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Smart Bombs: The price is always right

One reason why U.S. health care costs have raced far ahead of the rest of the industrialized world was mentioned in an Associated Press article about how Medicare will now cover an expensive prostate cancer drug that extends the average patient’s life by four months.

“We tend to put our health care dollars into very high-tech interventions that produce marginal improvements,” said Dr. Steven Miles, a professor at the University of Minnesota’s Center for Bioethics. “The problem is that we have created a health care system that is uniquely inadequate in terms of access to primary health care, which is where you get the most bang for your buck.”

You want to complain about government spending? Here is the perfect opportunity. The cost of this therapy for incurable prostate cancer is $93,000. By law, Medicare cannot consider price when deciding to pay for treatment. Attempts to change this law would be labeled “rationing.”

In America, we prefer to ration by access, except if a person is about to die. Then we switch to universal care and spread the high costs to everyone, all in the name of freedom.

Math is cruel. When “Clintoncare” was being debated in 1993, the common cry from Rush Limbaugh and company was that government would take over one-seventh of the economy. “Obamacare,” we’re now told, would mean government control over one-sixth of the economy.

If it’s repealed and nothing else is done, health care spending will double by 2019, according to projections by the federal Centers for Medicare and Medicaid Services. At that point, would-be reformers would face the argument that a government solution would entail taking over one-fifth of the economy.

See a pattern here? The longer we put off a solution, the greater the share of health care spending in the overall economy. That would at least be defensible if it meant a higher percentage of people had coverage, but that’s not true. It means health care costs are metastasizing like an aggressive cancer.

Using Limbaugh Logic, this prognosis is an even stronger signal to do nothing.

Revenue filtered. Because it needs to fill a $92 million budget hole, the Idaho Legislature is set to finance higher education at its lowest level in 11 years and cut millions more from K-12 budgets, on top of the $128.5 million that it whacked last year. Be nice if there were a way to raise revenue that had solid public support.

Well, actually, there is. Raise the cigarette tax.

A proposal to raise the levy by $1.25 a pack is being stubbed out in Boise, but lawmakers can’t claim to have tried everything before enacting draconian cuts. They are, in fact, forgoing $50 million that would limit the chopping and provide more money for future budgeting.

Idaho’s cigarette tax of 57 cents a pack is the ninth lowest in the nation and well under the national average of $1.34 a pack. Montana’s levy is $1.70 a pack; Washington’s is $3 a pack.

In addition, the public health benefit is significant. A USA Today article notes, “For every 10 percent price increase, cigarette consumption drops by 3 percent to 4 percent among adults and double that among youth.”

Instant karma. Wouldn’t it be great if we could somehow reward civility and punish incivility in everyday life? This would be especially gratifying in politics.

Guess I’ll just have to settle for what happened to a rude customer purchasing a Mega Millions lottery ticket in Albany, N.Y. Seems this guy cut in front of Mike Barth, who was waiting to buy tickets for himself and six co-workers who pooled their money. Barth let this pushiness slide and got the next ticket.

It ended up being worth $319 million.

Smart Bombs is written by Associate Editor Gary Crooks and appears Sundays on the Opinion page. Crooks can be reached at or at (509) 459-5026.