Hiding the elephant in smoke

How many are we willing to kill with secondhand smoke?

You can learn a lot by listening to what isn’t said in a conversation.

Take health care reform. It seems that every time I turn around the debate revolves around how these reforms will be paid for, and by whom. Has everybody forgotten that the fundamental problem with health care is that it costs too much, by a half?

Or are the people shouting the loudest the ones with the most to lose? What’s at stake if costs were brought in line with the cost of health care in other countries — in other words, a 50 percent reduction — is staggering: If Americans stopped all personal spending on vehicles — not another penny for new cars, or used cars, or trucks, motorcycles, boats, airplanes, tires, oil filters — it would amount to just a third of what they now spend on medical care.

You can see why there’s such a scramble to derail reform. There are a myriad of reasons Americans spend more than twice as much as other developed countries, and they don’t all have to do with the fact that we eat far, far too much junk and refuse to exercise.

One huge reason is that we get way more medicine than we need — too many doctors prescribe unnecessary care, and too many patients demand all the care their insurance will cover, regardless of whether it’s necessary.

This point is not lost on the medical community but is rarely emphasized in press accounts. Meaningful health care reform, which would not only alter the way we live but also the way we are healed, will take trillions of dollars out of health care pockets. What’s remarkable is how this downsizing conflicts with the most popular reform themes — getting health insurance to millions more, for example, or insisting that America faces severe shortages of doctors, nurses and pharmacists.

Try cutting spending in the face of all that.

Pretty much lost in the uproar is that you wouldn’t spend a dollar on health care if you didn’t have to. Real health care reform would put trillions of dollars back into the public’s pocket. Listen closely to the debate and see if that’s the message that comes through.

And if you do hear someone argue that government ought to stay out of it, pay particular attention to their explanation for two things: why heath care costs are rising at twice the rate of inflation in spite of aggressive cost-containment efforts by the federal government and why, in light of that, you should now believe the private sector is suddenly going to reverse that trend.

Make sure you get a convincing explanation for why that hasn’t happened already.

I’ve been reminded of this issue-avoidance as I listen to the dialogue over Salina’s smoking ban. The incessant complaints that it infringes on personal freedom or hurts bars’ bottom line conveniently sidesteps the fact that the ban was enacted because smokers are harming the health of others.

(Driving up their health care costs, we might even say.)

The Centers for Disease Control and Prevention estimates that secondhand smoke kills as many people in the United States as traffic crashes. So when a city commissioner (or anyone else) stands up in public and says he or she opposes the ban because it cramps bars’ style, what’s really being said is that the number of people being killed by secondhand smoke isn’t too high a price to pay for the freedom to run a business or smoke in a bar.

Except that’s not what they actually say. I wonder why.

How do they make this calculation in favor of personal rights? Do they think the CDC is, to abuse a phrase, blowing smoke? If so, you’d think they would have the courage to say so; elaborating on what is flawed about the studies CDC relies upon would give them credibility. To leave this part out, to simply say this is about personal freedoms, is dishonest.

After all, the ban isn’t about convenience. It isn’t about indulging delicate types who want everything their way. This is about the fact that when people smoke in a crowded room, everyone’s health is compromised.

All sorts of people, including commissioners, have spoken out against the ban. If they were stand-up citizens, they’d explain just how they decided the health consequences are outweighed by the loss of freedom.

But don’t hold your breath waiting.

nReporter Duane Schrag can be reached at 822-1422 or by e-mail at dschrag@salina.com.

source: http://www.salina.com/

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