Since the U.S. Surgeon General’s report on smoking and health in 1964, governments at all levels in the United States and across the globe have led an all-out assault on smoking.
We’ve seen tax hikes upon tax hikes in the name of saving the children and ending smoking-related disease. We’ve seen warning labels, smoking bans, sales and marketing restrictions, litigation and a master settlement agreement resulting in billions of dollars paid to states. We’ve seen government-subsidized (or mandated) nicotine replacement therapies and a never-ending campaign of billboards, radio and television ads that have at various times attempted to educate, scare and ultimately shame smokers into quitting. But if we really want to solve the smoking problem, government isn’t the answer.
During the last ten years with the rise and growth in the market for e-cigarettes and vapor products, we’ve seen an organic, consumer-driven revolution sweep the nation and much of the world that holds the promise to do more to reduce smoking and smoking-related disease than expensive, intrusive and offensive government programs ever could. The response from government regulators, legislators and tobacco control groups masquerading as public health advocates has been nothing short of shameful.
We’d hope that health organizations and governments that have claimed to be working in the public interest would welcome promise toward reducing lung cancer, heart disease, stroke and COPD – all of which cause smokers to suffer and die prematurely at a rate of half a million a year. Unfortunately, so far this promising trend has been received as anything but.
According to the U.S. Centers for Disease Control, even before the Affordable Care Act most Medicaid programs covered tobacco-dependence treatments. Among the 51 Medicaid programs, 47 provided tobacco-dependence treatment coverage for some enrollees, 38 covered at least one tobacco-dependence treatment for all Medicaid enrollees and only four offered no coverage for tobacco-dependence treatment. And the Affordable Care Act has required that tobacco cessation must be provided at no cost to enrollees under most types of insurance since 2014. What that means is that the biggest customer by far for nicotine replacement therapies like gums and patches and medications like Chantix and Zyban aren’t smokers. They are actually either big government programs that purchase products directly for smokers or insurance companies that are mandated by the ACA to provide services to their consumers at no cost. Those purchases, of course, are ultimately funded by taxpayer subsidies and increasingly expensive premiums, even for those that don’t smoke and have never smoked.
Additionally, federal, state and local governments employ over 22 million people and provide health care coverage for nearly 17 percent of the entire U.S. workforce. Most of these insurance programs – whether direct or third-party provided – include smoking cessation coverage (in some places at little or no cost to employees).
Overall, smoking cessation products in the U.S. and around the globe have been a dismal failure that have come at great (and continued) expense to taxpayers. It’s been a windfall for manufacturers of products that haven’t had a great record of success getting smokers off cigarettes. Nicotine gums and patches, for example, fail over ninety percent of the time. Sadly, the response of tobacco control and public health groups (and practicing physicians who rely on their guidance) to the all failure of these products has simply to call for more of the same.
There is one noteworthy exception to failed methods recommended by tobacco control and the public health community. Research seems to demonstrate that one approach – counseling for smokers attempting to quit – seems to genuinely and significantly enhance the ability of smokers to leave cigarettes behind. Counseling as an option for tens of millions of smokers poses a challenge, however; it is both expensive to provide and difficult to impose upon patients who might not be interested.
Thankfully, we don’t need government to provide and taxpayers to fund counseling for tens of millions of American smokers. For the last 10 years in the U.S. and across the globe, we’ve seen free markets and consumers drive innovation and the development of over three million new e-cigarette and vapor products to satisfy demand from a population of users. As many as 99 percent of this population of vapers are smokers or former smokers. This growing base of consumers has been looking for a meaningful way to stop smoking or reduce their cigarette consumption. And as they’ve searched and experimented, we’ve seen the rise of organic peer-to-peer counseling in vape shops and online forums that work better than government programs and don’t cost the taxpayers a dime.
These millions have demanded products that are affordable, available and appealing to their tastes. They’ve driven innovation with their wallets, and they’ve created a scenario in which manufacturers are in competition to constantly improve products to make them safer to use and more appealing. It is not a government program, but the free market creating the conditions for a rise-to-the-top competition to satisfy consumer demand for products that ably substitute for, or often exceed, the satisfaction provided by combustible cigarettes. While no one suggests vapor products are free from any possible harm, by avoiding combustion (and producing no smoke), these products eliminate or dramatically reduce the levels of toxins that kill nearly half a million American smokers every year.
E-cigarettes and vapor products didn’t come into being because of an expensive government program. And in order for vapor products, smokeless tobacco products like snus and heat-not-burn products to successfully help millions of smokers quit, they don’t require billions spent on failed government programs. Success doesn’t require special mandates from government requiring that insurance companies provide products at no cost. All we need from government is to get the hell out of the way and allow smokers access to scientifically valid information upon which to make informed personal health choices – and the right to make those choices for themselves.
Brian Fojtik is a Senior Fellow with Reason Foundation.
