Reforming the entire health care system is a herculean task. Every piece moved on the chess board leads to difficult calculations as they relate to spending. Some programs require outlays of money to recoup spending later, and thus we can get into an endless argument about the cost savings of the Affordable Care Act.
To avoid complexity, I am going to propose something exceedingly simple: outlaw tobacco and we will save $1 Trillon. You see, the United States loses $96 Billion a year in health care costs alone due to tobacco use and its related disease. Our Congress and State Legislatures are fighting vehemently over budgets right now. Allow me to introduce you to some low hanging fruit: $31 Billion in Medicaid spending, $27 Billion in Medicare spending, and $10 Billion in spending through the Veterans Administration are some of the direct health spending figures related to tobacco related diseases. Since all budgets in Washington are discussed in 10 year windows, I am going to stick by my magnanimous claim that we will save $1 Trillion by getting rid of tobacco.
So what’s the hold up? Maybe, it’s because the tobacco industry has been fighting to hang on to their billions of dollars in profits like a caged animal? In 2009 alone, the industry spent over $24 million on lobbying efforts. Or maybe the problem is our country’s history with tobacco? Our country was built in part from the profits of the most lucrative crop of the 17th, 18th and 19th centuries. Or perhaps Americans simply need to hang on to their legal drug-of-choice, since nicotine is so remarkably addictive.
We have known since 1950, when Sir Richard Doll published his work in the British Medical Journal, that cigarette smoking is linked to lung cancer. Yet, it took until the 1970s for the first municipality in the US to ban indoor smoking in public places, and it remained legal to sell cigarettes to minors until 1992. Thankfully, there has been a modicum of progress. America reached its peak of smoking around 1955, when 45% of our citizens smoked, and that rate has been declining since. It should not be a surprise to anyone who appreciates history that our peak of smoking occurred after World War II, since the US military included cigarettes in soldier’s food rations.
We already know how to reduce smoking rates. When Maryland increased the tax (p68) on a pack of cigarettes by $1 in 2008, sales of packs of cigarettes plummeted 27% in the following year. This trend has been true for EVERY State that has raised taxes on cigarettes. In fact, with the exceptions of California and Utah, taxes on cigarettes are inversely proportional to a State’s smoking rate, and as cigarette prices rise, their consumption drops.
As a member of the Board of Directors for Doctors for America, I am brimming with pride that our Founder, Dr. Vivek Murthy, has been appointed to the White House Advisory Group on Prevention. The Advisory Group is tasked with shaping the plan for preventive health for our nation for years to come. Let’s go after the low hanging fruit and stop the leading cause of preventable disease as part of that strategy.
If you have other ideas about how to shape our national strategy for prevention, take a moment to fill out this survey. We would love to hear from someone with the next trillion dollar idea!