In recent months, there has been a renewed initiative by most governments to make it costlier to light up a cigarette. In Australia, not only has excise duties increased, cigarettes can only be sold at designated areas and, since December 2011, they have to come in plain packaging, forcing all cigarette manufacturers to present their goods in khaki boxes with shrunken logos and a graphic health message.
The argument whether increasing taxes do significantly reduce the incidence of smoking has been with us for ages. Some have not been convinced, but irrefutable data has just been released which showed that in the US, when President Obama signed the tax hike — the biggest to take effect in his first term — on his 16th day in office, reversing two vetoes by the previous President Bush (causing the federal cigarette tax to jump from 39 cents to $1.01 per pack on April 1, 2009) the net result was, as reported by USA Today, a historic drop in smoking, especially among teens, poor people and those dependent on government health insurance.
Most impressively, about 3 million fewer people smoked last year than in 2009, despite a larger population, according to surveys by the Centers for Disease Control and Prevention.
These data are most certainly going to spur more countries to implement this form of social engineering via taxation, what with the economic recession resulting in declining revenues for the tax-man.
However, while most of us acknowledge the health hazards of smoking, increasing taxes may lead to newer problems. Increased smuggling, tax evasion, counterfeiting are challenges that law enforcement agencies have to handle effectively so that the ultimate objective is achieved. The tendency for smokers to downgrade to cigars (not necessarily more cost-efficient!) or cheaper brands will not reduce the incidence of smoking. Hence the necessity of concurrent health education campaigns.
The last-mentioned is an often under-estimated weapon, particularly when the stand of most cigarette companies is “We don’t build our business on persuading people to smoke or trying to stop people from quitting. We believe that if you want to quit, you should.”
The US spent $2.472 trillion on healthcare in 2009..that works out to $282 million an hour, give or take some loose change.
According to this article in the Journal of Health Affairs, this means that the healthcare portion of the GDP rose to an all-time high 17.3%, more than double of that of most other countries.
No wonder President Obama is placing healthcare reforms as a top priority – at the rate its going, healthcare expenditure will soon burst at its seams. Even more alarming is the fact that, for the first time in the next few years, public spending for healthcare services (Medicare, Mediaid, Veteran hospitals, children insurance program) will outstrip the largely private-sector driven healthcare expenditure. Put in another way, by 2012, public (government) spending will account for more than half of the total healthcare spending in the US.
Why is this so?
The main reason appears to be that healthcare spending continued to rise despite the recession that resulted in reduced spending in other areas of the economy.. After all, people do continue to get sick, in good times or bad.
This healthcare spending continued to rise partly due to the aging population; but the real reason is due to increasing prices (3.2% a year) and increasing use –utilisation in tech-jargon – at 1.5% annually.
Quite naturally, President Obama is looking at cutting expenditure like reducing Medicare costs, but this has not gone down well with the Democrats, creating delays in approval at Congress. Already, the President has backed down quite a bit from his original proposals and the way ahead appears to be for the Democrats and the Republicans to work together for a common solution – which is easier said than done.
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There are many reasons to push through President Obama’s health reforms urgently despite the rhetoric – escalating health costs, 80 million uninsured Americans, inefficient delivery systems, to name a few. But there’s one question that needs to be addressed for which the answer is practically unanimous.
Are Americans dying too soon? The answer is a resounding YES.
When it comes to “preventable deaths” – illnesses and injuries that should not kill at an early age with access to timely and effective health care – the United States ranks last among 19 industrialised nations, according to the Commonwealth Fund.
Well, the study may be a few years old, but the fact remains that not much has changed since and the belief is that the US continues to lose ground. And what are the diseases Americans most likely to die from that can be prevented? Gun-shot injuries and motor vehicle accidents top the list but chronic diseases like diabetes, stroke and epilepsy are bigger drivers of healthcare costs.
Many will defend US healthcare as one of the finest in the world. True, to a certain extent. When its good, its really good. But when its bad, it can be really terrible. The OECD (Organisation for Economic Cooperation and Development) describes the performance of the U.S. system as a mix, at best.
It ought to be noted that diseases like complicated cancers, AIDS and most heart diseases, while often treatable, are not considered preventable, because even with the best of modern medicine, patients often die before old age.
As the health reform debate rages on as to the best methodology to resuscitate, rehabilitate and enhance healthcare delivery in the US, thousands will continue to die from preventable causes. Many are asking whether the President will have the panacea for the ailing system.
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The news that the Obama administration will not seek to arrest marijuana users and suppliers as long as they conform to US state laws on its use for medical purposes must have raised quite a number of eyebrows(see here). In the first place, not many are aware that pot is legal, within restrictions, that is. Secondly, the new policy is a significant departure from the Bush administration, which had insisted it would continue to enforce federal anti-pot laws regardless of state codes.
Currently, 14 states in the US allow the use of marijuana for medical purposes: Alaska, California, Colorado, Hawaii, Maine, Maryland, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont and Washington. If Obama has his way, Federal anti-narcotic agents cannot prosecute outlets selling large amounts of marijuana as long as it is for medical use.
