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ANTISMOKING: WHO PAYS?

By Jeff Jacoby, Globe Columnist
Copyright 2002, The Boston Globe

February 3, 2002

Conservatives, despite what many liberals believe, aren't opposed to sugar and spice and everything nice. We are opposed to the fiction that they can be had only if the government provides, mandates, or pays for them. Food would be plentiful even without farm subsidies; letters would be delivered even if there were no US Postal Service; and fine TV programming would exist even if PBS never got a nickel of federal funds.

Which brings me back to something I wrote last week.

In my column on the fiscal turmoil in Massachusetts, I noted that the American Cancer Society was upset by a proposed 60 percent reduction in the state's lavish budget for antismoking programs. I quoted a spokeswoman's appeal: "We have to invest in tobacco prevention just as we would in a polio vaccine." But must it be the government that does the investing? "Why can't the American Cancer Society raise the necessary funds from willing donors," I asked, "and pay for these programs itself?"

It was a better question than I realized. For as I have since learned, the American Cancer Society used to do just that.

Massachusetts created its elaborate tobacco control operation in 1993 after voters adopted a ballot measure hiking the tobacco excise tax. (It was hiked again in 1996). But long before the state entered the field, private organizations -- including the American Cancer Society -- were helping smokers to quit.

"In those days we offered a variety of direct services, like smoking-cessation programs and counseling," recalls David S. Rosenthal, the director of Harvard University's health facilities and a past president of the American Cancer Society. "We had volunteers who were going one-on-one with smokers and volunteers going into the schools to work with teachers and students. We ran a Smoker's Quitline. And the Great American Smokeout Day began here in Massachusetts."

Other organizations were involved in antismoking work, too. One program operated by the Tobacco Control Resource Center offered six-week cessation courses in hospitals and community centers. The cost to participants was low. "We didn't turn away anyone who couldn't afford it," a former instructor recalls. "Though we did ask them to pay at least what they would have spent on cigarettes."

Before 1993, the state's budget to combat smoking was minimal -- less than $1 million per year. That changed dramatically with the influx of revenue from the new tax. The Massachusetts Tobacco Control Program began life with a huge budget -- $96 million -- and immediately set to work spending it.

Money was poured everywhere: into antitobacco advertising, into a statewide hotline for smokers trying to quit, into stop-smoking counseling and publications, into school activities to discourage smoking, into a tobacco education clearinghouse, into programs run by local boards of health, into tobacco litigation and activism, and much, much more.

Virtually overnight, a powerful tobacco-control industry arose, one that a growing constituency soon depended on for jobs, contracts, and power. Private groups, unable to compete with the state, ended their programs. No longer, for example, did the American Cancer Society train volunteers to run stop-smoking classes or operate its own Smoker's Quitline.

Which is not to say it was unhappy about the rich new player on the antitobacco block. It dropped its policy against taking government funding and was soon contracting with the state to supply tobacco-control services. Instead of providing cessation counseling or a smoker's hotline at its own expense, it began providing them at the taxpayers' expense. The sincerity of the American Cancer Society's antismoking fervor cannot be doubted. But neither can the fact that it came to have a financial interest in the new arrangement.

The upshot is that tobacco control in Massachusetts, once a mostly private endeavor, is now wholly funded with government dollars. A sharp budget cut would certainly be felt by the people who consume those dollars. But what effect would it have on smoking?

Interestingly, the answer appears to be: almost none. Over the past decade, there has been a marked decline in smoking in Massachusetts. Cigarette tax collections indicate that the number of packs sold each year has fallen from (roughly) 550 million in 1991 to 355 million in 2001. Adjust for the smokers who travel out of state to buy tobacco, and it appears that tobacco consumption has dropped by around 30 percent. But nearly all of the drop was caused by the 1993 and 1996 hikes in the cigarette tax. It isn't clear that the hundreds of millions of dollars the state has spent to fund its tobacco-control empire has had any impact on smoking at all.

To say that smoking prevention is important to public health is not the same as saying that the Department of Public Health must be in charge of smoking prevention. A huge government budget is no guarantee of effectiveness. Sometimes all it guarantees is a lot of noise when government budgets must be cut.

Jeff Jacoby is a columnist for The Boston Globe
His E-mail address is -
jacoby@globe.com
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