Barack Obama

President Obama Wants Tax Hike on Cigarettes, Smoking a Pre-Existing Medical Condition Under Some Obamacare Health Exchanges

Perverse incentives abound

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a bridge too far
Camille Richez/Foter.com

Among President Obama's half trillion dollars in tax hikes is a 94 cent tax on cigarettes expected to raise $78 billion over ten years. The president wants to spend it on early education.

Meanwhile, healthcare exchanges created by Obamacare are starting to classify cigarette smoking as a pre-existing condition, prohibiting insurance companies for charging more to customers who take a higher risk by smoking. In noting the most recent such decision, in the District of Columbia, the National Review points out the absurdity of the decision and how it serves to illustrate the bureaucratic morass Obamacare imposes on the health insurance market:

Obamacare was sold as a way to help poor people and sick people get health insurance, but, as the D.C. decision shows, the actual intent of the law is the abolition of health insurance. The notion of insuring a preexisting condition is an oxymoron; insurance is by nature concerned with that which may happen in the future rather than with that which already has happened. In very large groups, human health outcomes are predictable with a fair degree of precision: Given 10 million people, actuaries can make pretty accurate predictions about how many people are going to get lung cancer and how many are going to be in car accidents. Some factors are relevant to some conditions: Being 17 years old and getting in a car accident, for example, or smoking and heart disease, emphysema, cancer, etc. Insurance, which places a price on calculated risks, will take some of those factors into account. But you cannot in any meaningful sense insure somebody against cancer when they already have cancer.

Obamacare is designed to destroy the insurance market. Markets do not function without prices, and Obamacare ensures that prices will not be allowed to emerge. There is a medical price associated with smoking, but the District of Columbia has decided to suppress that price by law. Pretending that smoking has no relationship with health-care costs does not make it so — it is only a way to push costs around in a way that is agreeable to the likes of Barack Obama, converting a system that prices risk into a system of entitlements.

Smokers have actually been shown to cost insurers less (spoiler: they die younger) but they present a higher risk and identifiable associated costs. The treatment of cigarettes as a revenue source by governments at all levels shows that while government may not hesitate to suppress the cost of smoking on healthcare, it's eager to impose costs on smoking of its own. The government's love-hate relationship with cigarette smokers ought to be a stark warning of how perverse government incentives could become as it becomes more and more involved in the business of healthcare.

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  1. If only the mandate had been tossed. Then insurance companies would be going under in record time.

  2. I know we should typically attribute stupidity to politicians before malice, but to me there is really something genuinely sinister about Obamacare and the way that he’s really managed to convince a large portion of voters that it’s going to fix healthcare.

    1. “fundamentally transform america”

    2. Stupidity and malice are not mutually exclusive. Progressives live on the synergy of the two.

  3. Obamacare is designed to destroy the insurance market.

    I thought it was partially designed to force everyone to become the insurance companies’ customers.

    Markets do not function without prices, and Obamacare ensures that prices will not be allowed to emerge.

    Sure they will. Prices will go up for everyone to cover not being allowed to do as much variable pricing.

    1. I thought it was partially designed to force everyone to become the insurance companies’ customers.

      This is where it is even more evil than the government simply providing single payer. Not only will the consumer get to pay for all of the government bureaucrats they will also be expected to produce a modest return to the insurance “companies”.

  4. I don’t know what libertarians are smoking that makes them think that you can have democracy, mass immigration, and capitalism at the same time, in our day and age.

    1. Since I didn’t work this week, it is basically just shwag. You?

    2. “mass immigration,”

      Hey, everybody! Here’s your daily dose of bigotry, courtesy of XNor!
      Put your hands together for XNor. Or not…

  5. Libertarians who say that borders are oppression are just like liberals who say that property is theft.

    1. How does that work? If anything it would be the other way around. Open-borders people aren’t the ones trying to control what others do with their property

      1. Pro-American people aren’t the ones trying to tell a nation what it can do with its border.

        1. XNor| 4.10.13 @ 7:57PM |#
          “Pro-American people aren’t the ones trying to tell a nation what it can do with its border.”

          You’re always good for a laugh.

          1. Borers, property, both are just social constructs aren’t they?

            1. XNor| 4.10.13 @ 8:11PM |#
              “Borers, property,”
              I’m sure you’re familiar with the concept of false equivalence. You probably get called on it ten to twenty times a day.
              You’re a bigot and an ignoramus.

