http://reason.com/archives/2009/10/21/myocardial-infractions

Myocardial Infractions
Jacob Sullum | October 21, 2009


Six years ago, when I asked an epidemiologist about a report that a
smoking ban in Helena, Montana,
had cut heart attacks by 40 percent within six months, he thought the idea
was so ridiculous that
no one would take it seriously. He was wrong.

Since then 10 other studies have attributed substantial short-term
reductions in heart attacks to
smoking bans, and last week an Institute of Medicine (IOM) committee
endorsed their findings. But a
closer look at the IOM report, which was commissioned by the U.S. Centers
for Disease Control and
Prevention, suggests its conclusions are based on a desire to promote
smoking bans rather than a
dispassionate examination of the evidence.

Thousands of jurisdictions around the world restrict smoking. Some of them
are bound to see
significant drops in heart attacks purely by chance, while others will see
no real change or
significant increases. Focusing on the first group proves nothing unless
it is noticeably bigger
than the other two groups.

The largest study of this issue, which used nationwide data instead of
looking at cherry-picked
communities, concluded that smoking bans in the U.S. "are not associated
with statistically
significant short-term declines in mortality or hospital admissions for
myocardial infarction." It
also found that "large short-term increases in myocardial infarction
incidence following a
workplace ban are as common as the large decreases reported in the
published literature."

That study, published by the National Bureau of Economic Research (NBER)
in March, suggests that
publication bias-the tendency to report positive findings and ignore
negative ones-explains the
"consistent" results highlighted by the IOM committee. But even though the
panelists say they tried
to compensate for publication bias by looking for relevant data that did
not appear in medical
journals, they ignored the NBER paper, along with analyses that found no
declines in heart attacks
following smoking bans in California, Florida, New York, Oregon, England,
Wales, Scotland, and
Denmark.

If smoking bans reduce heart attacks, the effect could be due to declines
in smoking, declines in
secondhand smoke exposure, or both. The IOM report settles on that last
explanation, quite a leap
given that "only two of the studies distinguished between reductions in
heart attacks suffered by
smokers versus nonsmokers."

In any case, when people stop smoking, their heart attack risk declines
gradually over several
years, and it's hard to see why the risk would fall any faster for people
exposed to secondhand
smoke. Furthermore, estimates from the CDC and the American Heart
Association indicate that smoking
and secondhand smoke together account for about 25 percent of heart
disease deaths. So how could a
smoking ban, even one that eliminated all smoking, cut heart attacks by 40
percent (or 47 percent,
as another study claimed)?

The IOM panelists dodge these issues by declining to estimate the size or
the timing of the impact
from smoking bans, citing the limitations of the studies and the wide
variations between them. But
"if you can't even estimate the magnitude of an effect," notes Michael
Siegel, a Boston University
public health professor who was one of the report's reviewers, "you are
hardly in a position to
conclude that [it] exceeds random variation combined with the known
secular decline in heart attack
rates."

Even while taking refuge in imprecision, the IOM committee tries to make
transparently absurd
claims seem plausible by intimating that spending a half-hour in a smoky
bar just might kill you,
even if you were completely healthy when you went in. If so, where are the
bodies? The report
concedes "there is no direct evidence that a relatively brief exposure to
secondhand smoke can
precipitate an acute coronary event."

Siegel, who faults the IOM committee's "sensationalistic" approach, is a
longtime supporter of
smoking bans who nevertheless tries to separate his political advocacy
from his scientific
analysis. It's too bad the authors of the IOM report, who immediately used
it as an excuse to
demand strict smoking regulations throughout the country, did not follow
his example.

Jacob Sullum is a senior editor at Reason and a nationally syndicated
columnist.

http://reason.com/archives/2009/10/21/myocardial-infractions

Using studies to justify their actions perhaps? Using these studies, to
justify why it is okay to take away or restrict a persons freedom, perhaps?
If the smoker had to pay for their own healthcare needs, how concerned would
the government be about the cost of medical care that a smoker incurs?

If you do not die from one cause, won't you die from another cause? Can anyone
guarantee that you actually save money by stopping people from smoking?

