The Medical Freedom Channel

This week’s news brought three perspectives on an issue that combines concerns about health and wellness, both public and personal, with civil liberties and property rights. Yes, we’re talking about the whole smoking battle, in which a legitimate concern about the right to control your own property runs up against an almost equally legitimate challenge regarding the known detriment to the human body from the effects of tobacco products.

Before we go any further, let’s set the parameters: limiting smoking is and should be an individual decision and choice. Where privately owned establishments are concerned, regardless of how much of the “public” they serve as customers, the final option should be that of the bar-owner, restaurateur or other business owner, as to whether or not smoking is allowed on the premises. (As most such businesses have come to learn, providing a clear “no smoking” section in restaurants is just smart marketing, since even heavy chain-smokers often prefer fresh air when they’re dining!) On the other hand, with truly public facilities, owned and maintained as government rather than private operations, there is every reason to limit such behavior – or even forbid it entirely.

At the same time, however, there are distinctly measurable negative effects of tobacco smoking on health, and an even more measurable cost on the healthcare systems of this and other countries that results from those effects. This raises a legitimate concern about how to rein in those added costs, or at least find a way to make those responsible for them, actually pay the freight! It is this matter that makes the smoking fight worth examining more closely; conveniently enough, items in the Boston Globe and Tennessean newspapers this past week offer a grand jumping off point.

The first was a Globe editorial entitled, “Thank you for less smoking.” It began by reporting (and praising) the efforts of Sen. Edward M. Kennedy, incoming chairman of the Senate health committee, who is pushing a bill to empower the Food and Drug Administration to regulate the advertising and contents of cigarettes. “While the agency would not have the right to ban tobacco use altogether or completely eliminate its nicotine,” the Globe notes, “the FDA could force the industry to get rid of known cancer-causing agents in its products and to cut back their marketing to young people.”

Although they admit that adult smoking has actually declined pretty steadily over the last decade, they cite studies showing that “4,000 young people try their first cigarette every day,” and predict “about half of them will become hooked, running a greater risk of cancer, heart disease and emphysema,” noting that “Smoking is blamed for 400,000 deaths a year, making it by far the most common preventable cause of death.”

Congress has of course been trying to expand the FDA’s scope ever since a 5-4 Supreme Court decision in 2000 stated that only with Congressional sanction could the agency take this step. Now, with the Democratic majorities in both House and Senate, this is far more likely to occur. In addition to restricting tobacco advertising to children, the Globe notes, “the bill would let the FDA require strict enforcement of laws limiting sales to minors. It could require public disclosure of all the toxic ingredients in tobacco smoke and force the companies to place larger and more informative health warnings on their products. The agency could oblige the companies to begin removing poisons from tobacco.”

The Globe concludes by noting “the possibility” that Bush might veto such a bill if it came before him, but concludes that “a president whose only other veto was of a bill to expand federal funding of stem cell research could not easily use his veto pen against another bill that is so clearly aimed at protecting the health of Americans, especially American children. Congress should put him to the test.”

The next story of note occurred in Nashville, Tennessee, where a news story noted that the Volunteer State’s House Majority Leader Jimmie Naifeh (D-Covington) was resisting efforts by those lawmakers to push a ban on “public” smoking, to include “private businesses like bars and restaurants.” In response to that pressure, Naifeh (best known to Tennessee libertarians for his brazen and unconstitutional efforts to ramrod through a state income tax) took a propertarian stance, saying simply that. “A lot of folks like the idea of letting the business owner decide that on their own.” He also noted that his own businesses were smoke free, with no-smoking signs posted.

Then there was the third piece, just out in Sunday’s Globe, entitled, “Cigarette tax hike proposed in Maine.” That story outlined how Governor John Baldacci is trying to boost the state “sin tax” on a single pack of cigarettes by a full 50%, from the current $2 to $3. Were the intention to allocate every penny to programs to help people stop smoking, or to the state’s Dirigo health plan, so that those who now are smoking themselves into major illness and other complications (whose aftercare expenses will then be paid for by every other Maine resident and taxpayer) are at least contributing directly to the costs of those ailments … this might make some sense – in terms of a sort of “user fee” process of paying now, for the damages to be inflicted later.

