ASSIST 1AC

Contention 1: Inherency

The number of smokers in the U.S. is steadily increasing due to recent cutbacks for state
tobacco-control programs – States can’t be trusted with funding the programs
Steven Reinberg (HealthDay Reporter) THURSDAY, Nov. 12 2009 (HealthDay News)
http://health.usnews.com/articles/health/healthday/2009/11/12/progress-in-stamping-out-smoking-
has-stalled.html?PageNr=1

After decades of progress, the number of Americans who smoke hasn't budged over the last five years
and actually rose slightly from 2007 to 2008, according to a new report from the U.S. Centers for Disease
Control and Prevention. Over the longer term, smoking rates have declined. From 1998 to 2008, the
percentage of smokers in the United States dropped from 24.1 to 20.6 percent. However, the report
notes that "during the past five years, rates have shown virtually no change," and in fact the percentage
of Americans who smoke has begun to creep up again, rising from 19.8 percent in 2007 to 20.6 percent
in 2008. Many experts blame the turnaround on recent cutbacks in funding for state tobacco-control
programs, which had proven successful. [...] The CDC investigators place much of the blame for the
stagnation in smoking rates on states' underfunding of their tobacco-control programs. They point out
that from 2000 to 2009, states have received $203.5 billion in tobacco-related revenue . However, less
than 3 percent of the funds have been earmarked for tobacco-prevention and smoking-cessation
programs in the states, according to the report.

AND, tobacco industry lawsuits against ASSIST are having a chilling effect, halting all tobacco-
control policies
Brion PhD 2001 American Journal of Public Health “Tobacco Industry Allegations of “Illegal

Lobbying” and State Tobacco Control” http://ajph.aphapublications.org/cgi/reprint/91/1/62.pdf

Philip Morris identified the strategy of claiming that federal funds were being used for “illegal lobbying”
as a way to forestall the development and implementation of tobacco control policies. Philip Morris’

“Counter ASSIST Plan”. the perceived effect of tobacco industry claims of “illegal lobbying” on tobacco
control activities, we examined the ASSIST states. (This study was meant not to assess the legitimacy of
the claims or the value of the laws restricting lobbying behavior but merely to acquire a better
understanding of public health officials’ perceptions and responses to claims of “illegal lobbying.”)We
found that the tobacco industry’s strategy of accusing public health professionals of “illegal lobbying”
has had a selfreported chilling effect on some activities to implement tobacco control policies.

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 ASSIST Plan Text
Plan: President Obama should issue an executive order to substantially
increase funding to ASSIST programs that form tobacco control coalitions of
health, business, and education groups for impoverished persons in the
United States based on a means-tested basis. The program will also include
regular counseling, nicotine supplements, and drug tests. We’ll clarify.

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Contention 2: Solvency

American Stop Smoking Intervention Study (ASSIST) is empirically the most effective tobacco
control program, shown to have tripled historical decline rates in tobacco consumption
Stella Aguinaga Bialous, DrPH 2k1 “Tobacco Industry Allegations of “Illegal Lobbying”
http://ajph.aphapublications.org/cgi/reprint/91/1/62.pdf

Policy interventions were at the center of 2 large-scale government tobacco control efforts: California’s
Proposition 99Tobacco Control Program, 14 started in 1989, and the National Cancer Institute’s
(NCI’s)American Stop Smoking Intervention Study (ASSIST), started in 1991.ASSISTwas a 7-year, 17-state,
federally funded comprehensive tobacco control project, in partnership with the American Cancer

Society (ACS), state health departments, and public and private organizations, that emphasized the
policy dimension in tobacco control.15 Both the California program and ASSIST required formation of
tobacco control coalitions of health, business, and education groups. These coalitions work with, but are
not part of, the health departments. Both programs significantly accelerated the decline in tobacco
consumption. In the early years of the California program, the rate of decline in tobacco consumption
tripled compared with historical rates,8 and prevalence declined 1.9 times faster than in the rest of the
United States.16–18 Per capita cigarette consumption in ASSIST states was significantly lower than
consumption in non-ASSIST states; by 1996, this difference reached 7%.

