America’s new tobacco crisis: The rich stopped smoking, the poor didn’t

Read your own damn references [1] before postulating how the poor are poor because they have no self-control and not the other way around:

> A 2012 study at the University of Rochester (with a smaller N= 28) altered the experiment by dividing children into two groups: one group was given a broken promise before the marshmallow test was conducted (the unreliable tester group), and the second group had a fulfilled promise before their marshmallow test (the reliable tester group). The reliable tester group waited up to four times longer (12 min) than the unreliable tester group for the second marshmallow to appear. The authors argue that this calls into question the original interpretation of self-control as the critical factor in children's performance, since self-control should predict ability to wait, not strategic waiting when it makes sense. Prior to the Marshmallow Studies at Stanford, Walter Mischel had shown that the child's belief that the promised delayed rewards would actually be delivered is an important determinant of the choice to delay, but his later experiments did not take this factor into account or control for individual variation in beliefs about reliability when reporting correlations with life successes.

[1] https://en.wikipedia.org/wiki/Stanford_marshmallow_experimen...

As of roughly 5 or more years ago, half of tobacco consumed in the US is by people who are mentally ill and/or substance abusers. For example, people with Schizophrenia are heavy smokers and 90% smoke. Those with clinical depression 60%. They are self-medicating for their underlying illness. We need to ensure that they are getting proper treatment.

Income Disparities in Absolute Cardiovascular Risk and Cardiovascular Risk Factors in the United States, 1999-2014 https://www.ncbi.nlm.nih.gov/pubmed/28593301

This study shows that in the 15 years studied, only the smoking rate of high income individuals has decreased from 14% to about 9%. Those at the poverty level or below has remained about 36.5% who are smokers (some of those will be the mentally ill and/or substance abusers) and middle income is about 24% who are smokers.

Former NYC Mayor Mike Bloomberg with his latest donation of $360 million in December, now donated a total of $960 billion to combat tobacco in low- and middle-income countries (e.g. China, Russia, Bangladesh, but also Turkey). Bill Gates added another $125 million.

The plan is to implement the World Health Organization's (WHO) MPOWER program which has been implemented in NYC since 2001. Raising the cost of tobacco has over half the effect of getting people to quit or never start. Also very important is banning smoking in public places and hard-hitting, scary, advertisements spending about $1 to $2 per capita. Clinical interventions such as doctors speaking with patients about quitting, providing nicotine replacement therapy, and telephone counseling support are also important. But most of the gains are from the public policy initiatives.

A frustration I have with the healthcare system in the US is that too little is sent on public health interventions such as MPOWER compared with the spending on clinical interventions. If you want to lower healthcare costs, ultimately more effort has to be put in public health interventions which is much more scalable and more effective than clinical interventions.

Under ObamaCare, smokers can be charged premiums 50% higher than non-smokers because the healthcare costs of smoking are so high, yet most insurance plans don't charge the premium nor does the ObamaCare let insurers really verify if someone is a non-smoker.

If you want to lower the high costs of healthcare, nationally implement MPOWER in the US as well as other public health interventions. ObamaCare made a huge mistake when they did not implement the tobacco tax policies of Canada, UK, France and other nations which have universal care which is pay for the healthcare partially with high tobacco taxes in the range $5 to $7 per pack or more. Our federal tax is about $1. Raising that of these other nations would result in tens of billions of dollars for paying for healthcare while helping people, especially the poor, to quit smoking.

I once spent a night in the home of an elderly very poor couple on Tenerife, because they offered some sort of service where the husband would fetch people from the ferry, and bring them to the airport the next day. They were so kind. He was near mentally challenged, a super sweet guy working as a garbage man there, so they could just barely afford it. They lived there because she had horrible arthritis and the climate there was the only thing that had ever helped. They had basically no friends there, lived in a poor village in some outskirts, the broken down look over your shoulder kind.

And I still remember how she offered, just to be hospitable, some watered down fruit juice with like just a whiff of alcohol, and how she pointed to her super cheap cigarettes and said with a voice that was so full of cynicism and despair at the same time, that this was her only pleasure. I still remember that voice, the look her face had at that second, some kind of snarl -- not against me, they were so kind to me.. but against her fate I guess, and/or herself. It's impossible for me to describe, but indelible. Like all that misery, that is mostly pent up and that will follow her into the grave, escaping a bit in a short hiss. There is a German saying, to make a good face in a bad situation, and for just a split second, her face stopped doing that altogether, and I will never forget. God forbid that I do.

None of what I'm writing makes sense to anyone I'm sure, but I so wish I could describe the pang I felt then -- and the pang I felt just now, reading the suggestion that, basically, "they" are beyond help anyway, so let's make advertisements shaming people for smoking, so that those who still have something to lose might fear to be associated with those who don't. Would you also say this in the presence of "the" poor? If I could make one invention, it would be something that swaps the brains of humans around every 5 years, completely randomly. People would sober up rather quickly I'm sure.

The difference is when poor people screw up, they suffer, when rich people screw up everyone else suffers [1][2][3][4].

[1] https://en.wikipedia.org/wiki/Financial_crisis_of_2007–2008

[2] https://en.wikipedia.org/wiki/Marissa_Mayer#Yahoo

[3] http://money.cnn.com/2017/06/08/technology/business/yahoo-ve...

[4] https://en.wikipedia.org/wiki/Enron#California.27s_deregulat...

I wish! If there's any publication we could stand to read less of, it's WaPo.