The letter was in response to an editorial supporting a proposed ballot initiative that would increase the cigarette tax by 80 cents per pack and allocate a substantial portion of the revenues for programs to prevent smoking, provide services for those who want to quit smoking, and help cover the costs of medical treatment for smokers.
While not explicitly advocating for increased MSA expenditures for tobacco control, Dawson did point out that "the state spent less than one-half of its MSA money on tobacco control" and that "more than 50 percent of that money went to budget shortfalls and general purposes." So in suggesting that "a wiser course of action would be to better allocate the money the state already gets from smokers before resorting to an unfair and discriminatory tax on a minority of the state's residents," Dawson may well be suggesting that more of the MSA funds be spent on tobacco control programs. The argument, it seems, is that desired money for smoking-related programs should come from the existing MSA payments, rather than from a new increase in cigarette taxes.
The Rest of the Story
While I disagree with this argument in relation to the proposed policy in Missouri, I think it very clearly expresses my opinion regarding the proposed cigarette tax increase in Massachusetts.
First, here is why I disagree with the opinion in relation to the Missouri proposal:
That proposal is a ballot initiative - a proposal being generated by (and if approved, approved by) the citizens, not by the legislature. If citizens are disappointed with the way money from the MSA is being allocated, then it is appropriate for them to attempt to remedy the situation by generating a source of funds for programs to prevent smoking-related diseases that cannot be raided by politicians. Citizens do not have control over the way the legislature votes, so it is not enough to simply suggest that the legislature re-allocate the funding. The citizens do not control that decision.
In addition, because a substantial portion of the funds will be allocated to directly provide services for smokers, including cessation programs as well as medical services, I think it helps mitigate the unfair and discriminatory nature of the policy proposal.
Furthermore, the proposal's intent is clearly not to balance any budget on the backs of smokers, but to improve the public's health by preventing smoking-related diseases and to restore funding for tobacco control programs that the legislature inappropriately diverted from that purpose in raiding the MSA funds for general budget purposes. In that sense, the proposal is justified from a public health perspective.
Now, here is why I agree with Dawson's argument as it relates to the proposed cigarette tax increase in Massachusetts.
In contrast to the proposal in Missouri:
- the Massachusetts proposal is a legislative one; it was generated by the same legislators who decimated the state's tobacco control program and diverted funding that had been allocated by the voters to programs to prevent smoking-related diseases;
- the Massachusetts proposal would tax smokers for the sole purpose of raising money to close budget shortfalls (in this case, to plug up a hole in the state's ability to cover Medicaid payments for low-income families);
- the Massachusetts proposal would not allocate the resources derived from the tax on smokers to provide any services specifically for them, making it an unfair and discriminatory way of raising needed revenues; and
- the clear intent of the Massachusetts legislature is to balance the budget on the backs of smokers since that is the most politically easy solution to the state's budget woes.
In fact, I think that Dawson's arguments are right on the mark with respect to what is happening here in Massachusetts. There is plenty of money available to restore funding for the very same programs to prevent smoking-related diseases that the voters clearly intended to support when they voted to approve the Question 1 ballot initiative in 1992. Specifically, the Question 1 ballot initiative funds which the legislature has increasingly raided over the past 12 years, are plentiful enough to both restore the tobacco control program (including a high level of services for smokers) and to expand Medicaid to low-income families who are not presently covered. And that is before even touching the money that the state gets from the Master Settlement Agreement.
In other words, there is simply no excuse for the legislature, if it has any interest in public health at all, not to restore tobacco control funding that the voters have mandated. And thus, there really is no need for yet another increase in the cigarette tax. At this point, additional revenue that is needed should come first from the wealthiest citizens and corporations in the state, not from the poorest residents.
Dawson is exactly right - the legislature needs to better allocate the existing funds in Massachusetts first, not simply tax and tax smokers to cover the budget shortfall. Such a policy is indeed unfair and discriminatory, it is not justified on any public health grounds, and it in fact hurts the interests of tobacco control in the state by bringing to near zero the possibility that state legislators will face any significant pressure to restore the funding that they have raided from Question 1 for their own politically-expedient purposes.
What I hope anti-smoking advocates will begin to see is that there is a depth to public health policy analysis. Things are not necessarily black and white. While I think that the proposal to pursue a ballot initiative in Missouri that would increase the state's cigarette tax and allocate a substantial portion of the revenues to promote a vital public health goal as well as to provide services for smokers is appropriate and is justified on public health grounds, I think that the proposal to balance the budget in Massachusetts by raising cigarette taxes is unfair, discriminatory, and not justified on any public health grounds.
This suggests that what Jacob Sullum termed anti-smoking organizations' "knee-jerk support" for cigarette taxes may be inappropriate. To me, it is not as simple as stating that I support or do not support higher cigarette taxes. A public policy such as this one is complex and involves a number of considerations, including the intent of the proposal, the proposed uses of the revenue, and the actions that the legislature has or has not taken with regard to tobacco control policy and funding in the state.
Thus, when an anonymous blogger (sorry - the comment has been deleted after I switched to a new comment service so I cannot link to it) attacked me as no longer being a public health advocate because I put forth an argument against a cigarette tax increase proposal, it illustrated the fact that many anti-smoking groups and advocates have simply drawn a line. Any cigarette tax is a good one, regardless of anything.
For this reason, I shudder when I see a general statement like that by the Campaign for Tobacco-Free Kids, which declared that: "Increasing cigarette taxes is a WIN, WIN, WIN solution for states."
It is not necessarily a win, win, win solution. Certainly, for the most heavily addicted smokers, it is not a win situation. For the prospects for increased funding of tobacco control programs, it is not necessarily a win situation. In fact, it could be a complete decimation of any chance of obtaining a meaningful tobacco control program. For the value of fairness, it is not necessarily a win situation. And for the value of the integrity of public health policy, it is not necessarily a win situation.
The rest of the story suggests that the issue of raising cigarette taxes as a public health measure is not a straightforward one. There are many factors that need to be considered. I hope that by elucidating what I think are the most critical ones, I can contribute to a richer and more appropriate evaluation of cigarette tax policies by public health organizations and advocates.
As far as what R.J. Reynolds is arguing, I disagree...
...and I wholeheartedly agree.