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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.

Originally posted to laviolet on Sat Jan 24, 2009 at 08:10 AM PST.

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Comment Preferences

  •  Would those changes decrease smoking rates? (1+ / 0-)
    Recommended by:
    Lujane

    I'd think there should be good data if other countries have already effected similar changes.

    We are building a team that is continuously being built. - Sarah Palin

    by burrow owl on Sat Jan 24, 2009 at 08:19:35 AM PST

    •  Yes, but only gradually (1+ / 0-)
      Recommended by:
      Lujane

      That's what happened following the publication of the landmark 1964 Surgeon General's report.

      •  We are already down to the hard-core smokers... (0+ / 0-)

        I wouldn't expect much change...

        •  Depends on How Far They Go.... (4+ / 0-)

          The ultimate game plan of the hard-core antitobacco ideologues like the diarist is to use the FDA regulation to remove all additives out of tobacco products (except addictive nicotine of course...they have no plans to remove that and jeopardize their revenue stream).  If they go this far, most smokers won't like the taste of post-regulation cigarettes.  Legal cigarette sales will plummet while the tobacco black market will fill the void with billions of dollars worth of "real" cigarettes from overseas.

          Ultimately, I'm doubtful that the government would go that far.  They have a sweet little gig going with corporate tobacco and profit hundreds of billions per year from it.  At a time when revenues in general are plunging, it's hard to imagine they want to turn tobacco into Narcotics 2.0 where instead of taking in tidy profits from the industry, they're forced to spend billions of dollars per year chasing after the black market.

        •  What do you mean? (0+ / 0-)

          I've heard the statistic frequently that 25% of adults in the US smoke.

      •  That took us from no knowledge to knowledge. (1+ / 0-)
        Recommended by:
        Lujane

        What we're talking about here is a warning to a more prominent warning.  Those two shifts seem so dissimilar that I'd be wary of drawing out a conclusion from them.

        We are building a team that is continuously being built. - Sarah Palin

        by burrow owl on Sat Jan 24, 2009 at 08:41:08 AM PST

        [ Parent ]

    •  Not Likely.... (3+ / 0-)
      Recommended by:
      capelza, Lujane, mellowwild

      Government is wholly dependent on robust cigarette sales to finance its operations, and if the massive new tobacco tax used to finance the SCHIP expansion, they fully intend to mortgage an even higher share of the federal budget on tobacco for the future.  They want it both ways, but will ultimately yield to keeping the gravy train on the rails.  Government can scarcely afford to jeopardize its profit-sharing agreement with tobacco companies.

    •  The tax increase is the most powerful tool (1+ / 0-)
      Recommended by:
      Lujane

      to reduce consumption. Scientific studies, published in reports by the CDC and the US Surgeon General, show that overall adult elasticity of demand for tobacco is about 0.4 - which means that a 10% increase in price results in a 4% decline in tobacco use by adults. The kicker is that under 18 elasticity is higher, about 1.2 - meaning that you get a 12% decline in youth smoking for a 10% increase in price. And you get about a 4% decrease in prevalence of tobacco use among youth with a 10% price increase - decrease in prevalence means some are quitting entirely.

      "The millions who are in want will not stand idly by silently forever while the things to satisfy their needs are within easy reach." Franklin Roosevelt

      by semiot on Sat Jan 24, 2009 at 09:46:15 AM PST

      [ Parent ]

      •  How Does This All Come Together? (2+ / 0-)
        Recommended by:
        capelza, mellowwild

        The feds and especially state governments are making their budgets more dependent on robust tobacco sales with each passing year, yet your statistics confirm that the persistent increasing of soak-the-poor tobacco taxes is effective in diminishing the ranks of smokers.  Where does the money come from to finance government if smokers keep quitting?  This is absolute madness and speaks very poorly of most progressives' understanding of basic economics.

        •  Actually, people with below average income (0+ / 0-)

          have a higher elasticity for demand than the general population - meaning that the poor are more likely to cut consumption or quit altogether if prices go up, so their health in the aggregate is benefitted  more from a tobacco price increase than is that of the general adult population.