ASSIST solves 1.2+ million smokers

NCI ’03 (National Cancer Institute.
http://www.cancer.gov/newscenter/assistQandA)

The results from ASSIST are the latest evidence that investing in state tobacco control programs that focus on strong
tobacco regulations and policies is an effective strategy for reducing tobacco use. The small but statistically
significant differences in the reduction of adult smoking prevalence in ASSIST states, when applied on a population
basis, could be expected to have a large impact on the public. If all 50 states and the District of Columbia had
implemented ASSIST, there would be approximately 1,213,000 fewer smokers nationally.

The finding that states with a greater change in their tobacco control policies during ASSIST had larger
decreases in per capita cigarette consumption suggests that interventions which result in tobacco control policy
change can have a strong and sustained effect on the amount of cigarettes smoked. This conclusion adds to the
body of similar research and expert reports that document the importance of a comprehensive approach to tobacco
control. Although policy efforts take time, they can bring about major changes in social norms, including smoking
behavior.

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AND, ASSIST programs have a significant effect on smoking behavior, increased nationwide
federal implementation is key
NCI 2003 “Tobacco Control Policies Lower Smoking Rates”
http://www.jhsph.edu/publichealthnews/press_releases/PR_2003/ASSIST_study.html

For the evaluation, Dr. Stillman and her colleagues compared changes in tobacco control policies and
the effect on per capita cigarette consumption and smoking prevalence among adults in ASSIST states,
non-ASSIST states, and Washington, D.C. They developed the Initial Outcomes Index (IOI) to access the
intensity of a state’s tobacco control policies and the Strength of Tobacco Control Index (SOTC) to
measure the capacity and infrastructure developed to carry out tobacco control efforts in all states.
According to the researchers, ASSIST states had a small but significant decrease in smoking prevalence,
which would translate to about 280,000 fewer smokers nationwide if all 50 states and the District of
Columbia had implemented ASSIST. Overall, states that made greater improvement in their tobacco
control policies had greater decreases in cigarette consumption. States that developed greater capacity
and infrastructure to deliver tobacco control programs also had greater decreases in cigarette
consumption. [..] “Even given these factors, the results add to the body of research documenting that
strong policy-focused interventions can have a significant effect on smoking behavior.”

ASSIST costs 1/1000 the cost of tobacco on the healthcare industry.

NCI ’03 (National Cancer Institute
http://www.cancer.gov/newscenter/assistQandA)

NCI provided an average of $1.14 million per state per year during the six-year implementation phase
(1993-1999), for a total of $128 million over the eight years of the program. Other additional funding
and resources were available to the states through voluntary organizations and other non-federal
sources.

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Contention 3: Drop That Cigarette

Tobacco addiction causes malnutrition and traps people into cycles of poverty
International Development Research Centre, 2003, At What Cost?: The Economic Impact of Tobacco
Use on National Health Systems, Societies, and Individuals, online: http://www.idrc.ca/en/ev-106320-
201-1-DO_TOPIC.html, accessed November 4, 2007

