarantee.

But the real thing that frustrates me about American consumers is their sense of entitlement. Whenever a product or service becomes commonplace in the economy, they decide that they deserve it and that it must be a part of their lives. What they forget, of course, is that for credit cards to exist at all, some people must default and pay penalties and interest- otherwise there would be no way to support them for the rest of us. How shortsighted is it to think that we can handicap the mechanism that makes them work and expect them to stay around for us to take advantage of?

The same thing holds for health insurance. People are so used to it that they scramble to make people insured and then worry about costs, without realizing that people who are insured have higher costs by definition– that’s just the way insurance works, and that’s even if you control moral hazard and adverse selection, which is pretty much impossible.

Sorry for my absense; I’ve been starting a new semester at school. But I’m back with some good news, courtesy of Scott Brown. President Obama is backing off his fervor with health care in the face of Brown’s victory, which means I have a chance of not having to pay for insurance when I finally get to work and want to save my money. I wonder how his political capital for other issues will be after this.

Eric C. Sun, et al, have a new working paper about the effects and effectiveness of investment in cancer research. NBER abstract here. Also see Stephen Dubner of Freakonomics discussing the findings here. I find a passage from Dubner particularly interesting:

Believe it or not, this flat mortality rate actually hides some good news. Over the same period, age-adjusted mortality from cardiovascular disease has plummeted, from nearly 600 people per 100,000 to well below 300. What does this mean? Many people who in previous generations would have died from heart disease are now living long enough to die from cancer instead.

This is the way health progress is made, and why encouraging investment in new technologies is so critical. Progress might only extend life a few years, but the findings of the article show that

Between 1988 and 2000, life expectancy for cancer patients increased by roughly four years, and the average willingness-to-pay for these survival gains was roughly $322,000. Improvements in cancer survival during this period created 23 million additional life-years and roughly $1.9 trillion of additional social value, implying that the average life-year was worth approximately $82,000 to its recipient.

These incremental advances are worth so much to people at the end of life and there is such potential for mutually beneficial exchange that eventually this process leads to great progress. It is easy, though, to only see a small piece of progress at a time and say that changing incentives for health companies will not do much damage; that is the situation with health care reform in the US now.

Good article from Investors.com that echoes my sentiments about health care reform. The first paragraph puts it quite nicely.

The push to reform the system is going in exactly the wrong direction. Instead of minimizing patient involvement in payment for treatment, Washington should be seeking to increase patients’ role.

Economist Alan Viard talks about the high-income surtax in the House health care bill. I completely agree with his analysis. Any tax takes a toll on savings and therefore investment, and since the wealthy do by far the majority of the saving this type of tax is extremely distorting on investment and thus GDP growth. One particular excerpt I especially like:

Third, the proposed surtax reflects an unsustainable approach to tax and fiscal policy. As commentators across the political spectrum have recognized, the existing fiscal imbalance cannot be addressed without imposing sacrifices on a broad segment of the population. Any new spending programs, such as those in H.R. 3962, will impose additional burdens. By linking these programs to a tax imposed on only 0.3 percent of the population, the bill obscures that fiscal reality. If the programs in H.R. 3962 are worthwhile, they are worth paying for in an open and broad-based manner.

This is what I have been saying for some time. If giving so many more Americans health insurance is a worthy goal, there will have to be sacrifices in the form of higher costs or lower quality care. I think either of those things are too harmful to justify this, since we are only talking about giving people insurance, not care, not to mention all of the perverse incentives.

My sample column for The State Press, ASU’s student paper:

Well, I think I hear the fat lady. With the Democrats poised to seal health care reform on Christmas Eve, this seems a good time to consider why this bill is a huge step in the wrong direction for the United States. What could I be talking about? The Obama administration has assured us that the government can reverse its record of being inefficient compared to the private market and provide insurance for more people. Let’s see if they come through.

Remember that the objective of this legislation was to reduce health care costs. The Congressional Budget Office, though, has estimated that the reform will cost $871 billion over the next decade, without the perverse incentives I will talk about. So the lowest possible cost to taxpayers of a bill that was supposed to lower costs is almost $900 billion.

But we’ll get better care for that money, right? The media is always telling us that our health care system is much worse than other countries’, citing life expectancy. But an August 2008 study in the Lancet Oncology Journal shows that the US has higher cancer survival rates and longer life expectancy after detection in similar stages than European countries, a clear indicator of good care. Studies on other serious illnesses are underway and suggest the same results. Considering the higher incidence of obesity and smoking in the United States, the life expectancy rankings are, not surprisingly, skewed. Moving toward government-run health care will start to erode our success in these areas.

In addition to weakening our treatments, the money we spend on health care will not be as effective. Proponents talk about how involving government will lower costs, citing a lower percentage of Medicare costs for administrative expenses. But this, too, is misleading. Medicare serves an elderly population that has very high average costs; the administrative costs per recipient were 25% higher for Medicare than private insurers from 2000-2005, according to Susan Fu from the Center for Medicare and Medicaid Services, and considering Medicare spends almost nothing preventing fraud (and is exploited for $60 billion a year) this is especially striking. So for customers of health services, it seems that the quality of care for serious illnesses will decrease and the amount of money needed to accomplish those procedures will increase, not to mention costing the already-overburdened government almost $900 billion. Now that sounds more like bureaucracy to me.

And what about the insurance companies and doctors? Well, with the government’s expanded program regulating prices to keep them low, there will be lower wages. This leads to the shortage of doctors that results in waiting times in Canada and elsewhere. Insurance companies will suffer as well because of the bill. Restrictions on excluding certain high risk people and requirements to cover procedures that are sometimes unnecessary will cause insurance companies to raise rates to maintain margins, causing fewer people to buy insurance, lowering profits and raising costs. Now is the time to ask: is this really what we want?

First, we have to remember that the objective of this legislation was to reduce health care costs. The Congressional Budget Office, though, has estimated that the reform will cost $871 billion over the next decade, and that is without all of the perverse incentives which I will talk about next. This means that the lowest possible cost to taxpayers of a bill that was supposed to lower costs is almost $900 billion.

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