The Bill is passed.....

[lindajdunn]

My problem with ILS's risk is that this is a transfer of risk from one party to others (the hospital/doctors/taxpayers subsidizing hospitals, etc.)

Example: When my niece had no insurance and spent two weeks in intensive care, this led to bankruptcy. Just how much do college students have worth claiming? No home and a beaten-up car plus some personal belongings. It's not even worth hauling off to an auction. There's no risk of loss to people who have nothing if they "lose everything" due to medical bills.

If I were to become seriously ill and bankrupted, most of the expenses would be reclaimed through the bankruptcy court.

Thus, those who do not have assets and who opt out of insurance are not taking a risk... they're transferring the risk to the rest of us.

[Phaeton]

Sure. But how far are we going to extend that degree of separation? We could construe almost anything to have some impact on society (such as smoking, eating fast food, all of which "costs" society indirectly), but at some point we need to draw a line between mandating social responsibility and individual freedom.

There's a difference between commanding what people do and internalizing the externality. Theoretically, smoking is taxed to offset its harm. So, some argue, should fast food, and so, I argue, should gasoline. If you want to make the US auto industry make really fuel efficient cars (or anyone in the world) just shift the demand curve for cars to the left.


I have a very limited understanding of economics, but mandating insurance and a public option both do not seem like ideal solutions. I would love it if someone could please describe to me how a public option solves anything. I dislike the whole idea of mandating insurance in general.

There's a reason why the government can mandate car insurance: driving is legally a privilege. Living is not.

Basically the way I see the health care industry is that is is a series of local monopolies. The reason why is the cost of entry to becoming an insurance company must be very high. It's almost impossible to have an insurance company of 10 people. With the way the risk is spread out, if something happens to someone, everyone is pretty screwed. The cost of that operation is spread among those 10 people.

We have ways of dealing with monopolies. We can socialize them completely or apply regulation that limits profits and changes behavior. I don't see how a public option accomplishes either of these two things.

[Gav]

I actually agree people should not be forced to buy insurance.

Insurance is something I can pay for to protect me at a later date. It's a gamble, on both the side of the purchaser and the side of the insurer. The insurer is hoping that you'll never need to be covered, so that they make money without having to pay anything out. The purchaser is gambling that their spending of a lesser $ amount per month will be less than spending a large $ amount later. Otherwise they could have simply saved the money themselves and come out ahead.

To force everyone to take that gamble seems... silly to me. It tilts the balance of haggling in favor of the insurers. As it is now, if there are no good options, you can at least choose to simply go without, and set aside your own money hoping it will be enough when the time comes. If we mandate insurance, your only really viable option is to choose a lesser of evils in some cases, as the tax you'd receive from the IRS would make it essentially pointless to duck insurance and save on your own. Essentially the insurance companies can really have you by the balls in some cases (I understand the private option is supposed to be a counter to this, but I disagree with the public option for various stated reasons).

I appreciate the goal it's trying to accomplish - I disagree with the means. To me, it's all about tuning the opportunity so everyone has a fair shake. That, along with dealing with dishonesty (by all parties) swiftly and in a just manner. The mandating insurance takes the approach of legislating the goal, rather than making sure everyone has a means and fair opportunity (this is not the case now, either).

Give people the proper opportunity, and fix the problems in our system as opposed to changing everything around, and we could have a pretty efficient, pretty low cost system (IMHO).

Actually not all insurance is a gamble. There is insurance for inevitable events. I have such a policy and I am willing to bet there's a mjority of house owners, on this board at least, who do...

[prototoast]

My problem with ILS's risk is that this is a transfer of risk from one party to others (the hospital/doctors/taxpayers subsidizing hospitals, etc.)

Example: When my niece had no insurance and spent two weeks in intensive care, this led to bankruptcy. Just how much do college students have worth claiming? No home and a beaten-up car plus some personal belongings. It's not even worth hauling off to an auction. There's no risk of loss to people who have nothing if they "lose everything" due to medical bills.

If I were to become seriously ill and bankrupted, most of the expenses would be reclaimed through the bankruptcy court.

Thus, those who do not have assets and who opt out of insurance are not taking a risk... they're transferring the risk to the rest of us.

So hospitals need to have the balls to let poor people die.

[prototoast]

Actually not all insurance is a gamble. There is insurance for inevitable events. I have such a policy and I am willing to bet there's a mjority of house owners, on this board at least, who do...