Smoking affects smokers and their families in terms of time and cost needed to care for the smoker
at home or at the hospital; to launder clothes and clean the air of smoke; to repair and replace
articles damaged by cigarette burns; to travel to health-care providers; to quit smoking; and to try to
quit smoking (13). In addition, cigarettes cost money, and the need to smoke often results in
expenditures that would be more beneficial elsewhere. In developing countries, the cost of buying
cigarettes can amount to as much as 25% or more of an individual's disposable income (14). A report
written by PATH Canada and Work for a Better Bangladesh illustrates the costs of diverting income to
tobacco from an individual's basic needs, such as food and shelter, thus demonstrating that tobacco
use further aggravates poverty (15). If personal tobacco expenditures in Bangladesh were reallocated
to basic needs, a typical cigarette smoker could increase her monthly food expenditure by 50% on
average and have additional money for education and housing. Smokers who replace current tobacco
spending according to established patterns could add 400–800 calories/day to their children's diet,
and contribute more money to their education, clothing, housing, and other needs. This increase in
calorie intake represents almost 75% of the minimum daily calorie requirement for children aged
three and approximately 50% for children aged four to six. Tobacco use may also reduce an
individual's disposable income by increasing health-care and insurance payments. One example is
illustrated in a U.S. study that gathered 1988 data on paid claims from a large U.S. health insurer's
indemnity plan (16). Tobacco users had more hospital admissions per 1,000 (124 versus 76) and days
per 1,000 (800 versus 381), a longer average length of stay (6.47 versus 5.03 days), higher average
outpatient payments ($122 versus $75), and higher average insured payments ($1,145 versus $762).
Because insurance plans typically set premiums according to frequency claims and payments, the
results suggest that privately insured smokers in the United States may pay more in insurance than
nonsmokers with similar health-care plans.

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AND, Tobacco empirically kills more than all other systemic impacts combined – more die in
one year from tobacco consumption than throughout World War II
George Will on Thursday, June 18th, 2009 “Claims that smoking kills more people annually than other
dangerous activities combined” http://www.politifact.com/truth-o-
meter/statements/2009/jun/29/george-will/claims-smoking-kills-more-people-annually-other-da/

"Three decades ago, public outrage killed an automobile model (Ford's Pinto) whose design defects
allegedly caused 59 deaths," he wrote. "Yet every year tobacco kills more Americans than did World War
II — more than AIDS, cocaine, heroin, alcohol, vehicular accidents, homicide and suicide combined ."
More than AIDS? More than car accidents? We were skeptical, so we decided to take a look ourselves. It
seems that Will plucked part of his claim from the Campaign for Tobacco-Free Kids, a leading advocate
for the new law. According to the organization, about 400,000 people die from their own smoking each
year, and about 50,000 die from second-hand smoke annually. And according to the group's Web site,
"Smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders and suicides
combined." Even though that fact is repeated by many antismoking campaigns, and by the American
Cancer Society, we decided to crunch the numbers ourselves. According to the Centers for Disease
Control and Prevention, in 2006, when their database was last updated, 22,073 people died of alcohol,
12,113 died of AIDS, 43,664 died of car accidents, 38,396 died of drug use — legal and illegal — 18,573
died of murder and 33,300 died of suicide. That brings us to a total of 168,119 deaths, far less than the
450,000 that die from smoking annually. As for the part about World War II, Will came up with this
comparison himself. About 292,000 soldiers, sailors, airmen and Marines were killed in battle during
World War II, according to a U.S. Census Bureau April 29, 2004, report in commemoration of the new
World War II memorial in Washington, D.C. An additional 114,000 members of U.S. forces died of other
causes during the war, bringing the total to 406,000 people. Will's claim — that smoking kills more
people annually than in World War II or from other dangerous diseases and habits — holds up with the
CDC and the Census Bureau. As a result, we give Will a True.

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AND, All their arguments against tobacco use or downplaying its harms to health are wrong –
the vast majority of evidence concludes smoking is the leading cause of preventable death in
the world, its costs far outweigh its benefits

Carolyn Dresler, Head of the Unit for Tobacco and Cancer Group at the International Agency for
Research on Cancer in Lyon, France, and Stephen P. Marks, the François-Xavier Bagnoud Professor of
Health and Human Rights at the Harvard School of Public Health, director of the Human Rights in
Development Program at Harvard, Senior Fellow at the University Committee on Human Rights Studies
at Harvard and chair of the UN High-Level Task Force on the Implementation of the Right to
Development, Summer 2006, Human Rights Quarterly, Vol. 28, No. 3, p. 649-650

