The tobacco bill

Three-fourths of Maine people die of just four groups of diseases: cardiovascular, including stroke; cancer; chronic lung disease and diabetes. Gov. Angus King properly took aim last night at reducing these diseases through programs funded by the state’s $55 million annual settlement with the tobacco industry. His approach to spending the settlement deserves public and legislative support.

Maine’s death rate for these diseases, which are often preventable, place it fourth highest in the nation. The unfortunate distinction costs not only countless lives, but millions of dollars in health-care costs. The cost to the state Medicaid program just from smoking was estimated at $96 million a year in 1998 in the U.S. Public Health Report. The cost is generated by both old and young — older Mainers who smoked and now need long-term care and the 50 percent of women on Medicaid who smoke throughout their pregnancies, producing a wide range of illnesses in their children.

The governor’s plan would spend $9 million on a statewide campaign to prevent smoking and to help people quit, including paying the cost for those who qualify for counseling and pharmaceuticals. He would provide $11 million in competitive grants to communities and schools to find ways to help people shed the bad habits of smoking, poor nutrition and lack of exercise. These factors most often lead to illness and death from the four diseases mentioned above.

Hardly any adult needs to be told that smoking is harmful to health, and the last thing the state needs to do is lecture smokers. Instead, the settlement money can help communities get organized to provide healthful alternatives — sidewalks for exercise, talks on nutrition, classes to quit smoking. Most important in such programs is addressing these three aspects together, providing not only the evidence that, for instance, smoking is harmful, but also the opportunity to trade in a bad habit for a good one. And because these three bad habits sometimes are accompanied by a fourth, the governor made the right decision to include $5.5 million for the prevention of alcohol and substance abuse.

Doctors and other primary caregivers are included in the governor’s plan, as well. They would be awarded higher Medicaid reimbursement if they can show they have made an extra effort at preventive care — helping patients to bring down cholesterol or high-blood pressure, assisting with weight loss or smoking cessation. The $4 million set aside for this is a rare incentive in a health-care system that more and more often relies on monetary penalties to persuade providers to keep down costs.

The governor’s plan is similar to the program endorsed by the major anti-smoking groups, the Maine Coalition on Smoking OR Health. That group wants to spend a total of approximately $18.5 million on prevention and cessation; the governor’s two programs — one at the state level and one at the community level — would spend $20 million. But the plans are headed in the same direction, with compromises possible over some of the details.

The Legislature, too, should concentrate on these areas for the annual tobacco payment. Medicaid costs, after all, were the reason the states were able to build a case against the tobacco industry. Paying some of those current costs and controlling them in the future by providing opportunities for healthier living is what this money is all about.