In the US, 4 citizens actually obtain their marijuana from the federal government, with FDA approval. One of them takes it to relieve chronic pain and muscle spasms caused by a rare bone disease, invariably fatal, called multiple congenital cartilaginous exostosis.(see pic)
Typically, the medical use of marijuana is for patients with:
– chronic pain (particularly nerve pain caused by diabetes, AIDS, and hepatitis);
– movement disorders and muscle spasticity (especially for multiple sclerosis patients);
-“drug sickness'”, as an anti-nausea and anti-vomiting agent (for those, say, undergoing chemotherapy);
-poor appetite, as an appetite stimulant for those with wasting diseases like AIDS and cancer.
Marijuana, whose botanical name is cannabis, has been used medicinally — and as an intoxicant, of course — for thousands of years in Eastern culture. In Western medicine, several well-known pharmaceutical companies, including Eli Lilly , sold cannabis in powdered or tincture forms in the early 20th century as a painkiller, antispasmodic, sedative, and “exhilarant.” Since then, its use declined because more effective drugs became available.
The question now is that, with medical marijuana being legalised, what constitutes medical use? The potential of abuse is apparent – just look at California, where doctors are authorizing patients to take marijuana to relieve such minor ailments as anxiety, headache, premenstrual syndrome, and trouble sleeping. There are about 700 medical marijuana dispensaries now operating in California openly distributing the drug :- narcotics trafficking done legally!
It all began 2 weeks ago, when, following a police report from a neighbour in Cambridge,Mass. about an attempted burglary, Sgt James Crowley ended up arresting black Harvard professor Henry Gates,Jnr for disorderly conduct although the professor claimed he was actually entering his own home but had forgotten his keys.
The matter mushroomed when President Obama declared on prime-time TV that the police had acted stupidly. Although he later expressed regret, things did not subside much; so the President did what he thought was best: invite all parties to the Rose Garden patio at the White House for some beer. “I have always believed that what brings us together is stronger than what pulls us apart”, said Obama.
After the 40-minute chat under the canopy of a magnolia tree, there was no apology from all three but everyone agreed to disagree and meet again in the future.
There are several lessons about this tale – never speak out when you don’t have the facts before you (and this applies to Presidents as well). Another is – get to know who your neighbours are! Yet another – damage control and conflict resolution can often be settled over a cup of tea – in this case, beer.
For the record of beer-lovers, Obama had his usual Bud Light, the professor Adams Light and the policeman the wheat beer Blue Moon. Not to be outdone, when teetotaller Vice-president Joe Biden arrived later, he had the nonalcoholic beer Buckler.
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When you’re the newly-installed leader of the most powerful nation in the world and you inherit two of the biggest issues facing the country and the world, there are many ways to skin the cat. The woeful state of the economy aside, healthcare is the next main concern for Americans.
Roughly 45·7 million Americans—15% of the country’s population—lack health insurance. Both wealthy and poorer states have almost a quarter of residents between the ages of 18 years and 64 years uninsured. The US Congressional Budget Office predicts that, nationwide, the number of uninsured people will rise by 10 million in the next decade. And this in a country where health-care expenditure alone is estimated to exceed US$2·5 trillion this year (17% of the GDP).
How did this situation arise? Well, largely because there has never been a national policy of healthcare; healthcare services were private-sector driven and subjected to market forces. Only the elderly (Medicare), the poor (Medicaid) and the military (Veterans Health Admin) were provided with some sort of cover, and this too was limited. Not that there were no attempts by previous Presidents to redress the issue. The Clinton (Hilary, not Bill) healthcare plan was mooted in 1993 to provide universal healthcare for all Americans but fell by the wayside – largely because it was formulated behind closed doors and eventually attacked by its own party members.
Enter President Obama. Realising Clinton’s mistake of not getting public consensus first before planning, one of his first tasks was to call for a White House Forum on Health Reform summit in the East Room which was held on 5th March 2009 and attended by 150 representatives, including legislators from both parties and representatives of interest groups such as drug companies, health professionals and labour unions.
Lesson No 2 – engage the people across the country. Via the internet, 9000 community discussions were held throughout the country from December 2008 and 3,000 reports filed in to the forum.
Even at the Summit, it was clear that the President wasn’t going to get his way as exemplified by his campaign promises on healthcare reform (covered by my posting here “Obama vs McCain on Healthcare”). But there was room for compromise and consensus..lesson no 3.
Although the path is long and expensive and the solutions far from apparent, the President concluded that there was “a clear consensus” over the need for reform, promising a “transparent and inclusive” process.
Initiating a national healthcare financing plan is an arduous challenge for any country in the world, but the lessons from Obama so far show a practicable and feasible way of tackling the problem, no matter how enormous it is. Perhaps, other countries (like Malaysia, where they have been vacillating a national insurance plan for decades) can benefit from these lessons on the way to go forward.
