“AND CARTHAGE MUST BE DESTROYED”: THE IMPERATIVE OF TOBACCO CONTROL.
By Harold Pollack
One of the commenters asked about tobacco. Cato the elder ended every speech with the admonition: “And Carthage must be destroyed!” Nothing against Carthage, but Cato was right never to let anyone to forget his simple message. Anyone blogging about public health must do the same....
More than 400,000 Americans die every year, completely needlessly, from emphysema, cardiovascular diseases, lung cancer, and the rest. Obesity is trying to catch up, but tobacco remains the number one cause of avoidable death and illness in America. The carnage is equivalent to three fully-loaded jetliners crashing every day of the year.
My father-in-law Greg was one of those lost. A burly, movie-star handsome man, he was healthy and vibrant right up to the point he was diagnosed with lung cancer. Within a few short months, he wasted away and died with great dignity, my wife tending to him. My mother-in-law Janice also died too soon from smoking, succumbing suddenly from congestive heart failure brought on by undiagnosed lung cancer. They would have each had a good 20 years left to them.
We’ve had some luck reducing tobacco use, though not nearly as fast as we need to see. Many policies reduce tobacco use: media campaigns, indoor smoking regulations, labeling and warning requirements. We need to get the stupid tobacco product placements out of the movies. Every health economist will tell you: Raising cigarette prices is one powerful way to discourage tobacco use, especially to reduce youth smoking.
When Democrats and Republicans passed a bipartisan SCHIP bill last year—vetoed by President Bush--they financed the bill through a $0.61/pack increase in federal cigarette taxes. Many in the public health community wanted the tobacco tax increase as fervently as they wanted the expanded child insurance coverage. I certainly did.
Here’s why the veto was so disappointing. Congress’s Joint Committee on Taxation ran the numbers. One can quibble with the specific models, but the basic story is reasonable. They estimated that the tobacco tax would have increased annual federal revenue by almost $7 billion. Moreover, the tax would have led an estimated reduction of 2.3 million in the population of U.S. smokers. Calculations regarding the future health benefits are necessarily speculative. Based on current data, a reasonable estimate of deaths averted exceeds 500,000. Not bad for 61 cents—especially when we can keep billions of dollars in tax revenue as the loose change.
There is one legitimate concern about tobacco taxes: We’ve been beating up a bit on the smokers, who are on average less educated and affluent than other Americans. So it’s important to use tobacco tax revenues used to provide healthcare for low-income smokers, as well as to help other low-income Americans.
It still hurts to pay taxes. It hurts more to lose people we love.
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COMMENTS (28)
Should the state really be trying to control people's lives like this?
Posted by: Chris | August 13, 2008 9:58 AM
Should the state really be trying to control people's lives like this?
Ummmm....yes. Just ask any liberal.
Look, everyone knows the dangers. Spending money educating smokers on something they already know is a waste.
People drink. What do the socialists plan to do about them?
Posted by: El Viajero | August 13, 2008 10:11 AM
Being addicted to tobacco represents a pretty significant loss of control of your life to the tobacco companies, it seems to me.
Furthermore, a 61 cent tax hardly represents "control." Should we eliminate all sales taxes, gas taxes, etc.? How about income taxes - they are clearly a disincentive to work, just as this tax is a disincentive to smoke - and social security taxes?
Most 16 year-olds don't know the dangers of smoking in any meaningful sense. It's merely an academic knowledge, unless you've seen a close relative die of smoking-induced disease. It has no personal relevance. Spending money (gotten from a ... tax ... perhaps?) educating youth helps, to some extent, but only to some extent. There is plenty of room for other factors, such as affordability, to play a significant role.
Posted by: john | August 13, 2008 10:39 AM
An addendum: Being dead at age 62 due to smoking-induced heart disease seems to me to represent a pretty significant loss of control over one's life, too.
Posted by: john | August 13, 2008 10:41 AM
The revenue from tobacco taxes need to go toward preventing young people from smoking and/or helping them quit. Anything else is too abstract and a difficult proposition (i.e. regressively taxing poor people who smoke to pay for health insurance for poor people who smoke...WHAT??).
Many states squandered the 1994 MSA money on infrastructure or pay raises for state employees. Important things, to be sure, but NOT related to smoking prevention.
