6.4 Considering Policies
6.4.1 Interventions for Smoking Cessation
Let us begin by thinking about the regulating of smoking.
First, there is no doubt that cigarettes are medically harmful goods (the Ministry of Health, Labour and Welfare 2002). Given the extent of its health risk, I person- ally think the consumption of cigarettes should be strictly regulated in the long run and smoking should be banned completely in 20–30 years at the latest, if possible.
Needless to say, issues will arise, such as decreased tax revenues, which strain the national budget, and the loss of livelihood among tobacco, among others, when the smoking rate drops due to regulation; however, I will move the discussion along without getting into those issues. Permitting harmful consumption goods in antic- ipation of tax revenue would be “putting the cart before the horse,” as would be the case with opium or other drugs. The impact on tobacco farmers should be addressed from the perspective of industrial policy; not regulating harmful consumption goods in order to protect the vested interests of existing industries that cannot remain solvent under competition is also like “putting the cart before the horse.”
However, when actually thinking about ways of regulating smoking, it might be necessary to separately consider current smokers who are already cigarette- dependent and future smokers who are not.
With current smokers, since the government has already permitted the consump- tion of cigarettes even though cigarettes are known to be very addictive, it is neither fair nor realistic to suddenly prohibit smoking and inflict significant pain (Ida 2010). Having been a heavy smoker, I completely understand the pain that comes
with being forced to cut down smoking. For now, I think a reasonable policy would be to gradually induce smokers to cut down and quit smoking through measures such as raising, in phases, the tobacco tax. In doing so, perhaps the government can make the commitment now to transition to a complete ban on smoking at a certain point in the future (20 years from now, for example), to allow smokers to somewhat take that into consideration and begin adjusting their smoking behavior from now on.
Because a social benefit arises from being able to save healthcare costs if people were to smoke fewer cigarettes and became healthier, it is rational to create a mechanism by which society could share some of the cost related to getting smokers to cut down or quit smoking. In that sense, the Japanese government’s 2006 policy, enacted to allow health insurance to cover outpatient smoking cessa- tion, is an appropriate measure. We could also provide subsidies for using smoking cessation drugs or smoking reduction aids.
Another approach is for entities such as health insurance associations to take the lead and organize smoking cessation groups that can function as a commitment device for smokers who wish to quit or cut down smoking. Perhaps a reasonable level of success can be achieved if scientific data are obtained and reasonable advice on smoking cessation methods is provided through the help of medical doctors. These are measures that bear existing smokers in mind.
The situation is largely different when thinking about restrictions on future smoking by those who are currently underage or who have not yet been born because they do not have smoking habits at this point, even if we were to regulate smoking now. I will call those who have not yet reached the legal smoking age
“potential smokers” to imply that they could begin smoking in the future. Based on the assumption that cigarettes are harmful habitual goods, it is desirable to regulate future smoking among potential smokers at an early stage. In particular, smoking among those who just turned the legal age should be strictly regulated.
As an intervention, we could institute a licensing system for smoking, for example. The idea is to create a mechanism so that a smoker’s license is issued only for those who applied from now on, and people, including those who are already over the age of 20, cannot smoke without a license. Just like a driver’s license, smokers would be required to carry their license when smoking, and violators would be subject to a penalty. Another idea is to require individuals to take a class at the time of license issuance (and as part of compulsory education) to learn about the harmful effects of cigarettes.
This system is a policy that changes the traditional default, which allows everyone to freely smoke after turning 20, to one that does not allow people to smoke cigarettes unless they opt-in through a form of smoker’s license application.
It is a libertarian paternalistic policy in the sense that people are still completely free to choose to smoke; however, the regulation is slightly stronger in the sense that one can be penalized for smoking unless he or she goes through formalities.
A smoker’s license system would be effective in restraining potential smokers under the age of 20 from smoking in the future, from two perspectives. First, since individuals who might start smoking are not nicotine-dependent, restricting their
option to smoke would not inflict the kind of suffering that smokers would expe- rience. For individuals who have a strong hyperbolic tendency and a strong status quo bias, it should be much easier to continue being a nonsmoker without applying for a license.
Second, the generation of potential smokers’ parents—particularly current smokers with a strong tendency of hyperbolic discounting—should be receptive to restraining current minors (and themselves) from smoking in the future; this is because, unlike when making a short-term decision that relates to the gratification of current generations, when making a decision that relates to the future (i.e., the next generations’) gratifications, they can make future-oriented decisions under a low discount rate. This is the same as in the case of the previously mentioned SMarT plan, which made hyperbolic employees commit to collecting future sav- ings. According to the2008 National Health and Nutrition Surveyby the Ministry of Health, Labour and Welfare (MHLW), more than 60 % of smokers want either to quit or to cut down smoking (see Fig.6.2). Those who realize that the initial choice of starting to smoke was a self-destructive choice that led to the present predica- ment of “I cannot quit even though I want to” should be able to try and make the sophisticated choice of committing to an environment that prevents their children’s generation from repeating the same mistake.
I have suggested at the beginning of this section that smoking should be eventually banned completely. However, we could ban individuals who have just turned the legal age and do not have the problem of nicotine dependency from starting a new smoking habit at an earlier stage. As much as I want to say “do this immediately, if possible,” it would probably take several years of preparation to reduce the number of underage smokers. Of all the individuals who had a habit of smoking as of 2008, the percentage of those who had started smoking while still underage was 29.1 % among men and 16.5 % among women (2008 National Health
28.5%
37.4%
32.9%
25.5%
0%
10%
20%
30%
40%
50%
60%
70%
Men Women
Want to quit smoking Want to cut down smoking
Fig. 6.2 Percentage of smokers who want to quit or cut down smoking. Note: Prepared based on the data from the2008 National Health and Nutrition Surveyby the Ministry of Health, Labour and Welfare, Japan. Individuals who indicated their intention to quit smoking: Those who said “I want to quit smoking” or “I want to cut down smoking” in response to the question “Do you want to quit smoking?”
and Nutrition Survey, the Ministry of Health, Labour and Welfare). Perhaps the ban would be feasible 10 years or so from now. Upon implementation, we could ban individuals under the age of 20 from smoking by refusing to issue them a smoker’s license.