          "The millions who are in want will not stand idly by silently forever while the things to satisfy their needs are within easy reach." Franklin Roosevelt

          by semiot on Sat Jan 24, 2009 at 01:28:22 PM PST

          [ Parent ]

  •  You brought it up... (6+ / 0-)

    These insipid targeted revenues are nonsense. First, it was state lottery and casino taxes were going to balloon funding for public education. Then, tobacco settlement funds were going to skyrocket funding for public education, except for the massive amounts that were going to be used for smoking cessation programs. Fail and MAJOR FAIL.

    As you point out, if SCHIP is money well spent, don't use a doomed gimmick to fund it. Pay for it just like all other public expenses, through the general revenue fund. This is business as usual and will only creat MORE FAIL.

    I voted with my feet. Good Bye and Good Luck America!!

    by shann on Sat Jan 24, 2009 at 08:24:45 AM PST

    •  The lottery can work. (0+ / 0-)

      Georgia, of all states, proves it with the HOPE scholarship.  I wouldn't be nearing a degree without the GA lottery.

      An agnostic not because I don't know if there's a God, but because I don't care.

      by filmgeek83 on Sat Jan 24, 2009 at 08:29:24 AM PST

      [ Parent ]

      •  In MI (3+ / 0-)
        Recommended by:
        Odysseus, capelza, Lujane

        lottery revenues were used for education, but only as a replacement for general fund expenditures, not as an additional source of funding. So, no net gain for education, just the ability to piss away general fund money on things like prisons.

        "All that serves labor serves the nation. All that harms labor is treason. -Abraham Lincoln

        by happy camper on Sat Jan 24, 2009 at 08:31:33 AM PST

        [ Parent ]

        •  And this is a counterpoint to my argument how? (0+ / 0-)

          Your states legislators are morons, but that does not mean the lottery, properly administered, cannot help.

          An agnostic not because I don't know if there's a God, but because I don't care.

          by filmgeek83 on Sat Jan 24, 2009 at 08:51:24 AM PST

          [ Parent ]

          •  Do some research on the effects of lotteries (3+ / 0-)
            Recommended by:
            capelza, happy camper, mellowwild

            on the people who play them.  They are generally poorer and less able to afford to lose the money they lose regularly - meanwhile Mr & Mrs Country Club get lower taxes on their lovely home.  Encouranging people who can least afford to throw their money away is no way to properly fund government programs.

            •  Just Like Cigarette Taxes..... (3+ / 0-)
              Recommended by:
              inclusiveheart, capelza, mellowwild

              ....and the pending "fast food/soda pop taxes" about to hit us.  From what I can see, the nation's tax policy is about to become massively more regressive under Democrats than it ever was under Republicans.

              •  It is entirely possible. (3+ / 0-)
                Recommended by:
                capelza, Mark27, mellowwild

                The irony is that people wasting money on lottery tickets might be able to afford slightly better quality food from time to time with their extra money - and now that the recession/depression is on they want to go and tax the cheapest meals that are yes not so great for you - but they are better than going without food altogether.

                I am so tired of people latching onto ONE thing and thinking they are going to be able to solve the world's problems by address that ONE thing.  Our day-to-day lives are chock full of cancer causing agents.  Tobacco is the whipping post, but so many other things we encounter daily are really taking their toll - of course those things have not been studied extensively like tobacco has so people - politicians in particular - like to write that whole can of worms off and stick with the easy route of addressing tobacco exclusively.  If there was a real effort to keep people healthy, we'd have addressed the carcinogenic effects of diesel fumes well before we went after tobacco usage.

            •  Te lottery is a tax on stupidity (0+ / 0-)

              "The millions who are in want will not stand idly by silently forever while the things to satisfy their needs are within easy reach." Franklin Roosevelt

              by semiot on Sat Jan 24, 2009 at 09:48:58 AM PST

              [ Parent ]

              •  True...So Why Is It Defended By Progressives? (3+ / 0-)
                Recommended by:
                Odysseus, capelza, mellowwild

                Aren't we the ones supposed to be protecting vulnerable people rather than preying on their weaknesses?

                •  I don't defend it. (1+ / 0-)
                  Recommended by:
                  capelza

                  But I'm not a progressive - I am a liberal.

