Governor Chet Culver and Democratic leaders in Iowa have proposed a one dollar per pack increase in the state's excise cigarette tax in order to provide the revenues needed to fund universal health care coverage for Iowans. According to an article in the Charles City Press, improving health care coverage was a critical part of the election campaign for the governor and many Democratic leaders. However, this coverage cannot be provided without finding a new source of revenues, and a cigarette tax is being proposed as the source: "We cannot reach universal health care without a large infusion of public dollars,’’ said Sen. Jack Hatch, D-Des Moines."
According to an article in the DesMoines Register, "Gov. Chet Culver has offered "compelling arguments" for a $1-per-pack cigarette tax increase, and lawmakers likely will make a quick decision on the issue, House Speaker Pat Murphy said Friday. Murphy, a Dubuque Democrat, initially resisted Culver's call for the increase in the cigarette tax, arguing that lawmakers likely would not approve more than a 60-cent-a-pack increase. But Murphy said he and many other legislators are softening their opposition because of pressure from Culver and a realization that proposed expansion of health care programs rely on the full $1 increase. ... Murphy said he is working to ensure legislators understand that the cigarette tax is key to Culver's plan to expand access to health care, including to 50,000 children who lack coverage and to 6,000 adults working at or near the poverty level. "One of the things that legislators have to understand is that several of the things Governor Culver sets out in his budget are based on this," Murphy said."
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As currently fashioned, this proposal is a very bad idea. The last thing in the world that we want to do is to make health care coverage of our poorest citizens dependent upon people continuing to smoke.
While it may appear attractive as a short-term fix, in the long-run, all this idea does is to make the state of Iowa, and the health of its citizens, dependent upon continued cigarette consumption. It all but eliminates the incentive for policy makers to take any subsequent actions that would substantially reduce cigarette smoking rates in Iowa. This is not a prescription for a healthy public health system or for healthy public health policy.
In fact, the proposal would establish an infrastructure under which healthy public health policy can no longer thrive. You simply cannot have rational public health policy in a state when your children and your poor are depending on cigarette tax revenues in order to be able to obtain their health care.
I have a number of suggestions for opponents of this legislation. Actually, they are ideas for T-shirts that could be used to reveal the true nature of what lawmakers in Iowa are on the verge of establishing. Here goes:
1. "Support our children. Buy by the carton."
2. "Support the poor in Iowa. Smoke cigarettes."
3. "Help provide health care coverage for all Iowans. Chain smoke."
4. "Try harder. Be a better citizen. Help ensure your neighbor's health. Smoke more."
5. "Keep health care available for all Iowans. Smoke early and often."
6. "Don't let 50,000 kids down. They're depending on you. Please don't quit smoking. Do it for the kids."
7. "Help 6,000 poor Iowans get health care. Smoke as much as you can."
The knee-jerk support for any and all cigarette taxation by public health and anti-smoking groups is problematic. This kind of thinking supports the above absurdity. If anti-smoking groups made it clear that they would not support cigarette tax increases unless the revenue was used to directly benefit smokers and reduce tobacco-related morbidity and mortality (i.e., specifically allocated to fund smoking education, prevention, and treatment programs), then we would not likely have this kind of stupidity going on.
Unfortunately, the support of anti-smoking groups for cigarette taxation is a knee-jerk response, with very little thought going into the unintended consequences of these policies. And having health care dependent upon continued smoking is one of the most absurd of these consequences.
Not all cigarette tax increases are win, win, win proposals, as the Campaign for Tobacco-Free Kids and other anti-smoking groups have suggested. When our health care system depends upon continued cigarette consumption in order to provide essential medical care to the children and poor, then we are not in a win situation. In fact, it's about as bad of a loss as I can think of when it comes to funding for health care.