DOCTORS' LOUNGE
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TAXING TOBACCO TALES AUTHOR Mary Barry, MD
T
axing tobacco is hitting the three.
It’s the walk-off triple that empties
the dugout. It’s bowling 300 on a
Thursday night. It’s the goal-line
tackle that saves your season and
ruins theirs. It is, in fact, the only tax
that feels good to levy.
For far too many years, Kentuckians
who smoked enjoyed the cheapest cigarettes
around; the Civil War brought us the first federal tobacco tax that
stuck, in 1862, because of the Union’s growing debts. After much
ado and years of advocacy, in 2018 we finally got our tax raised
from 60 cents a pack to $1.10. Each pack is also taxed at the $1.01
federal rate and big cities have added their own taxes. In NYC,
you’ll pay $12.85 for a pack of Marlboros, and $5.40 here. Missouri
is still the cheapest place to ruin your lungs, at only 17 cents state
tax per pack. But per the “State of Lung Cancer” report from the
American Lung Association, Kentucky still leads the nation in
lung cancer incidence, 92.6/100,000 people; Missouri ranks 45 th
with an incidence of 73.2/100,000 people.
We know too well that so many cancers are related to smoking;
so many illnesses and hospitalizations and complications
are related to COPD from smoking, so many brittle bones,
pneumonias, falls, laryngectomies and deaths are from smoking.
We look at the beauty and vigor of our teens, and our hearts just
break at the thought that they, too, will become the frail old lady
in the wheelchair and not the master swimming champ. We look
at the millions and millions this country spends on health care for
smokers and our blood boils at the sheer needlessness of it all. Not
one of those dollars was a necessary nor inevitable expenditure.
Not one was paid willingly by anybody; all of those costs were
borne out of mercy, since none of us is perfect. We begrudged
every dollar.
Since June, 2,602 people have fallen ill to the vaping-use
associated lung injury, EVALI, with 64 dead as of Feb. 11—the
youngest a 15-year-old boy in Texas. In 2018, about 3.6 million
of our teenagers used electronic cigarettes and last year, 5.4
million—a huge jump. We have no way yet – when this generation
is 80, we should know – just how much lung, head, neck and other
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cancers will grow only from the use of e-cigarettes, not Marlboros.
For this is the first generation truly to eschew old tech for new
tech, the vaping devices.
Right now in our General Assembly, the bipartisan House Bill
32 proposes to add an excise tax on e-cigarette/tobacco vaping of
27.5% - the same tax rate as the current cigarette tax. Led by Rep.
Jerry Miller, nine representatives are working hard for support on
this bill. Many doctors and citizens have joined in support and
it was reported favorably after a first reading. We need a second
reading to get a vote; here’s a good stat to use when you call your
senators and representatives. Tell them that regular cigarette
sales dropped by 36 million packs in this state after the 2018 tax
hike. The greatest drop in purchasing was among the young, the
pregnant and people living in poverty.
Dr. Gordon Tobin has written a strong recommendation to
base the taxation on the nicotine content delivery of the vaping
device: that’s the addicting, danger-laden part. I favor a tax like
New York City, but that’s unlikely here. A tax that starts at 27.5%
and rises in proportion to the amount of nicotine per e-cigarette
would be the best financial approach to help Kentuckians to quit.
As poor as we are as a state – as debt-ridden, pension-strapped,
underpaid and overworked as we are – taxing the evil weed is a
brilliantly lucrative move. It pays off in health. It pays off in
prevention. It pays off in fixing potholes, paying teachers, funding
scholarships and cancer research. It should help pay for lung
cancer screening. Retirement pools might overflow. We can send
lots of cash to our Community Health centers, the backbone of
mental health care in this state. The e-cigarette tax should help pay
for outreach to schools, church groups, camps and sports teams
for the 12-20 age groups. We have to show them the facts.
Taxing e-cigarettes should save lives: and that’s the winning goal.
Dr. Barry is working at various Norton CMA offices as a “float/fill-in” only position.
She is a clinical associate professor at the University of Louisville School of
Medicine, Department of Medicine.