                  •  Most Liberals Prefer To Be Called Progressives... (2+ / 0-)
                    Recommended by:
                    capelza, mellowwild

                    ....I'm fine with either one.  Either way, glad you're not showcasing your liberal/progressive bona fides by crowing how the lottery is a tax on the stupid like some are.

                    •  I call myself a liberal because my understanding (2+ / 0-)
                      Recommended by:
                      capelza, Mark27

                      of the terms has led me to believe that there is actually a difference - this personal responsibility stuff is one very big area of disagreement between me and most people who call themselves progressive.  I believe in broader liberal policies and programs rather than targeted initiatives like taxing tobacco or soda heavily.  I think that the government's involvement in personal behavior has gotten well out of hand both from the right and the left because both sides seem to be afraid of doing anything big like just pass Medicare for all already and be done with this piecemeal ineffective system we are supporting now.  I think that taking all the money from Tobacco Free Kids and all of those other windfall dollars wasted on pamphlets and advertising and giving Americans access to yearly check ups with doctors will do more to make Americans healthy overall than any of those programs have - especially knowing how many millions of dollars have gone into them.

              •  More like a tax on desperation - or rather (4+ / 0-)
                Recommended by:
                semiot, capelza, Mark27, mellowwild

                preying upon desperation.

                If you know your lot in life is never going to be more than very little, dreaming of winning a lottery is hard not to do.  It doesn't make you stupid necessarily.  It makes you human with aspirations of living an easier life.  That is why it is even more disgusting that these operations are run by our government.

                •  I agree that the government (0+ / 0-)

                  ought not to promote the lottery, or count on it for income. Having said that, I have to say it is stupid (or maybe "ignorant" is the better term), given the odds, to waste one dollar on the lottery - especially if that dollar could go for things of actual benefit to oneself and one's family.

                  "The millions who are in want will not stand idly by silently forever while the things to satisfy their needs are within easy reach." Franklin Roosevelt

                  by semiot on Sat Jan 24, 2009 at 01:32:58 PM PST

                  [ Parent ]

          •  Not a counterpoint (1+ / 0-)
            Recommended by:
            Odysseus

            just a comment that there are many ways for such money to be earmarked, and we have to watch for sleight of hand. Your legislators funded a specific program, rather than simply replacing existing sources of funding for education in general. Good on them. Ours basically tossed the money in the pot, and did not increase funding for education.

            And yes, our state legislators tend to be morons, which I attribute in large part to term limits. But that's another story.

            "All that serves labor serves the nation. All that harms labor is treason. -Abraham Lincoln

            by happy camper on Sat Jan 24, 2009 at 09:09:48 AM PST

            [ Parent ]

        •  Gotta watch out for shell games. (1+ / 0-)
          Recommended by:
          capelza

          Illinois has the same structure.  General revenue funding was shifted away from education as the lottery proceeds were earmarked for Education.

          -7.75 -4.67

          "Freedom's just another word for nothing left to lose."

          There are no Christians in foxholes.

          by Odysseus on Sat Jan 24, 2009 at 10:10:53 AM PST

          [ Parent ]

      •  When the economy tanks (3+ / 0-)
        Recommended by:
        Odysseus, happy camper, mellowwild

        however, those lottery tickets don't get purchased so much, and whatever program depends on them loses funding.

        CA's lottery income dropped dramatically in the last couple of years as the price of gas rose-- many lottery ticket purchases being made at gas stations with the change, in years past.

        http://articles.latimes.com/...

        I must be dreaming...

        by murphy on Sat Jan 24, 2009 at 08:42:32 AM PST

        [ Parent ]

    •  Applause, Applause.... (2+ / 0-)
      Recommended by:
      shann, mellowwild

      It never ceases to amaze me how easy it is for cynical politicians looking for an easy, gimmicky revenue windfall through regressive and unethical "sin taxes" can play the sanctimonious health-and-wellness scolds like the diarists like a $10 banjo time and time again.

  •  Regulation won't help. (1+ / 0-)
    Recommended by:
    semiot

    This is one instance I don't think regulation is the answer.  Better education works, and has been proven to since the rates of teenage smoking has gone down.  Tell kids what's in cigarettes and less of them smoke.  It's one instance where government propaganda is completely justified.

