First, the public health argument: it's a fairly simple argument, and one we've heard for quite some time. It says that cigarettes are a deadly product. Even when used as directed, they kill their customers -- not overnight, of course, but over the long term. Cigarettes are also highly addictive, so once a person begins smoking, it's very difficult for them to ever quit, further worsening the negative health outcome.
All of this is quite true. Cigarettes are indeed cancer sticks. Inhaling cigarette smoke is the closest thing to suicide other than jumping off the Golden Gate bridge or leaping from a tall bank building in downtown Manhattan. From a logical, reasonable, public health point of view, cigarettes should definitely be outlawed. They have no place whatsoever in a civilized society, and in fact, they are impairing the growth of society by reducing the longevity of our adult population and adding significantly to our overall health care costs.
But then we have the libertarian argument which says that people should have the free choice to do whatever they want, even if it harms their own body. We let people engage in dangerous sports, for example -- dirt biking, mountain biking, and snowboarding -- and they're responsible for their own health outcomes in those endeavors, aren't they? Well, not exactly. When people get injured in sports, their injuries are often covered by insurance, and insurance costs are shared by the population at large. So there is a hole in the argument that people only really impact themselves when they engage in dangerous activities. Because when they get hurt, it's everybody else who financially subsidizes their health care costs.
But there is a valid point in the libertarian argument: we are supposed to be living in a free society, and in a free society, shouldn't people be trusted to make their own decisions? It's not right, the argument goes, for the government to act like the parents of individuals and force people to avoid certain products or ingest other products according to whatever health standards the government has set up. And certainly few who know anything about health would trust the health judgment of the government where health policies are driven by the financial interests of Big Pharma and big business rather than legitimate public health concerns.
The libertarian argument has yet another important point to consider, and that is the effectiveness of government regulation on the sale of nicotine products. Suppose the government banned nicotine -- would that mean that nicotine products would vanish over night, and no one would have access to them? Of course not! All it would mean is that a huge black market of cigarettes would develop, and we would further enrich the drug dealers who are now peddling crack cocaine, marijuana, and other controlled substances by handing over a huge, multi-billion dollar industry in the sales of tobacco products.
This tactic would have a tremendous cost on society. Would we then declare war on tobacco the same way we've declared war on drugs today? Because the war on drugs has been a huge waste of taxpayer dollars, and has not been very effective at actually eliminating illegal drug use, drug trafficking, drug addiction, and so on. The reality of the economics here means that even if we ban nicotine products, there would certainly be a black market for them, and we might, in fact, be much better off keeping them legal where they can be regulated and taxed. So that's the libertarian argument in a nutshell, and I don't claim to speak for the libertarians on this one -- this is just an overview of the more common viewpoints on the subject.
I have an alternative solution to all of this, one that keeps the free choice in the hands of the users, and yet reduces the financial impact on the public at large. And this stems from the question: why should society have to pay for the health care costs of people who choose to commit slow suicide by consuming tobacco products? If a person is going to give themselves cancer, and if they're going to do so deliberately, day after day, year after year, is that a cost that should really be borne by their neighbors and fellow citizens? It doesn't seem fair. When there are some people taking care of their health and avoiding smoking, why should those who smoke demand that everybody else pay for their health care costs?
My suggestion is that we keep cigarettes legal, but we create a new policy that says those who engage in cigarette smoking are no longer covered by Medicare, Medicaid, or private health insurance. I know, it's pretty radical, and it will never, of course, become law, because it sounds too harsh. But let me explore a couple of interesting points on this so you can get a feel for why this is at least worth discussing.
If these smokers are going to destroy their health, they should really be outside the system of public payment for their health treatment. If they choose to take a road of slow suicide, and they're going to destroy their health and create outlandish healthcare costs, then they should be warned up front that they're going to be responsible for their own health care costs. Because right now, smokers are essentially saying to society: "You should pay my health care costs. Even though I'm going to sit around and smoke cigarettes and destroy my health, you should pay for me."
