Everytime gas gets out of whack, there is a push to lower to taxes (despite crumbling roads, bridges, etc.).
Don't expect the cost of gas to drop, though ... the oil companies simply charge more to their retail folks, who then pass it on. Why? Because "neighboring states pay as much" etc.
Balance the budget on the backs of addicts.
It's been the strategy as long as I can remember (and that's a long time).
Bump up the tax on cigarettes and beer as needed, then scold folks for smoking and drinking. Set up some sort of fund for educating people about the dangers of addiction, then spend the fund for something else entirely. When that money's gone, repeat Step One.
Still not enough money? Push scratch tickets a little harder and call for casinos to make up the difference. (And remember to caution folks to get help if they think they're having a problem with gambling. Just wait until after you've bought a Quik-Pik to make the call, OK?)
I propose a tax on anything made with corn byproduct. Nothing drastic as a dollar, just a five percent tax. We could rebuild Boston twice over with that tax.
There's tax on booze -- it's just that most liquor stores include it in the sale price so you don't see it as additional cost like you would if you were buying something with sales tax. That's why liquor in NH isn't so cheap -- there's no tax.
This is just another sign that this thing is a trainwreck
in the making. Enforcement by the DOR with a $900
fine for non-compliance was bad. Then this week we
learn that they underestimated the cost by, oh, maybe
30%. Now we'll make up the deficit with a cigarette
tax? What's next, encouraging Staties to write more
tickets on the Pike to....no, wait. That one's already
taken.
If Romney wasn't already cooked as of yesterday
(and he is) then McCain could have beat him bloody
with this Romney-endorsed disaster.
I thought the most interesting news article yesterday was the one about the long-term health care costs of smokers and the obese. It turns out that, sure, you'll live longer if you don't smoke and aren't obese -- but you'll end up dying later after more sickness, and costing more.
The researchers found that from age 20 to 56, obese people racked up the most expensive health costs. But because both the smokers and the obese people died sooner than the healthy group, it cost less to treat them in the long run.
On average, healthy people lived 84 years. Smokers lived about 77 years and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.
Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.
The cost of care for obese people was $371,000, and for smokers, about $326,000.
Put that in your Hillarycare and smoke it.
Van Baal described the paper as "a bookkeeping exercise" and said that governments should recognize that successful smoking and obesity prevention programs mean that people will have a higher chance of dying of something more expensive later in life.
I wonder what the public policy implications of this "bookkeeping exercise" will be. I doubt it will meet my imagination: wall-size posters encouraging those past middle-age to smoke ("You've lived long enough. You deserve a smoke today!") and recasting obesity as a positive quality of life choice ("It's not how long you live, it's how well you live. Fat: It's where the flavor's at!")
Will insurance companies start offering policy _reductions_ for smokers, who won't live long enough to rack up Alzheimer's costs or lengthy nursing-home stays? I can see giving the reps a piece of your mind: "What do you mean, I have to pay more because I'm fat? Why, you idiot! I'm saving you money! I'll keel over from a heart attack before I'm sixty! Go charge that health nut next door a premium!"
Obesity is a statistical construct. Studies of people in large cohorts demonstrate that so-called "fit-fats" - statistically obese people with high activity levels - are healthier (on average) than "normal" BMI people who are sedentary. Obesity does track with lack of exercise, however, but the large body alone doesn't conflate with disease and risk.
Another fun paradox amok conventional wisdom: smokers tend to have higher lung function to begin with than non-smokers. Smokers lose that lung function faster as they age, but the "crossover" point with non-smokers comes around mid-life. The theory is that people who don't smoke have lower initial lung function and simply can't stand to smoke as a result. Teens with higher initial lung function notice the effects less - and get themselves hooked.
But I'd have been more interested if you addressed the findings of the study rather than its constructs.
Basically, in order to reduce the cost to public coffers, should we be encouraging smoking rather than penalizing it? Should we really be firing cops for smoking? After all, working people might be paying the costs of smoking-induced heart attacks and cancer through their own insurance, whereas we might all be paying for septuagenarian health problems through state pensions and medicare.
