In my practice as a cardiologist in Maine, I have developed a true appreciation for the appalling results of tobacco addiction. Some of my most frustrating conversations take place with people who have already had one heart attack, or cancer, but still feel they cannot face life’s stresses without cigarettes as their drug for anxiety.

Once the addiction has started, it is a demonic adversary. We know one of the most effective weapons against this expensive blight is to prevent young smokers from starting. Thankfully, past state legislative action and tobacco taxes have helped. When I came to Maine in 1996 to begin a medical practice, I was horrified to learn that Maine had one of the highest rates of teen smoking in the nation, at almost 40 percent. The associated cost to the state for illness associated with cigarette use was astronomical. Then in 1998, Maine was awarded money arising from a lawsuit brought against the tobacco industry. Research on smoking habits, public service programs and steadfast legislative resolve to use the money for health-related purposes, combined with an increase in the cigarette tax helped turn the tide. In 2008, our teen smoking rates had fallen to a low of 14 percent. Maine’s effective program to reduce smoking was a national model. Unfortunately, that was then, and this is now.

This year, the teen smoking rate in Maine increased for the first time since 1997. Maine’s yearly report card from the American Lung association has gone from straight A’s to a mixed report with C’s in prevention, cessation and tobacco taxes. Last year’s expenditures for smoking-related illness in Maine topped $600 million, more than our current painful budget shortfall.

Tobacco taxes are first and foremost a powerful public health tool. We’ve learned by tracking the data for over 20 years that increasing cigarette taxes has great impact on youth smokers, preventing them from becoming the “replacement smokers” that the tobacco industry must enlist in order to stay in business. I’ve read the arguments against cigarette taxes — that they are “regressive, penalizing the poor,” or they “create unstable tax revenues” or “encourage smuggling from New Hampshire.”

I’ve looked at the data for the state of Maine and none of these arguments hold up under scrutiny. What is truly regressive about tobacco is the chronic illness and increased poverty that addiction creates among users. Maine tax revenues from cigarettes have steadily increased over time, and have helped to reduce state expenditures for smoking related illnesses. At the same time, sales data from New Hampshire proves that Maine’s past tax increases do not result in significant cross-border sales.

Adversaries to increasing the tax on cigarettes trumpet that Maine already has a very high tax. The truth? We have the second lowest cigarette tax in New England. I am sympathetic to the cry for “no new taxes,” but the reality is that if we don’t take every opportunity to reduce costly chronic disease, we will never get health costs under control and we will all pay higher and higher health care bills down the road. We’re already seeing the devastating effect this trend has on Maine families and businesses.
When we set aside all the tobacco industry scare tactics, raising the price of cigarettes successfully discourages young people from starting to smoke, creates a strong incentive for current smokers to stop, and delivers a consistent revenue stream to state coffers that can help protect jobs and prevent cuts to town and school budgets.

We need a one dollar increase in the cigarette tax that is applied to all tobacco products equally, making it much more expensive to buy loose tobacco and little cigars (both of which are currently taxed at rates significantly lower than cigarettes, making them an appealing alternative to kids). A one dollar increase will keep 8,500 Maine youths from becoming smokers and help 4,600 current smokers to quit. It will save 3,900 lives and $192 million in tobacco-related health costs, and that’s good for families and good for our struggling businesses.

When I query my patients about it, those who smoke are some of the strongest advocates for additional barriers. They want to quit. Raising the tobacco tax helps them to do it.

Dr. Dervilla McCann is a physician practicing in Auburn. She is chairwoman of Health Policy Partners of Maine.


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