Tobacco is a naturally occurring plant, used for centuries in societies for religious or cultural purposes
without systematic documentation of harm. However, it is now recognized as the only legal product
that, when used as intended, kills 50 percent of its consumers. Over 5 million die from tobacco-related
deaths every year. It is the leading preventable cause of death in the world . We have demonstrated in
this article the magnitude of the problem and its human rights dimensions. Large multinational
corporations now control the cultivating, manufacturing, marketing, and selling of tobacco products in
the globalized economy of the twenty-first century. At the same time, the industry generates income for
farmers, traders, retailers, advertising agencies, corporate stockholders, and national treasuries.
Tobacco products are legal and tobacco control has only begun in the last decades to be considered a
legitimate and indeed necessary dimension of sound public policy. Under these circumstances, [End
Page 649] one may ask whether it is appropriate to consider tobacco control as a human rights issue. Do
the producing, marketing, and consuming of a legal product violate human rights? Does a human rights
framework provide any useful insights for dealing with this complex set of issues? We answer both
questions in the affirmative. The evidence is incontrovertible that the rights to life, to health, to
livelihoods, to education, to food, to a healthy environment, and to development are seriously affected
by the tobacco industry. A particularly dangerous trend is reflected in the staging model of the epidemic ,
according to which prevalence of smoking by women is expected to peak in the next decades, followed
by sharp increases in female deaths due to smoking, particularly in low- and medium-income countries.
Tobacco control is therefore more than sound public health ; it is a necessary strategy to ensure the
human rights of the affected populations.

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Default to systemic impacts first – This framework is best for debate because;

A) It’s more real world: Our impacts are happening now in the real world so you give
us 100% probability the 450,000 people will die per year. That’s 1,200 per day
which means by the end of this debate almost 70 will have died from a tobacco
related death. We can guarantee the dying will end if you vote affirmative while
their less probable impacts are more questionable and no policy makers ever refer
to critical literature to criticize a policy.

B) More educational: We are talking about real events that are happening now.
Talking about how to solve current systemic problems our nation has is way more
educational than their one-shot risk scenarios and trying to predict the future. You
can’t predict future problems when you can’t even solve current ones.

AND

Criticizing policies maintains the status-quo and allows for more people who could
have been helped to die. Talking in philosophical terms about how great the
status-quo is gets us nowhere and overall kills education, if you could get a PhD in
philosophy or a PhD in political science which one would get you a job?

C) Fairness: You should weigh systemic impacts heavily against their less probable,
longer timeframe scenarios otherwise the negative could always win claiming their
nuclear wars and a Schell card would always outweigh.

AND

There are hundreds of other ontological, methodical, and otherwise ridiculous

kritik frameworks, links, and implications that moot our 1AC if you don’t weigh our
systemic impacts accordingly it kills debate.

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Contention 4: The Healthcare Industry
Scenario one: The Economy

Tobacco consumption trends will costs the health care industry $100 billion a year
Center for American Progress 11 June, 09 “Health Care Costs from Smoking Are a Drag”
http://www.scienceprogress.org/2009/06/smoking-costs/

Health care costs from smoking are a drag. Cutting back on smoking could reduce U.S. health care
spending by nearly $100 billion a year, For the moment, cigarettes remain unregulated drug delivery
systems. Here’s a look at some of the most recent data on national smoking trends: 19.8 percent of
adults in the United States (43.4 million people) were current smokers in 2007. 30 percent of all cancer
deaths involve smoking as the primary cause. 443,000 people died prematurely every year as a result of smoking
and exposure to tobacco smoke during the period between 2000 and 2004. During that same period, smoking
caused $98 billion in productivity losses each year. For every person who dies of a smoking-related disease, 20
more people suffer with at least one serious illness from smoking. 20 percent of high school students were
smokers in 2007. 3,600 people between the ages of 12 and 17 pick up smoking every day.

