Should We Pay People To Quit Smoking?

[LSN80]

I know the concept in and of itself sounds absurd, but Jody Sindelair makes a good argument to do so for Medicaid patients.

http://www.cnn.com/2011/10/05/opinion/sindelar-smoking-medicaid/index.html?hpt=he_c2

Who is Jody Sindelair? An opinion writer for CNNHealth, a Health Economics Professor for Yale, and a Behavioral Psychologist. With President Obama suggesting slashing of Medicaid by 72 billion dollars annually to assist in lowering our national debt, Sindelair offers an unorthodox suggestion instead. In the article above, Sindelair writes:

There is a way to both save taxpayer dollars and improve Medicaid patients' health. We can achieve both if we are willing to consider an unorthodox solution: Pay Medicaid recipients who are smokers to quit using cigarettes.

Sindelair goes on to discuss how 33% of Medicaid recepients smoke, as compared to 20% of the average population. Citing that the public has become better informed on the hazards of smoking combined with smoking bans in many public places and steeper tobacco taxes as reasons for why smoking has been cut in half over the past 50 years Sindelair notes a disparity--Those who smoke who are on Medicaid don't respond to the same public policies who are amongst the general population. SIndelair notes the following regarding her research:

Investing in preventive health care is difficult when you live month-to-month, so there is little motivation for the pack-a-day smoker on Medicaid to quit. However, an indulgence the poor really can't afford is cigarettes. Smoking is expensive. A pack-a-day smoker could save more than $2,000 per year by quitting.

The general argument I could see being made here is that the financial savings alone should be enough to convince anyone to quit smoking. However, just having this intrinsic motivation appaarently isn't working. Ive seen this before during my early years practicing therapy. Kids who would misbehave wouldn't respond to threats to have their allowance taken away due to bad behavior--But they would respond to promises to having it raised. At first, I found the notion to be absurd, until I saw it work. So if it can't work with kids, why not fully-functioning adults?

One of the biggest arguments here is obviously addiction. Children may enjoy, have grown accustomed to, and find it easier to act out, but there's no evidence of addiction to bad behavior, at least in youth. Tobacco is an addictive product, with difficult side effects that come with quitting. It's why you see people who quit smoking pick back up again 6 months later on so many occasions. So what does Sindelair propose?

Smokers on Medicaid would receive small payments in return for quitting or getting cessation counseling as a step toward quitting. Participants would have to hold up their end of the bargain. They would get paid only if medical claims data indicated that they were getting counseling or they tested to be smoke-free. Tests can easily be conducted using breathalyzers to measure carbon monoxide levels. Programs would be offerred in the short term to help assist with the troublesome issues that come with quitting.Smokers on Medicaid would receive small payments in return for quitting or getting cessation counseling as a step toward quitting. Participants would have to hold up their end of the bargain. They would get paid only if medical claims data indicated that they were getting counseling or they tested to be smoke-free. Tests can easily be conducted using breathalyzers to measure carbon monoxide levels.

It may seem implausible that such a limited compensation could push anyone to quit a practice as addictive as cigarette smoking, but there is solid evidence that it works. Research on addiction has repeatedly demonstrated that small payments have persuaded even cocaine addicts to stop using. Furthermore, in my research, I have found that the financial motivation to quit is more effective for low-income smokers than a motivation based on health concerns.

As I noted before, I found it surprisingly effective in children to offer them compensation in order to behave better. I suppose I shouldn't be surprised by this-Most kids aren't motivated by great family dynamics, relieving their parents stress, or a household that runs fluently. They're mostly motivated by things that benefit themselves, especially when they're young. Yet most parents scoffed at the notion at first. Paying their children to live as they're raised to behave seems absurd. But when exasperated, they were willing to try virtually anything, and to both the surprise of myself and them, paying kids to behave worked. Sindelair weighs in similarly regarding her proposal on paying Medicaid recepients to quit smoking.