No, I’m not going to debate on whether he should be in the White House. Its really about President Barack Obama’s health routine, which is something most Americans would do well to emulate. Those who saw pics of Obama bathing on the Hawaiian beaches last summer will note his lean but muscular physique. Take a look:
So, at 47, how does he keep in shape? Well, by design certainly rather than by accident. Despite his busy schedule as President, he wakes up 6.45 in the morning and does his workouts daily, both cardio and weights. After dressing up, he reads several newspapers and has breakfast with his family before sending off his two daughters to school. Then its a 30 sec walk downstairs to the Oval Office just before 9 am.
Buts its not all sedentary behind-the-desk work, as he has been known to roam the corridors. According to the International Herald Tribune, Obama tends to roam the halls; one day, he turned up in the office of his press secretary, Robert Gibbs, who had his feet up on the desk when the boss walked in. “Wow, Gibbs,” the press secretary recalls the president saying, “Just got here and you already have your feet up.”
For Obama, lunch generally means a cheeseburger, chicken or fish in his small dining room off the Oval Office. There is a new addition to White House cuisine: the refrigerators are stocked with the president’s favorite organic brew, Honest Tea, in Obama’s preferred flavors of Black Forest Berry and Green Dragon.
In the evening,he eats dinner with the family and often returns to work reading briefing papers for the next day, often up to 10pm (unhealthy?). An indication of what he likes to eat is seen by the appointment of his former chef in Chicago, Sam Kass, an advocate of healthy, environment-friendly foods, as a new chef in the White House.
Considering the problem of obesity and today’s preponderance of lifestyle diseases like diabetes,hypertension and heart disease, many would do well to emulate his leadership by example, as far as a healthy lifestyle is concerned. And that includes most of today’s leaders too.
Medical personnel take doctor-patient confidentiality seriously and will not reveal a person’s medical details to the public without the individual’s consent or without a court order. But this does not seem to be the norm when you are a US presidential nominee! Obama, McCain, Biden and Palin have all been asked to release their medical records for public scrutiny. The American public (including doctors,too!) are demanding that the candidates bare all their past medical records. In fact, more than 2,700 doctors in the US have petitioned that McCain release the documents to the public domain.
Why? Because, ostensibly, the public want to know whether the new President (and Vice-President, who will have to step in should anything befall the nation’s chief executive) is fit enough to fulfil the voters’ mandate to run the nation. The electorate want reassurance that the nominees can fulfil the requirements of holding the highest office; so, the nominees need to sacrifice quite a bit of their privacy, as far as their medical records are concerned. The voters need to make an informed choice based on these records, say a spokeman for the petitioners. So have the 4 nominees obliged? Most of them have, except for Sarah Palin. Take a look at what has been released:
John McCain,72 : has hypertension (currently on hydrochlorothiazide), high cholesterol(on simvastatin), allergies(Zyrtec),sleep problems (zolpidem) and takes aspirin as a blood-thinner. Of most concern, though is his past bouts of malignant melanoma,a form of skin cancer which was diagnosed as stage 2 in 2000 and carries a 66% recurrence rate.
Barack Obama,47: released the results of his medical check-ups up till Jan 2007 which were all normal. A smoker for the last 20 years but stopped last year.
Sarah Palin,44: has not released medical records so far. Has a child with Down’s syndrome.
Joseph Biden,65: has had brain surgery twice for aneurysms in an artery of the brain. Released 49 pages of his medical records to the Press recently showing he was healthy.
Read my recent entry “Obama’s Fitness To Rule” here.
Considering that the President of the United States in the last 20 years has been either a Bush or a Clinton, at least one thing is certain -no more Bush or Clinton. A new man will be at the helm, to be decided this November 4th, which is less than a month away. Some of the biggest issues that may well decide who will win and become the 44th President include : the state of the economy, Iraq, fuel prices, illegal immigration and healthcare.
The lattermost issue (healthcare) is one of the most contentious. And It is not difficult to see why: when one considers that 46 million Americans are still not insured, the waiting lists are getting longer, increase in healthcare costs rising in the double digits annually and the tightening of insurance benefits via increasing premiums and copayments (the percentage of the hospital bill that the patient has to pay out of his own pocket).
How did healthcare in the US get into such an unhealthy state? For one, there was never a formal scheme or program by government to implement access to healthcare for everyone. Fragmented attempts by both government (Medicare and Medicaid) and the private sector( private health insurance existing for profit) has left many out of the loop. Added to this has been the unbridled medicolegal litigation costs and medical inflation.
So how to the two Presidential candidates plan to improve access to healthcare? Simply put, McCain the Republican wants government to increase private insurance coverage so that everyone can buy insurance with the help of a tax rebate obtained largely by moving the rebates from employers to employees. Now, everyone can buy! is the hope of McCain supporters.
Obama the Democrat, on the other hand, is pushing for government to provide healthcare for everybody by expanding the role of the existing Medicare into a compulsory public insurance scheme.
Both candidates’ proposals has got its pros and cons and many other countries have tried the proposed models earlier and encountered their fair share of problems. Essentially, its a case of private vs public insurance.
Other countries will be watching too because, whatever direction the US takes, it will have a definite impact on the healthcare world. As they say, when America sneezes, the world catches a cold…