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I did not ask for national health care. However, if we are going to add yet another entitlement for the masses, then at least the people that use it the most should pay their fair share. Smoking, obesity and other self-indulgent behavior increases the cost of healthcare to everyone regardless of other cost multipliers such as pharmaceutical and health insurance companies. Cost saving are obviously important, but immaterial to this discussion of the control of the costly public behavior. Basically, if the public wants the freedom to indulge and the healthcare to care for it, then they need to pay for it. Their freedom to indulge should end at my pocketbook.
When your 62 yo father with emphysema needs oxygen to breathe or heart bypass for a life of cigarette use and your 57 yo mother needs new knees because she just cannot stop consuming Krispy Kremes, it becomes difficult to deny them life-prolonging health care. This is why Obama is discussing the ‘need’ for healthcare in the first place. So, if the self-indulgent behavior is curbed, then fewer dollars are needed. If the behavior continues, then at least it is paid for ahead of time.
To set the various taxes, start with the annual costs of healthcare. The fraction that is attributed to any given self-indulgent behavior must be offset by the tax. So, if healthcare costs $1.2 trillion and 35% is related to cigarettes, then the cigarette tax per pack must equal $420 billion. If consumption diminishes, then the costs associated with cigarettes diminish as well. One can then apply this same formula to any and all behavior that results in higher healthcare costs such as food (tax based on total calories rather than singling out soda sales), bullets, driving, etc. Eliminating the cost of preventable healthcare would result in MUCH lower premiums, since only truly random diseases (leukemia, birth defects and trauma) would need to be covered by the new premiums. Remember that the people who do not overindulge are still paying these taxes, but because of their low rate of behavior, the tax would be low and would be easily offset by the savings that they see in their healthcare premiums.
Obviously this is a pragmatic approach which flies in the face of Washington politics, so I think Obama will just stick with his standard rhetoric and raise taxes further on people making more than $250K.