Insurance transfers risk at a premium. For something like life insurance, the risk/gamble is when the death occurs, even though it's inevitable. If you die a year after buying life insurance, the insurance company loses money. If you die 70 years later, the insurance company makes money. The event is inevitable, but the time frame isn't.

[keith]

So hospitals need to have the balls to let poor people die.

A whole new category of organ donor;

Just cut 'em out I'm uninsured.

[jeff]

Thus, those who do not have assets and who opt out of insurance are not taking a risk... they're transferring the risk to the rest of us.

A form of moral hazard: "invincibles" who think they don't need insurance yet get sick anyway, or in a car accident, have pushed the risk to everyone else.

If it were understood in the "pay as you go" sense of social security. Everybody in the pool pays, and everybody is eligible to receive benefits so (IMO) it's fair. Oh, so it's mandatory? Well, it insulates me from having to pay for those who took chances with their health and our money.

Theoretically, smoking is taxed to offset its harm.

Is it really? I thought the reason is that so-called "sin taxes" on tobacco and alcohol exist because the population permits them and they're an easier way to raise tax revenue than other taxes, not because somebody computed the cost to society and figured out a tax rate.

I have a very limited understanding of economics, but mandating insurance and a public option both do not seem like ideal solutions. I would love it if someone could please describe to me how a public option solves anything. I dislike the whole idea of mandating insurance in general.

The idea is that the health insurance companies have little or no incentive to end lucrative business practices such as denying care to those with pre-existing conditions, refusing to authorize needed and contracted care, or stonewalling against paying out for claims. A public option provides a non-profit alternative (and remember that non-profits health insurance has been around forever, as in BC/BS). See Rural Electrification as an example of a public funding alternative led to changes in private sector behavior that benefited all.

There's a reason why the government can mandate car insurance: driving is legally a privilege. Living is not.

I draw the opposite conclusion and see this as a stronger justification for requiring health insurance than automobile. Mind you, some libertarians on the board have protested auto insurance too.

So hospitals need to have the balls to let poor people die.

"Let them eat cake", in other words. Up there with "the law in its infinite wisdom permits both the poor and rich to sleep under bridges".

I find that a morally repugnant position (a subjective opinion, I admit). Perhaps we should also only provide police and fire department protection to people who can pay for them.

Everyone likes to think it can't happen to them, which reduces their interest in programs that only take care of "other people". I'll point out that very few of us are so rich that they could handle catastrophic illness, even if they are currently insured. It works like this: get sick, and then insurer refuses to authorize the treatment or cover the claim. Lose job because can't work due to being sick: now you're uninsured. Can't get new insurance because you have a pre-existing condition. Reality is different from imagining that this applies to the "undeserving poor".

[jeff]

Useful reading for people who think we have the best healthcare: http://www.nytimes.com/2009/11/10/he...ml?ref=science

[Bayou Bum]

Useful reading for people who think we have the best healthcare: http://www.nytimes.com/2009/11/10/he...ml?ref=science

It is useful. I find it very useful in acknowledging the higher quality of hospitals in the US and the problems faced with government provided care.

The Dutch are in the midst of a significant health overhaul to inject greater competition into the nation’s insurance and hospital markets

I'm glad to see that they are moving away from socialized medicine in favor of more competition.

40 percent of the nation’s population gets care from Medicare, Medicaid and Veterans Affairs, all of which have significant restrictions on the choices available to patients. “We don’t have these kind of public insurance groups in our country,” he said.

I agree, and Obama wants to increase that number to 100%. We should get rid of all government programs and create programs provided with competition.

What I do not want is the rationing of care and what we call budgeting. So that hospitals get a certain amount of money, and there is no incentive for them to innovate. Because the aging of our society is a major threat for health systems in the future. Many people will want and receive health care, but if there is a shortage of labor, and demand will rise, so prices will go up enormously.

That’s the main reason we tried to change the system and why innovation is so important. Without it, there won’t be enough doctors or nurses, because competing parts of the economy will pay more.

This is the kind of change we should be encouraging, more competition and choices!

[jeff]

Silly BB. to selectively quote out of context, but it will only fool people who don't take the effort to click on the link. But just to make it simple, and erase the false impression you try to leave, some quotes from the article:

In the front of the article: the health system in the United States may be twice as expensive as those in Europe, and the population may be less healthy, but at least Americans have access to many more choices of doctors and insurers. Right? No, says Ab Klink, the Dutch health minister.

and this one: “And what struck me,” he said, “is actually the lack of competition you have.”

