NOTIONS: How to save lives, money, and still win re-election

March 19, 2007

As a hearing-impaired, diabetic, migraine-suffering cancer survivor, father of a cancer survivor and widower of a cancer victim, I've followed my share of doctor's orders. So I've taken two of Monroe's tenaciousness pills, and I'm calling (well, writing) you in the morning.

Since my late wife the non-smoker was diagnosed with a smoker's cancer, I've shared our sad story to educate government officials and citizens about the dangers of secondhand smoke.

But let's skip the emotions this time, abandon impatience and set aside our hostility toward those who've done too little for too long to protect us from the leading cause of preventable, premature death in America.

Let's focus, instead, on what really matters: money and votes. Money first:

You have before you a proposal called the Healthy Indiana Plan. It would provide three things for your constituents and their families: childhood immunizations for Hoosier youngsters who can't afford them, health care coverage for many of Indiana's uninsured, and smoking-prevention and -cessation programs to discourage young people from starting the habit and to help current smokers quit.

This would be funded by increasing Indiana's cigarette tax-one of the lowest in America.

This makes considerable fiscal sense.

You'll hear, of course, from a few citizens primed by Big Tobacco lobbyists that smokers shouldn't have to fund health care coverage for the uninsured. You'll also hear that, if we're going to raise tobacco taxes, we should raise alcohol taxes and impose obesity taxes, too.

This smoke-and-mirrors argument fails for several reasons: First, smoking accounts for billions of dollars in annual health care costs and lost productivity. Other bad habits, while pricey, cost us less. Second, no one ever died of secondhand obesity. Third, even when it's abused (e.g., drunken driving), alcohol causes a tiny fraction of the death toll exacted by tobacco when it's merely smoked as directed.

Raising the cigarette tax has one big fiscal benefit that no other funding mechanism (e.g., increased gambling receipts) can match: Only a significantly increased cigarette tax has proven to reduce smoking. Indeed, every state and city that has increased this tax has seen (a) increased revenue, (b) a drop in the number of young people starting to smoke, and (c) a decrease in the number of citizens continuing the habit. As more smokers quit, productivity climbs and health care costs decline.

The Healthy Indiana Plan delivers other fiscal benefits through its strategic allocation of funds. An ounce of prevention beats a pound of cure, after all.

The biggest impact is health care coverage for uninsured Hoosiers. There's a common misperception that uninsured people go without health care. Not really. They may go without the most cost-effective care (the preventive kind), but if something goes wrong, they often appear in emergency rooms for the most expensive care in the world. You and I pay the piper when these costs are passed on through higher taxes and health insurance premiums.

The Healthy Indiana Plan would provide more cost-effective medicine to uninsured Hoosiers. It would, consequently, save us all money.

The Healthy Indiana Plan also would fund smoking-prevention and -cessation programs at the level recommended by the Centers for Disease Control. By helping smokers quit, this delivers the biggest benefit to people paying the higher tax.

This particular investment is crucial. Back when Indiana's prevention and cessation programs were funded at CDC-recommended levels, Indiana's secondworst-in-America smoking rate went down. But when the state slashed funding, smoking went up. Again, the more people smoke, the more you and I foot their bills.

Finally, the Healthy Indiana Plan would save us money by funding immunizations for kids. Immunizations, of course, are far cheaper than treating non-immunized children for full-blown diseases. It keeps more of them alive, too.

Now for a dose of political logic. This is a remarkably safe vote for Republicans and Democrats alike. In a survey conducted by a bipartisan research team, nearly two-thirds of Hoosiers said they support a $1-per-pack tax increase. That majority held fast among liberals and conservatives, men and women, urban and rural, wealthy and poor in virtually every region of the state. Only smokers (and not nearly all of them) opposed the idea.

Bottom line: The Healthy Indiana Plan will save us lots of money. The people who account for higher health care bills will pay the higher tax. And it's a safe vote for elected officials of all stripes.

So, Sen. Long and Speaker Bauer, when your teams huddle at the 11th hour of the final session day, make like Indiana's own Greg Oden and deliver a resounding slam dunk. The crowd will go wild.

Hetrick is chairman and CEO of Hetrick Communications Inc., an Indianapolis-based public relations and marketing communications firm. His column appears weekly. To comment on this column, go to IBJ Forum at www.ibj.comor send e-mail to bhetrick@ibj.com.
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