AND, high health care costs drag the economy down with the industry
Linda a. Johnson AP business writer June 25, 2009 “Meltdown 101: Why High Health Costs Hurt
Economy” http://www.lawattstimes.com/component/content/article/858-meltdown-101-why-high-
health-costs-hurt-economy.html

Q: How big a part of the economy is health care? A: It accounts for about one-sixth of the entire economy —
more than any other industry. Spending on health care totals about $2.5 trillion, 17.5 percent of our gross
domestic product — a measure of the value of all goods and services produced in the United States. That’s up from
13.8 percent of GDP in 2000 and 5.2 percent in 1960, when health spending totaled just $27.5 billion — barely 1
percent of today’s level, according to the Kaiser Family Foundation, a nonpartisan health policy group. […] Q: How
do health care costs drag on the economy? A: Growth in overall health care costs, including spending on
the huge Medicare and Medicaid programs, is out of control, said Robert Laszewski, president of consultants
Health Policy and Strategy Associates. That limits how much money the federal government and businesses
have to invest in solving the energy problem, developing products that can be sold to other countries,
creating technology that can bring medical breakthroughs, building infrastructure and more . Q: How do
rising health costs affect workers and businesses? A: Health insurance premiums have skyrocketed,
making it ever-tougher for workers and employers to afford them . From 1999 through 2008, annual health
insurance premiums jumped 119 percent, according to Kaiser data. The average family premium paid by workers
rose from $1,543 to $3,354 a year, and employer payments per worker jumped from $4,247 to $9,325. During that
span, worker earnings rose only 34 percent and overall inflation was just 29 percent. So worker income has
barely kept pace with inflation, more of the paycheck is going to health costs, and there’s less left over for
things like vacations, dining out, home improvements or a new car — especially for low-wage workers and retirees.
That represents a huge drag on economic growth, considering that consumer spending powers about 70
percent of the economy.

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Scenario two: Bioterrorism

First, a bioterrorist attack on the United States is inevitable

Michelle Williams, Associated Press Writer Saturday, 5 February 2k

http://www.independent.co.uk/news/world/americas/expert-says-biological-attack-on-us-inevitable-
724610.html

Terrorists will likely attack the United States with the small pox or anthrax viruses within the next five to
10 years, says an expert who warns the country is unprepared. "We are a long way away from being
even modestly prepared," D.A. Henderson, director of the Johns Hopkins Center for Civilian Biodefense
Studies, said Friday at a conference on bioterrorism in San Diego. "But we're doing a lot more now than
we did 12 months, or even 6 months ago." The two-day conference brings together more than 300
physicians, scientists, public officials and law enforcement agents to discuss possible ways to respond in
the event of an attack. "With a virus, signs aren't apparent for days or weeks," Henderson said. "The flu-
like symptoms may get misdiagnosed until the disease reaches an epidemic level." With shortages of
hospital space, vaccines and antibiotics, "there would be chaos," he said.

AND, the healthcare industry is critical to an effective defense against a bioterror attack

Green, 4 – PhD, Director, Outreach and Lead GE3LS Advisor, Ontario Genomics Institute (Shane,
American Medical Association Journal of Ethics, May, Vol. 6, No. 5, http://virtualmentor.ama-
assn.org/2004/05/pfor2-0405.html)

Consider the threat of bioterrorism: the potential use of biological weapons against this country raises
the specter of a unique kind of war in which battles will be fought not against soldiers and artillery but
against epidemics. Without significant reform to ensure access to health care for all Americans, the US
will be unable to fight such battles effectively. Why Access? Using infectious diseases as weapons,
bioterrorism threatens to weaken the civilian workforce and, hence, a nation's ability to go about its
daily business. Moreover, in the case of diseases that are transmissible person to person, each infected
individual becomes a human weapon, infecting others, who then infect others, and so on, tying up
medical responders and overwhelming medical resources. A nation's greatest defense against
bioterrorism, both in preparation for and in response to an attack, is a population in which an
introduced biological agent cannot get a foothold, ie, healthy people with easy access to health care.

