PE Magazine Cover Stories

COVER STORIES

Monday, Nove

Medicare covers end-smoking counseling

You're never too old to quit smoking, government officials said Tuesday, announcing that Medicare will immediately start covering the cost of counseling for certain beneficiaries who want to quit tobacco.

Medicare's new smoking cessation program "has great potential to save and improve lives for millions of seniors," said Mark McClellan, administrator for the Centers for Medicare and Medicaid Services.

Not every Medicare beneficiary qualifies for the new benefit -- only those who have an illness caused by tobacco use or complicated by tobacco use.

Medicare officials said Tuesday they did not have an estimate of how much the new program would cost or how many people would be eligible for it. It covers only counseling sessions, not the cost of nicotine patches and gum or products pitched to help smokers quit. About 300,000 senior citizens die annually from smoking-related illnesses, according to the Centers for Disease Control and Prevention.

Medicare operated a pilot program for smoking cessation in seven states between November 2002 and December 2004. The official who oversaw it, Jim Coan, said the government paid about $32 for each counseling session, which usually lasted from three to 10 minutes. The maximum amount of claims that could be submitted per participant was four per year.

Coan did not have cost estimates for the program. He said about 7,500 people participated, far short of the goal that had been set for the program.

The new nationwide benefit covers only those with smoking-related illnesses or complications. In the pilot program, any Medicare beneficiary living in the seven states -- Alabama, Florida, Missouri, Nebraska, Ohio, Oklahoma and Wyoming -- could participate.

Dr. Ronald Sturm, a senior economist with the RAND Institute, a nonprofit research group, said Medicare's decision to limit the annual benefit to two cessation attempts per year -- each including a maximum of four counseling sessions -- would limit the program's costs.

Still, elderly people who have smoked throughout much of their life aren't typically the best candidates to quit smoking -- unless they are facing a life-threatening scenario.

"Will they quit smoking in their last few years? Not likely," Sturm said. "It's not going to change much. It's not going to cost much."

Officials at the American Medical Association applauded the government's move. They said seniors actually have a better chance of successfully quitting smoking than do people in other age categories.

"Studies have shown that seniors who try to quit smoking are 50 percent more likely to succeed than all other age groups, and seniors who quit can reduce their risk of death from heart disease to that of nonsmokers within two to three years after quitting," said Dr. Ronald Davis, an AMA trustee.

Between Law and Politics

In calling for Ariel Sharon to be prosecuted as an international criminal, London's mayor poses the choice between a world governed by the rule of law and a world based simply on the convenience of power, writes Curtis Doebbler*

Recently London Mayor Ken Livingstone accused Israel of ethnic cleansing and called for the arrest of Israeli Prime Minister Ariel Sharon as an international criminal for his crimes against the Palestinians.

As one might expect, the Israeli government reacted with outrage,demanding that Livingstone apologise. International law and history, however, seem to require otherwise.

A glimpse back at recent history indicates, as Livingstone stated, that many groups have been persecuted in the past. The Jews -- among other minorities -- were persecuted by the Nazis. There is no question that this was a terrible cruelty, affected by a government that claimed to want to exterminate the Jewish population entirely.

Muslims have been persecuted too. In Algeria, French colonial government brutally dispensed with Muslim claims to self-determination. In Libya, Hitler's Italian allies in 1931 summarily executed Omar Mukhtar for trying to realise the same ambition. After World War II, Italian General Rodolfo Graziani was found to be a war criminal for his role in suppressing Libyan self-determination. And perhaps the most deadly of campaigns against Muslims were the religiously motivated European crusades.

History does not justify persecution. One might think that it would teach us not to make the same mistakes our predecessors made. One might think that the Jews, for example, having being persecuted, would not persecute others. Indeed, having lived through such a horrific tragedy as the holocaust, one might have thought the Jews would be the people most willing to avoid its repetition.

This has not been the case and the situation is more complex still, in that the Jews who founded Israel were already busy with their own persecution of Muslims in Palestine when they were confronted by Nazi persecution. The confiscation of Palestinian land and the attempt to imposed conditions of life on Palestinians to drive them from their homes did not begin after the Jews were persecuted in World War II. Already by the beginning of the 20th century it was well underway.