              1. I know the concept, but it doesn’t apply in this case. Both are social constructs. You just happen to worship one and hate the other.

                1. XNor| 4.10.13 @ 8:26PM |#
                  “I know the concept, but it doesn’t apply in this case.”

                  A bit too complex for you, I see.

                  1. How are property rights not a social construct?

                2. They’re not “just” social constructs, though. Property rights alleviate the self-destructive nature of the commons. What purpose do national borders serve, then? Oh yeah, keeps them dirty wetbacks in Mexico where they belong, right?

                  1. National borders serve a multitude of purposes, such as defending the property, liberty and living standards of the citizenry. What is so outrageous about Mexicans staying in Mexico? Mexico is hell for a reason.

                    1. “Mexico is hell for a reason”

                      The Mexican economy is growing faster than ours, which is why capitalism is going to solve your “problem” for you. They’re not going to come here when they can’t get a job anyway. Net immigration in 2011 was negative, I believe.

                    2. There are two possibilities here.

                      A) He is a sockpuppet troll whose only goal is to show up every night and get a rise out of people.

                      B) He is a retarded white supremacist with the IQ of a tree stump who shows up to spout pseudoscientific nonsense and weird Marxist propaganda in between bouts of banging his cousin.

                      Talking to him is useless.

                    3. Good god, the troll got banned before I even got home from work?

                    4. jesse.in.mb| 4.10.13 @ 9:25PM |#
                      “Good god, the troll got banned before I even got home from work?”

                      Mike’s been just HELL on bigots recently; another one bit the dust over the weekend.

                    5. So much for a no holds barred comment section. But I can still advocate for impoverished child slaves of the race of my choice to polish my monocles, but God forbid I care how they got to my factorium?

                    6. WHAAAAAAA! WHAAAAAAAA! Mom, the kids at Reason won’t let me play because my white hood keeps getting in the way! They also tell me I’m ugly because of all the swastikas I’ve carved into my forehead! I don’t even know how they can see the swastikas, what with the hood and all! /Murkin

        2. Um, yeah you are.

          In any case, nations don’t have rights, individuals do, so it’s a false equivalence

          1. If the American people wanted to open the borer to tens of millions of immigrants you might have a point. Bu they don’t. They want immigration reduced. Why should individuals have rights and nations not? This moralistic argument is based merely on personal preference. Some people prefer the rights of individuals to exploit their property to the exclusion of their countrymen’s well being, others want to leave their children a nation that looks vaguely like the one they were born in.

            1. Some people prefer the rights of individuals to exploit their property to the exclusion of their countrymen’s well being…

              Da, comrade!

    2. Property as theft is an absurd logical contradiction, which is why it attracts lefties (who, ironically given your other comments, think logic is a social construct). Not so with borders as oppression, though. In order to create an equivalence, you’d have to claim “borders are immigration!” or something equally stupid.

      1. There is some similarity here. Property is based on denying individuals the right to come into the property holders land and take the resources they feel entitled to. Borers are based on not letting people come into the citizens nation and exploit the nation, without regard to the welfare of the citizenry.

        1. How are people coming into the nation to exploit it? Work is not exploitation.

          1. When people loose their job because their employer gave it to an illegal, those people suffer.

            1. Who is losing their jobs to “illegals’? Please use the awesome power of the internet to find even one specific example.

              1. Teenagers.

                1. Construction workers.

                  http://www.thesocialcontract.c…..orker.html

                  1. What a heaping pile of stupid, whiny, entitlement. That whole industry has had new immigrants pushing labor prices downward for ages; 100 years ago it was Italians, 50 years ago Norwegians, 25 years ago Polish, and now Mexican. And every single time the sons of the last generation bitched about the new guys taking food out of their kids’ mouths.

                    I look forward to the future when 2nd and 3rd generation Mexicans complain about the Filipinos and Congolese terkin their jerbs.

                    1. I’m saying it now: I’m not going to learn Tagalog.

                    2. Probably the right call. Not even their kids bother with it.

      2. He’s clearly a sock puppet, guys. He used the word ‘borers’ twice, in place of borders. He’s some sort of weird communist, white supremacist hybrid.

        He isn’t a real person, and arguments are useless.