In article <hc2i41$6o2$1 at (no spam) news.eternal-september.org>,
"Eric Gisin" <gisin at (no spam) uniserve.com> wrote:

http://reason.com/archives/2009/10/21/myocardial-infractions

Nice cut and paste job of an article by a long time tobacco company
apologist who has been on their payroll for years according to
http://www.sourcewatch.org/index.php?title=Jacob_Sullum

On Sun, 25 Oct 2009 15:39:05 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:

Using studies to justify their actions perhaps? Using these studies, to
justify why it is okay to take away or restrict a persons freedom,
perhaps?
If the smoker had to pay for their own healthcare needs, how concerned
would
the government be about the cost of medical care that a smoker incurs?

In general, Americans DO pay for their own health care. Government pays
only for Medicare
(over 65) and Medicaid/SCHIP (children and disabled). See my article in
alt.smokers about
assigned risk medical insurance, to which government contributes almost
nothing except in
Massachusetts.

If you do not die from one cause, won't you die from another cause? Can
anyone
guarantee that you actually save money by stopping people from smoking?

Several economic studies, Manning is the most often cited, found smoking
has a negative
cost to society. The reason is lower Social Security payouts due to lower
life expectancy.

"Robert" <no at (no spam) e.mail> wrote in message
news:skcae5ddt103t3dgim88f835jel5dootcp at (no spam) 4ax.com...
On Sun, 25 Oct 2009 15:39:05 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:

Using studies to justify their actions perhaps? Using these studies, to
justify why it is okay to take away or restrict a persons freedom,
perhaps?
If the smoker had to pay for their own healthcare needs, how concerned
would
the government be about the cost of medical care that a smoker incurs?

In general, Americans DO pay for their own health care. Government pays
only for Medicare
(over 65) and Medicaid/SCHIP (children and disabled). See my article in
alt.smokers about
assigned risk medical insurance, to which government contributes almost
nothing except in
Massachusetts.

Do they now? What percentage of the American people, pay for their own
healthcare, using their own money directly?

If you do not die from one cause, won't you die from another cause? Can
anyone
guarantee that you actually save money by stopping people from smoking?

Several economic studies, Manning is the most often cited, found smoking
has a negative
cost to society. The reason is lower Social Security payouts due to lower
life expectancy.



That does not make any sense at all. If a smoker will receive less from
social security because they will die at a younger age, how is that a
"negative cost to society"?

On Mon, 26 Oct 2009 14:36:26 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:


"Robert" <no at (no spam) e.mail> wrote in message
news:skcae5ddt103t3dgim88f835jel5dootcp at (no spam) 4ax.com...
On Sun, 25 Oct 2009 15:39:05 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:

Using studies to justify their actions perhaps? Using these studies, to
justify why it is okay to take away or restrict a persons freedom,
perhaps?
If the smoker had to pay for their own healthcare needs, how concerned
would
the government be about the cost of medical care that a smoker incurs?

In general, Americans DO pay for their own health care. Government pays
only for Medicare
(over 65) and Medicaid/SCHIP (children and disabled). See my article in
alt.smokers about
assigned risk medical insurance, to which government contributes almost
nothing except in
Massachusetts.

Do they now? What percentage of the American people, pay for their own
healthcare, using their own money directly?

The federal government pays 35% (Medicare, Medicaid, Military), state and
local government
pays 11%. The other 54% is paid by private insurance (36%) and out of
pocket (15%).

"The average family health insurance premium, provided through an employer
health benefit
program, was $11,480 in 2006. Employees paid an average of $2,973 towards
the premium
amount." Source: Kaiser Family Foundation
http://www.healthpaconline.net/health-care-statistics-in-the-united-states.htm

"Robert" <no at (no spam) e.mail> wrote in message
news:i7lce5thi3184ich804hof5h0svm6eau4s at (no spam) 4ax.com...
On Mon, 26 Oct 2009 14:36:26 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:


"Robert" <no at (no spam) e.mail> wrote in message
news:skcae5ddt103t3dgim88f835jel5dootcp at (no spam) 4ax.com...
On Sun, 25 Oct 2009 15:39:05 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:

Using studies to justify their actions perhaps? Using these studies, to
justify why it is okay to take away or restrict a persons freedom,
perhaps?
If the smoker had to pay for their own healthcare needs, how concerned
would
the government be about the cost of medical care that a smoker incurs?

In general, Americans DO pay for their own health care. Government pays
only for Medicare
(over 65) and Medicaid/SCHIP (children and disabled). See my article in
alt.smokers about
assigned risk medical insurance, to which government contributes almost
nothing except in
Massachusetts.

