CITIZENS   FOR  LIMITED  TAXATION
and the
Citizens Economic Research Foundation

CLT UPDATE
Sunday, April 16, 2006

Mass. healthcare plan:
A runaway express train heading our way

"In every generation, there are those who want to rule well - but they mean to rule. They promise to be good masters - but they mean to be masters."

-- Daniel Webster (1782-1852)
Massachusetts state and US senator


So the state is forcing people to buy insurance many will need subsidies to afford, which is a recipe for higher taxes and more government intervention down the road.

A Wall Street Journal editorial
April 12, 2006 -
RomneyCare


Remember when I recently said, "The devil, after all, is always in the details."

CLT UPDATE, Apr. 4, 2006
Commentary


Many Massachusetts residents who live healthy lives by exercising and not smoking could enjoy lower insurance premiums under one of several provisions of the landmark new healthcare law designed to discourage risky behavior and help control medical costs....

In one of the most significant changes, the law allows private health insurers to charge higher premiums for smokers than for nonsmokers....

The new law also allows private insurers to provide larger discounts for residents who complete weight-loss programs, enroll in exercise classes, and complete other wellness goals....

While the details will take months to work out, the changes represent a significant increase in the state's efforts to encourage people to take responsibility for their health and, by extension, reduce overall healthcare costs....

In the private insurance market, the law's changes for wellness discounts and tobacco-use surcharges apply to all policies sold to small groups, such as small businesses ...

One question is whether health insurers would require a person to prove he or she is a nonsmoker and therefore qualifies for lower rates. Life insurance companies, for example, use blood tests to look for chemical traces left by cigarettes....

Insurers said they now are trying to figure out whether to adopt such "smoker's premiums," how much they would charge, and how they might require nonsmokers to prove they don't smoke and therefore qualify for lower-cost insurance policies.

The Boston Globe
Sunday, April 16, 2006
Bay State's nonsmokers could save
Health law can reward lifestyle gains


A Bay State lawyer who helped sue Big Tobacco in the 1990s is now taking a pop at Big Soda, threatening to sue the likes of Coca-Cola and Pepsi for their part in fattening up American kids and possibly shortening their lives.

"You canít blame it all on soda, but that doesnít mean you canít blame a lot of it on soda," said lawyer Richard Daynard, president of the Northeastern Public Health Advocacy Institute....

U.S. companies annually produce enough soda pop to provide 557 12-ounce cans - or 52.2 gallons - to every man, woman and child.

American teens get 13 percent of their calories from carbonated and noncarbonated soft drinks.

Consumption of sweeteners such as sugar (sucrose) and high-fructose corn syrup, often pumped into calorie-dense foods, snacks and drinks, has risen in the United States from 113 pounds per person in 1966 to 147 pounds in 2001.

The Boston Herald
Sunday, April 16, 2006
People vs. Pop:
Lawyer slugs soda industry for fattening kids


This could go on for the rest of our lives, if the safety nannies have their way. If it [primary enforcement of the mandatory seat belt law] eventually passes [it did this year], they will then move on to the fast food issue, because, like the financially successful Big Tobacco issue, the arguments are exactly the same: people die, illness costs society, etc. There is no end to it.

CLT Update - May 29, 2003
Commentary


Chip Ford's CLT Commentary

As usual, we saw the future in the past and it's coming at us like a runaway express train.  This too was inevitable.

Back in 1989 I testified before a U.S. Senate committee hearing a bill on a national mandatory seat belt law (MSBL), as its only opponent. The proponents' primary argument was that traffic accident injuries were putting too much of a "financial burden on society."

I argued then against trading the ephemeral promise of safety for freedom. I stated that first came out inalienable rights, then came the people's decision to form a government for the very purpose of protecting those rights; we adopted a constitution, a contract, to limit the power of government. This was followed by an evolving leviathan that's attempted to do too much -- such as providing health care at taxpayers' expense. This gradual expansion of power has now come full circle, concluding with a need to surrender those very rights for which we first formed a government to protect, so that it can provide and impose that which it was never intended to do.

The result was passage of a law which withheld federal highway funds from states that do not comply, do not bend and adopt a MSBL. That potential loss of federal funding was one of the arguments proponents of the second Massachusetts MSBL successfully used to win against our 1994 repeal ballot question: that and of course "the financial burden on society."

The Behavior Modification Express had pulled out of the station. It now rolls down the tracks at breakneck speed.

The $206 billion tobacco lawsuit settlement of 1998 was intended as "reimbursements to the taxpayers of our state for dollars already spent" -- the alleged premise under which the lawsuit to recover damages was pursued. Besides state governments, the only ones to be "made whole" by the extortion of "Big Tobacco" were the trial attorneys who made billions. Taxpayers didn't see a cent of the settlement; it just grew government.

Next in the crosshairs of "Big Trial Attorneys," as we predicted years ago:  They're coming after "Big Soda" now and undoubtedly "Big Calories" across the board after that. Deep pockets are there to be picked.