However, the stated intention of Baldacci and the other supporters of this plan is to put revenues gained from this increase into General Funds; money for cessation programs would then be taken back out of that already melded “state wealth,” as a separate process. Thus, this becomes just one more revenue-raising model, like jacking up parking and speeding tickets on the local level, that has no relationship to paying the costs for an utterly avoidable situation. (Note: I’ve already e-mailed my sister-in-law, newly elected to the Maine State House of Representatives, to solicit her aid in making this proposed increase at least be focused on the problem, and not just another tax scam.)

So here are three aspects of the no-smoking issue, all with implications for liberty as well as for wellness. In each case there are efforts to impose a way of being on others, rather than focusing on convincing them to change their behaviors willingly. At first glance, they seem pretty clear-cut as initiations of force, and thus violations of the foundation of true freedom, which must be given to others if one is to enjoy it oneself. However, there’s more to it than that, at least in this opinion.

Smokers DO add costs to medical care, due to the stress and other negative effects created on their bodies by smoking. Were this a completely free society situation, their damaging behavior would be penalized directly, by bumping up the cost of their payments for health services, insurance, etc. To some extent this is already happening, but to truly counter the effects of smokers on public health, it may need to get a lot tougher.

The reason is subtle but significant. On at least some level, the mindset of the smoker is shared by the overeater, the couch potato and other (stereotypical yet very real) variations on humanity, who’ve come to expect that – regardless of how they do or do not make an effort to minimize their medical requirements in life – the system will always be there to care for them.

As a result, the healthcare industry, along with their third-party adjunct in the insurance world, has been allowed to slack off from promoting wellness, prevention and early screening, and to focus instead on the aftercare and maintenance of people who are ailing from things they could mostly have avoided, just by taking better care of themselves – that is, by being personally responsible for the effects of their actions.

We libertarians expect this of people regarding everything from personal protection to harm caused (even unintentionally) to others; we should consider the same rules regarding self-destructive behavior, when it is likely to redound on those others in the end. Since all the “coverage” is weighted heavily toward these end-of-life and convalescence issues, and we’re conditioned to believe in “catastrophic insurance” as the essential component of any program for healthcare, the cost for simple preventative and precautionary health insurance is just as exorbitant as any other, since they insist on tacking on that “woe is me” long-term rider, thereby doubling if not trebling the cost.

As a result, it’s become almost as sanguine to have NO health insurance, as to be bogged down with the payments for these extra features. Those who are investing in health savings accounts – combined with the most minimal forms of “coverage,” a regular exercise program and sensible eating choices – now often find themselves much more in control of their own wellness, and even more prepared if something does arise, since they’re generally being warned well in advance of any serious problems cropping up.

And so we come back to the smoking issue. Shouldn’t those who are contributing to the problem, pay the most to fix it? Shouldn’t those who are not part of the problem be rewarded, for being therefore part of the solution? And if so, how do we do this?

To this writer/editor, it seems obvious: (a) Allow and promote “wellness” programs, at an affordable cost, for those seeking nothing more than a regular maintenance check-up, and separate the high-dollar “catastrophic coverage” from such persons entirely; AND (b) expand such programs to include the homeopathic, naturopathic and nutrition-based treatments so many millions are already making use of – not as a thing separate from the allopathic methods, but as a valued partnership with them. If you are helping yourself, and keeping yourself well, in conjunction with such “alternative” healing practitioners, it should be just as valid as if you were consulting with an AMA union-member for your maladies.

So can we finally start to separate these issues, and begin to reward those who don’t mess themselves up, by allowing them to pursue these alternate pathways? Let those who would choose a more fluid lifestyle avoid the pathways (and the inflated payments) of the less self-responsible, and blaze their own trails to wellness and longevity, as productive and happy human beings. And let these attempts to legislate such behavior, and to coerce people’s personal choices, fall to the wayside.