Many people, including politicians, will chafe at paying people to do something they ought to do on their own. Smoking carries the taint of a moral vice, a bad habit that should require no incentive to abandon. However, government and taxpayers would have a lot to gain from this approach, too. Medical care for tobacco-related diseases costs Medicaid an estimated $22 billion every year. Treating the many illnesses associated with smoking -- emphysema, coronary heart disease and lung cancer, to name a few -- is expensive. Pregnant smokers risk premature childbirth and often expensive medical treatment for their newborns.

Would you be surprised that 10 states have already received funding to test such programs out? Connecticut, Sindelair's state, along with 9 others, were just granted the approval and the funds from the federal government to test the effectiveness of incentive payments in Medicaid. The difficulty that's arising is whether expensive programs to aid at smoking cessation along with payment should be given to people short-term to aid at quitting smoking. Sindelair certainly thinks so.

Providing incentives to promote positive behaviors is a common practice and often uncontroversial. Employers and life insurers, for example, increasingly provide financial incentives to stop smoking. They consider these incentives good investments. Paying such incentives could both improve health for the poor and lower Medicaid costs for taxpayers.What if we really could make a difference by paying a little to save a lot?

Given the information provided above, would you be for or against using your taxpayer dollars to help people stop smoking and keep them smoke-free? Why or why not?

Any other thoughts on this are welcome.

 

[Mustang Sally]

It's always interesting to read of innovative ideas that might have a positive effect on society's ills, but this program makes me think only of the negatives involved.

When the welfare system was created in the 1930's, it was intended as a way to provide temporary relief to workers who hit rough spots in their lives. Immediately, however, "resourceful" people started finding ways to go on welfare and stay there for the rest of their lives, thereby creating the mess we're still trying to extract the country from today.

This non-smoking initiative might lead to similar problems. I can see non-smokers taking up smoking so they can be paid to quit a habit they didn't have before. I can see people getting doctors to falsely certify that their patients have quit smoking, enabling them to apply for these benefits. (After all, somebody's inducing doctors to write all those bullshit prescriptions for medical marijuana, no?) I'm sure there are other ways to beat the system......and people can be quite ingenious in finding them. If they engaged in productive usages for their native intelligence instead of seeking ways to get paid for what they should be doing for themselves, society might be in better shape today.

As the OP observed, the folks on Medicaid are the ones who can least afford the expensive habit of smoking, yet according to the statistic quoted, they smoke even more than the rest of us. Obviously, they're not concerned about helping their own financial situation....... so we're looking for ways to pay them to do it?

I can't see it, but I certainly don't have any better solution to offer, so who knows? Maybe it could work, if we could eliminate the fraud that's sure to ensue.

 

[Ferbian]

Absolutely not. Smoking is something that someone initially choose to start themselves, and it's something that, despite considered addicting, is more than doable to get out of if you actually want to. There's been plenty of things that would make people quit smoking, companies putting warnings on their cigarette packages, several in-door bans of smoking etc etc.

Yet with all of these things, people still smoke. So why should we bother paying them for something they initially could use to fund smoking even more? A smoker won't quit just because he gets paid to do so, mainly due to the fact that if they really wanted to stop smoking, and especially for financial reasons, they would have done so long ago. If someone wants to stop smoking, it shouldn't rely on the amount of money they earn, it should rely on whether they want to themselves, have the will power to go through with it, and have come to terms with the fact that it's simply healthier to stop smoking.

Every member of my family has stopped smoking, but not a single one of them have done it for financial reasons. It all lies in the health aspect, as well as the knowledge of their surroundings in terms of 'polluting' their friends and family who doesn't smoke. There's nothing that makes me think they would've ever stopped before if they were offered money to do so, so why should it work with someone else?

 

[TWJC: The Beginning]

I'm really surprised this Econ guy says that. Then again, he's probably saying it to push his or someone else's agenda.

Smokers don't actually cost society that much money. You have to think about it from a broad perspective. If you die 10 years earlier, that's 10 years less social security you get. Which means it's more money for everyone else. I don't have the study, but my macro econ professor had a link that showed that the average smoker costs society as a whole something like 39 cents when you factor EVERYTHING.

