January 1, 1970 (Vol. , No. )
Taralyn Tan Ph.D. Curriculum Fellow Harvard Medical
Probably no other aspect of government’s reach into our lives is more frustrating (especially around April 15) than taxation. Yes, we all have the taxation of our income, both at the state and federal levels. Depending on where you live, you must also cope with things like high property taxes, or sales tax, or both. The existence of these taxes is generally not opposed (though you will hear the more-than-occasional gripe in relation to the amount of taxation), and that is because taxes like these are accepted as being part of life. We all have to deal with them—nobody is singled out. But what about taxes that target a certain group of people? Should the government be allowed to do that?
The indirect answer (without regard to whether they should be able to) is that the government is doing that. For instance, look at the taxation of tobacco products. They’ve been around for quite some time, with the latest (and largest) federal hike coming last year when the Children’s Health Insurance Program Reauthorization Act of 2009 was signed into law. For smokers, the increase was a significant blow to the wallet: a tax increase from 39 cents to $1.01 per pack of cigarettes (and this did not include state taxes). For non-smokers, this was nothing more than a way to raise money for state children’s health insurance programs. (And nobody will argue taxing big, bad smokers to help sick children, right?)
Now, with the passage of the comprehensive healthcare reform legislation, we see a second example of the government taxing people with unhealthy habits to help pay for the healthcare of others. Hidden within the massive healthcare legislation was a provision that imposes a 10 percent tax on indoor tanning sessions beginning July 1. The idea is that over the next ten years, the estimated 28 million Americans who use indoor tanning booths will pay approximately 2.7 billion dollars of the costs associated with the healthcare overhaul.
You have to admit, there is a certain poetic allure to a system in which taxes from cancer-causing habits like smoking and tanning are used to fund insurance plans that may ultimately be covering the costs of cancer treatments. And to someone like me—a non-smoker and non-tanner, it doesn’t sound half bad. For it would be very easy for me to look at people buying tobacco products or purchasing time with a UV lamp and say, “Look, you’re doing this to yourselves. You don’t have to pay the taxes, if only you wouldn’t engage in such unwise activities.” Because, after all, these taxes don’t affect me.
But it’s a very slippery slope. For instance, are fast food chains (or just about any restaurant, for that matter) the next taxation-to-pay-for-healthcare opportunity? What about a dessert tax? Unhealthy foods certainly play a significant role in the healthcare woes of this nation, so it seems only fair that this unwise health choice also be taxed. As the line of taxation could easily move closer and closer to the lifestyles of those of us currently unaffected by the tobacco and tanning taxes, would we still be in favor of the system?
In all honesty, I would probably do my fair share of complaining if ever I found a tax imposed on my high-calorie coffee drinks or favorite desserts. Yet, I would get over it, because I completely agree with the government’s strategy to impose taxes on harmful products to pay for healthcare. However, I believe that it is unfair to selectively choose certain “unhealthy habits” to tax, while leaving others exempt. If indoor tanning salons are going to help pay for healthcare reform, those responsible for the sale of greasy pizza, chocolate cake, and very unhealthy fast food should also be required to contribute to the healthcare fund. Granted, beyond the obvious food culprits, the situation gets dicey. (For instance, some might argue that televisions and gaming consoles deserve to be taxed, as they contribute to sedentary lifestyles.) Expanding the taxation policy would certainly be much more complicated than drawing a line in the sand, with “healthy” on one side and “unhealthy” on the other, and at this point I don’t have the answers on how exactly it should be done. I just know that we are all culpable in one aspect or another, and it is therefore time to stop singling out the smokers and tanners as the designated villains by implementing tax laws that cover the rest of our health sins.