Saturday, May 20, 2006

Against Bill 112: Death and Taxes

It all starts with tax cuts. No, really, it does.

In the 1980s, Ronald Reagan and Margaret Thatcher unleashed the age of neoliberalism, which revolutionized the way we think about the role of government. Essentially, the question they posed was this: instead of taxing citizens to enable the government to provide them with the services they need, why not reduce their taxes and allow them to pay for services themselves? The idea eventually spread to Canada, with all three governments slashing, to varying degrees, personal and corporate tax rates to almost unanimous applause. After all, who doesn’t like a tax cut?

The problem is, the ideology of tax cuts doesn’t account for contingencies like wars, natural disasters, and large-scale demographic shifts, the kinds of things that require a coordinated response from entities larger than the individual. This can lead to problems. For example, the current American president’s refusal to roll back tax cuts while his country fights no less than two wars has led directly to the highest deficit in U.S. history. Similarly, Hurricane Katrina exposed the decades-long neglect of federal emergency management agencies, which could barely manage to stage a decent photo-op as hundreds of American citizens drowned.

But what does this have to do with smoking, Vila?

For years, experts have warned that when the swollen ranks of baby boomers reached retirement age, they would create an unprecedented burden on the health care system. In the United States, which does not have universal health care, the strain is being felt by private and government-sponsored insurance programs, which are doing everything they can to reduce costs. In Canada, the pressure is borne by the public health care system, which, having been starved for funds for more than a decade, is now in noticeable decline. As the demand for health services increases, the ability of the system to deal with the influx of aging Canadians is being stretched to the breaking point. Without question, something needs to be done.

Pre-Reagan, the logical solution would have been to raise taxes to pay for the rising cost of health care, just as pre-Bush, taxes were understood to be one of the sacrifices a nation must make when it goes to war. Today, by contrast, the ideology of tax cuts is so deeply entrenched that no politician in their right mind would risk suggesting even a small increase. Therefore, they are forced to look elsewhere for alternatives.

In the case of health care, the solution that presented itself was to once again shift the fiscal burden from government to the individual, by way of the doctrine of prevention. From this perspective, it isn’t the government’s responsibility to look after the health of its citizens—it’s the individual citizen’s responsibility to look after themselves. In other words, since government can no longer afford to take care of us when we’re sick, the onus is on us not to get sick in the first place. And if we do, it must be our own damn fault.

Of course, prevention isn’t in and of itself a bad idea, up to a point. That point being reached when the imperative to prevent disease brings with it the social denormalization of those considered to be unhealthy. Smokers, of course, have been the primary target of denormalization campaigns for more than twenty years. However, as this article clearly shows, the next targets are the overweight and the obese, whose afflictions, like that of smokers, are thought best treated “like a communicable disease.”

Economics aside, there is something suspiciously moralistic about the doctrine of prevention, as well as something deeply intolerant about the way it is applied to human beings. It assumes, as statisticians often do, that an ideal individual exists, one who embodies a norm of perfect healthfulness from which the rest of us deviate. As (Dr.) David Romano recently reminded me, government studies that purport to show the increased health costs of smoking do so by assuming that a non-smoker uses $0 of health care—i.e., that non-smokers never have cause to visit a doctor, to stay in hospital, or, presumably, to ever die.

This is preposterous. Yes, smokers have an increased risk of cardiovascular disease and some cancers. But smoking is one of several thousand possible causes of illness, quite a few of which can be linked to behavioural choices. For example, the second most common form of cancer among women (after breast cancer) is cervical cancer, which in the majority of cases is caused by infection with the Human Papilloma Virus, a sexually transmitted disease. Should we infer, then, that sex is the second greatest health threat to women, and therefore to be avoided at all costs? I certainly hope not.

Behaviour aside, a certain propensity for unhealthfulness is, unfortunately, part of the biological fact of being alive. My brother has never smoked a day in his life, but his health, which is otherwise excellent, has been profoundly compromised by an inherited gene that causes schizophrenia. There is nothing he could have done to prevent his condition (except, perhaps, to take up smoking), and his long-term prognosis is poor at best. In fact, studies indicate that, even as a habitual smoker, I will probably outlive him. Is this fair? No. But it’s the way life is.

In any event, the health care system is no better equipped to take care of my brother than it is to take care of me, and this fact exposes the lie that is at the heart of the doctrine of prevention. If I have to wait three months to see a doctor, or cannot get the surgery I need, then some of you will say that I deserve what I get because I choose to smoke. But what will you say to my brother when the voices in his head drive him to seek medical help, but when, because of reductions in health spending that are the consequence of tax cuts, there is no bed for him at the hospital, no outpatient care to give him, and no social worker to make sure he doesn’t fall through the cracks of our broken system? Does he somehow deserve it too? More to the point, do you?


wade said...