I say just tax smoking (because I don't smoke and so I would "free load" off that tax revenue), legalize pot and tax it (again, don't smoke, just want to free load), tax fatty foods (don't do that either), and encourage smoking (the more of you smokers that die young means more social security for me).

 

[poppycock]

I really don't think that would work at all. Speaking as a smoker myself I will fully admit that I would probably use the money to buy more smokes. Going from what you said they would be able to test me and stop the pay if I did such a thing but that really would not stop me and then the money would stop and it would all be pointless, perhaps apart from me getting a few free packs of cigarettes. I really don't know how they can go about stopping people from smoking. The ads they put on the packs and on TV do not really work. The main reason for people giving up is if they have developed something like cancer but by that time the damage is done and that does even stop a lot of people smoking.

I remember reading or hearing that to stop kids smoking they are going to make all packets of cigarettes plain white or blank. The packets are apparantly what draw a lot of kids in. I am sure that is not very true and was not true in my case. Raising the prices doesn't help either. I think if people want to smoke they should allow them to smoke. It's a choice and they know the dangers. The ads may not work in terms of stopping smokers smoking but they do bring awareness to the dangers so young kids can see what damage smokes do and make their own minds up.

I fully support the smoking ban in public places because it's not fair for others who do not smoke to inhale the shit not through choice but through people smoking around them.

 

[klunderbunker]

No.

This is like paying someone to stop stealing. There are millions of people that don't do this in the first place, so why should people that do it and then quit be rewarded? If you don't start, you'll never have to be persuaded to stop. No.

 

[Remix]

Given the information provided above, would you be for or against using your taxpayer dollars to help people stop smoking and keep them smoke-free? Why or why not?

Any other thoughts on this are welcome.

I'll be honest and say I didn't read your post. I already agree with the concept, in a way. Paying someone money to quit is silly and damn near impossible to actually enforce. What's going to stop them spending the money you give them on cigarettes as soon as they walk out the door?

But given that I'm British and my tax money gets spent on healthcare, I can definately see the good points of having smoking cessation services available on the NHS. It's definately works out as cheaper to give a person advise and prescribe one of the many, many products available to help people stop smoking than deal with the long term risks of smoking (from cancer to CVD).

 

[Larry]

As a smoker myself, If and when I decide to quit smoking I certainly wouldn't want other people to pay for it via some government program. I can do it on my own if I want to, I've done it before, and I'll likely do it again at some point. I kind of go on and off here and there. It's not really a matter of addiction it's more a matter of the fact that I just like it. I like to blow out the smoke, I like the different blends and their different flavors, I like the variety of brands to choose from, etc...To me it's no different than how some people like to drink wine and try the different kinds, or people who like to smoke cigars of different kinds. By no means would I ever expect anyone to pay me to quit, that's kind of up to me and me alone. I shouldn't need a monetary incentive to do so if I am going to.

 

[Sparky]

As a smoker myself, If and when I decide to quit smoking I certainly wouldn't want other people to pay for it via some government program.

This isn't a flame attempt but I call bullshit. If somebody waved cold hard cash into your face when you wanted to give up smoking to give up smoking nobody in the world would turn it down. why do something for free when you could get paid for it?

But I feel it shouldn't happen. as Ferbie said, people choose to start up smoking themselves why get paid to start up again.

how many people, druggies, gamblers people who just plain don't get enough money will take up smoking just to get paid to give it up? a quick legal way to get free money? I know I would.

Plus people would treat the system like a joke. "give" up smoking for a week or two, get the money fail giving up and start up again. plus there would be know way to prove you have infact gave up.

 

[Larry]

This isn't a flame attempt but I call bullshit. If somebody waved cold hard cash into your face when you wanted to give up smoking to give up smoking nobody in the world would turn it down. why do something for free when you could get paid for it?

But I feel it shouldn't happen. as Ferbie said, people choose to start up smoking themselves why get paid to start up again.

how many people, druggies, gamblers people who just plain don't get enough money will take up smoking just to get paid to give it up? a quick legal way to get free money? I know I would.