Posted by: PMB | August 13, 2008 10:44 AM
"Calculations regarding the future health benefits are necessarily speculative."
Indeed they are. It is quite possible that having smokers die young (and quick) is less costly overall than later long term healthcare. Not to mention savings that pension plans get from smokers dying.
And also, those 500,000 deaths avoided?? How about delayed?
Let's not oversell the benefits - it leads to disappointment.
Posted by: catclub | August 13, 2008 10:47 AM
the problem with tobacco taxation, is that its regressive. lower income persons are far more likely to smoke, less likely to have resources to assist in quitting, and would are most adversely affected by taxation.
Posted by: Anonymous | August 13, 2008 10:58 AM
Wow. Telling people it's going to cost a little more to kill themselves is controlling their lives. How much worse it is to have a tax deduction for spending on health care or saving for retirement. And that evil payroll tax that funds Social Security -- let's not control people that way either.
And yeah, we probably could do more to control people's lives by discouraging excess alcohol consumption, although good mechanisms may be harder to find. (Last I looked, which was a long time ago, almost half of US alcohol intake was by people who had already had four or more drinks that day...)
Posted by: paul | August 13, 2008 11:05 AM
Should the state really be trying to control people's lives like this?
Probably not. Then again, nicotine gets a free ride while far less dangerous and addictive drugs are tightly regulated. That seems blatantly unfair, no? If we want to make all drugs as unregulated as nicotine, I think many liberals would be on board for that, bit since we insist on keeping very tight restrictions on non-nicotine drugs, I think it is reasonable to ratchet up nicotine restrictions over time.
Posted by: Turbulence | August 13, 2008 11:38 AM
Raising cigarette prices is one powerful way to discourage tobacco use, especially to reduce youth smoking.
We must be careful not to go to high on these taxes. The danger is a black market that sucks in young men.
Posted by: floccina | August 13, 2008 11:46 AM
Just look at all the benefits from making marijuana illegal! We could probably double that if we followed the same path with tobacco.
Posted by: Dave Justus | August 13, 2008 11:51 AM
Interestingly, one of the main reasons for my female friends to start smoking when they were young was the appetite-suppressant effect. Certainly, when one sees footage of 'ideal' stick-thin models, they're invariably puffing away. As society and public health officials take a stronger stand against over-eating, we're going to have to watch out for this.
Posted by: Sam | August 13, 2008 11:51 AM
Being dead at age 62 due to smoking-induced heart disease seems to me to represent a pretty significant loss of control over one's life, too.
As does addiction. There are plenty of smokers who want to keep smoking, and they should be free to. But taxing an addictive product to help fund programs that will help people who want to do so kick the addiction hardly seems like state control to me.
Posted by: professordarkheart | August 13, 2008 12:21 PM
"Interestingly, one of the main reasons for my female friends to start smoking when they were young was the appetite-suppressant effect. Certainly, when one sees footage of 'ideal' stick-thin models, they're invariably puffing away."
Good point Sam. Most teen girls know that smoking is an appetite suppresant, but no one wants to deal with that issue.
There's lots of evidence that it is much easier for young people to become addicted - just need a few cigarettes a day (social smoking) compared to an adult who might take a pack a day to become addicted. If you don't begin smoking by age 20 or so, it's unlikely that you'll start at a later age.
Posted by: CParis | August 13, 2008 1:37 PM
More than 400,000 Americans die every year, completely needlessly, from emphysema, cardiovascular diseases, lung cancer, and the rest. Obesity is trying to catch up, but tobacco remains the number one cause of avoidable death and illness in America.
Yes, the Institute of Medicine estimates that tobacco causes over 400,000 premature deaths in America each year. Obesity and lack of exercise, almost as many. Inadequate health insurance, by contrast, is estimated to cause only about 19,000 premature deaths. Only about 5% the number caused by tobacco. The disparity in health problems (that fall short of actual fatality) attributable to tobacco vs. inadequate health insurance is probably similarly large.
This is one reason why I think the left's obsession with health insurance, and in particular "universal coverage," is a case of massively misplaced priorities. Even a small reduction in the rate of smoking would save more lives than giving everyone in America gold-plated health insurance, and yet liberals obsess endlessly over health insurance (Ezra is particularly obsessed by it) and pay very little attention to more aggressive anti-smoking policies. Or to other kinds of policy influencing lifestyle-related causes of poor health and premature death.
