Editor's Opinion

Thursday, January 15, 2004

Tough Love for Smokers

Smokers, black-lunged and hacking as they may be, are a surprisingly hardy breed.

You can see them there, huddled outside the workplace doorways, shivering in below-zero conditions or struggling to stay alight in the wind or the drizzle.

Skipping dessert at the no-smoking restaurant to sprint to their cars to Hoover down a smoke while the family or friends finish their meals.

Enduring the discomfort of being "carded" by a pimply kid at the local convenience store, like an illegal alien caught at the border, while the rest of the line stares on in silent disapproval.

Studiously ignoring every attempt at education, from billboards pointing out their suicidal foolishness to their own kids flushing their smokes down the toilet in an attempt to help.

And they will pay, no matter what it costs, for cigarettes. It doesn't matter if a carton of smokes is $30 or more - enough to feed a good-size family for a day, buy a nice sweater, fill up an SUV with go juice, take the whole crew to a movie or a ball game. They still buy them, and will keep doing it if they hit $45.

If the prospect of lung cancer wasn't going to stop them, neither is Governor Tom Vilsack, who is playing a lead role in driving through a 60-cent increase in the state's tobacco tax.

If we can't teach people to take better care of their health, the theory goes, we will just keep taxing them until they can't afford to ruin it anymore.

The state has a history of the same approach with booze, with limited results. And the "drug tax stamp" doesn't seem to dissuade drug addicts, either.

But the Iowa's Health Initiative group estimates that a $1 increase in cigarette taxes would reduce youth smoking by 21.2% - not because kids are any less inclined to smoke, but because they figure they aren't inclined to spend an extra buck to do it.

Maybe. But are those same kids willing to raid the checking account for $75 Lucky jeans, $125 pair of sneakers or a $300 cell phone really going to be that bashful over a buck?

Smokers will no doubt complain that their civil rights are being violated, and that if they choose to drag their way into an early grave, that's their business.

And maybe it is.

But it is also true that Iowa spends approximately $235 million in state Medicaid expenditures for smoking-related illnesses (about 14% of all Medicaid dollars), and the birth defects and second-hand smoke exposure to children continue to compound the costs - financial and human - into future generations. We all pay for the habit, ultimately.

The Iowa Academy of Family Physicians has issued a statement in support of the governor's effort to hike up cigarette taxes. "The dollars created by this proposal are critical to reducing the toll tobacco takes on Iowans' lives and the state economy," the doctors say.

The lives are the real issues here, not the economy. Yes, a $1 hike in cigarette taxes would bring an extra $210 million or so into the state budget in lean times. But I truly hope this effort isn't seen as a fundraising tool, but a health issue.

The governor's proposal, to his credit, calls for the funds raised from the extra cigarette tax to be used to increase funding for health programs, such as tobacco prevention and the "hawk-i" child health insurance program.

Of course, earmarked money doesn't always stay that way in the tug-of-war that is partisan politics.

Dr. David Carlyle of the Iowa Academy of Family Physicians says the Governor's proposal and the cash it foreshadows is the first chance the state has ever had to have a "meaningful, fully-funded tobacco program."

Having seen those dedicated smokers survive bans in the workplace, bans in the restaurants, below-zero smoke breaks, all manner of social and family pressures and the very real threat of their own mortality, and keep merrily puffing along, I haven't much hope that spending millions more on prevention is going to make much of a dent now. Perhaps the money can do some good in cessation, treatment and offsetting a bit of the staggering public cost of longterm health care due to smoking.

Taxation isn't much of a solution, and it probably isn't really fair to those who smoke - it is legal. But then again, neither is the damage that smoking has done to the society and public budgets fair.

All things weighed, I'd have to go with the governor, or even with the $1 tax proposed by the Iowa Health Initiative.

But it isn't a desire to punish smokers or even to heal the crippled state budget that tips the balance on this issue.

I've seen people die with lung cancer, and I don't think I could oppose anything that has even a prayer of saving someone and their family from going through that.