Plus people would treat the system like a joke. "give" up smoking for a week or two, get the money fail giving up and start up again. plus there would be know way to prove you have infact gave up.

I get what you're saying and I certainly didn't see it as a flame attempt. However, being candid I just wouldn't want the government handout to do something that is my personal responsibility to do. I think there are too many people dependent on government aid for things that are their responsibility to handle as is, this would just be another unnecessary drain on our economy that likely turned into another tax on American citizens to pay for it. Uncle Sam waives free money in my face technically everyday in the form of unemployment, food stamps, free healthcare, welfare, etc... And I take none of it, I wouldn't take this either.

 

[Smooth Sexual Chocolate]

No.

This is like paying someone to stop stealing. There are millions of people that don't do this in the first place, so why should people that do it and then quit be rewarded? If you don't start, you'll never have to be persuaded to stop. No.

I agree with the No, but it's not at all like paying people to quit stealing. What it is like is a system already in place, and that's paying fat people to lose weight. Almost the same exact concept, put in place for pretty much the same reasons. I don't agree with either, but I don't really agree with much our ass backwards government does.

 

[J.J.]

If people stopped smoking, fewer Medicaid dollars will be spent on smoking-related health treatment. That is logical. But it does not necessarily follow that Medicaid will save money overall. Absent cigarettes, individuals will live longer and could potentially end up consuming more health care services than they would have received if smoking had cut their lives short. I am very skeptical of claims of these types of efforts to save money, especially when you have governments so dependent on the revenue streams. But I do know for sure that we could save $10 million by rescinding this grant to pay people not to smoke.

 

[Dagger Dias]

I would be against this idea. It's bad enough that the government takes our hard earned money for things they actually need it for, but now they are going to take it to pay people to do something they could just as easily do on their own? No. I do not support this. I don't smoke and never will, but I know people who used to smoke and quit completely on their own. All it takes is determination, patience, and having the will to not give in to temptation in starting again. The government should not pay people to quit smoking because they have taken enough of our money as it is and the smokers can quit on their own. Yes, I realize it's difficult to quit. Life is hard though and this idea would only cause people to start smoking in order to get the government money from assisted "quitting". That's only asking for trouble.

 

[LSN80]

I would be against this idea. It's bad enough that the government takes our hard earned money for things they actually need it for, but now they are going to take it to pay people to do something they could just as easily do on their own?

I disagree with this part. Although nobody in my immediate family smokes, my grandfather on my dad's side did. He had a heckuva time quitting, so much so that he never fully did. He was able to reduce how much he smoked, but was never able to kick the habit completely, despite doctor's warnings. It's what killed him.

I think so many people underestimate the power of addiction in this world. We look at street drugs or painkillers and some understand how hard it is to kick them, but people look at smoking and think others should be able to quit at the drop of the hat. There's a reason why there are so many products in place aimed at helping people to quit smoking, all-the-while saying that they make no guarantees. Why? Because for some, quitting is incredibly hard.

Granted, this is coming from someone who smoked heavily for 3 months six years ago to deal with a difficult breakup, and did quit at the drop of a hat. But not everyone is equipped with the willpower or genetics to do so, which is why products are in place, and programs such as this are in place. Combine this with the fact that healthcare for smokers on Medicare(who this program is designed for) costs the government 33 Billion in healthcare for smoking related diseases, and it's easy to see that we're already paying smoker's to smoke. Wouldn't it be better to reduce that astronomical figure by paying people not to smoke?

No. I do not support this. I don't smoke and never will, but I know people who used to smoke and quit completely on their own. All it takes is determination, patience, and having the will to not give in to temptation in starting again.

You're making a universal statement for something that's not so simple. The longer one smokes, combined with the frequency, re-arranges the chemicals in the brain. In other words, there are people who need more then just patience and determination, they need help. Combine this with the fact that it would be a very short-term payout, and it seems much more reasonable,

The government1 should not pay people to quit smoking because they have taken enough of our money as it is and the smokers can quit on their own.