        1. What does a “sock puppet” even mean to you? Someone who disagrees with the you?

        2. He’s some sort of weird communist, white supremacist hybrid.

          You mean he’s some sort of…nationalist socialist?

        3. And now he’s gone.

  6. Wednesday’s wild ride came as someone gave away thousands of dollars worth of Bitcoins on Reddit, the social news site. News blog Business Insider calculated a Reddit user under the name “Bitcoinbillionaire” had given away $13,627.69896 worth of Bitcoins to Reddit users over the day. The mystery donor signed off with a quote from Ron Paul, libertarian politician and one-time would-be presidential candidate: “It’s no coincidence that the century of total war coincided with the century of central banking.”

    Undoubtedly not the cause of the crash but pretty hilarious.

    1. Now that is awesome, Ron Paul’s influence despite his being out of office will continue

    2. I didn beleef it until I sau my friends rooomates uncles chex. He realy dod make $13,627.69896 worth of Bitcoins on lhis laptop reading Reddit! He bort himselgf a new hyandai.

      1. nice

      2. You forgot the link. You are a bad spam bot.

        1. Interestingly, they usually spell that correctly.

        2. You forgot the link. You are a bad spam bot.

          Don’t blame him, he did it all by himselgf.

  7. “Smokers have actually been shown to cost insurers less (spoiler: they die younger) but they present a higher risk and identifiable associated costs. ”

    Exactly, good luck making that argument in Canada where people always say that smokers are “draining” the public health system and thus we can tax them as much as we want.

    1. Yeah, the more people are forced to pay for each other, the more picky they get about whom they’re paying for.

    2. If you try hard enough GT, you can build models to tax literally anything and everyone in Canada.

      1. Why reinvent the wheel when The US Gov’t is now licensing the US Tax Code at very reasonable yearly rates?

    3. Half the reason Lefty’s are so crazy about government monopolies on healthcare is because it gives them an excuse to tax and/or ban all those things people ingest that they hate, liek cigarettes, sodsa, fast food ETC. Tyranny disguised as faux benevolence.

      The other half, of course, is that they’re (mostly) all authoritarian assholes who will take any avenue of exerting their will and idiotic beliefs on everyone they can.

    4. ‘Exactly, good luck making that argument in Canada where people always say that OTHER PEOPLE are “draining” the public health system and thus we can tax them as much as we want.’

      Fixed.

    5. Even if smokers did cost more in healthcare, I’d like to see how that compares to how much they pay in tobacco taxes.

  8. “Smokers have actually been shown to cost insurers less (spoiler: they die younger) but they present a higher risk and identifiable associated costs.”

    Perhaps, but obviously we can’t have companies pricing such risks for themselves–because that would make government interference seem unnecessary.

  9. “Smokers have actually been shown to cost insurers less (spoiler: they die younger) but they present a higher risk and identifiable associated costs.”

    One other important point:

    ObamaCare requires insurers to spend 85% of the premiums they collect on paying for care.

    This stupid idea was supposed to keep insurers from driving up the cost by taking more than a 15% profit, but it what it really does is kill 85% of the insurers’ profit incentive to cut costs.

    For every dollar they save, they get 15% in profit–which is absurd.

    Point being, cost savings (on things like less costs for smokers) doesn’t really matter much to insurers–since instead of being able to increase their profits dollar for dollar by lowering their costs, only a small slice of the money they save turns into a profit.

    1. Not really. You cut a dollar of costs. You pocket 15 cents. You cut premiums another 85 cents, and pick up more business.

      Your argument is like saying that if WalMart cuts costs a buck, and only pockets 15 cents of that buck, that they will only get 15 cents profit, even if they sell a buttload more of that item.

      The problem with the 85% thing is that it is a price control, and results in some insurance not being a book of business that can be profitably written — so the insurer cancels all that coverage.

      1. What I’m saying is that on a marginal basis, where companies in other industries get to increase their profits (other things being equal) by cutting costs–dollar for dollar–that incentive to cut costs doesn’t exist under ObamaCare. This may do a lot to explain why premiums keep rising!

        Oh, and, incidentally, whatever increased market share the insurers get under ObamaCare for cutting their costs? They’d also get to keep ONLY 15% of that, too, right?