In the 1920's Palestinians relentlessly, and with little effect, tried to convince the British occupiers of their land to limit its confiscation by Jews immigrating to Palestine under the pretext of an ancient right. By the start of World War II, one of Israel's founders, Ben Gurion, was writing of a fait compli whereby the leaders of the new State of Israel were now in a position to remove "the Arabs and take their place".

Needless to say the confiscation of Palestinian land was a serious violation of international law. This law does not recognise the right of peoples to take land based on title claims that are several thousand years old and that have remained dormant all those years. Instead, international law recognises the right of peoples who have lived on land for hundreds of years to acquire title to that land and more importantly to be able to exercise their right to self-determination. In violation of this law the Palestinians were herded like slaves of the British into a partitioned state in 1948 that ironically, just like apartheid in South Africa for many years, received the blessing of the United Nations.

But Livingstone was not giving a lesson in history. He was talking about what is happening today and how that violates international law. Surely he was being blunt, but he was not, as the Israeli ambassador himself was doing, misrepresenting the law when he called Israel's action in Palestine "ethnic cleansing", although he might have been more specific.

The crimes of which Livingstone spoke that are being perpetrated by Israel on the Palestinians are best understood as crimes against humanity or the crime of genocide. The distinction between the two is small, but important. But it is equally important to emphasise that ethnic cleansing can be either crime, depending on slightly different conditions being met.

Perhaps the crime against humanity that best describes Israel's action is the crime of persecution on political and religious grounds. The intention, or mens rea, of persecution must be to use force against members of a group in a way that causes serious violations of their human rights. The Israeli policy of assassinations is evidence enough of the crime of persecution. It is a policy of the state. It involves the use of force. And it is aimed at individuals whose politics the Israelis do not like.

There can be little doubt that Israel's consistent use of force to arbitrarily kill Palestinians in the occupied territories is a crime against humanity.

There are many more such crimes. A half century of horrifying human rights reports by credible NGOs and governments have documented these abuses. The United Nations, despite the obstruction of the
United States, has even been driven to form a special commission answerable to the General Assembly to record the gross and systematic violations of the human rights of Palestinians.

The acts these bodies have recorded include arbitrary killing or murder of men, women and children; the imposition of inhumane conditions of life on Palestinians that have the consequences of exterminating them; the willful causing of physical injury and suffering or torture; the deportation and confinement of civilians; and the taking of civilians as hostages. This is not a complete but only partial list of all the acts Israel undertakes that are crimes against humanity as well as war crimes.

The crime of genocide is committed when an individual acts with intent to destroy, in whole or in part, a national, ethnic, racial or religious group. Thus the additional element is the intention to destroy the group. This difference can be seen in the statement of the International Criminal Tribunal for the Former Yugoslavia that was charged with deciding cases concerning crimes against humanity and genocide. The tribunal has held in the Kupreskic and Others Case that "when persecution escalates to the extreme form of willful and deliberate acts designed to destroy a group or part of a group, it can be held that such persecution amounts to genocide."

Ironically, the term "genocide" was coined by Raphael Lemkin in the aftermath of the Nazi persecution of the Jews. He thought that persecution was so serious that there must be a worldwide prohibition that would prevent this from happening again. His efforts lead to the adoption of the Genocide Convention in 1951, which almost every state in the international community is a party to, including Israel. Unfortunately, Israel seems to have used this treaty to develop state policy instead of viewing it as a
restriction on such policies.

This can be seen in a comparison of Israel's policies towards the Palestinians with the Genocide Convention. The convention lists specific acts as prohibited when they are intended to destroy part or a whole group of people, such as the Palestinians, who have a national, religious and ethnic identity. The Palestinians are without doubt the type of group that this treaty was intended to protect. The listed acts include killing members of the group, causing serious bodily or mental harm to members of the group, and deliberately inflicting upon members of the group conditions of life calculated to bring about the physical destruction of the group in whole or in part.

Maybe the time has come where we decide whether we are to live in an international community respecting the rule of law or the rule of political convenience. This is perhaps what Livingstone was asking.