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All Smoke


Let’s see if I have this straight: The tobacco companies will pay the states $206 billion over the next 25 years to “reimburse” them for medical expenses incurred for the treatment of Medicare patients with smoking-related illnesses. As part of the settlement of state lawsuits, the companies have pledged to combat teen smoking in a variety of ways: no more Joe Camel or sponsorship of sporting events or logo-laden hats and jackets. Where are the First Amendment absolutists?

The price of cigarettes is already going up. I hope no one is surprised. Businesses have only one source of money: their customers. So, thanks to the states’ attorneys general, cigarette smokers, who disproportionately are lower-income people, will “reimburse” Medicare for the illnesses of other smokers. Now that makes a whole lot of sense.

Logic is not a conspicuous feature of the settlement.

If a person smokes all his life and gets sick, and if the government pays for treatment (a proposition we’ll examine in a moment), why is reimbursement due from the makers of cigarettes? How about those who sold the cigarettes at wholesale and retail? Without them, the consumer wouldn’t have smoked the manufacturer’s product. (While we’re at it, why not go after everyone involved in the production of fatty foods for reimbursement for heart-bypass operations?)

But we have to go deeper than that. No one is forced to smoke. Kids try cigarettes for the first time out of curiosity, under peer pressure, or because it looks cool. That first smoke usually makes them sick. If they try a second time, that’s a choice they make. It might be a dumb decision, but it is a decision. And in a free country, it is between them and their parents. The government should butt out.

Anyone is capable of quitting. There are more ex-smokers than smokers in America. Most quit without help. The complaint that “the cigarette makers made me do it” is hollow.

If Medicare really wants to get tough, why doesn’t it bill the patients? And then it could announce that henceforth it will no longer pay for the treatment of smoking-related illness. If you smoke, you’re on your own. I suspect the administrators and politicians behind them would quake at such an idea. But since people choose to smoke, and the government wants to discourage smoking, why not put them on notice that the taxpayers won’t pay for their medical treatment?

I can think of a few reasons why the government wouldn’t do that: political cowardice and the cigarette makers’ deep pockets. Principle and logic obviously have nothing to do with it.

My suggestion is only half-serious. The fully serious version is that no one, smoker or not, should expect the taxpayers to pay for their medical care. It’s unjust. Government is a bad health insurer. We don’t need government health insurance.

It’s worse than that. Government health insurance for the elderly (or anyone else) is frightening. Sooner or later, the government will get into the triage business. The scarcity of resources and inevitable cost inflation will prompt it to decide who gets what medical care. Today it may seem alarmist to warn that the government could refuse to pay for the treatment of older smokers and people with clogged arteries. Tomorrow, it will be accepted public policy. When government gives something away, there can’t be enough of it to go around. Then the government will ration.

The unjust extortion of the tobacco companies merely puts off the day when the inexorable logic of government health insurance starts to bite. After the states squander the $206 billion and Medicare is strapped for cash, government will begin saying who shall live and who shall die.

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    Sheldon Richman is former vice president and editor at The Future of Freedom Foundation and editor of FFF's monthly journal, Future of Freedom. For 15 years he was editor of The Freeman, published by the Foundation for Economic Education in Irvington, New York. He is the author of FFF's award-winning book Separating School & State: How to Liberate America's Families; Your Money or Your Life: Why We Must Abolish the Income Tax; and Tethered Citizens: Time to Repeal the Welfare State. Calling for the abolition, not the reform, of public schooling. Separating School & State has become a landmark book in both libertarian and educational circles. In his column in the Financial Times, Michael Prowse wrote: "I recommend a subversive tract, Separating School & State by Sheldon Richman of the Cato Institute, a Washington think tank... . I also think that Mr. Richman is right to fear that state education undermines personal responsibility..." Sheldon's articles on economic policy, education, civil liberties, American history, foreign policy, and the Middle East have appeared in the Washington Post, Wall Street Journal, American Scholar, Chicago Tribune, USA Today, Washington Times, The American Conservative, Insight, Cato Policy Report, Journal of Economic Development, The Freeman, The World & I, Reason, Washington Report on Middle East Affairs, Middle East Policy, Liberty magazine, and other publications. He is a contributor to the The Concise Encyclopedia of Economics. A former newspaper reporter and senior editor at the Cato Institute and the Institute for Humane Studies, Sheldon is a graduate of Temple University in Philadelphia. He blogs at Free Association. Send him e-mail.