I think that we as non-smokers in society should stand up and say we are no longer willing to subsidize the slow suicide habits of people who choose to smoke. Why should we fund their healthcare costs... which is essentially a way of subsidizing their tobacco habit? It's almost as if we are rewarding them for being smokers, even while they are draining economic productivity out of society.
This approach would keep smoking legal, would allow people to exercise free will, but at the same time would make them responsible for their health choices. And of course, someone who smokes could stop smoking, and within say, one or two years could once again be covered by health insurance, Medicare, and Medicaid. That's a decision they could make to get back into the system, if they wish, but if they wait until they are diagnosed with lung cancer or heart disease while they're still smoking, it's too late.
You see, this puts the decision back in their hands without requiring the government to act like Big Brother. The arguments against this system will of course start with the most obvious, which is that this is cruel to those people who are smokers. It's cruel not to cover their health care costs -- what are you going to do, kick them out of the hospitals? My answer to that is that these people are being cruel to themselves in the first place. They are committing suicide -- they're doing it knowingly, willingly, consciously, day after day. If you're smoking, you have no regard for your own health, why should society have any more regard for your health than you do?
And actually, it's worse than that: smokers are killing those around them through the destructive effects of secondhand smoke. Not only are smokers destroying their own health and demanding that you pay for it, they're also poisoning the air we all breathe. They are indirectly compromising the health of you and your family as they sit outside buildings and erect a smoke barrier through which you have to pass just to go through the front door. So now you have increased health care costs due to the destructive habits of smokers who seem to want to light up everywhere: parks, beaches, sidewalks... you name it. Why are we subsidizing that kind of activity? Why is smoking in public places still legal at all?
Other people might say that, Mike, you're suggesting this because you've never actually lost anybody to lung cancer, you're not close enough to this issue to understand the impact of it. That's not true either -- I've lost two close family members to lung cancer. I know what it's like to be around smokers and to lose loved ones to nicotine, and it's not that I would have wanted to punish those family members by denying them healthcare, it's that I would have wanted to talk to them 40 years ago, before they ever started smoking and said, hey, you have a choice. If you want to use this product, you can, but there will be a price to pay, and the price will be long-term cancer, a lot of pain and suffering, an early death, and you will no longer be covered by health insurance, Medicare or Medicaid. You won't be paid to be a smoker. On the other hand, if you choose to avoid smoking, you can be covered by health insurance, you can live a longer, healthier, happier life, without these negative consequences. The choice is yours to make.
Free choice. It's a tricky thing, you see. Almost everybody says they want it, but nobody wants to be responsible for the consequences of it. When people exercise free choice by smoking cigarettes, they still want somebody else to pay for their cancer or heart disease. To me, that's not free choice: that's acting as a parasite on society. That's nothing more than shifting responsibility to someone else when your own free choice turns out to be the wrong choice. Some people even think health care is a "right." As in, "I have the right to use illegal drugs, smoke cigarettes, drink alcohol, get obese, avoid exercise, eat junk foods... and then to demand that you pay for my health care costs." Seriously. Some people actually believe that.
Without question, this debate about smoking will continue to rage in our society. There will be those who say we should outlaw nicotine and tobacco now. Others will say we should allow consumers to have free choice, and there will be a few who might come up with creative suggestions like the one I've offered here. But the fact remains that as long as people continue to smoke in our society, there will be a tremendous cost not to just individuals, but society as a whole.
One argument in favor of supporting a national ban on smoking is that if people can't act like adults, then maybe a government body needs to jump in and help people make some healthier decisions. If we are supposed to be trusting people to make good decisions about their health and avoid cigarettes, then why aren't they doing so? Why are there still so many people smoking? The answer is because a lot of people in this country really have the minds of children. They can't make good decisions, so it's rather ridiculous, I think, to pursue the libertarian argument and say that these people should be allowed to make decisions on their own when it comes to tobacco use. The people obviously can't handle that decision.
On the other hand, the freedom-loving individual in me says, I sure wouldn't want the government making decisions for me, because I'm fully aware of the consequences of my actions, and thus a blanket policy from the government would be unfair, if not outright Orwellian. These are some of the issues that are worth considering.