President's
Message
Tobacco Settlement Reimbursement and The eRADicator
By Jay E. Shankar, M.D.
Tobacco use is the single most preventable cause of death and disease in our
society. Most people begin using tobacco in early adolescence, typically by
age 18. In 1998, tobacco smoking accounted for the deaths of nearly 2000 San
Bernardino County residents. The estimated cost of smoking in San Bernardino
County in 1999 was $600 million: $200 million in direct medical costs, $50 million
in morbidity costs (disability days), and $350 million in mortality costs through
lost productivity.
A recent column by L.A. Times staff writer Stephanie Simon reports on a study released in August by the National Conference of State Legislatures that documented how the tobacco money has been spent in the first three years of payout. Only eight states - including California - meet the minimum guidelines for anti-smoking programs set out by the CDC. Such programs are expensive; they would require, on average 15% to 20% of the tobacco settlement revenue. The three states with the highest adult smoking rates are spending their tobacco settlement money on a variety of projects, many unrelated to health care. Nevada (31.5% of adult smokers) spent 40% on college scholarships, 30% on services for the elderly, 10% on children's health, 10% on disease prevention, and 10% on smoking prevention. Kentucky (29.7%): 50% to help tobacco-growing counties find other sources of income, 25% on early childhood programs such as day care and immunizations, about 17% on health insurance programs, 5% for lung cancer research, and under 3% for anti-smoking programs. Ohio (27.6%) spent 50% on public schools, 25% on anti-smoking programs, and 25% divided among medical research, law enforcement and public health programs.
During the 1990s, California was able to cut its per-capita consumption of cigarettes in half, aided by its aggressive campaign, funded by a cigarette tax, that included anti-tobacco advertising, indoor smoking bans, classroom education, and a "quit hotline" staffed by counselors who talked callers through nicotine cravings. While the recent tobacco settlement with 46 states represents a significant victory over the tobacco industry, there are sober facts that demand our continued attention:
In view of these statistics, the SBCMS Board agreed to do more to reach our Inland Empire youth.
The eRADicator
In June 2000, the Inland Empire Health Plan (IEHP) invited our Medical Society
and the Riverside County Medical Association to join with them in creating an
anti-smoking superhero for the Inland Empire. The anti-smoking character would
be similar to IEHP's award-winning bicycle safety superhero "Rad Rider
- Safety Cycler." IEHP asked our assistance in designing a unique costume,
story line, web presence, comic book, and anti-smoking materials specifically
tailored for our Inland Empire anti-smoking super hero. We signed a sponsorship
agreement with IEHP, and Executive Directors Linda Stratton (SBCMS) and Dolores
Green (RCMA) met several times with IEHP's David Tamayo and Annette Bonetti
from the Graphtek Agency. They reviewed the script, the cast of characters,
the sketched comic book pages and provided suggestions.
Thus, the eRADicator and his supporting cast of characters was born: The eRADicator (Incredible strength of body and mind, speed and agility, pure heart and lungs, iron will, champion of children and the environment); Gray Ash (Raised by parents addicted to smoking, poisoned by second hand smoke, sickly, weak); Doctor Dewgood (Highly intelligent, polite, expert regarding health sciences, exercises regularly, good natured); Assistant Milo (Extremely bright, good natured, always willing to help, computer expert); the "Seven Evil Dwarfs" (representing the seven tobacco companies); Professor Bad Blaze (Devious, master of manipulation, Ph.D. in subliminal suggestion, bad attitude, steals candy from babies); Nic-Teen (Robotic Drone, incapable of self thought, powered by nicotine); Tommy (innocent, friendly, loves his parents, honor roll student); and Tommy's Mother.
The eRADicator promotes anti-tobacco awareness to help protect kids from the dangers of tobacco and misleading tobacco advertising. The program has two goals: to get kids to quit and to prevent them from ever starting the habit.
On September 4, I joined RCMA's President, Dr. William Cherry, at a luncheon sponsored by IEHP's CEO Richard Bruno and Medical Director Brad Gilbert, where the eRADicator and Rad Rider joined us in costume for lunch and a photo opportunity. The two superheroes will make their public appearance at the September 15-16 Route 66 Rendezvous in downtown San Bernardino.
A supply of eRADicator comic books and posters is available for SBCMS primary care member physicians. Contact Sue Bradshaw by phone, (909) 825-6526 or e-mail, sbradshaw@sbcms.org to order free copies for your office.
Tobacco Settlement Funds: Physician Reimbursement for Uncompensated Care
As
reported by Dr. Kenneth Lane in the September/October 2000 Bulletin, the San
Bernardino County Board of Supervisors on July 11, 2000 allocated $2 million
of the $18.5 million in tobacco settlement funds the county received for tobacco
education and indigent care. The remaining $16.5 million was to go toward retiring
the debt incurred by building the Arrowhead Regional Medical Center. This was
a turnaround from the original budget proposal in which none of the settlement
money was earmarked for health care. SBCMS and other organizations were able
to bring about the change through a dynamic grassroots campaign, which included
letters to the Board of Supervisors and public comment to the board.
At the Medical Society's urging, a Tobacco Ad Hoc Committee was established
for the purpose of advising the San Bernardino County Board of Supervisors how
to distribute the $2 million tobacco settlement funds earmarked for healthcare
in this county. It was hoped that the committee, comprised of stakeholders and
community representatives, would also spur an increase in public/private health
care collaboration. On June 5, 2001, the Board of Supervisors accepted the recommendations
of the Tobacco Ad Hoc Committee and officially approved the $2 million for tobacco
and indigent health care. $1 million was designated for agencies through a Request
For Proposals (RFP) process. San Bernardino County encouraged interested and
qualified organizations and individuals who were interested in developing community-based
and private sector projects designed to reduce the use of tobacco in our county
to submit RFPs before the July 9, 2001 deadline. Projects were sought to fill
the following program priorities:
A. Youth Prevention Programs Focused on K-3 and 9-12 grade youth.
B. Tobacco Cessation Services for Youth and Adults
C. Enforcement and Education to Ensure Compliance with Youth Access Laws.
In his report to the July 2001 Board of Directors, Dr. Kenneth Lane reported that, of the one million dollars of tobacco settlement funds earmarked for healthcare in our county, $750,000 will go to reimburse hospitals and $250,000 to repay uncompensated care for physicians. The SBCMS Board of Directors felt that $250,000 is inadequate. Unfortunately, while hospitals have documented giving eight to ten million dollars in uncompensated care, no hard data exists on physicians' uncompensated care.
Realizing that the funds won't last long, the Board of Directors decided to alert SBCMS members so they may apply for reimbursement of their uncompensated care before the $250,000 is exhausted. In September SBCMS members received a letter with instructions on how and where to apply for reimbursement.
SBCMS is pleased to be a part of the eRADicator anti-smoking campaign directed
to the youth in our community. We are convinced that the program can make a
difference. We are also pleased to have had the opportunity to influence the
Board of Supervisors' decisions in spending the county's tobacco tax settlement
funds and achieving a modest reimbursement for your uncompensated care. As a
final note, I would like to urge all physicians to join me in continuing our
own personal anti-tobacco efforts, which could include conversations with our
patients and the media, promoting and participating in the Great American Smokeout
and other American Lung, Cancer and Heart Association efforts, and by placing
anti-tobacco educational materials, including eRADicator comic books and posters,
in your office waiting rooms.
