Simon Chapman, an Australian anti-smoking activist, argues in PLoS Medicine that "new, creative, and radical efforts to achieve the tobacco control endgame" are "vitally important." Jeff Collin, a public health specialist at the University of Edinburgh, agrees, especially since "the attainment of a tobacco-free future, so critical to any global conception of health for all, remains elusive." But Collin objects to Chapman's proposal for a smart-card-based smoker's license, arguing that "effectively curbing this industrial epidemic is best achieved via actions that tackle the disease vector"—i.e., tobacco companies.

This is what passes for a debate in public health circles, where no one questions the government's duty to protect us from our own risky choices.The only argument concerns the best method of achieving "health for all." Worries about creeping totalitarianism are limited to the possibility that public perceptions of it might impede the march to a world in which no one sacrifices health or longevity for the sake of pleasure or convenience.

In this case, Chapman imagines an electronically monitored system in which smokers would pay progressively higher fees for rations of one to 10, 11 to 20, or 21 to 50 cigarettes per day. The annual fees would serve as a stick, penalizing smokers for their unhealthy habit, and a carrot, since they could be recovered (with interest!) by smokers who surrendered their licenses and committed themselves to a tobacco-free lifestyle. New smokers would have to pass a test showing their knowledge of the relevant health risks, and the minimum age for smoking would be gradually raised to 23. Chapman argues that the license fees—which "would neither be trivial nor astronomical," perhaps ranging from $100 to $200 a year (27 to 55 cents a day)—would encourage people to quit. Furthermore, "the requirement for a license would send a powerful, symbolic message to all smokers and potential smokers that tobacco was no ordinary commodity."

While "opponents of the idea would be quick to suggest that Orwellian social engineers would soon be calling for licenses to drink alcohol and to eat junk food or engage in any 'risky' activity," Chapman says, they can be reassured that there is no slippery slope because smoking is uniquely dangerous. He further positions himself as a moderate by questioning a Singaporean proposal for a complete ban on smoking by anyone born after 1999, saying "libertarian objections that adults should be free to take informed risks, as with smoking, may render such a plan politically unacceptable." Not that there is anything to such libertarian objections, mind you; it's just that tobacco controllers need to take such antiquated political prejudices into account.

Collin, Chapman's ostensible opponent in this quasi-debate, likewise worries that "the authoritarian connotations of the smoker's license," although not inherently problematic, "would inevitably meet with broad opposition." Similarly, Collin warns that people might object to the data collection necessary for Chapman's scheme to work, although "in countries where digital ID cards are routinely carried or objections to authorities holding data are limited...linking tobacco purchases to such [smart] cards may be largely unproblematic technically or politically." Collin also complains that Chapman's plan puts "a direct focus on smokers," as if they are responsible for their behavior, when we all know it is really the fault of evil corporations. Charging for cigarette licenses "would be censuring the poor," he says, and "has the potential to dramatically exacerbate [smokers'] stigmatization"—unfair, presumably, because they just can't help themselves. Collin reminds Chapman that "a fundamental challenge confronting any endgame strategy is that the move towards a tobacco-free society should address the social determinants of health and promote equity and social justice."

Yes, that is the problem with forcing smokers to pay for a government-issued smart card that keeps track of their consumption and punishes them for their own good: insufficient social justice.