After the paragraph you cite with 40% coming from government, he said even among those in the United States who get insurance from their work, he went on, “it’s the employer who is making the choices of the health plans from which you can choose.” In the Netherlands, everyone chooses from a list of 10 or so insurers who offer a standardized health plan that can be enriched with other options. Those who cannot afford the premiums are given subsidies; premiums are based on the benefits offered, not on a person’s age, health status or sex.

and this one: doctors in the United States were many times as likely than doctors elsewhere to report that restrictions in insurance coverage caused major problems with the time that they or their staff were able to spend providing needed medication or treatment.

So, contrary to the impression you try to make, the article makes it completely clear that we're the country that has less competition and poorer healthcare

For cryin' out loud, BB. If you're going to be dishonest make it a little harder to figure out that they said the opposite of what you claimed. You're just being sloppy.

[prototoast]

So, contrary to the impression you try to make, the article makes it completely clear that we're the country that has less competition and poorer healthcare

The point he would have been making if he were more articulate is not that the US has more competition and better healthcare, but the fact that the current shortcomings in our system are all caused by government intervention. The current government involvement in health care is what's made it so bad, and so it isn't unreasonable to think that expanding the government's involvement would only to continue to inhibit a well functioning system.

[lindajdunn]

The current government involvement in health care is what's made it so bad, and so it isn't unreasonable to think that expanding the government's involvement would only to continue to inhibit a well functioning system.

?????
Let's try to parse that sentence.

First claim: government involvement is what's made it so BAD
Second claim: Government involvement would inhibit a well functioning system.

So which is it? Is it bad or well-functioning?

[prototoast]

?????
Let's try to parse that sentence.

First claim: government involvement is what's made it so BAD
Second claim: Government involvement would inhibit a well functioning system.

So which is it? Is it bad or well-functioning?

There is a hypothetical well-functioning system that is being repressed by the current government intervention (medicare/medicaid and subsidized employer sponsored insurance). The proposed changes would only magnify the current problems and further inhibit the hypothetical well functioning system.

[jeff]

prototoast, there are two problems in BB's post, nice as you are to try to rescue it.

First, he misrepresents what the Dutch minister said. Whether that's a result of BB's duplicity, poor reading skills, or being inarticulate is up to the observer. The Dutch minister makes very clear that the system in his country provides better care than the US, including better choice. Everyone in his country is insured, with subsidies for those who can't afford coverage, and that the superior results (compared to the US) were achieved with price controls - something free market advocates would claim to be impossible. To claim that his remarks show that the Netherlands is moving more to a US-style system is a distortion.

Second is this business about the "fact (sic) that the current shortcomings in our system are all caused by government intervention". Not only is this not a fact, even though you claim it to be one, but it's not stated in the article, and not supported by facts. Countries with far more government intervention than ours happen to provide better and universal coverage at lower costs and with superior health results. If there is a hypothetical well-functioning system suppressed by the government's intervention then I'd like to see you offer some evidence rather than just stating it must be so.

[Bayou Bum]

Silly BB. to selectively quote out of context, but it will only fool people who don't take the effort to click on the link. But just to make it simple, and erase the false impression you try to leave, some quotes from the article:

I encourage all to read the article. As usual, you only read what supports your position and try to ignore all the rest or just call what you disagree with lies.

In the front of the article: the health system in the United States may be twice as expensive as those in Europe, and the population may be less healthy, but at least Americans have access to many more choices of doctors and insurers. Right? No, says Ab Klink, the Dutch health minister.

Yes, it is more expensive in the US and the Republicans have plans on reducing costs. While I disagree with him that the population is not less healthy than in Europe, the cause is not health care but living choices (choices ... one of those freedoms that liberals don't believe you should have).

and this one: “And what struck me,” he said, “is actually the lack of competition you have.”

Read the next part where this was blamed on Medicare, Medicaid, and the VA, all government plans. This would only be worse under Obamacare.

After the paragraph you cite with 40% coming from government, he said even among those in the United States who get insurance from their work, he went on, “it’s the employer who is making the choices of the health plans from which you can choose.” In the Netherlands, everyone chooses from a list of 10 or so insurers who offer a standardized health plan that can be enriched with other options. Those who cannot afford the premiums are given subsidies; premiums are based on the benefits offered, not on a person’s age, health status or sex. ;

Sounds like the Republican health care plan. More competition. Why aren't you supporting this for the US instead of one choice, the federal government?

and this one: doctors in the United States were many times as likely than doctors elsewhere to report that restrictions in insurance coverage caused major problems with the time that they or their staff were able to spend providing needed medication or treatment.