    An agnostic not because I don't know if there's a God, but because I don't care.

    by filmgeek83 on Sat Jan 24, 2009 at 08:32:43 AM PST

  •  first get universal health care (4+ / 0-)

    Tell you what, first get universal health care and then we will talk about tobacco.  Until then it is the height of hypocrisy to deny preventive health care to folks because of wealth, while at the same time regulating their behavior because it might have a cost effect on this imaginary health care.

    Even so, we need to return to the days when personal liberties and freedoms were valued.  I’m still not ready to trade liberty for the illusion of safety.

  •  "Feel Good" Pandering (4+ / 0-)

    Every time politicians take actions they say are against "big tobacco," the Tobacco Industry survives just fine (after all, it's one of the last remaining export industries left in the USA) but the ones that get hit are the one-out-of-five American adults who smoke. They're disproportionately poor and minority, get hit with the most regressive tax in the United States, pushed outside to catch pneumonia in the name of "public health," and otherwise stigmatized, demonized, and treated like lepers.

    But it doesn't stop us from smoking.

    It never will.

    •  Yep...Government Makes Out Like Bandits.... (2+ / 0-)
      Recommended by:
      capelza, mellowwild

      ....the tobacco industry does just fine....and low-income smokers and their children get their pockets picked by sanctimonious politicians.  Yet the people who perennially support this unconscionable fleecing are "progressives".  Just ask them!

  •  considering the burden (1+ / 0-)
    Recommended by:
    semiot

    that tobacco places on our health-care system, a steep rise in taxes is absolutely necessary. It works on two levels, forcing some to quit, and giving society something back. This is really that way progressive taxes work, too--big capital avails of the natural resources (the commons) that we all share, and draws the benefits without giving back.

    High taxes discourage certain deleterious activities, and give us something back. We need to educate people about this absolutely necessary role of taxes in maintaining a finite world.

    •  Tobacco Saves Our Health Care System Billions... (3+ / 0-)

      It's a controversial point, but due to the early attrition of smokers, the lifetime health care tab run up by smokers is 21% lower than that of healthy-weight nonsmokers.  If everybody smoked a pack a day, Medicare would be indefinitely solvent.

      This is not an endorsement of everybody smoking a pack a day, but is a disendorsement of the canard that "smokers are a burden on our health care system".  As often as that meme is shouted through the echo chambers of the health-and-wellness police, it's diametrically opposed to reality....and just an excuse to pick the pockets of Americans with household incomes of $30,000 per year.

      •  I don't know where you got that 21% number... (0+ / 0-)

        ...but here are the facts.

        "For 1997–2001, cigarette smoking was estimated to be responsible for $167 billion in annual health-related economic losses in the United States ($75 billion in direct medical costs, and $92 billion in lost productivity),13 or about $3,561 per adult smoker."

        http://www.cdc.gov/...

        Those costs are of course even higher now.

        •  I Got My Figures Here.... (2+ / 0-)
          Recommended by:
          capelza, mellowwild

          http://www.omaha.com/...

          Given that this study is financed by the Dutch government, it's hard to write off as tobacco company blather.  On the other hand, the CDC has a long history of manipulating scientific data to validate their preordained conclusion on all matters related to smoking.  

          Undoubtedly, their $75 billion in health-related costs figure is a gross calculation of all smoking-related health care costs incurred between 1997 and 2001 and not a net calculation that compares it to the nonsmoking population's health care costs.  Kind of like an insurance company saying Client A cost us $5,000 in auto repairs without accounting for the fact that the company had made $10,000 in premiums from Client A before he filed his $5,000 claim.

          This is the sort of three-card monte game the CDC and other antismoking groups play all the time.

  •  also an easy issue (0+ / 0-)

    to win people over about; there's already a broad predisposition twd taxing big 'backy.

    •  Not Always..... (2+ / 0-)
      Recommended by:
      capelza, mellowwild

      On the surface, you're right.  It's politically easy for "progressive" middle-class nonsmokers to smugly argue why the smelly working-class filth on the other side of the tracks should be forced to single-handedly absorb a massive new tax, but it doesn't take much to change the debate.  Look at the 2007 ballot initiative in Oregon, which was a miniaturized version of SCHIP with the same funding mechanism, forcing low-income smokers to finance middle-class health care.