That said, I can attest with the all-important *personal anecdotes* to your two points. I know many "fat-fit" people, including... er... myself. At 245 pounds, I won't cop to being fat, not even "portly." ("Large" will be fine, thank you.) But, statistically speaking, I'm obese (BMI>30). On the other hand, I can swim a mile in 30 minutes (repeatedly for hours), walk or bike for hours, sling a 50 pound sack of concrete like a pillow, and I've got the heart of a 20-year old. I'm not near to dyin' of fatness. Maybe I'll drop some weight, maybe I'll just buy bigger pants.
I also have crap lungs. I've had pneumonia about five times, starting as a kid, and I never started smoking mostly because it made me cough until I started to black out. I tried to be cool, but I failed.
That said, it is still true that smokers and fat people die younger on average. Not all of them, to be sure, but enough of them to be interesting. Enough of them, if the study is right, to save me some money.
I hear ya on the "I'm big, but try to outlift/outlast me" front. I might die of pneumonia, but even my doc's office jokingly put a sticky on my blood lipid report reading "needs to eat more bacon".
I think that calculus of "costs less to die sooner" comes about as a result of restriction and oversimplification. Smoking contributes to a lot of morbidity that we don't have a good handle on - such as non-fatal complications of viral infections, and other non-fatal (but costly) conditions. Witness recent studies in Pueblo Colorado on smoking bans in public places and heart attacks. As smoking rates have dropped, the role of air pollution in heart disease and even lung cancer has become more clear.
In other words, we really can't clearly quantify the role of smoking unless we restrict the analysis to what we know. That may be a mistake. These analyses also don't include the costs of second-hand smoking that can run up the tab huge - conditions such as asthma developing in early childhood, respiratory infections in young children, low-birth weight attributable to second-hand smoke, etc. When you start including children, you get into big money right there!
I guess that your perspective makes "externalities" pretty literal. It's much easier to capture the cost of somebody who dies from lung cancer... (internalities?) But early childhood asthma... that's not only external to the smoker, but harder to trace causally. And, yeah, big money. One sick kid costs a lot over his lifetime than does one healthy octogenarian.
As for morbidity, it seems that the conclusion of this study is that morbidity is a good thing in terms of health care costs. It's a lot cheaper to die than to live sick. Heart attacks aren't terribly expensive. Clutch chest, drop dead. Those saved from heart attacks may end up costing more through decades on multiple medications. So the smoking bans may end up costing money... but, as you say, that's if you only consider the immediate effects. The heart attack itself may save money in the long term -- that's one less guy to drain the pension fund! -- but it is worth wondering if the externalities balance out the savings.
I think the value of this study is in questioning one of the basic assumptions of our health care ethos, which is that any prolongation of life is ipso facto good. The lion's share of health care costs are in the last decades of life, as burnt-out savings are replaced by ballooning medicare in trying to squeeze a couple more years out of life through medications and appliances. That's something that is increasingly biting us all, through failing state pensions, growing medicare, and socialization through increased insurance costs. I expect that this 'end-loading' phenomenon is quite likely to result in decreased funds available, and decreased attention to, beginning of life concerns, such as prenatal care. Not to mention them damn old fogeys using up all the diapers.
But you've got it backwards. According to this study, we might want to pay you to smoke, so you'll kick the bucket before you get a chance to monopolize a hospital bed. Unless you're making your kids sick too, you might save us all some money by smoking yourself to infarction.
I've got it -- maybe we should put a free scratch ticket in every pack.
Well, if I'm not going to get the 30 grand, I'll take the scratchies!
Yeah, there are multiple solutions to the problems presented. I'm just tired of folks getting all righteous about digging into my pockets.
(Just to head off some stuff: If your first reaction to the above is "Well, then, why don't you quit?", then you didn't read what was at the link I gave.)
Okay. Works for me. Just don't smoke around me, and we're fine. I can understand smoking just because you like to; I've got bad habits too, which I have no intention of giving up. But I hope you'll understand that I think the smoking ban in bars is the best thing since sliced bread.
