Does it make sense to pour money into smoking cessation efforts? A Sen. Leland Yee-authored bill that Gov. Arnold Schwarzenegger must either sign or spurn by Thursday would do just that. It'd be great politics -- Yee's bill
, SB 220, would force all insurers doing business in this state to fund programs helping adults to kick the habit. But is it good policy? U.C. San Francisco Professor Stanton Glantz
, one of the nation's foremost experts on smoking and smoking cessation offers a big yes. But, also, a no.
Smoking cessation programs for adults, intuitively, don't work fantastically well. Quitting is hard to do. Most people fail, many times, before finally quitting. If they quit. That's why the most effective thing to do is often to run preventative programs to keep young people from ever smoking in the first place; the older you get, the harder it is to change your ways -- even without nicotine.
Yet Glantz is an exuberant supporter of Yee's bill. That's because smoking cessation is a remarkably inexpensive and successful remedy -- if you consider it a medical investment. If you are using public health dollars, however, to fund cessation efforts -- you're wasting the public's money.
"If you're looking at smoking cessation as a medical intervention and you compare it to the cost-effectiveness of other medical interventions -- coronary bypass surgery or chemotherapy -- it's among the most cost-effective medical interventions you can do," said the director of the Center for Tobacco Control, Research & Education.
"But if you look at smoking cessation as a population-level public-health intervention, then it's not a good use of money. Aggressive media campaigns, clean indoor air laws, policies designed to increase the price of cigarettes through taxation -- in terms of reducing smoking, those are all an order of magnitude more cost-effective than clinical cessation."
That being said, Glantz believes insurance companies would be "dumb" to not cover cessation. Even if most people relapse, keeping people "up and around and functioning" instead of coming down with emphysema is good for the companies' bottom line.
"Doing surgery on somebody -- chemotherapy, a hip replacement -- that's very expensive," says the professor. "The benefits you give to patients, the cost of buying another 'good year' are way higher than the cost of smoking cessation. The medical system should be paying for these things. If health care companies are doing it, it will save the state money on catastrophic care. The caveat is, the money needs to come out of the medical system -- not the public health system."
Update, 4:45 p.m
.: SB 220 was vetoed by Gov. Arnold SchwarzeneggerFollow us on Twitter at @TheSnitchSF