Posted by: Mixner | August 13, 2008 3:18 PM
One of the commenters asked about tobacco. Cato the elder ended every speech with the admonition: “And Carthage must be destroyed!” Nothing against Carthage, but Cato was right never to let anyone to forget his simple message. Anyone blogging about public health must do the same....
Why? Smoking is a private matter, not a matter of "public health" at all.
And I thought liberals claimed to be pro-choice.
Posted by: David Nieporent | August 13, 2008 11:29 PM
"Being dead at age 62 due to smoking-induced heart disease seems to me to represent a pretty significant loss of control over one's life, too."
Hah! You idiot.
I hope I can smoke myself to death before you assholes manage to tax me out of the market, which is probably never going to happen because I'll buy cigarettes out of the back of a van in an alley and there won't be shit you can do about.
Fools.
Posted by: Billy Beck | August 13, 2008 11:49 PM
good for you billy. i will be in the same boat. the state will NEVER control what i choose to put into my body. if that means doing something the state has decided is illegal or immoral, then so be it.
Posted by: ceanf | August 14, 2008 8:52 AM
Folks,
If taxing tobacco purchases is good for society, can we also tax abortions?
Posted by: Segodnya | August 14, 2008 10:21 AM
ceanf: I am an American, by flamin' Christ. The people don't know what they're fucking with. This is a great American tradition. My grandfather drank his way through Prohibition as a political act, because a bunch of presumptuous martinets told him that he couldn't.
I'll be goddamned if I'll let these punks push me around like this.
Posted by: Billy Beck | August 14, 2008 11:02 AM
Taxation is theft. No matter how much or for what reason. The US Revolution was fought over a 5% tax. And rightfully so.
Posted by: Bill St. Clair | August 15, 2008 5:57 AM
"Being addicted to tobacco represents a pretty significant loss of control of your life to the tobacco companies,"
Ah. But it's MY life. Your being addicted to socialism represents a very significant loss of control for ME of MY life. Every additional penny of taxation represents a small step toward total slavery. (That means NO control for ME of MY life, fool.)
No, I don't smoke cigarettes. Usually, now, I do find cigarette smoke annoying though somehow I got through all those hockey games at the old Madison Square Garden without noticing until you control freeks made smoking somewhat unusual.
Posted by: ml/nj | August 15, 2008 7:45 AM
God, I hate you people.
Posted by: billy-jay | August 15, 2008 8:18 AM
The more addicted they are to nicotine, the angrier a smoker gets. By the way, there is nothing "private" about the huge impact of secondhand smoke exposure on millions of innocent bystanders, who should not have to choose between employment or spending time in public places and his or her life and health.
Posted by: Sean L. | August 15, 2008 5:29 PM
Not everyone is addicted to nicotine and cigarettes. I don't like cigarettes but enjoy Cigars and I did't start smoking until I was 42.
I smoke now because of you health nazi's. I smoke outside on my deck with a nice glass of red wine.
It's enjoyable not addictive. Maybe it is for most but it's not something I have to do every day. In fact I can go as long as I want without one, but I choose (my choice).
Am I the only person whose noticed that as the smoking bans went into effect, low-at and no-fat foods started to spiral into grocery stores, that obesity rates skyrocketed? Coincidence?
Posted by: Anonymous | August 15, 2008 9:08 PM
The more addicted they are to nicotine, the angrier a smoker gets. By the way, there is nothing "private" about the huge impact of secondhand smoke exposure on millions of innocent bystanders, who should not have to choose between employment or spending time in public places and his or her life and health.-Sean L.
Except that smelling a little SHS while will not affect your health in any meaningful way, no matter how much the zealots fudge the numbers.
Posted by: Anonymous | August 15, 2008 9:15 PM
Sean L.,
I don't smoke at all, but you anti-smoking goons make me very angry.
Posted by: billy-jay | August 16, 2008 1:06 AM
Every year nearly 392,000 peoples are dying from tobacco-caused disease, making it the leading cause of preventable death and an additional 50,000 people die from exposure to secondhand smoke. SmokingHarms - Quit smoking, Passive Smoking Harms
Posted by: coxhoward | March 26, 2009 8:01 AM