If anything, I'm giving you a great rebuttal for the self-righteous prigs (MassPRIG?) who irritate you so. Just tell them you're actually saving them money by smoking, because you're going to drop dead of an infarction instead of doddering on to senility. As Swirly points out, the math might not be just right on that, but it's at least as good as theirs.
I think banning smoking in some places is a swell idea, too. Despite common misconceptions concerning the senses of smokers, I can very much smell where smokers have been. I'd rather not. I try to always be aware of others when I light up.
The first year, the penalty for not being insured is pretty low; next year, I imagine that even more people will join, or that the non-joiner penalty will make a bigger dent in the cost. However, I don't think that's going to make much of a difference.
An extra buck on smokes sounds good. So does an extra tax on gasoline, to be honest. But I'm not surprised it cost more than the initial estimates. I mean, if they'd been honest about the cost, we wouldn't have had "universal" health care, would we?
Comments
Background info
By adamg - 2/6/08 - 12:13 pm
DiMasi, Murray consider increase in cigarette tax.
make it two dollars
By bostnkid - 2/6/08 - 12:20 pm
and lower the gas tax by a dollar.
To what?
By Neal - 2/6/08 - 12:30 pm
-79¢? The gas tax in MA is 21¢.
ok
By bostnkid - 2/6/08 - 1:14 pm
then drop the 21 cents and tag it to the smokers
More $$ for the oil companies that way
By SwirlyGrrl - 2/6/08 - 1:17 pm
Everytime gas gets out of whack, there is a push to lower to taxes (despite crumbling roads, bridges, etc.).
Don't expect the cost of gas to drop, though ... the oil companies simply charge more to their retail folks, who then pass it on. Why? Because "neighboring states pay as much" etc.
Balance the budget on the
By July (not verified) - 2/6/08 - 12:52 pm
Balance the budget on the backs of addicts.
It's been the strategy as long as I can remember (and that's a long time).
Bump up the tax on cigarettes and beer as needed, then scold folks for smoking and drinking. Set up some sort of fund for educating people about the dangers of addiction, then spend the fund for something else entirely. When that money's gone, repeat Step One.
Still not enough money? Push scratch tickets a little harder and call for casinos to make up the difference. (And remember to caution folks to get help if they think they're having a problem with gambling. Just wait until after you've bought a Quik-Pik to make the call, OK?)
I propose a tax on anything
By August (not verified) - 2/6/08 - 1:31 pm
I propose a tax on anything made with corn byproduct. Nothing drastic as a dollar, just a five percent tax. We could rebuild Boston twice over with that tax.
that would be fantastic.
By pomsmith - 2/6/08 - 2:23 pm
and incredibly lucrative.
No tax on booze
By Brian - 2/6/08 - 2:31 pm
I'm fairly certain there is no tax on alcohol. When one was proposed a few years ago it died after a "Don't tax Joe Six Pack" campaign.
There's tax on booze -- it's
By Amy (not verified) - 2/6/08 - 5:40 pm
There's tax on booze -- it's just that most liquor stores include it in the sale price so you don't see it as additional cost like you would if you were buying something with sales tax. That's why liquor in NH isn't so cheap -- there's no tax.
Mandated health insurance
By bobmetcalf - 2/6/08 - 12:35 pm
This is just another sign that this thing is a trainwreck
in the making. Enforcement by the DOR with a $900
fine for non-compliance was bad. Then this week we
learn that they underestimated the cost by, oh, maybe
30%. Now we'll make up the deficit with a cigarette
tax? What's next, encouraging Staties to write more
tickets on the Pike to....no, wait. That one's already
taken.
If Romney wasn't already cooked as of yesterday
(and he is) then McCain could have beat him bloody
with this Romney-endorsed disaster.
Apropos of this,
By Gareth - 2/6/08 - 12:39 pm
I thought the most interesting news article yesterday was the one about the long-term health care costs of smokers and the obese. It turns out that, sure, you'll live longer if you don't smoke and aren't obese -- but you'll end up dying later after more sickness, and costing more.
Put that in your Hillarycare and smoke it.
