The Centers for Disease Control and Prevention estimated that, in 1991, 435 000 Americans died of tobacco-related diseases such as cancer and heart and lung diseases, accounting for 20% of the total annual deaths independent of the effects of passive smoking on other Americans. The human and economic costs of tobacco use to American citizens are devastating, especially for children, women, minorities, and the elderly. The economic costs of tobacco use in this country are estimated at $65 to $100 billion per year. For these reasons, the American Heart Association, the American Lung Association, and the American Cancer Society are supporting an increase of $2 in taxes on each package of cigarettes. Representatives of the Clinton Administration have indicated that they are considering "sin taxes" as a means to finance universal health care. Now is the time for the medical profession to speak out strongly in support of this cigarette tax. This tax is not regressive because it is on a product that, when taken as recommended, kills people. It is also not excessive because it places the average total cigarette tax in the United States ($2.51 per pack) at a level still less than the average of most industrialized countries (Table 1). A cigarette tax is the best-known means of preventing and decreasing tobacco use among our children, a segment of our population that is increasing its tobacco use. Moreover, because smokers not only die but become incapacitated from lung and heart disease and are admitted to hospitals twice as often as nonsmokers, a tobacco tax should immediately effect a decrease in health care costs. Thus, any decrease in revenues occurring secondary to decreased smoking should be paralleled by decreased health care costs and a healthier citizenry.

The estimated $35 billion per year in revenues from this tobacco tax, which is really a user's fee, would allow implementation of universal access to health care without increasing the federal deficit. It should also be emphasized that the present cigarette tax, if applied in total to health care costs, would reimburse less than 10% of the health care costs, including lost productivity, caused by tobacco-related diseases. The Rand Corporation has estimated that it would take a tax of $5 per package of cigarettes to pay for health care costs generated by tobacco-related diseases if lost productivity were included in the calculations. I therefore hope that you will provide your strong support for the Congress to enact an increase of $2 in tax per package of cigarettes.