Do they now? What percentage of the American people, pay for their own
healthcare, using their own money directly?

The federal government pays 35% (Medicare, Medicaid, Military), state and
local government
pays 11%. The other 54% is paid by private insurance (36%) and out of
pocket (15%).


So, the statement that "American DO pay for their own health caee" is false?

"The average family health insurance premium, provided through an employer
health benefit
program, was $11,480 in 2006. Employees paid an average of $2,973 towards
the premium
amount." Source: Kaiser Family Foundation
http://www.healthpaconline.net/health-care-statistics-in-the-united-states.htm

So, since medical inflation is running at or above 8% per year, that means
the cost of that insurance will double in around eight years, and will
double again every succeeding period of time?

On Tue, 27 Oct 2009 07:02:13 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:


"Robert" <no at (no spam) e.mail> wrote in message
news:i7lce5thi3184ich804hof5h0svm6eau4s at (no spam) 4ax.com...
On Mon, 26 Oct 2009 14:36:26 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:


"Robert" <no at (no spam) e.mail> wrote in message
news:skcae5ddt103t3dgim88f835jel5dootcp at (no spam) 4ax.com...
On Sun, 25 Oct 2009 15:39:05 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:

Using studies to justify their actions perhaps? Using these studies,
to
justify why it is okay to take away or restrict a persons freedom,
perhaps?
If the smoker had to pay for their own healthcare needs, how concerned
would
the government be about the cost of medical care that a smoker incurs?

In general, Americans DO pay for their own health care. Government
pays
only for Medicare
(over 65) and Medicaid/SCHIP (children and disabled). See my article
in
alt.smokers about
assigned risk medical insurance, to which government contributes
almost
nothing except in
Massachusetts.

Do they now? What percentage of the American people, pay for their own
healthcare, using their own money directly?

The federal government pays 35% (Medicare, Medicaid, Military), state
and
local government
pays 11%. The other 54% is paid by private insurance (36%) and out of
pocket (15%).


So, the statement that "American DO pay for their own health caee" is
false?

I didn't answer your question about percentage of Americans paying for
their own health
care (or doing without). It is 77%. The 23% subsidized by government are
elderly,
children, young mothers and officially disabled. An adult, non-disabled,
under 65 male
cannot get government aid, period (excepting prison and military).

"The average family health insurance premium, provided through an
employer
health benefit
program, was $11,480 in 2006. Employees paid an average of $2,973
towards
the premium
amount." Source: Kaiser Family Foundation
http://www.healthpaconline.net/health-care-statistics-in-the-united-states.htm

So, since medical inflation is running at or above 8% per year, that means
the cost of that insurance will double in around eight years, and will
double again every succeeding period of time?

Cost will rise faster than inflation because a demographic bubble,
boomers, is nearing
elderhood. The average age is going up. But we cannot afford to pay
double. That would put
health care at 35% of GDP, more than total government spending with
deficits. Something
has to change, soon.

An estimated 30% of health care spending goes to slippage, administrative
inefficiencies.
A single payer system would eliminate 90% of that.

caused by poor communication between doctors, fear of malpractice suits,
path of least
resistance and patient expectations. These are management issues, not
medical issues,
which haven't been and won't be solved by isolated doctors. Some entity
needs to start
managing the whole system. Insurance companies could have done it, but
didn't. Mayo Clinic
is an examplar of how it should work. We need something like Mayo on a
national scale.

Is there any system that we can devise that will not have unnecessary
overuse? If you do not pay for what you want or need, are you more or
less likely to "overuse" the system? If you paid for what you need or
want, aren't you less likely to "overuse" the system?

"Jerry Okamura" <okamuraj005 at (no spam) hawaii.rr.com> wrote in message
news:Zp%Fm.10824$U55.9748 at (no spam) newsfe02.iad...



Is there any system that we can devise that will not have unnecessary
overuse? If you do not pay for what you want or need, are you more or
less likely to "overuse" the system? If you paid for what you need or
want, aren't you less likely to "overuse" the system?

A single payer system with doctors still operating as private entities but
all billing the same place. No fault insurance type of thing. Cover
whatever happens. No disputes over who pays for it just fix it. No such
thing as "pre-existing, you're either sick or you're not. The fees are
fixed and reviewed by government and medical people. Doctors still become
wealthy people in this country and nurses have been known to make a decent
living as well. And you don't end up paying huge dollars to solve problems
which would have been cheap if they were treated when they began.