I wonder what the public policy implications of this "bookkeeping exercise" will be. I doubt it will meet my imagination: wall-size posters encouraging those past middle-age to smoke ("You've lived long enough. You deserve a smoke today!") and recasting obesity as a positive quality of life choice ("It's not how long you live, it's how well you live. Fat: It's where the flavor's at!")
Will insurance companies start offering policy _reductions_ for smokers, who won't live long enough to rack up Alzheimer's costs or lengthy nursing-home stays? I can see giving the reps a piece of your mind: "What do you mean, I have to pay more because I'm fat? Why, you idiot! I'm saving you money! I'll keel over from a heart attack before I'm sixty! Go charge that health nut next door a premium!"
"obesity" is not a disease
By SwirlyGrrl - 2/6/08 - 12:49 pm
Obesity is a statistical construct. Studies of people in large cohorts demonstrate that so-called "fit-fats" - statistically obese people with high activity levels - are healthier (on average) than "normal" BMI people who are sedentary. Obesity does track with lack of exercise, however, but the large body alone doesn't conflate with disease and risk.
Another fun paradox amok conventional wisdom: smokers tend to have higher lung function to begin with than non-smokers. Smokers lose that lung function faster as they age, but the "crossover" point with non-smokers comes around mid-life. The theory is that people who don't smoke have lower initial lung function and simply can't stand to smoke as a result. Teens with higher initial lung function notice the effects less - and get themselves hooked.
I knew this would interest you
By Gareth - 2/6/08 - 1:39 pm
But I'd have been more interested if you addressed the findings of the study rather than its constructs.
Basically, in order to reduce the cost to public coffers, should we be encouraging smoking rather than penalizing it? Should we really be firing cops for smoking? After all, working people might be paying the costs of smoking-induced heart attacks and cancer through their own insurance, whereas we might all be paying for septuagenarian health problems through state pensions and medicare.
That said, I can attest with the all-important *personal anecdotes* to your two points. I know many "fat-fit" people, including... er... myself. At 245 pounds, I won't cop to being fat, not even "portly." ("Large" will be fine, thank you.) But, statistically speaking, I'm obese (BMI>30). On the other hand, I can swim a mile in 30 minutes (repeatedly for hours), walk or bike for hours, sling a 50 pound sack of concrete like a pillow, and I've got the heart of a 20-year old. I'm not near to dyin' of fatness. Maybe I'll drop some weight, maybe I'll just buy bigger pants.
I also have crap lungs. I've had pneumonia about five times, starting as a kid, and I never started smoking mostly because it made me cough until I started to black out. I tried to be cool, but I failed.
That said, it is still true that smokers and fat people die younger on average. Not all of them, to be sure, but enough of them to be interesting. Enough of them, if the study is right, to save me some money.
Are you my brother?
By SwirlyGrrl - 2/6/08 - 1:52 pm
I hear ya on the "I'm big, but try to outlift/outlast me" front. I might die of pneumonia, but even my doc's office jokingly put a sticky on my blood lipid report reading "needs to eat more bacon".
I think that calculus of "costs less to die sooner" comes about as a result of restriction and oversimplification. Smoking contributes to a lot of morbidity that we don't have a good handle on - such as non-fatal complications of viral infections, and other non-fatal (but costly) conditions. Witness recent studies in Pueblo Colorado on smoking bans in public places and heart attacks. As smoking rates have dropped, the role of air pollution in heart disease and even lung cancer has become more clear.
In other words, we really can't clearly quantify the role of smoking unless we restrict the analysis to what we know. That may be a mistake. These analyses also don't include the costs of second-hand smoking that can run up the tab huge - conditions such as asthma developing in early childhood, respiratory infections in young children, low-birth weight attributable to second-hand smoke, etc. When you start including children, you get into big money right there!
Externalities
By Gareth - 2/6/08 - 2:59 pm
I guess that your perspective makes "externalities" pretty literal. It's much easier to capture the cost of somebody who dies from lung cancer... (internalities?) But early childhood asthma... that's not only external to the smoker, but harder to trace causally. And, yeah, big money. One sick kid costs a lot over his lifetime than does one healthy octogenarian.