This may be a problem but I do not know of any insurance company, or even medicare/medicaid that dictates to a doctor how much time they can spend with a patient. If you do, please provide examples.

So, contrary to the impression you try to make, the article makes it completely clear that we're the country that has less competition and poorer healthcare

This is where you just make up sh*t to support your point of view. Where does it say that the US provides poorer healthcare? Actually, it states the opposite. Hospitals like Johns Hopkins and the Mayo Clinic are better than those in the Netherlands and that prices were not that different than those in Holland.

In addition, the article addressed issues facing their health care system that I have pointed out as problems with Obama/Pelosi plans. They admitted problems with rationing, lack of innovation, rising costs, and lack of medical personnel. All part of why they are moving to more competition.

For cryin' out loud, BB. If you're going to be dishonest make it a little harder to figure out that they said the opposite of what you claimed. You're just being sloppy.

So, as you can clearly see, and would admit if you actually had a position you could actually stand on, I have not told any lies. I only used the reference you provided to make my point. It is your fault if you are too blinded by Obama's divine light to see the real facts. Either that, or you are deliberately spreading falsehoods. I prefer to think it is the former as I hate to think of you as a deliberate liar.

[jeff]

I encourage all to read the article. As usual, you only read what supports your position and try to ignore all the rest or just call what you disagree with lies.

The first sentence is good.

Yes, it is more expensive in the US and the Republicans have plans on reducing costs. While I disagree with him that the population is not less healthy than in Europe, the cause is not health care but living choices (choices ... one of those freedoms that liberals don't believe you should have).

Are you agreeing with him that we are less healthy than Europe? Your phrasing is unclear.

Proof for the claim that it's due to lifestyle choices? Life style and healthy habits definitely are essential factors, but you need to support your claim that's what makes us different from the healthier countries. After all, they smoke more than us and most of those countries have older populations.


Harvard University says that's not the reason: http://www.reuters.com/article/healt...58G6W520090917

Read the next part where this was blamed on Medicare, Medicaid, and the VA, all government plans. This would only be worse under Obamacare.

You are quoting selectively: he also says it's because employers make your health care plan choices for you. Tsk tsk, BB.

Sounds like the Republican health care plan. More competition. Why aren't you supporting this for the US instead of one choice, the federal government?

Oh, I like competition just fine - one reason I like the idea of a public option. Which is not "one choice" no matter how many times you say so.

Are you really saying that the Republican health plan provides comprehensive health care for everyone, prevents refusal to authorize care, and subsidizes those who can't afford it. Let's hear the details from you, then. WSJ article http://online.wsj.com/article/SB124286548605041517.html says $5,700 - that's not nearly enough.
They're going to insure that everyone in the country is covered for $63B? http://gopleader.gov/UploadedFiles/a...approaches.pdf I don't think so. But tell us the details, please.

The CBO says that the R. plan leaves 52M nonelderly uncovered. Nice!
http://cbo.gov/ftpdocs/107xx/doc1070...entBoehner.pdf

This may be a problem but I do not know of any insurance company, or even medicare/medicaid that dictates to a doctor how much time they can spend with a patient. If you do, please provide examples.

Not literally, but they set reimbursal schedules so low that doctors can't afford to spend a lot of time with a patient because they start losing money. Just how much $ will the HMO give you for a This has been widely reported and complained about in places like JAMA and NEJM.

This is where you just make up sh*t to support your point of view. Where does it say that the US provides poorer healthcare? Actually, it states the opposite. Hospitals like Johns Hopkins and the Mayo Clinic are better than those in the Netherlands and that prices were not that different than those in Holland.

From the article: Mr. Klink was in Washington last week to attend an annual meeting sponsored by the Commonwealth Fund, a private health care research foundation, and swap ideas with counterparts from other countries. At the meeting, the foundation released the results of a survey of doctors from 11 countries that reflected poorly on the United States.

The director certainly says that Mayo Clinic and JH are outstanding, but also said The Dutch health care system offers top quality. We have some famous institutions in our country. So I do think we have a high standard of quality, and it’s open for everyone. Sure, we have great health care in this country *if you have money*, and *if you don't lose your job*.

