INSTANT DENTISTRY: EAT YOUR HEARTS OUT, BRITS

I developed a problem with one of the fillings in my teeth over the weekend so first thing on Monday, I rang a few dentists listed in the phone book and got an appointment NEXT DAY at a dentist less than 15 minutes drive from where I live.

I arrived on time at 2.30pm, was in the chair within 10 minutes, and out of the chair with my filling fixed in another 10 minutes. It cost me $50 (about the price of 4 packets of cigarettes) and I was home again within 45 minutes of setting out.

And a small but pleasant bonus: The dental receptionist was a real stunner -- pushup bra and all.

I even had time for a chat with the dentist about the "evils" of the old amalgam fillings, of which I have several. He pointed out that the dentists who were handling daily the mercury used to make up the amalgam should have been the ones most at risk but that there was no evidence that they were affected.

In Britain, a large part of the population rely on NHS dentistry but just cannot get the service that is supposedly available. Some have even resorted to pulling their own teeth out with pliers etc.

In Australia, people have always seen dentistry as a private expenditure which can be included in your private health insurance (up to a point) if desired. There is a "free" government service but the wait for it stretches into the years and it is therefore seen as only for the very poor.

If Britain had a voucher system for dentistry instead of the present dysfunctional system, all Brits could have the sort of rapid relief from discomfort that I experienced.




SCHIP financing burns poor

Congressional Democrats have chosen an unlikely source to pay for the bulk of their proposed $35 billion increase in children's health coverage: people with relatively little money and education. The program expansion passed by the House and Senate last week would be financed with a 156 percent increase in the federal cigarette tax, taking it to $1 per pack from the current 39 cents. Low-income people smoke more heavily than wealthier people in the U.S., making cigarette taxes a regressive form of revenue.

Democrats, who wrote the legislation and provided most of its votes, generally portray themselves as champions of the poor. They do not dispute that the tax plan would hit poor communities disproportionately, but they say it is worth it to provide health insurance to millions of modest-income children. All the better, they say, if higher cigarette taxes discourage smoking. "I'm very happy that we're paying for this," Senate Majority Leader Harry Reid, Nevada Democrat, said Friday, noting that the plan would not add to the deficit. "The health of the children is extremely important," he said. "In the long run, maybe it'll stop people from smoking."

Congress probably will revisit the cigarette tax issue soon because President Bush has pledged to veto the proposed $35 billion expansion of the State Children's Health Insurance Program. The decade-old program helps families buy medical coverage if their income is too high to qualify for Medicaid. Mr. Bush has proposed a more modest growth for the program, and both political parties seem inclined to pay for it through a tax on an unpopular group: cigarette smokers.

By most measures, the average smoker is less privileged than the average nonsmoker. Nearly one-third of all U.S. adults living in poverty are smokers, compared with 23.5 percent of those above the poverty level, according to government statistics. The American Heart Association reports that 35 percent of people with no more than 11 years of schooling are smokers. Those with 16 or more years of formal education smoke at a 12 percent rate. Non-Hispanic black men smoke at slightly higher rates than non-Hispanic white men. But the reverse is true among women.

The demographics of smoking and taxation received scant attention during last week's House and Senate debates, perhaps because many Democrats and Republicans agree that cigarettes are the best target for a tax increase if the insurance program is to grow. A few lawmakers, however, took a swing. "I know there is very little sympathy for smokers these days," Rep. Jack Kingston, Georgia Republican, said during the House debate. "But it is still a tax increase on the backs of the smokers. And in order to get enough money to pay for this, it would require 22 million new smokers."

Rep. Frank Pallone, New Jersey Democrat, defended putting the burden of expanded medical care on smokers. "The tobacco tax is a great way to pay for it," he said, "because if you tax people who are smoking and they smoke less, then we have less health problems." Rep. Jim McCrery, Louisi-ana Republican, did not buy that logic. "To propose funding a growing program with a declining revenue source is, I would submit, irresponsible fiscal policy," he said.

If the federal cigarette tax nears $1 per pack, smokers in many states will pay hefty sums into government coffers unless they kick their habit. On top of the federal tax, New Jersey levies a $2.57-per-pack tax on cigarettes, followed by Rhode Island at $2.46. California is near the middle, at 87 cents a pack. Three states tax cigarettes at less than 30 cents per pack. South Carolina is the lowest at 7 cents.

Bill Phelps, spokesman for Philip Morris USA in Richmond, said a steep tax increase could accelerate the national decline in smoking to the point that the insurance would have to find other revenue sources. The average U.S. price of a pack of cigarettes has risen by 80 cents since 1999, Mr. Phelps said, largely because of state tax increases. Governments received more than $21 billion in cigarette excise taxes in the 2006 budget year, he said, "so we think this trend is unfair to adults who smoke and to retailers who sell tobacco products."

In Congress, these groups receive little sympathy. But some lawmakers say voters should know the details of the insurance program's proposed funding structure. Rep. Mike Pence, an Indiana Republican who spoke against the bill in last week's debate, said: "The headline ought to read, 'Smokers in America to pay for middle-class welfare.' "

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