2009-09-22 20:12:26 - Two new studies confirm earlier research showing that smoking bans in public places reduce heart attacks by 25%-35%, and that a nationwide smoking ban could prevent more than 150,000 heart attacks each year. Since heart attack hospital admissions are so expensive, and long-term care can be even costlier, Action on Smoking and Health (ASH) suggests that a national smoking ban could save almost as much as some other health care funding proposals, but with no tax on anyone.

A single heart attack admission can cost $15,000-$20,000 in totally unnecessary medical bills, so a nationwide ban on smoking could save the health care system $3 billion a year, just in terms of the initial hospital admissions. Since the long term care for persons who have had heart attacks can be many times that amount, and experts believe that smoking bans will also reduce the incidence (and the costs) of treating lung cancer, emphysema, and possibly even strokes, the potential savings could be $10-$20 billion a year, an amount comparable to many the revenue from many taxes now being proposed to fund health care reform.

"Here's a very simple technique which has proven to be feasible in dozens of states, and

which has already saved billions of dollars, which Congress could do at the stroke of a pen, and slash health care costs for everyone without imposing a dime of taxes or adding one penny to the deficit," suggests public interest law professor John Banzhaf, Executive Director of ASH, America's first antismoking organization.

ASH has also proposed a surcharge on health insurance premiums paid by smokers as another alternative to taxing comprehensive health care plans, botox users, and other targets in reform bills now being debated by Congress. Banzhaf maintains that a smoker-surcharge funding mechanism is preferable because:
* MSNBC has reported that a surcharge on smoker premiums, unlike the 35% tax on comprehensive health care plans, is supported by a majority of voters
* Unlike other competing and often unpopular funding proposals, it would actually slash health care costs
* It would incorporate the concept of personal responsibility into health care reform, as Obama, Sebelius, and many other have claimed is necessary
* It is only fair, since Baucus' and other proposals would force taxpayers to pay for smoking-cessation drugs for smokers

Banzhaf notes that many media outlets are reporting widespread dissatisfaction with a Baucus-bill proposal to impose a 35% tax on comprehensive health care plans. It is argued that the proposal violates no-new-taxes pledges, that many unions oppose it because it will impact their hard-working members and retirees, there are concerns that it is unfair to those with high-risk jobs, and that, ironically, it will discourage plans which are actually already reducing health care costs.

ASH proposes a surcharge (in the nature of a user fee) on health care premiums paid by smokers. MSNBC reports that it is supported by a majority of voters. Since the small percentage of voters who smoke (only about 13% on a daily basis) impose almost $200 billion a year in totally unnecessary costs on our economy, a modest surcharge to make them repay a small fraction of that amount is fair and more than justified.

Since smokers already pay over $90 billion a year for tobacco products, a surcharge designed to raise only the same as the Baucus 35% tax plan ($22 billion a year) does not seem unreasonable, says ASH. Indeed, a $40/month surcharge would raise the same revenue, and do so without imposing any new taxes. Even a much smaller surcharge (e.g., less than $20/month), would bring in $100 billion over 10 years, and be an important step in the right direction.

ASH's plan would also incorporate "personal responsibility" into health care reform, something everyone -- including President Obama and HHS Secretary Kathleen Sebelius -- says is necessary, but which no one is actually proposing. ASH suggests that it is fairer to impose some of the costs of health care reform on those primarily responsible for most unnecessary and preventable medical expenses, rather than on those who simply have comprehensive health care plans.

ASH notes that there is a certain irony in proposing to fund plans to provide more health care to Americans by imposing a whooping 35% tax on health plans which unions, hard working Americans in risky occupations, and others have fought so hard for, and which presumably help to hold down those very health care costs.

Numerous studies show that even moderately increasing the costs of smoking -- e.g., higher taxes, the multi-state tobacco settlement, etc. -- help the overwhelming majority of smokers who already want to quit to do so, with a corresponding decline in both long-term and short-term health care costs and related expenses.

Indeed, if a smoker surcharge could reduce smoking by as little at 10%, it would save about $20 billion a year -- about the same as the Baucus 35% tax -- and that doesn't count the revenue raised from the surcharge itself. Thus it would be a win, win, win proposition, argues Banzhaf.

The Baucus bill would require that Medicaid cover smoking cessation drugs like Chantix, Zyban, and others. This would be a tremendous benefit to the great majority of smokers (estimated to be over 80%) who already want to quit, but who haven't yet been able to do so on their own. But it would also impose on the great majority of voters who do not smoke the obligation to pay increased taxes to cover the costs for the drugs.

It could thus be argued that, as a quid pro quo for this additional benefit, smokers should have to contribute towards health care costs. Those who are able to quit with the help of these drugs will no longer have to pay a surcharge on their health insurance, and they and their families will lead longer, healthier lives with much lower medical care costs for themselves as well as for taxpayers. Those who choose not to quit now will be required to pay at least a small portion of the costs their choice to smoke imposes on nonsmokers, but these drugs will remain available to them in the future.

The complete smoker-surcharge proposal by Action on Smoking and Health (ASH), America's oldest antismoking organization, can be found at:
ash.org/proposalsurcharge

PROFESSOR JOHN F. BANZHAF III
Professor of Public Interest Law at GWU, and
Executive Director and Chief Counsel
Action on Smoking and Health (ASH)
America's First Antismoking Organization
2013 H Street, NW
Washington, DC 20006, USA
(202) 659-4310 // ash.org