As for morbidity, it seems that the conclusion of this study is that morbidity is a good thing in terms of health care costs. It's a lot cheaper to die than to live sick. Heart attacks aren't terribly expensive. Clutch chest, drop dead. Those saved from heart attacks may end up costing more through decades on multiple medications. So the smoking bans may end up costing money... but, as you say, that's if you only consider the immediate effects. The heart attack itself may save money in the long term -- that's one less guy to drain the pension fund! -- but it is worth wondering if the externalities balance out the savings.
I think the value of this study is in questioning one of the basic assumptions of our health care ethos, which is that any prolongation of life is ipso facto good. The lion's share of health care costs are in the last decades of life, as burnt-out savings are replaced by ballooning medicare in trying to squeeze a couple more years out of life through medications and appliances. That's something that is increasingly biting us all, through failing state pensions, growing medicare, and socialization through increased insurance costs. I expect that this 'end-loading' phenomenon is quite likely to result in decreased funds available, and decreased attention to, beginning of life concerns, such as prenatal care. Not to mention them damn old fogeys using up all the diapers.
Would You All Please Read This?
By Suldog - 2/6/08 - 1:54 pm
jimsuldog.blogspot.com...into-coughers.html
The figures need updating, but the basic premise still applies.
Suldog
http://jimsuldog.blogspot.com
I read it
By Gareth - 2/6/08 - 3:02 pm
But you've got it backwards. According to this study, we might want to pay you to smoke, so you'll kick the bucket before you get a chance to monopolize a hospital bed. Unless you're making your kids sick too, you might save us all some money by smoking yourself to infarction.
I've got it -- maybe we should put a free scratch ticket in every pack.
Scratchies? Woo-Hoo!
By Suldog - 2/6/08 - 3:30 pm
Well, if I'm not going to get the 30 grand, I'll take the scratchies!
Yeah, there are multiple solutions to the problems presented. I'm just tired of folks getting all righteous about digging into my pockets.
(Just to head off some stuff: If your first reaction to the above is "Well, then, why don't you quit?", then you didn't read what was at the link I gave.)
Suldog
http://jimsuldog.blogspot.com
Well, it wasn't, and I did.
By Gareth - 2/6/08 - 3:47 pm
You said you haven't quit because....
you like to smoke.
Okay. Works for me. Just don't smoke around me, and we're fine. I can understand smoking just because you like to; I've got bad habits too, which I have no intention of giving up. But I hope you'll understand that I think the smoking ban in bars is the best thing since sliced bread.
If anything, I'm giving you a great rebuttal for the self-righteous prigs (MassPRIG?) who irritate you so. Just tell them you're actually saving them money by smoking, because you're going to drop dead of an infarction instead of doddering on to senility. As Swirly points out, the math might not be just right on that, but it's at least as good as theirs.
Not YOU, Gareth!
By Suldog - 2/6/08 - 4:00 pm
Sorry, Gareth. The parenthetical was for anyone else whose first thought was that, not you. I know you read it.
Suldog
http://jimsuldog.blogspot.com
Slight Elucidation
By Suldog - 2/6/08 - 4:06 pm
I think banning smoking in some places is a swell idea, too. Despite common misconceptions concerning the senses of smokers, I can very much smell where smokers have been. I'd rather not. I try to always be aware of others when I light up.
Suldog
http://jimsuldog.blogspot.com
Next year, the penalty for non-joining is higher
By Aaron (not verified) - 2/6/08 - 1:52 pm
The first year, the penalty for not being insured is pretty low; next year, I imagine that even more people will join, or that the non-joiner penalty will make a bigger dent in the cost. However, I don't think that's going to make much of a difference.
An extra buck on smokes sounds good. So does an extra tax on gasoline, to be honest. But I'm not surprised it cost more than the initial estimates. I mean, if they'd been honest about the cost, we wouldn't have had "universal" health care, would we?
How about a dollar per cup
By Anonymous (not verified) - 2/6/08 - 4:38 pm
How about a dollar per cup of coffee? I don't drink coffee, so I think it's a great idea.