Recently smokers have been stunned to see the cost of their favorite cigarettes increased dramatically by 61 cents, bringing the federal tax total to $1.01 a pack. Critics of this tax increase have complained that this tax hurts the poor the most, which is undoubtedly true. Others have said that it makes the Obama Administration, with their often repeated promise that no one who earns less than $250K a year will pay a penny more in additional taxes, seem dishonest. This is clearly true as well. But I think a larger observation can be made about the cost of government providing health care for its citizens. In other words, what can and should government expect if it is to pay the expense of our medical treatments?
It is in the best interest of anyone who pays for the healthcare for another to insure that the recipient of that healthcare remain as healthy as possible. This is true of a parent, an insurance company, a place of employment, and a government. It follows then that those who pay for this healthcare would want to and would have a certain right if not obligation to dictate the behavior of those who are having their healthcare costs provided for. It also follows that the more dependent one is upon one’s fellow taxpayers, the more restrictions these taxpayers by way of the government can place on one’s behavior. So is it fair that a cigarette tax punishes a welfare recipient whose treatment has to be covered by the government more than a millionaire who would receive no taxpayer money to pay for his or hers? I’d say yes.
But what if government provided the healthcare for not just the poor but for the rest of us as well? If government decides to pay all of our healthcare costs through universal health care, does this not mean that government’s power to limit our freedom to engage in risky behavior is extended as well? As I’ve said, a government that is responsible for the healthcare for its citizens will have the right to demand that its citizens stay healthy. I worry that this will go far beyond taxing cigarettes but rather is likely to include all sorts of restrictions on our unhealthy behavior.
I will paint a scenario. You receive a letter from the state that you are required to see a government doctor on a certain date for an examination. If you have anything, better to catch it early with frequent examinations, no? This doctor determines that you are overweight and have poor eating habits – both major health risks. So the doctor tells you that you are not only not allowed to smoke, or drink more than two glasses of wine a day (or whatever amount that is considered to be healthy), but you are no longer allowed to raise your heart attack risk by eating at your favorite Red Robin then going home to finish a pint of Ben and Jerry’s. Instead you will be required to stick to a pre-approved diet as well as an exercise regimen. Also, you can cancel that ski trip to Vermont you had planned for the weekend. Government no more wants to pay for the leg you may break whizzing down a snowy mountain than it does for whatever ailment your poor dietary choices are leading you to. And your occupation is a bit stressful for you, isn’t it? Perhaps another line of work would be more appropriate. Furthermore, government can also decide that you are not worth treating. After all, the cost of treating a 90 year old for cancer won’t be cheap, and how much longer is this geezer expected to live anyway?
It may seem Orwellian to predict that government would have this much power over us, but look at what government has done or has tried to do in order to keep up healthy. Increasing the cigarette tax is the least of it. Government has restricted the sale of sugary beverages like Snapples at school vending machines, just as it has tried to restrict the building of fast food places within a certain distant to schools. Our kids are too fat, you know. NYC Mayor Bloomberg, an anti-smoking crusader, has worked successfully to ban transfats in restaurants and is now working to limit their use of salt. NY Governor Paterson wanted to raise taxes on sodas that aren’t diet sodas and on what he considers to be junk food. Restaurants across the country have been forced to provide healthy alternatives on their menus, not because of the demands of their patrons but rather because of the demands of government and “health Nazis” who would protest the restaurant otherwise.
Can we be forced by government to be healthier, to not only be less of a risk to the well-being to others but also the well-being of ourselves? Well, yes. Just as we are required to wear a seatbelt, we can be required to limit our consumption of cupcakes, especially if government will be paying the cost of our healthcare. And it may even be worth it for most to lose their rights to be unhealthy so that they can be treated for their ailments and injuries for free (not counting the exorbitant amount of taxes one will have to pay for this free healthcare, of course). Medical emergencies are expensive and often lead to bankruptcy. But to others who are burger junkies like me, it may not be worth the restrictions. Freedom entails the right to make foolish choices, does it not? And if I am a fool to prefer the right to eat what I want when I want then so be it.
It would be great if universal healthcare would be optional. If you like it, take it. If you don’t, don’t take. Unfortunately, like in the case of Social Security, once government decides that it is for your own good, the option of not participating will not be given.