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I will open my remarks with an observation about the title of this conference, ‘Issues in Smoking Cessation: Who Quits? Who Pays?’ With the exception of a couple of presentations, I would suggest that we have focused relatively little on the questions in the subtitle. Dr Giovino opened the conference with an excellent discussion of who quits smoking, the first issue in the subtitle. Dr McGinnis addressed the second issue in his sobering, but realistic remarks on who is likely to pay in the near future. In between have come a series of presentations and panel discussions that have addressed a critically important issue that is not in the title explicitly, but has been the focal point: treatment efficacy, with particular concern with nicotine replacement and treatment delivery mechanisms. Other than Dr McGinnis’ remarks, the principal commentary on the issue of ‘who pays ’ has consisted simply of cessation experts lamenting the lack of insurance coverage.
I will address a very specific question: who should pay for smoking cessation, with special consideration of the issue of third-party coverage of cessation services. I will examine this matter in a policy context, but with more than a small dusting of personal philosophy thrown in. Note, incidentally, that when I say policy, I include insurance company policy and private business policy along with governmental policy (although the latter is clearly the principal concern of participants in this conference).
Prevention: the stepchild of health care
This conference is obviously, and probably not accidentally, very timely from a policy perspective. Insurance reimbursement of smoking cessation is one piece of a relatively small but visible dimension of the debate about health care reform, namely how to handle disease prevention within the health care reform framework.
Disease prevention (including smoking cessation) has long been the stepchild of American health care. Years ago, Dr …