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An occasional collection of thoughts, musings and provocations on current health issues.*  by Roger Hughes, Executive Director - SLHI

The Virtues of Bad Habits

One of the wonderfully perverse effects of America's avoidance of coming to grips with paying for the health care of people who can't afford to pay for it themselves is the elevation of bad habits into civic virtues.

Arizonans are masters at this. Already plans are underway for yet another initiative to increase taxes on tobacco products to pay for health services legislators are unwilling to fund through general revenues. This effectively transfers responsibility for indigent health care from the general public to a segment of the populace - smokers -- and gives them an opportunity to serve others while they pollute their bodies and the environment.

On the one hand, this makes sense. If people are stupid enough to smoke, let's at least make sure we get some social benefit from it. We have to breathe the second hand smoke and pay for the respirators and chemotherapy to keep them alive after they've willfully poisoned their bodies. The least they can do is pick up part of the tab for people who can't afford health services on their own, smokers and non-smokers alike.

Further, if we raise the tax high enough, more people will quit smoking because they won't be able to afford a pack of cigarettes. We'll be doing both them and us a favor.

But what about the free ride we non-smokers are getting by transferring the public obligation for indigent health care to smokers? Aren't we being a bit hypocritical here?

We know that a significant number of smokers are young, low income, less educated, or even afflicted with a serious mental illness for which smoking's short-term palliative effect outweighs, at least in the smoker's mind, it's long term negative consequences. These are people who often are the least able to bear the economic burden of financing someone else's health care. It hardly seems fair to shoulder them with a civic obligation that belongs to all of us.

Fortunately, there's a way around this ethical quagmire: tax more bad habits, and thereby give more people an opportunity to be civically virtuous.

For starters, we should immediately tax alcohol and fatty foods. Tobacco kills you slowly; too much liquor can kill you instantly, and if you drive while drunk, it can kill others, too. Too many cheeseburgers and ice cream clogs your arteries and leads to heart attacks and an early death. Tax it, and millions of dollars will be available for all manner of public health and social goods.

But why stop there? We should legalize marijuana and levy huge taxes on it. Arizonans love their civil liberties. You ought to be able to smoke a joint and contribute to the public good. The same with gambling. Put slots in the grocery stories and hair salons. Tax it, tax it. Public coffers will swell, and universal access to health care will rise like a Phoenix from the ashes of our personal excesses.

For all the perfect people who don't smoke, drink, gamble, do drugs or eat fatty foods, we can tax driving over the speed limit. Everyone knows that it's thin young women driving red sports cars and rich real estate developers driving Lexuses who are doing all the speeding. Let's give them an opportunity to help the less fortunate as well.

No doubt this still leaves a few people out. For them, we'll undertake a media campaign to promote bad habits. Our slogan might be, "Be Bad and Do Good!" We already know how to market supersized meals and Lipitor chasers. We can sell anything.

Too bizarre, you say? Not really. It's the American way. We define the public good in terms of individual wants and desires. Put a meter on those desires, and we can spread the wealth around.

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