In addition, the article addressed issues facing their health care system that I have pointed out as problems with Obama/Pelosi plans. They admitted problems with rationing, lack of innovation, rising costs, and lack of medical personnel. All part of why they are moving to more competition.

So, as you can clearly see, and would admit if you actually had a position you could actually stand on, I have not told any lies. I only used the reference you provided to make my point. It is your fault if you are too blinded by Obama's divine light to see the real facts. Either that, or you are deliberately spreading falsehoods. I prefer to think it is the former as I hate to think of you as a deliberate liar.

Uh, sure.

[Bayou Bum]

prototoast, there are two problems in BB's post, nice as you are to try to rescue it.

First, he misrepresents what the Dutch minister said. Whether that's a result of BB's duplicity, poor reading skills, or being inarticulate is up to the observer. The Dutch minister makes very clear that the system in his country provides better care than the US, including better choice. Everyone in his country is insured, with subsidies for those who can't afford coverage,

That is where the quote ended. What you added is a lie. What is the point of having a discussion on an article when you use such obvious lies to distort the truth?

and that the superior results (compared to the US) were achieved with price controls - something free market advocates would claim to be impossible.

And you like to claim other people are dishonest. Disgusting actually.

To claim that his remarks show that the Netherlands is moving more to a US-style system is a distortion.

In 2006, the Netherlands had a social health insurance system that didn't work and no longer exists. It switched to a competitive model where people by private insurance with government subsidies to those who cannot afford it and everyone is required to purchase insurance. (I don't agree with everyone being required to purchase insurance). Initially, prices were set by the government for all services but due to rationing and shortages, they have removed controls on most prices and are continuing to remove government controls.

The Bush administration observed the Swiss and Netherlands approach saying: "We thought it made sense to look at two countries that have universal coverage but rely on the private sector to get there."

Second is this business about the "fact (sic) that the current shortcomings in our system are all caused by government intervention". Not only is this not a fact, even though you claim it to be one, but it's not stated in the article, and not supported by facts. Countries with far more government intervention than ours happen to provide better and universal coverage at lower costs and with superior health results. If there is a hypothetical well-functioning system suppressed by the government's intervention then I'd like to see you offer some evidence rather than just stating it must be so.

Actually it was stated in the article. Since you obviously like to lie and make up quotes that aren't there, I find I have no desire to discuss this with you anymore. You can have the last word here, but I get the satisfaction of knowing that Obama's plan will fail.

[Inquartata]

I don't want to pay for my neighbor's viagra.

See? Everyone has something he doesn't want to be forced to buy for others.

( For me, it's "everything". )

Something will get passed in 2010. When it does, I'll be drinking sparkling apple cider.

It may be all you can afford on what's left after you pay for everyone's health care...

So are you saying access to healthcare for everyone is a bad thing?

In that it flouts the basic laws of economics, yes. If he won't say it, I will. Resources are scarce, demand for them is infinite. There is simply no getting around that fact, and "heath care" uses resources.

Under the bill everyone would be required to carry health insurance. Those who can't afford to pay for it will be given subsidies. If you decide that you do not want to purchase health insurance you will be taxed under the IRS. If you do not pay the IRS bill, you risk criminal penalties, i.e. jail time.

And what of those who simply have different priorities?

Let's say that you value early retirement more highly than carrying the health insurance that you have not ever needed. Why is it the right of the state to tell you that no, you MUST place the priority they choose higher than the one you choose? What gives the government the right to tell you that you MUST divert assets which you would have invested to provide a retirement income to health insurance premiums instead, thus making early retirement impossible?

And why are we to think that once that precedent is established it won't be extended to mandating other forced choices?

Example: When my niece had no insurance and spent two weeks in intensive care, this led to bankruptcy. Just how much do college students have worth claiming? No home and a beaten-up car plus some personal belongings. It's not even worth hauling off to an auction. There's no risk of loss to people who have nothing if they "lose everything" due to medical bills.

If I were to become seriously ill and bankrupted, most of the expenses would be reclaimed through the bankruptcy court.

Ack!

WHY do people always insist on basing national policy on "What happened to my niece" or "When I had gallstones this happened"?

Your individual bad experience is no justification for forcing me to pay for remedying it!

Thus, those who do not have assets and who opt out of insurance are not taking a risk... they're transferring the risk to the rest of us.

You know what the real problem is?

