Monday, January 12, 2009

Loaded Statement

This dude gave a quote for a smoking-related article on CNN that I think is a) dumb and b) illustrates a point about paying for healthcare.

Retired radio broadcaster and iReporter Gerald Dimmitt, 65, has smoked since he was 14.

"I've always smoked a pipe," he said. "I have successfully quit about 40 times." But, he says, he always restarted, because "it calms me down."

Dimmitt has even more incentive to quit now, since developing lesions and irritation in his mouth. After speaking to his doctor, he received a prescription for Chantix, a pill to aid with smoking cessation. But when he went to pick up his prescription at the pharmacy, he was charged $139 (because it's not generic) for two weeks worth. Outraged, he left the Chantix behind.

"If smoking is so dangerous ... why then do they want to charge $139 to make me stop? There is something very wrong with that. I guess they would rather pay to take care of lung cancer," he said.

So, $139 is too much to pay to quit smoking (when apparently everything else this guy has tried has failed)--fine. But to imply that "they" would rather pay for lung cancer... when the treatment would involve some combination of surgery, radiation, and/or chemotherapy, along with hospital stays, and medication, and would cost THOUSANDS of dollars, that makes $139 seem more like a bargain. Essentially, this guy is saying that $139 out of his pocket is intolerable, so he'd rather make his insurance/Medicare/Medicaid (or whatever health coverage he has) pay for lung cancer instead--because clearly, if $139 is too much for this guy, then thousands is beyond his reach.

I'm largely a supporter of some form of universal health care (although not single-payer), but I'm still torn on some issues, and this is one of them. This guy is going to deliberately forego a treatment that could help him stop smoking and save himself and his health insurance (or Medicare/Medicaid, I don't know what he has) thousands of dollars because he doesn't want to pay out of pocket. Essentially, his insurer is now going to pay for his poor judgment that he's acknowledging publicly on

Now, is the answer to subsidize anti-smoking therapy? Maybe that's not a bad idea, if we're going to suggest banning smoking on federal property and such--use penalties on one side and rewards on the other, give a little extra incentive. Is the answer to penalize such people who are deliberately NOT trying treatment which may be effective in quitting who are deliberately placing an extra burden on the health care system? Maybe--in the private insurance world, these people may already pay a higher deductible, and I'm okay with that. I think that even with a universal health plan, people should be required to pay for part of their health care. ER visits should cost money. Prescriptions should cost money, especially brand-new brand-name meds like Chantix (although I'll admit, $139 for 2 weeks does seem steep).

I just hope his insurer read his little "comment". I guess it's less "dumb" than I initially thought, because if his insurer will pay for his lung cancer why should he pay to quit smoking? Oh, I don't know, unless he'd like to LIVE without CANCER. Because lung cancer kills you. People (myself included) need to take some freaking responsibility with their own health.

Now I'm all riled up to start my Monday. Grrr.


Chris said...

If I were his insurer, I would say "Fine, don't have it, but if you get lung cancer, I won't be paying"

Destress Yourself said...

Dearest Tiny Shrink,

There is much more to this than the $139. It is a wonderful excuse for him not to quit. Although your rant is good, if he really wanted to quit he would pay the $139. Maybe, he has the belief that, even though he pays, he will only quit for a while and ultimately never quit anyway, therefore, waste money.

And Chris, harsh words my friend. We are all imperfect and we just happen to be pointing out this smokers imperfections.

Anonymous said...

$5. a pack, 2 packs a day comes to $300 a month. I'm guessing a month of Chantix looks pretty darned good next to a year of cigarette costs. (I found $5/pack on the web, but I have no clue if that's accurate.)

Carrie said...

I agree with your post. Before I started medical school, I shadowed a community FP doc who had Medicaid or uninsured patients. Many of them were likewise uncompliant and unwilling to pay for prescription costs, even when it was just $5-10 for generic (yet, they could somehow come up with much more money for cigarettes--go figure). She never gave away meds or service for free; she said it was important that people pay something for their care (even if they truly could only pay $1), so that they value it and are invested. This man on CNN is obviously not invested in his health, when expects that someone else (insurance, Medicaid) will always pay. What happened to having some accountability that his actions caused him to become addicted to a drug that is unfortunately not cheap to quit? Like you said, we no longer have any responsibility in our care, and our sense of entitlement that we should have someone else foot the bill even for things that were our own doing, is unbelievable to me.
Whether we realize it or not, we do tend to correlate value with price. People today pay more for a haircut than a copay for a visit to the doctor--it's really no wonder that doctors don't get as much respect as in the past. I'm kind of getting off topic now; my initial point is that I agree that patient should pay something even in a universal health care system. Like you said, ER visits cost a lot of money, and patients should feel some of that burden (or maybe be charged more for non-emergency visits to the ER) so that they don't use the ER as their PCP. There should be some penalties in place to force accountability.

Mayhem said...

This man is obviously beyond all help. He's simply not on the same wavelength as the rest of us. Case in point this statement:

"I have successfully quit about 40 times."

Really? Successfully, you say?