Baucus Bill Bombs on Personal Responsibility

Although the health reform bill proposed by Senator Max Baucus talks about “shared responsibility,” it imposes no responsibility whatsoever on the small minority of Americans whose choice to smoke costs almost $200 billion a year in totally unnecessary costs which must now be borne by the nonsmoking majority, charges Action on Smoking and Health (ASH), which has proposed a plan featured on MSNBC to impose a surcharge on smokers to help fund health care reform.

“Instead of a 35% tax on comprehensive health insurance plans — including those protecting many current and retired union members — Senators should impose a surcharge or user fee of those whose deliberate choice to continue smoking increases the taxes as well as the health insurance premiums of all nonsmokers. It could raise as much money, be fairer, and, rather than deterring measures to keep people healthy, would keep people much healthier by slashing the incidence of expensive smoking-caused diseases now imperiling our health care system,” says public interest law professor John Banzhaf, Executive Director of ASH.

The Baucus bill proposes to raise $215 billion over 10 years by taxing comprehensive health insurance plans. But requiring smokers to pay a surcharge of as little as $40/month on their health insurance — similar to the surcharge they have long paid for their life insurance — would raise more money.
Also, if the surcharge encouraged only 15% of current smokers to quit, these savings would exceed the $215 billion the Baucus bill would impose on the well insured. After all, smokers now spend over $90 billion a year in tobacco products, so they should be able to afford an additional $21.5 billion if they refuse to quit.

To fund reform, Baucus would also restrict the rate of growth of certain Medicare spending. It would reduce payments to insurance companies in Medicare Advantage programs relied upon by millions of senior citizens. It would also restrict Medicare reimbursements for services like home health care and medical imaging.

“Isn’t it fairer to target smokers who cost us all almost $200 billion a year than to seek to balance health care reform on the backs of innocent senior citizens who depend on Medicare Advantage and services like home health care? Why slash life-saving medical imaging like X-rays, MRIs, etc. and not the major cause of most easily preventable diseases,” asks Banzhaf.

Many studies show that the percentage of smokers is highest among those with the lowest incomes — exactly the same population where so many of the currently uninsured are now found. Thus, any health reform plan which guarantees to pay their treatment costs is likely to cost even more than estimated because of the extraordinarily high rates of heart attacks, stroke, lung- and other cancers, respiratory diseases etc. caused by their much higher rate of smoking.

“It is unfair to let the small percentage of adults who chose to smoke (about 19%, of which only about 13% smoke daily) impose on all of us totally unnecessary costs medical and other costs far in excess of that required to completely fund health care reform,” argues Banzhaf, while taxing those who aren’t contributing to these costs like people with comprehensive health care plans, and restricting Medicare Advantage programs, life-saving medical imaging, etc.

Instead, it is far fairer and much more effective to begin to require smokers to pay their fair share of those costs; a move which could raise most of the money necessary to fund health care reform which slashing the costs of medical care for everyone. “It’s a win, win, win proposal,” says Banzhaf.

Professor of Public Interest Law at GWU, and
Executive Director and Chief Counsel
Action on Smoking and Health (ASH)
America’s First Antismoking Organization
2013 H Street, NW
Washington, DC 20006, USA
(202) 659-4310 //

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  1. I could not agree with you more. When it comes to personal lifestyle choices (ie smoking), the additional cost should not be spread amongst all of us. Instead the smokers need to be responsible to cover the increased cost as smoking is a choice and a choice that increases healthcare costs. So why should I have to pay more for my healthcare to help spread the risk among someone who chooses to smoke. The answer is I shouldn’t.

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