In my earlier post today, I cautioned against a hasty acceptance of the Iowa legislative leadership's proposal to provide universal health care coverage to Iowans through revenues generated by an increased cigarette tax on the grounds that it would make health care coverage dependent upon high levels of continued cigarette consumption. Here, I argue that the proposal is unfair because it balances the state budget on the backs of smokers.
What anti-smoking advocates need to realize is that when a cigarette tax increase to generate revenues to fund government programs, it is smokers who are paying for those programs. Even if some smokers choose to quit or cut down on the amount they smoke due to the tax, other smokers will be the ones who shoulder the burden of paying for those programs. This is unavoidable.
It is also true that in general, the heaviest smokers (the ones who will pay for the government programs) are among the poorer citizens. They are the individuals who can least afford the added burden of paying for these government programs.
If one were deciding the fairest way to allocate the financial burden of paying for a new government program, would it not be most fair to put that burden on those (individuals and companies) who can most afford to pay for it, rather than the opposite?
Anti-smoking advocates may argue that the tax is actually benefiting smokers because it causes many of them to quit smoking or at least to reduce the number of cigarettes that they smoke. While this is true, one cannot escape the fact that many smokers will not quit, and it is these smokers who will pay for the programs for the benefit of everyone else.
It seems to me that if you are going to use taxes to fund specific new programs, the benefits of the tax should accrue, at least in part, to those who are paying it.
For example, if we want to widen the Mass Pike to decrease commuting time and we decide to obtain the needed revenue by increasing tolls on the Pike, that seems fair because the people who are paying those tolls are precisely the ones who stand to benefit from the reduction of Pike traveling time (this is, by the way, why you won't hear me complaining about the recent toll increases - sure I'm paying for it, but I'm also benefiting from it).
Providing universal health care coverage for all Iowans benefits all residents who don't currently have health insurance. However, the majority of those people do not smoke. So the only ones paying for the program will be smokers; yet, the majority of those benefiting from the program will be nonsmokers. This seems inherently unfair.
One could argue that smokers do benefit from the tax increase because it helps them to quit smoking. But if they quit, they will not be paying the tax. The burden of the tax will accrue to those who do not necessarily benefit from it.
It would be one thing if the tax were to be used specifically for programs that benefit smokers - such as prevention and cessation programs and medical care costs for smokers. I support the idea of cigarette tax increases when the revenue is used specifically for the prevention or treatment of smoking-related illnesses. Because in those situations, the people bearing the tax burden are precisely those to whom the benefits accrue.
But when the revenue is being spent for ancillary purposes -- especially for programs that the government should be funding anyway -- then the tax is inherently unfair.
What troubles me is that anti-smoking groups seem to have knee-jerk support for any cigarette tax increase, without even considering the fairness of the specific proposal and the distribution of the burden and benefits of the tax increase.
It needs to be recognized that principles of fairness, equity, and social justice are central principles of public health practice. Contrary to what many tobacco control practitioners seem to believe, public health is not simply about improving the public's health. It is about improving the public's health in a way that is consistent with equity and fairness, and in a way that advances, rather than impedes, the provision of social justice to all citizens.
From what I can see of the Iowa cigarette tax proposal so far (it is still in the draft stage and there is nothing on paper to review yet), it appears to be an unfair policy that will pay for a new government program that would otherwise throw the budget out of whack by taxing the poorer citizens of the state, rather than those who can most afford to pay for the program. I do think it is time to stop balancing state budgets on the backs of smokers.
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