      The lobbying effort was wildly persuasive, even in liberal Oregon, to convince the public of the obvious...that it's batshit crazy to make sales of a deadly and diminishing product solely responsible for financing a huge new government program that will generate ever-increasing operational costs.  It failed 60-40.  Particularly when you factor in the increased prevalence of cigarette smuggling as a consequence of perenially increasing cigarette taxes, if the tobacco tax madness got as fair of a public hearing nationally as it did in Oregon, support for the current SCHIP program would shift from 2-1 in favor to 2-1 against in the course of a month.

  •  Using someone's addiction (2+ / 0-)
    Recommended by:
    Mark27, Jez

    to fund health care is just wrong.

    Especially when the goal is to stop smoking.  

    Or, like the lottery and state run video poker and the like...the state actually preys on the weak for money.

    Fund the SCHIP and other healthcare programs, period.   Don't tie the funding to any one thing, especially smokers.   It creates a moral bind.  We want people to stop smoking, but we need the money smokers give us to provide healthcare to others.

    •  It's So Diametrically Opposed.... (4+ / 0-)
      Recommended by:
      Odysseus, capelza, Jez, mellowwild

      ....to every aspect of what I've always believed to be progressive values.  Supporters of tobacco taxes (and other aspects of the seemingly endless list of grievances modern-day progressives have with smokers) manage to simultaneously violate the principles of progressive taxation, tolerance towards others, and sane budgeting by tirelessly calling for their antismoking jihad.  Seems like Dems are determined to make whatever gains they made with working-class voters in the last two election cycles as short-lived as possible.

      •  I couldn't agree more (3+ / 0-)
        Recommended by:
        Mark27, Jez, mellowwild

        It is something I find very disturbing...

        But especially the hypocrisy of the funding ideas.   Either you want them to quit, or you expect them to fund something with their addiction.   Once the funding is locked into that addiction, the "moral high ground" is lost anyways.  

  •  Package Warnings in the UK (0+ / 0-)

    I have always been amazed at the small print warnings in the USA.

    Here in the UK, they are in bold large print taking up much of the package, they are also direct and to the point. One of the more interesting package warnings I have seen is;

    SMOKING CAUSES IMPOTENCE

    I am an ex pat lifelong Republican voting for Obama, dual nat member of New Labour, that works in The City.

    by Libertarian Friend on Sat Jan 24, 2009 at 10:00:39 AM PST

  •  Actions should have direct consequence.. (0+ / 0-)

    When there is a tax on tobacco and that revenue is used to fund college scholarships, what message is given to the smoker?

    I have been amazed in the US how taxes have little to do with what is being taxed.

    May I offer a small step that would reinforce actions have consequences and help with the American health care crisis.

    In the United States as well as the United Kingdom, life insurance premiums are dependent on smoking status. However, in the United States much of the health insurance sold is not dependent on smoking status. Would it not make sense to require health care premiums to charge larger premiums to smokers so non-smokers do not subsidize them? Or better yet, have smokers pay an "excess premium" that is directly used by the insurer to keep premiums lower for non-smokers?

    I am an ex pat lifelong Republican voting for Obama, dual nat member of New Labour, that works in The City.

    by Libertarian Friend on Sat Jan 24, 2009 at 10:06:26 AM PST

  •  You have to attack the image of smoking... (0+ / 0-)

    People know it's unhealthy, and know they could spend the money elsewhere, but kids get locked into the imagery.  The "I don't give a damn" badassry of it in the movies and television shows.

    How many smokers take it up for the first time in their 20's? I bet the percentage is very low.  It's all about getting the kids addicted when they're young and impressionable.  Big tobacco doesn't cell cigarettes, they sell an image.

    And did you exchange A walk on part in the war For a lead role in a cage?

    by Jonze on Sat Jan 24, 2009 at 10:08:55 AM PST

    •  How Do You Attack Its Image..... (1+ / 0-)
      Recommended by:
      capelza

      ....without violating basic freedoms of speech?  We're already sacrificing property rights in the name of antitobacco jihad.  Does freedom of speech have to go too?

      And frankly, it's hard to imagine the "image" of smoking being any less glamorous than it is today, with chattering-teeth smokers huddled "25 feet away from building entrances" while puffing on their cigarettes.

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