Meanwhile the new Massachusetts healthcare plan picks up where they've left off, further eroding personal choice in the name of "the financial burden on society," starting out again, of course, by doing it "for the children."

We know what will happen if smoking suckers ever to accede to the state's alleged goal and quit smoking entirely. The state would not only lose the hundreds of millions that it collects annually from one of the highest tobacco excise taxes in the nation, but its share of the tobacco settlement would be dramatically reduced under the settlement agreement. If that should occur, I don't need to tell you who'll pick up the billion dollar slack to continue funding all those "unmet needs" Beacon Hill has committed to pay for with all that tobacco revenue.

This week's Wall Street Journal editorial warned that this healthcare debacle was sure to lead to "higher taxes and more government intervention down the road." As with the law's estimated cost, we didn't have to wait long for "more government intervention" either.

As the new Massachusetts healthcare plan express picks up speed where the trial attorneys have broken ground and laid the track, as "Big Insurance" joins with Big Government to enforce behavior modification, only one thing is certain:  Worse awaits at the next station, eventually and just as inevitably. The only question now is, what's next after they take down "Big Calories" -- which lifestyle choices will be targeted next to reduce "the financial burden on society"? It looks like perhaps mandatory exercise.

In Massachusetts, Big Brother's foot is in the door; it's just a matter of time before he rips it off its hinges, and time's running out.

I've gotta go, someone's knocking at my door . . . maybe it's only the Easter Bunny?

Chip Ford


The Boston Globe
Sunday, April 16, 2006

Bay State's nonsmokers could save
Health law can reward lifestyle gains
By Liz Kowalczyk, Globe Staff


Many Massachusetts residents who live healthy lives by exercising and not smoking could enjoy lower insurance premiums under one of several provisions of the landmark new healthcare law designed to discourage risky behavior and help control medical costs.

In one of the most significant changes, the law allows private health insurers to charge higher premiums for smokers than for nonsmokers. In addition, the state will spend $7 million annually for the next two years to offer smoking-cessation classes for enrollees in Medicaid, the state and federal program for the poor and disabled.

The new law also allows private insurers to provide larger discounts for residents who complete weight-loss programs, enroll in exercise classes, and complete other wellness goals. Regulations currently cap those discounts at 5 percent; the law lifts that cap, said Representative Patricia A. Walrath, a Stow Democrat who cochaired the legislative committee that crafted the final bill.

The law also gives Medicaid recipients who meet other wellness goals, such as quitting smoking or undergoing cancer screenings, discounts on premiums and copayments. The Department of Public Health will determine the specific goals and the discounts on the small copayments and premiums Medicaid recipients pay. Families, for example, pay a maximum premium of $36 per month.

While the details will take months to work out, the changes represent a significant increase in the state's efforts to encourage people to take responsibility for their health and, by extension, reduce overall healthcare costs.

It is unclear how much money the changes will ultimately save by reducing medical treatments that are the result of unhealthy lifestyles. But lawmakers searching for ways to slow the rise of healthcare costs insisted that the provisions be included in the sprawling healthcare bill that will require all state residents to have insurance by July 1, 2007.

"We want to discourage unhealthy habits like smoking that only add to the cost of healthcare and obviously have a negative impact on the health of individuals," said Senator Richard T. Moore, Democrat of Uxbridge, cochairman of the Joint Committee on Health Care Financing.

At least two other states, Iowa and Michigan, are encouraging healthy behavior through discounts for Medicaid recipients. The Massachusetts approach differs somewhat between the Medicaid program and the private insurance market, in part because the state's regulatory authority differs greatly between the two types of insurance coverage.

The changes take aim at a high-risk population: Medicaid recipients and the uninsured, who have far higher rates of smoking than the general population. While 17 percent of Massachusetts residents with private insurance smoke, the rate is 37 percent for the uninsured and 39 percent for Medicaid recipients, according to 2003 data compiled by the state Department of Public Health.

Because of the high rate of smoking among Medicaid recipients, legislators included the $14 million in new funding for smoking-cessation programs, which will allow the state to offer programs to nearly all Medicaid recipients who smoke. Estimates by legislative staff put smoking-related medical costs for Medicaid recipients at $700 million a year, and stop-smoking groups lobbied heavily for the Legislature to include money for these programs.

In the private insurance market, the law's changes for wellness discounts and tobacco-use surcharges apply to all policies sold to small groups, such as small businesses, said Chris Goetcheus, Insurance Division spokesman. The changes will also affect up to 400,000 residents who currently are uninsured and who will buy low-cost health plans under the new law.

Major health insurers were cautious about the change.

"We're still evaluating this," said James Roosevelt Jr., chief executive of Tufts Health Plan. "Obviously we want to provide every incentive for people not to smoke. We cover treatment for smoking addiction and smoking programs. We need to figure out whether the most effective approach is to make tools for quitting smoking available to people or to penalize them on the premiums."

