The political fresh air sweeping through Washington may soon become literal, as congressional Democrats prepare legislation to toughen regulation of cigarettes and other tobacco products.
Two actions by the federal government would have the biggest positive impact on public health: enactment of a Medicare-for-everyone national health insurance program, and tougher regulation of tobacco, the most preventable cause of illness and death.
The Food and Drug Administration has regulatory authority over almost everything Americans consume internally--except tobacco. Here's a brief history from the American Heart Association:
[T]obacco is one of the least-regulated consumer products in the marketplace. The tobacco industry's political and economic influence has allowed tobacco products to be exempted from virtually every consumer health and safety law enacted by Congress.
In 1996 the U.S. Food and Drug Administration (FDA) asserted jurisdiction over tobacco products under the Food, Drug, and Cosmetic Act. ... The tobacco industry sued the federal government, arguing that the FDA lacked legal authority to regulate tobacco products. The United States Supreme Court ruled in June 2000 that Congress had not expressly given the FDA legal authority to regulate the tobacco industry, and that the Congress must specifically enact legislation to allow the FDA to regulate tobacco. As a result, all FDA tobacco regulations were dropped...
In July 2008, such legislation passed the House, but was never taken up in the Senate due to opposition by Bush and Senate Republicans. Bush had already vetoed an increase in cigarette taxes in 2007.
The 2008 legislation, according to the Campaign for Tobacco-Free Kids, would have required larger and more effective warnings on tobacco products nad required tobacco companies to disclose the contents of their products. Health warnings on cigarettes in other countries are much more explicit than the laughably generic "hazardous to your health" message in the U.S. And if the tobacco companies were required to list ingredients, what would happen to smoking rates once people see that cigarattes contain ammonia (to increase the addictive properties of nicotine) and that smokeless tobacco contains ground fiberglass (to cut the gums and allow nicotine to enter the bloodstream)?
Recent reports from the New York Times and The Atlantic's Marc Ambinder indicate that congressional Democrats, with the Bush veto threat removed, are again preparing legislation authorizing the FDA to regulate tobacco products. According to the Times account,
In the House, Henry A. Waxman of California, a Democrat and chairman of the Energy and Commerce Committee, plans to move quickly with the F.D.A. legislation... A majority of House and Senate members are co-sponsors, and Mr. Waxman’s former chief of staff, Philip M. Schiliro, has been named Mr. Obama’s White House liaison to Congress.
Democratic leaders in both houses of Congress... have also said they hope to pass legislation to raise federal cigarette taxes by 61 cents, to $1 a pack.
Altria, the largest tobacco company, seems resigned to the prospect of increased regulation, but they already control 50% of the U.S. market. The smaller companies will put up a fierce fight because the regulations would hamper their ability to cut into Altria's share with new products. You can also be sure that Senator McConnell from tobacco-growing Kentucky will threaten a Senate filibuster. According to Ambinder, plans are to have the legislation on the desk of President (and intermittent smoker) Obama by March.
Although FDA regulation of tobacco would be a major step forward in protecting public health, the legislation would be a mixed blessing in that the tobacco tax revenue would be used to finance the SCHIP children's health insurance program. Obviously the intention is to finance SCHIP by targeting cigarette smokers, a constituency with diminishing numbers and clout. This is still a seriously flawed way to address the problem of providing health insurance to children and does nothing to provide coverage for their parents. So now I'm back to the other major step: comprehensive, publicly financed, Medicare-for-all health insurance. Note that I've avoided the term "single payer" because that framing will not help to reach that goal. More on that in a later post.
Hat tip to reader "boomersun" at Open Left, where I found the Ambinder item.