Well, here's the thing. Smokers on Medicare(who this program is designed for) costs the government 23 Billion in healthcare for smoking related diseases, and whose pocket do you think that comes out of? Ours. To me, this rediculous amount makes it clear that we're already paying smoker's to smoke. Wouldn't it be better to reduce that astronomical figure by paying people not to smoke? EVen if the program had only a 25% success rate, that would cut the healthcare expenditures for smokers by 6.25 billion. This program would cost nowhere near this much, so hypothetically, it would save us, the taxpayers, money.

Yes, I realize it's difficult to quit. Life is hard though and this idea would only cause people to start smoking in order to get the government money from assisted "quitting". That's only asking for trouble.

Again, not necessarily true. There are regulations around this program. They aren't perfect by any means, but it would be idiotic to pick up a dangerous habit just to make some cash. I wouldn't start using cocaine to make money, would you? Before someone calls me rediculous, more people die from cigarette related diseases then people who do so from all street drugs combined.

Further, then tenants of the program are this. People would get government asistance such as counseling and being "weaned" off of cigarettes, combined with medication to help them do so, along with the money, of course. But the catch here is this: Smokers would only get paid if medical claims data indicated that they were getting counseling or they tested to be smoke-free.

Taking it one-step further, breathalyzers can also measure carbon monoxide levels, which are higher in long-term cigarette smokers. Although not an exact science, it would help authorized doctors to tell those who have taken up smoking just for the payout as compared to those who have been long-term smokers. These same breathalyzers also would allow doctors to tell if people have been smoking recently, and if they had, it would negate their payout.

I realize this isn't a perfect system, and in reality, people would quit smoking out of concern for their own health and out of the desire to not develop a terrible habit. But if this could both help people quit smoking and save us the taxpayers money in the long run, I think this is the best possible solution, in theory.

 

[J.J.]

I would endorse the promotion of electronic cigarettes to the smokers as a second option. More so at affordable price instead of potentially paying smokers. Just too many loopholes. Suppose people start smoking just for the ability to gain extra finances?

 

[Shotaro]

It certainly would not work for me. I smoke, hell I'm slightly ashamed to say I enjoy it. If money would make me quit I would've quit years ago. I go through a carton (200 cigarettes) a week on average at ~£70 or ~$100 (not entirely sure of the exchange rate at the minute but that seems about right) over 52 weeks that's £3,640 or $5,200. That's almost two months worth of pay (after tax etc) - if money could make me quit I would've done so a long time ago. In the UK they give out smoking cessation aids (patches,gum hell even nicotine uptake inhibitors) on the NHS and the % of the population that smoke has not noticeably declined. The most effective thing they did was the smoking ban in bars.

The other thing is the amount the tax on cigarettes brings in to the government. In the UK over a smokers lifetime (assuming they smoke from 18 -the current legal age- until the day they die) the amount of tax they raise is significantly greater than the amount the NHS spends on almost any individuals treatment. (considering almost £1,700 of my annual spending on smoking is taxation - if I live to 66 - 50 years of smoking - legal age was 16 when I was younger- that's £85,000 tax raised from just myself over 50 years as a smoker)

In addition I would point out that the health risks of smoking are somewhat exaggerated. I am not saying they are good for you - empirically they are bad. However any disease that can be linked to smoking (stroke,heart attack, pulmonary adaema, lung cancer, throat cancer, mouth cancer and many more) is counted as a smoking related death. Smoking is bad, but it is not Satan

 

[Monkey_Mania]

No. Here's a novel idea, how about we create some jobs so we can pay people to work just like the world is supposed to fucking work? As a smoker, I choose to smoke because I enjoy it. I do not consider myself addicted because I can go weeks without a cigarette, I only smoke because I enjoy the act of smoking. I also think that we should fix the tax problem before we start trying to control peoples lives. Call me crazy, I would just rather get paid to be a productive member of society at my place of employment and continue living my life happily the way I do.