Spokesman Chris Murphy said Blue Cross and Blue Shield of Massachusetts is also researching the issue. While some studies have shown that smokers cost the healthcare system 30 percent more than nonsmokers because they have a greater chance of needing treatment for lung cancer and other diseases, he said, that does not mean that Blue Cross would charge smokers 30 percent more for health insurance.

"The whole purpose of these plans is to keep them affordable," he said, "so I don't think you're going to see onerous penalties."

One question is whether health insurers would require a person to prove he or she is a nonsmoker and therefore qualifies for lower rates. Life insurance companies, for example, use blood tests to look for chemical traces left by cigarettes.

The Legislature directed the Division of Insurance to develop regulations that lay out details of the new policy, including how insurers could be certain if a person "or their dependents have not used tobacco products within the past year." Insurance regulators will also decide whether to limit how much insurers can factor tobacco use into premiums.

Until now, Massachusetts regulations did not allow insurers to take tobacco use into consideration when setting premiums for small groups or individuals, regulators said.

Insurers said they now are trying to figure out whether to adopt such "smoker's premiums," how much they would charge, and how they might require nonsmokers to prove they don't smoke and therefore qualify for lower-cost insurance policies.

State regulations allowed insurers to consider age, location, group size, group participation rate, and industry type when setting premiums for small groups, according to the Insurance Division. In setting premiums for individuals, insurers considered age and location. The new healthcare law combines the small group and individual markets by April 2007 and adds tobacco use and "wellness program usage" as a rating factor in developing premiums. But even when all of those factors are taken together, regulators limit how much variation can exist between premiums.

Insurers set premiums for large groups, or companies, not based on these factors but by looking at the medical history of their members. Many large companies already offer some discounts to their employees who enroll in smoking-cessation, weight-loss, or other programs to improve their health.

Gregory Connolly, a professor at the Harvard School of Public Health, said insurers should "clearly make smokers pay their way."

"When a smoker buys a pack of cigarettes for $5, the actual cost is more like $13 to $15 if you consider the future burden on healthcare costs and on employers due to lost time at work because of illness," he said. "In a rational economic model, we should say if you want to smoke, fine, just put up the $15. At the same time, it's a disease, and insurers have an obligation to provide smoking-cessation programs."

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The Boston Herald
Sunday, April 16, 2006

People vs. Pop:
Lawyer slugs soda industry for fattening kids
By Jessica Fargen and Kristin Erekson

A Bay State lawyer who helped sue Big Tobacco in the 1990s is now taking a pop at Big Soda, threatening to sue the likes of Coca-Cola and Pepsi for their part in fattening up American kids and possibly shortening their lives.

"You canít blame it all on soda, but that doesnít mean you canít blame a lot of it on soda," said lawyer Richard Daynard, president of the Northeastern Public Health Advocacy Institute.

"Getting sodas out of schools is a really simple step. The temptation is always present," he said.

His ideal plaintiff, he said, is a parent whose child goes to a school that has soda machines.

Nine of 10 schools sell candy, soda and other snacks, according to government statistics.

With one in five children considered obese, a battle is bubbling over how to fight the crisis, which reportedly has caused the early onset of diabetes and hypertension in teens, and could lead to heart disease.

At Malden High School, soda machines are timed to be off during most of the school day, but the timers donít always work, said Cheryl Maguire, food service director. Sometimes, she said, if a machine is on sheíll pull the plug.

"On the days that the soda machines are mistakenly on for some reason, our milk consumption goes down," she said. "Students will buy Pepsi rather than milk. You can see the difference."

Caroline M. Apovian, director of the Center for Nutrition and Weight Management at Boston Medical Center, said increased soda-drinking and marketing to kids has paralleled the rise in overweight kids. Still, to "go after soft-drink companies exclusively is probably not fair," she said.

"But if you are going to do one thing to help prevent childhood obesity, if thereís one thing to do, it would be to get rid of soda."

Companies spent $10 billion marketing food and drinks to kids in 2004, and most ads geared toward youth are for high-calorie, low-nutrient foods and drinks, according to the Institute of Medicine of the National Academies. Some marketing dollars have gone to schools, where beverage companies pay to have their name on things such as scoreboards.

Such marketing has changed dramatically since the 1960s, when a 6-ounce bottle of Coke was seen as a dessert at dayís end, Apovian said.

"(Now) people are using it as something they drink twice a day with lunch and dinner, but itís sugar," she said. "Itís liquid candy."

How sweetened it is

U.S. companies annually produce enough soda pop to provide 557 12-ounce cans - or 52.2 gallons - to every man, woman and child.

American teens get 13 percent of their calories from carbonated and noncarbonated soft drinks.

Consumption of sweeteners such as sugar (sucrose) and high-fructose corn syrup, often pumped into calorie-dense foods, snacks and drinks, has risen in the United States from 113 pounds per person in 1966 to 147 pounds in 2001.

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