        Oh, and, I should add, if there’s still some incentive to cut $1.00 in costs because of the 15 cents in profit they can keep under ObamaCare, that incentive would still be there–and more!–if they were able to keep $1.00 in profit instead of just 15 cents, right?

  10. “The government’s love-hate relationship with cigarette smokers ought to be a stark warning of how perverse government incentives could become as it becomes more and more involved in the business of healthcare.”

    Only one more; see, oh, Bloomberg.

  11. I agree with the policy.

    We don’t charge Dick Cheney and people of the like extra.
    We don’t charge people that work 14hr days and end up with a stroke extra.

    1. Next up, why charge people whose houses are already ablaze extra for fire insurance?

      1. All for it.

        And, if proven you’ve committed arson for insurance purposes, yea…they should charge you more.

        But just for having the bad luck of having a fire in one’s home should hurt you.

        1. English, motherfucker. Do you speak it?

          1. Say what again. SAY WHAT again! And I dare you, I double dare you motherfucker! Say what one more time.

            1. What?

        2. “But just for having the bad luck of having a fire in one’s home should hurt you.”

          Actually, insurance is all about mitigating for bad luck.

          I’m giving you a reading assignment:

          http://www.amazon.com/Against-…..0471295639

          …thing about insurance is, you don’t get to mitigate for bad luck after the fact.

          That’s not insurance. That’s welfare.

          1. Bah, way too much playing along, Ken. Just call her a stupid cunt. You know you want to.

          2. Thanks for the book link. It’s going on the Kindle tonight!

      1. Not @ you, Ken.

  12. Obamacare is designed to destroy the insurance market.

    Insurance companies are bad, mmmkay?

    1. And when all of the problems Obamacare was designed to solve continue to get worse, President Biden will scream “market failure!” and push for a single-payer system crafted by Elizabeth Warren and Nancy Pelosi.

      1. And when all of the problems Obamacare was designed to solve continue to get worse, President Biden will scream “market failure!” and push for a single-payer system crafted by Elizabeth Warren and Nancy Pelosi.

        Actually some of my lefty friends were annoyed that he didn’t skip straight to single payer. They all seem to have decided that the ACA is a tactic to get single payer, at least in my circles, most of them are horrified that he would fuck up our entire medical system worse than it was in a gambit to get a different policy down the road, and the remainder think it’s brilliant.

        1. Yup. And those of us working in healthcare, we can see it just down the road. Too bad, you 85% of Americans who were satisfied with your health care. Everything is going to be totally fucked for you just so another 8% of people could get coverage. I hope you all like waiting rooms, because in the future, if you have any health needs, you will be spending a lot of time in them. But at least you can play on your cell phone!

          1. I work in a clinic that does primarily federal work comp. I kept telling people I’ve seen what having the federal government as your claims adjuster looks like and it’s not pretty. I was told my experience wasn’t relevant to the debate by a few of the friends who are now in the “crashing the system to get single payer is brilliant!” category now.

    2. Insurance companies are bad, mmmkay?

  13. Smokers have actually been shown to cost insurers less

    But, if they don’t live as long, then they don’t pay as much in premiums either. So they might or might not net out as a better bet for insurers.

    1. But the part of life that they don’t live is typically where people have the most medical costs, so it probably evens out.

  14. American and Alice Bowie, merrily babbling away on the same thread.

    Yay.

  15. Funding anything with a cigarette tax is absolutely moronic. The number of people who smoke has been dropping for years and this generation of young people is even less likely to smoke then the last generation.

    So if you’re funding something with cigarette taxes, that income is going to drop over time. Then where is the money going to come from?

    1. Politicians have a short time frame — until their next election.

      When they aren’t stealing enough for their tastes from smokers, they will find someone else to victimize.

    2. “Then where is the money going to come from?”
      Not the point. The points (two, actually) are:
      1) We’re using coercion to force someone to give up an enjoyable act (the Puritan strain runs strong on lefties).
      2) We’re taxing other people so you get free shit (until it isn’t).

      1. Yes but lefties see no problem with either of those things.

        Even by their standards trying to fund something with a tax that is guaranteed to decrease over time is incredibly stupid.

        1. “Even by their standards trying to fund something with a tax that is guaranteed to decrease over time is incredibly stupid.”
          See Prolefeed’s comment re: time horizons above.
          When this tax isn’t doing the job, well, that guy’s out of office, collecting the pension. The next guy will tax weed.