Hello, Villa dear. It's Wade. I do appreciate the arguments that you offer. I am intrigued to hear what a smartypants has to say in the defense of a position against the smoking ban. And yes, I like you too. Maybe the smoking ban will find us socializing more, as I will be willing to be in bars and such? That would be swell.
I suppose my general thought on your arguments thus far is they come from a position of faith or allegiance to the smoking habit, and not independent of it. To be fair, I couldn't be more "objective" either, as I am wholly on the other side. Still, I find these arguments to be akin to a Creation-ist Christian trying to use science to support her point. When one starts from a position of faith or allegiance, the argument is undermined somewhat.
That being said, it is a well-constructed argument.
I just can't get past the part where smoking invades my space. Fat people don't affect my health via second-hand fatness. They are definitely a burden on the health care system though.
The bad thing that I do is hurt myself on my bike, which could be seen to cost the taxpayers money when I break something. There is my risky behavior. However, my freestyle BMX riding doesn't hurt the people beside me when I do it.
My girlfriend and I were asked to go to Foufounes the other day. We both declined, but then it hit us that in less than two weeks, we could go to a smoke-free Foufs! With the smoking ban, I can leave the house again!

xanthium said...

I am a smoker, but I can see the reasoning for an indoor smoking ban (although it is a very bitter proposition in a Montreal winter). The problem that I have is when it expands and begins to encroach into all public spaces, as it has here in California. In many places, you can't smoke on the beach (I think it was because all smokers are filthy litterers--as if one can't throw away although many feel free to bring packaged food and leave bits of plastic everywhere) or near a building entrance (the annoyance of walking through smoke has been hyberbolically construed as a health risk, although no one has yet banned the urban SUV, or even the Hummer, which are much worse for the air). I guess my point is that you have to live in society with other people, who will inevitiably do things that you disapprove of, but that doesn't make a fascist state any more appealing.

monica said...

even if it is the soft fascism of good intentions...but then again, isn't the road to hell always paved with good intentions?

*Wade--why can't I leave you a note on your blog? I'm happy to see that you are doing well...

wade said...

I've always been a fan of the idea of benevolent dictatorship. This is, of course, a cousin to "soft facism". Plus, I did find Palpatine's arguments persuasive in SW I, II, and III.
I saw a news report today that Quebec has banned the use of certain weedkillers in the name of the public's health. They had a lawn expert on that discussed how difficult it will be to rid one's lawn of dandylions now. He kept stressing that this was "the Government's" decision. The way My mind works, I'm just mad that people think they need to have "the perfect lawn."
The smoking ban may be hard on smokers. It cuts into your rights. I get that. But it's better for you. And it's WAY better for me! Yay me!
Smoking is something that people start as teenagers for the wrong reasons. And then they should quit as adults.
I'm particularly unsympathetic here because I have control issues, and I quit anything that has control over me. In the last six months, I quit chocolate, red Twizzlers, and then candy in general. I've made a lifestyle out of quitting. I don't drink, smoke, use drugs, eat or use animal products.... These were all things that were not initially easy to do. But it's possible. And I've benefited from the quitting of vices. (Although I'm honestly not recruiting or proud.)
And Monica: my comments are off because I can't control what people might say! And I'm sure you have access to more direct means of communication, no? Thanks for the good words!

xanthium said...

I don't know Wade, sounds to me like you're a slave to purgation.

I've never really believed that negative freedom was really liberating, not even when it was explained in catechism as a function of God's love. It always seemed like a churchy trick to get you not to be bad, when being bad can be fun.

Smoking for me has always been an adult pleasure, something that calms my nerves and makes a beer or coffee truly excellent, and that I've always done in moderation. I don't really know that being without vices would be better for me. It's like of like that old joke, "the food might not be good, but at least there is plenty of it." Seems to me the same could be said about life without any vices at all.

christopher hearns said...

I'm somewhere between a smoker and a non-smoker. Haven't had a cigarette in about a week, where I was smoking daily for like two weeks. Been months since I bought any smokes. But ten years ago I smoked for three years. I smoke socially, but two weeks ago I was smoking by myself in my flat. But I should also say that I'm lucky. I can smoke a half pack a day for a week and then just stop, not have another smoke for a year.

I think the smoking ban is great. Having been to towns like Ottawa, I have to say it feels really nice to walk out of a bar at the end of the night not selling like smoke. Or waking up next to someone, rolling over to be closer to them, and not getting a face full of stale smoke hair.

Some people respond to that with a vote with your feet. Except, there's nowhere else to go, smoking bars are the only game in town. (That by the way goes double for the employees of bars)

But this argument raised here isn't about that, it's about whether or not the government should take action to safeguard it's citizenry from itself in order to lower it's health care costs.

Now, even without the monetary cost, I have to say, I'm in favour of it. I'm in favour of people having to wear seat belts. Not being allowed to speed. Making it more and more difficult to smoke until people quit. I'm in favour of these things because I think the government has a responsability to ensure the health of it's citizenry.

And yes, that means when they start bringing in initiatives to encourage a slimmer population, I'll be in favour of that too. Although hopefully it won't be all stick. Hopefully there will be some carrot initiatives too.