Ah, but then we get the dreaded "people dying on the wait list" syndrome.
The horror sories you've been told by insurance companies and some of your
government who have vested interests in the status quo. Doesn't happen,
its a myth.
The way it works is if you are in greater need you get moved up in
priority. It happened twice last year in my own family. That woman from
Canada you heard about in the news a few months back who had a "tumour"
and would have died had she not gone to the US - she lied from beginning
to end. She didn't have a tumour she had a cyst and she was neverr in
danger of anything other than a little discomfort. The wait list is how
the system limits delivery. People who really don't need something fixed
in a hurry get to wait. Some of them get better on their own, some of them
get to wait a long time to get their hangnail treated. The odd person with
trivial problems does sit on the wait list and eventually use resources,
but theres not many willing to do that. Wealthy people with trivial
problems they are willing to pay for are still free to go outside the
system if they choose.

Every system has some way to limit how treatment happens. Yours currently
limits it by how much money or insurance you have at your disposal, ours
limits it by how badly you actually need it. The Canadian system is not
perfect, its still being underfunded by neocon politicians for ideological
reasons, but in spite of their interference it still works reasonably
well. There are examples of systems in Europe which work even better.

Obama's solution does not go far enough. It still allows a hodgepodge of
payers which will maintain the confusion and still cause too much expense
overall. He's afraid to confront the insurance companies who are making a
fortune and tell them its over. I suppose he has to start somewhere but I
fear its going to be so timid a start that it won't be effective and it
will give the opposition the chance to say see we told you so.

"Robert" <no at (no spam) e.mail> wrote in message
news:c28fe51rvgg3bn77583tvkin5em4pmoqb6 at (no spam) 4ax.com...
On Tue, 27 Oct 2009 07:02:13 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:


"Robert" <no at (no spam) e.mail> wrote in message
news:i7lce5thi3184ich804hof5h0svm6eau4s at (no spam) 4ax.com...
On Mon, 26 Oct 2009 14:36:26 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:


"Robert" <no at (no spam) e.mail> wrote in message
news:skcae5ddt103t3dgim88f835jel5dootcp at (no spam) 4ax.com...
On Sun, 25 Oct 2009 15:39:05 -1000, "Jerry Okamura"
okamuraj005 at (no spam) hawaii.rr.com> wrote:

Using studies to justify their actions perhaps? Using these studies,
to
justify why it is okay to take away or restrict a persons freedom,
perhaps?
If the smoker had to pay for their own healthcare needs, how concerned
would
the government be about the cost of medical care that a smoker incurs?

In general, Americans DO pay for their own health care. Government
pays
only for Medicare
(over 65) and Medicaid/SCHIP (children and disabled). See my article
in
alt.smokers about
assigned risk medical insurance, to which government contributes
almost
nothing except in
Massachusetts.

Do they now? What percentage of the American people, pay for their own
healthcare, using their own money directly?

The federal government pays 35% (Medicare, Medicaid, Military), state
and
local government
pays 11%. The other 54% is paid by private insurance (36%) and out of
pocket (15%).


So, the statement that "American DO pay for their own health caee" is
false?

I didn't answer your question about percentage of Americans paying for
their own health
care (or doing without). It is 77%. The 23% subsidized by government are
elderly,
children, young mothers and officially disabled. An adult, non-disabled,
under 65 male
cannot get government aid, period (excepting prison and military).


How can it be 77%. Your own posting says that the federal government pays
35%, state and local government pays 11%.

And 54% is paid for by private
insurance, which is paid for by the business a person works for, for the
most part. I would think that very few people actually pay for their own
health insurance with the money they earn.

"The average family health insurance premium, provided through an
employer
health benefit
program, was $11,480 in 2006. Employees paid an average of $2,973
towards
the premium
amount." Source: Kaiser Family Foundation
http://www.healthpaconline.net/health-care-statistics-in-the-united-states.htm

So, since medical inflation is running at or above 8% per year, that means
the cost of that insurance will double in around eight years, and will
double again every succeeding period of time?

Cost will rise faster than inflation because a demographic bubble,
boomers, is nearing
elderhood. The average age is going up. But we cannot afford to pay
double. That would put
health care at 35% of GDP, more than total government spending with
deficits. Something
has to change, soon.

So, what do you think the "change" should be? The Obama solution or
something else?