        2. They are “making healthcare more affordable” in part with a tax on medical devices, which is just surreal.

    3. It’s ok, where there are willing people ready to hand over anything to the state, there’s something to tax somewhere.

      Sugary drinks today, Frosted Flakes tomorrow!

      One day someone will suggest we tax air.

      1. Tax those pennies on your eyes…

        1. If you take a walk, I’ll tax your feet

  16. Then where is the money going to come from?

    Higher cigarette taxes, duh.

    1. Ahh, smokers. The socialists love a captive industry…you can tax the hell out of ’em.

      1. Until they quit…

        1. So you tax cessation aids even heavier than cigs to keep people from quitting.

          It’s like you don’t understand how to steal at all.

  17. Smokers have actually been shown to cost insurers less

    Not in any meaningful underwriting sense of the word, unless the government does away with one of the most significant predictor of costs for any individual, their age. For any age bracket, the average health insurance costs for a smoker will be higher than that for a non-smoker.

    1. OK, but where does the curve bend since the smoker is likely to die earlier?

      1. There is no curve to bend if you’re pricing by age. If smokers cost 20% per year than non-smokers of an equivalent age, but you can’t charge differently for the two classes, you wind up undercharging smokers and overcharging non-smokers for every single age class.

        The fact that the smoker dies earlier is irrelevant, since they do not pay premiums once they die. Their lifetimes costs are lower, but their lifetime premiums are also lower.

        1. That should read 20% MORE per year …

        2. Isn’t that just because old-age insurance is Medicare? I mean, maybe the insurance company pays more for the smoker, but the taxpayer pays less, since the smoker dies before he gets his medicare.

          1. Dunno. The smoker still stops paying (“contributing”) when she dies.

            1. Yeah, but they usually live through their productive years, when the vast majority of contribution is made, and die before taking the benefits. You have to run the numbers, but it would seem they’re going to lean toward net gain for other taxpayers.

      2. There is no INSURANCE curve to bend.

        There is a GOVERNMENT ENTITLEMENT curve that could theoretically be bent, if you’re talking about Medicare / Medicaid, but by subsidizing smokers you’re encouraging them to continue smoking and running up costs for each year they are alive. And once they are dead, they quit paying taxes.

        Theoretically the federal government could reduce budget deficits by subsidizing smoking, but that isn’t remotely insurance, it’s just the difference between the theft from taxes versus the bribes to voters via entitlements.

    2. When I’ve heard it quoted before that smokers cost less, it was specifically in regards to their costs to Medicare and may have referenced Social Security, as well.

      From an insurer’s perspective, they may only have to insure until a) the person gets sick, b) the person dies, or c) they can pawn the person off on Medicare.

      If smokers cost the taxpayer less because once they go, they tend to go quickly and the government doesn’t have to keep paying for them to live in a nursing home for an extra ten years, you’re right, that doesn’t save insurance companies much money at all.

      1. The piece that Bailey originally linked to (and Krayewski linked to Bailey’s piece) doesn’t seem to mention private insurers specifically saving any money at all.

        Here’s the piece:

        http://www.nytimes.com/2008/02……html?_r=0

    3. Costs may be higher but the insurance company still makes money off of them therefore they positively contribute to the insurance pool keeping the overall cost lower than if they weren’t in the pool at all. Perhaps not as low as if they did not smoke but thats like how every dollar you don’t pay in taxes “costs” the government money.

    4. They will cost less when we implement Part 2: the aspirin-only plan for smokers.

    5. Smokers already pay more for healthcare by subsidizing SCHIP and all the “cost of smoking to society” through the Master Settlement Agreement. Non-smokers are the real “free riders” here.

      1. And if you really want to cost actual risks into health care there is a method to do that. It’s called everyones pays as they go.

        1. Why do you hate Vagina-Americans?

  18. BTW, if that image is from “A Bridge Too Far”, it’s an illustration of rational risk-taking.
    Folks in combat situations have greater risks to deal with than smoking.

