Denying smokers insurance won’t break the habit: Critics

The governor’s call to exclude smokers as beneficiaries of the free health insurance scheme for low-income residents will do nothing to help kick the city’s nicotine addiction, say anti-tobacco activists.

“The administration’s policy is discriminative,” National Commission for Tobacco Control chairman Farid Anfasa Moeloek said Wednesday.

“It’d be far better to allocate the money from the cigarette excise to improving healthcare services for all people.”

Jakarta Governor Fauzi Bowo made the call last week, pointing out smokers were well aware of the risk of their habit, and thus should not get any state-sponsored coverage.

He stressed the administration should not have to pay the medical bills for smokers’ tobacco-related illnesses.

Last year, the Jakarta administration allocated Rp 550 billion (US$58.9 million) from its Rp 24 trillion budget for the insurance scheme and to deal with dengue outbreaks and flooding.

The central government, meanwhile, allocated Rp 21 trillion for national healthcare spending, or just 3 percent of the country’s total Rp 1,005 trillion state budget in 2009.

“The healthcare budget is supposed to go up to 10 or 15 percent to improve the quality of healthcare services,” Farid said.

“That amount would be sufficient for direct services as well as to insure all citizens.”

He criticized the government for what he said was its lack of commitment on the issue, adding the main pillars of state welfare were education and healthcare.

Farid suggested one way to get people to stop smoking would be to raise the cigarette excise.

“This would be a disincentive for consumers, who would have to pay more for cigarettes,” he said.

Sonny Harry B. Harmadi, chairman of the University of Indonesia’s Demography Institute, said a 10 percent hike in the tobacco excise would be ideal, providing a “win-win solution for all”.

“By raising the excise this much, the market price will still be within the budget of most smokers, thus keeping cigarette producers in business,” he said.

“On the other hand, the higher prices will discourage children and poor people from buying cigarettes, which is exactly what we want.”

A study in 2005 showed that an increase in the tobacco excise by 10 percent would raise prices of cigarettes by 2.6 percent and reduce consumption by 0.9 percent.

If the Jakarta administration really wanted to implement its controversial policy, Sonny said, it must ensure only smokers, and not their families, were denied coverage.

“That’s what most insurance companies do, right?” he said.

“They refuse to pay for the treatment of illnesses or conditions that are a direct result of the lifestyle choices we make, such as HIV/AIDS. We can treat smokers in the same way.”

Tubagus Haryo Karbyanto, the deputy chairman of the Jakarta Residents Forum (Fakta) and a member of the tobacco control commission, said the administration’s plan was feasible, given that the country’s healthcare paradigm was focused on treatment rather than prevention.

“The policy must be implemented rationally, in phases, such that it doesn’t prove counterproductive or infringe on people’s constitutional rights,” he said.

Otherwise, he added, the administration could end up looking discriminative.