Saturday, Apr. 04, 2009
Fixing Health Care Cheaply, Chapter 1: Butt Out
By Scott Haig
This week the House voted 298 to 112 to give the Food and Drug Administration the power to regulate tobacco along with food and drugs. Ted Kennedy will soon introduce his version of the bill in the Senate. The White House supports the bill: "Tobacco use is a major factor driving the increasing costs of health care in the U.S.," said a statement by the Office of Management and Budget, "and accounts for over a hundred billion dollars annually in financial costs to the economy."
Which begs the question: Why regulate it at all? Why put cigarettes under the jurisdiction of the agency charged with making sure our food and drugs are safe, when cigarettes are, as we all know by now, unsafe by definition. Used as intended, they are bound to make you sick. Rather than equate them with food and drugs, if lawmakers were serious about the health costs of smoking, they would take the logical next step and just make the damn things illegal. (See pictures of vintage smoking advertisements.)
Upon launching his campaign, President Obama stopped smoking. Quite publicly. Letting the world see him chew gum and fidget with his pencils was an invaluable example. I have now practiced long enough to have seen scores of people, more than a few of whom I've loved, get miserably sick and die from tobacco use. I've pointed to the black spot on their X-ray and watched strong men and women collapse, touched the smoke-grown tumors in the operating room, the path lab, even on those poor experimental bunnies' ears and I'm convinced. You can be dubious about global warming if you want — but not about cigarettes. They absolutely do cause cancer, vascular and lung disease — the things that kill most of us. I've watched scores quit too, seen their skin get pinker, their wounds heal faster, their lungs work better. It's true: No matter when they quit they're better off for it.
Not many of us in medicine smoke cigarettes any more. Few who live in the fancy zipcodes do either. Cigarettes, to an extent, have become an indicator of lower socioeconomic status. This week public hospitals were handing out free nicotine patches as the federal cigarette tax more than doubled, to $1.01, which means that in places like New York City a pack costs more than $9, sometimes more than $10. Like the lottery, this is exactly what Democrats should hate — a tax on the poor. (Do Dems stay silent on cigarettes because the government needs the money?) Certainly, in this economic climate, passing sin taxes is more tempting than ever. But the value of a cigarette tax depends on enough people continuing to smoke, and no matter how much revenue streams in, it pales before the estimated $100 billion in health-care costs caused annually by cigarettes.
Apart from the proven power of the tobacco lobby, perhaps lawmakers fear the unintended consequences of stronger action: The intensely addictive quality of smoking certainly means that a black market would thrive in the face of an outright ban. Homegrown tobacco wrapped in E-Z Widers would surely be passed around behind the bleachers.
While I'm not sure I agree with every moral dimension of the tax, I do know that far fewer people will die from cigarettes because of it than are dying now. Past tax hikes have showed that smoking is price sensitive: Fewer kids start smoking and more smokers quit with each increase in the cost of a pack. Government "quit lines" got record numbers of calls on April 1, the day the current tax took effect. Restaurant smoking bans have also helped; so have ad campaigns about the dangers of smoking. Finding any and every way to deter and defeat the habit — including outlawing cigarettes and levying fines (no, not jail terms) for possession — would be a huge benefit to both our physical and fiscal health.
Read "The Year in Medicine 2008: From A to Z."
See pictures of the world's most polluted places.
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http://www.time.com/time/health/article/0,8599,1889469,00.htmlMicro Sez:We knew this was going to be debated sooner or later.