    1. It’s not from A Bridge Too Far. It is just a portrait of a little Euro-cutie smoking a cigarette. The photo is by Camille Richez. Do a quick GIS for “Camille Richez”. Interesting work. Interesting, indeed…

  19. Actually, I think the “smokers are cheaper” argument is really about Social Security.

    1. OK, in this case the “contributions’ stop at X age, so the curve here could be bent by life expectancy.

  20. If the government can force you to eat broccoli, can it force you to smoke cigarettes? It seems that may be good for the country.

    1. Kinky…

  21. FEEEEEEEEEELings

    The crowd that filled the ballroom of the downtown Hilton Hotel for the “Get In Chicago” luncheon included many of the people who have long labored behind the scenes to improve the quality of life for black people in this city.

    Some are politicians. Some are civic leaders. And some are business leaders who defied the odds by building successful businesses in a city where race and class have been formidable barriers.

    Frankly, when black people say, “It takes a Village,” these are the people who make up that village.

    Ummmmmm.

    Does “Ur DOIN IT RONG” mean anything to you people?

    1. I’m going to Chicago next week. I hope to improve the quality of life for black people in the city. Are there any restaurants, bars, boutiques, or museums in the Near North Side? They will gladly get my money. But truthfully, I’m not driving down to the ‘hood just to patronize some “Black-owned Businesses”.

      I understand that there is a legacy of racism, and access to capital, business permits, and certain neighborhoods has been tough. But we are in a different social and economic climate now, and there is no excuse for not building business where the money is. If your idea is to build a business in the shitty ‘hood because you are trying to “keep it real”, you will be doomed to failure.

      Either fix your neighborhood. Or move out to Barrington and open a Chicago rib joint.

      1. “Chicago rib joint”?

        That series of words you put together makes about as much sense as “World Series Champions, the Chicago Cubs.”

        You’re going to need to jump on the 55 and drive south until you see a big stainless steel arch if you want some good barbecue.

        1. Yeah, and then take a right onto I70 and drive 400mi more.

          1. Not far enough.

          2. Right? You meant left didn’t you?

            1. Only way to get to KC from SL when you’re driving south is to turn right.

  22. President Obama wants tax hike on _____________.

    No, really? Holy shit, who would have thought?

  23. Smokers have actually been shown to cost insurers less (spoiler: they die younger) but they present a higher risk and identifiable associated costs.

    Is this several wrong things in one sentence, or one not-even-wrong?

  24. I will never understand it. Is taxation a way to discourage bad habits? Or is taxation the price we pay for civilization? Here theyre depending on smokers’ bad habit to fund education for the kids. Do they want people to stop smoking or not?

    1. Taxation is the way you get what you want.

      Since free markets and capitalism can’t insure that you get what you want, since other people might get what they want, taxes are a cure-all.

    2. I’d prefer if they have to do this tax, they’d at least spend the revenue on actual health care services, rather than another goddam smoking education project. Is there anyone left in the USA who doesn’t know that smoking is bad for you?

  25. I already pay way to much for my fucking cigarettes. This stupid anti-smoking crap pisses me off so much. I’m fine with all the terror based education that students got in school but the rest of it is bullshit. Pretty much no one doesn’t know about the risks involved with smoking and if they choose to accept them that’s their own business. All I can say is thank god for e-cigs, they’re not as satisfying as the real thing but they are so much cheaper.

    1. Until the taxman cometh yet again. To hell with them. It’s smoke time.

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  27. The trouble with that article is that it claims Obamacare is meant to destroy the insurance market, yet it’s patterned after Romneycare. Did he want to destroy it, too?

    Beyond that, there isn’t a free market in health care to begin with. You have restrictions on who can practice it. You have restrictions on what treatments can be used, what drugs can be proscribed, who can use them, where you can buy them from. Not to mention the IP law on drugs and medical devices.

    And laywers. Let’s not forget lawyers.

    But the net result is that we pay twice as much for our health care than anyone else in the world, yet it’s really not any better, and many people simply aren’t without healthcare at all.

    Frankly, I hope Obamacare destroys our current medical system. Whatever we replace it with cannot be any worse.

  28. “The president wants to spend it on early education.”

    The president wants to spend the money on his union supporters.

  29. Ut oh, here we go again lol.

    http://www.SurfitAnon.tk

  30. “Smokers have actually been shown to cost insurers less (spoiler: they die younger)”

    Maybe, but since they don’t pay premiums after they die, it’s probably more accurate to say that they cost insurers more per year than to say they cost less per lifetime.

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