The American Dilemma and How We Can Fix It


I wish this were one of those warm and fuzzy pieces that so many of you seem to like reading as much as I enjoy writing. It isn’t. I offer this disclaimer so that if that’s the kind of piece you’re in the mood for perhaps you might return to this post at a later time.

There is probably no one in this country who hasn’t taken a position or doesn’t hold a view on Obamacare. I’m still trying to wade through all two thousand plus pages of it so that I can come to an informed judgment. Apparently, not all of our lawmakers have my diligence.

When I called my Congresswoman’s office to ask several questions about it, one of her staff said that she probably wouldn’t be able to answer my questions “just yet” since the Congresswoman hadn’t read it herself. (She had voted to pass the bill three days earlier).

It makes me wonder – is this any way to run a country?

The sad answer to that question is that’s apparently what our citizens will settle for in their elected officials. Having demonstrated that she could vote on legislation without bothering to examine its contents, this Congresswoman is planning on a November run for the Senate from the great state of Nevada. She’ll probably win. But to return to our subject …

On the surface, who would oppose something that is supposed to extend health coverage to more people? Only the most cold-hearted of us would say, “Hey, if they can’t afford to see the doctor they’re probably worthless people anyway – let them die. It’s just less trash that we have to worry about.” I don’t know anyone with that mindset – and I hope not to meet any in the future.

As I see it, there is an inherent flaw in our present system which is only extended further in this bill. That flaw is that our healthcare system is reactive rather than pro-active. We wait until we are ill – and then we tax the system to the best of our abilities with doctor’s appointments and an addiction to prescription drugs heaping yet more stress and expense on an already stressed out system.

If we placed our focus on staying well rather than trying to manage the symptoms of the diseases we have brought upon ourselves, we would not only have a better and far less expensive healthcare system but we would be a far healthier nation.

This may surprise you – but this thinking is not completely alien to those in power in government. To support my thesis, I point to the excise taxes that are levied on cigarettes.

Government at both the federal and state level place an excise tax on each pack of cigarettes that is sold in the country. The theory behind the tax is that cigarette smoking is an unhealthy behavior and by taxing it we discourage people from engaging in it.

That sounds like a reasonable theory to me and I was curious to learn how many packs of cigarettes were sold annually. Unfortunately, I was unable to find the statistic for the entire United States. However, I was able to find a listing of the amount of excise taxes that each state collected on cigarettes (the most recent data being for 2009).

By dividing each state’s revenues by the amount of its per pack excise tax I was able to calculate the total number of packs sold in each of the fifty states and the District of Columbia and thus arrive at a nationwide total.

Just as a point of information, the excise tax rate ranged from a low of $.30 per pack in Virginia to a high of $4.35 a pack in New York. In addition to the excise tax, smokers pay the going sales tax rate on their purchases (including sales tax on the excise tax) – and some municipalities have yet an additional excise tax that they levy. The following numbers do not include these additional revenues.

Here’s what the states reported and what the Federal government received from its imposition of the $1.01 Federal Excise Tax per pack of cigarettes:

$14,493,944,400 Federal Excise Tax Revenue

$17,157,014,000 State Excise Tax Revenue

The grand total is $31,650,958,400 of excise tax revenue per year. (If you get lost in large numbers as I do – that’s over $31.6 billion a year).

As I said earlier, the theory behind imposing this tax is that by making smoking more expensive we make it less affordable. That kind of thinking is exactly consistent with my position that we should discourage unhealthy behavior and encourage healthy alternatives.

Of course, logic would suggest that if you carried this to its ultimate conclusion, Uncle Sam could raise the excise tax to twenty dollars a pack and then lung cancer and emphysema would be diseases that only the rich could enjoy. But then we would need to begin a conversation on unequal accessibility to illness. (Or we could just blame it on Bush).

We know that smoking results in nasty medical conditions. But in fairness to those of you who smoke, in the thirty or so years before those have developed, you will have collectively contributed over $1 trillion in excise taxes to society to help pay for the care you will undoubtedly require.

Let’s look at another life-style choice which has now surpassed the cost of treating those who are long-term smokers. That condition is overweight and obesity. According to the NIH, sixty-two percent of us fall into one of those categories. That’s not a good thing.

While not the sole cause, there is no doubt that our national addiction to sugar is a contributing factor. We sprinkle it on our morning cereal (if it hasn’t already been done for us by the manufacturer), we find it in our chocolate bar snacks, and it is present in large quantities in the soda (pop to some of you) which we consume with abandon.

Study after study has shown that consuming refined white sugar has serious long-term implications for our health. Yet sugar, one of the major contributors to our becoming a nation of fatties and diabetics, is considered food – whether we purchase it in five pound bags or pick it up in a six or twelve pack of soda or at the drive through window. Why have we not applied the same good logic to sugar which we apply to cigarettes?

The obvious answer is that the backlash from those who are soda-addicted would be enormous. I don’t know how many of us drink soda either regularly or infrequently but we do know that only about sixteen percent of us currently smoke. I suspect the number of us who regularly consume soda is probably five times that number. But if we formulate policies based on voter appeal rather than rationality, we are ultimately signing our own death warrants.

I commend New York City Mayor Michael Bloomberg for raising this issue and proposing a “sugar tax.” I consider him a statesman rather than a politician. But even to those who represent us in government who are career politicians, I would appeal to you to think about doing the right thing for your constituents – while they’re still healthy enough to get out and vote for your re-election.

An obvious first step would be to include only healthful alternatives in our public school cafeterias. If we start learning good eating habits as children, we are far more likely to hold on to those habits as adults. Who knows – maybe some of these kids can take home what they’ve learned and teach their parents how to eat better.

Of course, if each of us took responsibility for his or her own life and health, I wouldn’t be writing this post.  And in its place I could have put up one of those warm and fuzzy pieces that you like to read and I like to write.

I invite your thoughts and comments.


Comments on: "ON REAL HEALTH REFORM" (2)

  1. Well, I think a 2,000+ page healthcare plan is patently ridiculous. 1,995+ of those pages are loopholes and codicils assuring the most profit for insurance companies and pharmaceutical corporations – one of the wealthiest & most powerful corporations in the nation. In spite of its claim, U.S. healthcare is not about providing healthcare for citizens. It is about corporate profit. Period.

    • You are absolutely correct. Whatever happened to the KISS theory? And the truth is that 90% of the pharmaceuticals merely treat symptoms (usually with nasty side-effects) and do nothing to address the underlying condition is nothing short of scandalous. Thanks for taking your time to read this – and I hope you pass it along.

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