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AND, independently bioweapons are more deadly and risk extinction

Ochs 02 - MA in Natural Resource Management at Rutgers [Richard, “Biological Weapons Must be

Abolished Immediately,” 6-9-2002, http://www.freefromterror.net/other_articles/abolish.html]

Of all the weapons of mass destruction, the genetically engineered biological weapons, many without a
known cure or vaccine, are an extreme danger to the continued survival of life on earth. Any perceived
military value or deterrence pales in comparison to the great risk these weapons pose just sitting in vials
in laboratories. While a "nuclear winter," resulting from a massive exchange of nuclear weapons, could
also kill off most of life on earth and severely compromise the health of future generations, they are
easier to control. Biological weapons, on the other hand, can get out of control very easily, as the recent
anthrax attacks has demonstrated. There is no way to guarantee the security of these doomsday
weapons because very tiny amounts can be stolen or accidentally released and then grow or be grown
to horrendous proportions. The Black Death of the Middle Ages would be small in comparison to the
potential damage bioweapons could cause. Abolition of chemical weapons is less of a priority because,
while they can also kill millions of people outright, their persistence in the environment would be less
than nuclear or biological agents or more localized. Hence, chemical weapons would have a lesser effect
on future generations of innocent people and the natural environment. Like the Holocaust, once a
localized chemical extermination is over, it is over. With nuclear and biological weapons, the killing will
probably never end. Radioactive elements last tens of thousands of years and will keep causing cancers
virtually forever. Potentially worse than that, bio-engineered agents by the hundreds with no known
cure could wreck even greater calamity on the human race than could persistent radiation . AIDS and
ebola viruses are just a small example of recently emerging plagues with no known cure or vaccine. Can
we imagine hundreds of such plagues? HUMAN EXTINCTION IS NOW POSSIBLE . Ironically, the Bush
administration has just changed the U.S. nuclear doctrine to allow nuclear retaliation against threats
upon allies by conventional weapons. The past doctrine allowed such use only as a last resort when our
nation’s survival was at stake. Will the new policy also allow easier use of US bioweapons? How slippery
is this slope? Against this tendency can be posed a rational alternative policy. To preclude possibilities of
human extinction, "patriotism" needs to be redefined to make humanity’s survival primary and absolute.
Even if we lose our cherished freedom, our sovereignty, our government or our Constitution, where
there is life, there is hope. What good is anything else if humanity is extinguished?

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Finally, federal funding of ASSIST is key – Continued increase in smoking levels will collapse
the healthcare industry
William Faloon L i f e E x t e n s i o n M a g a z i n e S e p t e m b e r 2 0 0 9 “ Why American Healthcare is
Headed for Collapse” http://www.lef.org/magazine/mag2009/sep2009_Why-American-Healthcare-is-
Headed-for-Collapse_02.htm

I am as libertarian in my thinking as anyone I know, but there are radical approaches that could not only
spare Medicare, but protect future generations as well. Cigarettes officially kill 440,000 people in the US
each year, but the real number is higher. When tabulating cigarette smoking-induced deaths, many
cancers related to cigarette smoking (such as pancreatic and esophageal cancers) are not usually
counted. The fact that 18-year-olds are allowed to buy something as addictive as cigarettes is obscene.
What is worse is that even if a person stops smoking in their 20s, the DNA gene damage inflicted in their
early years predisposes them to lifelong increased cancer risks. I am personally livid over the amount of
secondhand smoke I was forced to inhale throughout my early life. It could very well be the cause of my
death. While outright prohibition would not work in the long term, the federal government could
impose a three-month moratorium on all tobacco sales. This would enable a huge number of smokers to
quit. Financial penalties for anyone caught selling cigarettes during this proposed three-month ban could
be so large that it might conceivably work. motivate them to break their addiction. I realize this
proposal is draconian and would be still another If just 30% of all smokers stopped as a result of this
three-month moratorium, that alone might save Medicare. Just debating it in Congress may remind
smokers of what they are doing to their bodies and government intrusion on individual liberty. The facts,
however, are that smoking-related illnesses are responsible for a huge portion of Medicare/Medicaid
outlays—and this country can no longer afford it.

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