An estimated 30% of health care spending goes to slippage, administrative
inefficiencies.
A single payer system would eliminate 90% of that.

If you reduced administrative inefficiences to zero, wouldn't medical
inflation over time, wipe out any "savings" that you may have achieved by
reducing administrative inefficiencies?

Another 20% goes to unnecessary overuse
caused by poor communication between doctors, fear of malpractice suits,
path of least
resistance and patient expectations. These are management issues, not
medical issues,
which haven't been and won't be solved by isolated doctors. Some entity
needs to start
managing the whole system. Insurance companies could have done it, but
didn't. Mayo Clinic
is an examplar of how it should work. We need something like Mayo on a
national scale.


Is there any system that we can devise that will not have unnecessary
overuse? If you do not pay for what you want or need, are you more or less
likely to "overuse" the system? If you paid for what you need or want,
aren't you less likely to "overuse" the system?

When you pay for your own medical needs, what are the odds that anyone other
than yourself will decide on whether you live or die? When someone else
pays for your medical needs, what are the odds that in order to save money,
they will decide if you live or die? When you depend on someone else to pay
for your medical needs CAN they decide not to pay?

You are right on that point. But your reasons are wrong. The solution to
controlling cost is to return the rationing decision back to where it
belongs and that is the user of the service. That is the only way you can
reduce the medical inflation rate, which is the reason we have a cost
problem.

Is there any system that we can devise that will not have unnecessary
overuse? If you do not pay for what you want or need, are you more or
less likely to "overuse" the system? If you paid for what you need or
want, aren't you less likely to "overuse" the system?

A single payer system with doctors still operating as private entities
but all billing the same place. No fault insurance type of thing. Cover
whatever happens. No disputes over who pays for it just fix it. No such
thing as "pre-existing, you're either sick or you're not. The fees are
fixed and reviewed by government and medical people. Doctors still become
wealthy people in this country and nurses have been known to make a
decent living as well. And you don't end up paying huge dollars to solve
problems which would have been cheap if they were treated when they
began.

How does your proposal reduce the medical inflation rate?

Ah, but then we get the dreaded "people dying on the wait list" syndrome.
The horror sories you've been told by insurance companies and some of
your government who have vested interests in the status quo. Doesn't
happen, its a myth.
The way it works is if you are in greater need you get moved up in
priority. It happened twice last year in my own family. That woman from
Canada you heard about in the news a few months back who had a "tumour"
and would have died had she not gone to the US - she lied from beginning
to end. She didn't have a tumour she had a cyst and she was neverr in
danger of anything other than a little discomfort. The wait list is how
the system limits delivery. People who really don't need something fixed
in a hurry get to wait. Some of them get better on their own, some of
them get to wait a long time to get their hangnail treated. The odd
person with trivial problems does sit on the wait list and eventually use
resources, but theres not many willing to do that. Wealthy people with
trivial problems they are willing to pay for are still free to go outside
the system if they choose.

When you pay for your own medical needs, what are the odds that anyone
other than yourself will decide on whether you live or die? When someone
else pays for your medical needs, what are the odds that in order to save
money, they will decide if you live or die? When you depend on someone
else to pay for your medical needs CAN they decide not to pay?

Every system has some way to limit how treatment happens. Yours currently
limits it by how much money or insurance you have at your disposal, ours
limits it by how badly you actually need it. The Canadian system is not
perfect, its still being underfunded by neocon politicians for
ideological reasons, but in spite of their interference it still works
reasonably well. There are examples of systems in Europe which work even
better.

It is a question of what happens in the future. Medical inflation that is
higher than the overall inflation rate means the total cost of healthcare
will rise. When it rises, and someone else is paying for your medical
needs, they have two choices. Either come up with the extra money (and
like taxes, we like the free benefit, we just don't like paying for it) or
ration care. That is the only two options the "payer" has.

Obama's solution does not go far enough. It still allows a hodgepodge of
payers which will maintain the confusion and still cause too much expense
overall. He's afraid to confront the insurance companies who are making a
fortune and tell them its over. I suppose he has to start somewhere but I
fear its going to be so timid a start that it won't be effective and it
will give the opposition the chance to say see we told you so.



You are right on that point. But your reasons are wrong. The solution to
controlling cost is to return the rationing decision back to where it
belongs and that is the user of the service. That is the only way you can
reduce the medical inflation rate, which is the reason we have a cost
problem.