The government forces us to accept that transferred risk, that's what the real problem is!

There's a reason why the government can mandate car insurance: driving is legally a privilege. Living is not.

Moreover, if you have sufficient personal resources to pay off a prospective judgement resulting from an accident, then usually you do not have to buy insurance.

There will be no such exemption for health insurance. Indeed, should you have sufficient personal resources to pay for your own health care that will be evidence that you are "rich" and can be taxed more in order to help pay for everyone else's health care.

Think of it: You are a multimillionaire who does not have to buy auto insurance, but the government slaps a higher tax on you to pay for your neighbor's auto insurance. Sounds fair, right?

Basically the way I see the health care industry is that is is a series of local monopolies.

Yes. And I have said before: Why aren't Obama, Reid and Pelosi et al. agitating to let companies compete, the way the auto insurers compete, and hard, for customers? Why are they not reforming the system by attacking the real root of the problem---lack of competition due to government restrictions and the unnatural attachment of insurance provision to employers instead of individuals?

Instead, they come up with a "public option", that is, establishing a new monopoly to swallow all the other monopolies. Because it will be a state monopoly, and a new lever of power for government, the solver of all problems, the answer to all questions!

A form of moral hazard: "invincibles" who think they don't need insurance yet get sick anyway, or in a car accident, have pushed the risk to everyone else.

And again, this is only because the government has seen to it that we must and will accept that risk. That's neither the only possible outcome nor the most rational.

I find that a morally repugnant position (a subjective opinion, I admit). Perhaps we should also only provide police and fire department protection to people who can pay for them.

These are public goods in the economic sense. Health insurance is not.
( "That is never too often repeated which is never sufficiently learned" , or apparently is never heard, or never understood, or rejected out of some irrational "but it oughta be!" moral opinion. )

In the front of the article: the health system in the United States may be twice as expensive as those in Europe, and the population may be less healthy, but at least Americans have access to many more choices of doctors and insurers. Right? No, says Ab Klink, the Dutch health minister.

Heh, so a Dutchman thinks his system is better than ours. What are the odds?

And I know it's horribly unfair and irrelevant, but I cannot resist wondering if the assistant Minister is named Schultz...

[I]even among those in the United States who get insurance from their work, he went on, “it’s the employer who is making the choices of the health plans from which you can choose.”

Yes.

And notice that none of our brave Washington health care reformers are inclined to reform that.

So, contrary to the impression you try to make, the article makes it completely clear that we're the country that has less competition and poorer healthcare

I wonder if he has seen the things I've posted ere now about things like the much better cancer survival rates under the US system than under the socialized ones...

If so, how convenient that he has forgotten to discuss them!

[Phaeton]

Yes. And I have said before: Why aren't Obama, Reid and Pelosi et al. agitating to let companies compete, the way the auto insurers compete, and hard, for customers? Why are they not reforming the system by attacking the real root of the problem---lack of competition due to government restrictions and the unnatural attachment of insurance provision to employers instead of individuals?

Instead, they come up with a "public option", that is, establishing a new monopoly to swallow all the other monopolies. Because it will be a state monopoly, and a new lever of power for government, the solver of all problems, the answer to all questions!

Theoretically, state-run monopolies can be functional entities. There are plenty of examples of state-run monopolies that work. But whenever you have something in public hands you have to be careful. That makes the company lose its profit motive, and that usually kills efficiency and stifles any kind of innovation.

Most monopolies that exist in the country are either A) destroyed or B) forced to maintain reasonable cost. I have no idea why we can't engage in something similar to marginal cost or average cost pricing.

Is it really? I thought the reason is that so-called "sin taxes" on tobacco and alcohol exist because the population permits them and they're an easier way to raise tax revenue than other taxes, not because somebody computed the cost to society and figured out a tax rate.

At least in part. Part of the reason that tobacco and alcohol are taxed at such high rates is that such high rates are necessary to reduce usage. Cigarettes and alcohol have rather inelastic demand. It also makes them pretty efficient to tax. The more inelastic the demand, the less the dead weight loss of the tax.

I honestly believe that just because the government makes money off of vice taxes and can, that that is the only reason. It isn't on paper. And, either way, the tax works. In this circumstance government greed can help the general population by helping internalize the negative externalities caused by smoking.

[Inquartata]

Theoretically, state-run monopolies can be functional entities. There are plenty of examples of state-run monopolies that work.

Define "work".