There is an obvious and overdue way to improve Americans’ health care without raising taxes, curtailing insurance coverage for those who already have it, burdening employers with higher costs or jeopardizing the two big government health insurance programs for the elderly and the poor.

The improvement would, in fact, save money for patients, the insurance industry, employers, states and the federal government. It would further the goal — espoused by the most conservative of Republicans and the most liberal of Democrats — of refocusing the health care system toward prevention to help curb the expensive treatment of advanced disease.

Is this a fantasy? It’s a genuine possibility with comprehensive federal regulation of the tobacco industry.

An idea that seems to have been on the drawing board as long as there has been research showing that cigarette smoking and other forms of tobacco use cause cancer now has reached that rarest of moments: There is a political environment that should, if reason prevails, produce legislation to require the Food and Drug Administration to regulate tobacco products.

Last year, in a lopsided, bipartisan — and historic — vote, the House passed a comprehensive regulation measure. But with President Bush threatening a veto, the measure ultimately died in the Senate. Now we have a president who has had trouble kicking his own smoking habit. When Barack Obama was a senator from Illinois, he co-sponsored the regulatory measure. Last week, President Obama told reporters from Southern news outlets that he still favors regulation, but wouldn’t specify what form it should take.

It should take the toughest form.

Lung cancer continues to be the leading cause of cancer deaths in the United States — and the easiest type of cancer to prevent. It still claims the lives of 161,840 people every year, and tobacco use increases the risk of about a dozen other types of cancer, including cancer of the stomach, pancreas, kidney and uterus.

The long political stalemate over tobacco regulation led, at least in part, to the proliferation of state lawsuits against the tobacco industry — and the landmark settlement reached a decade ago that became the roundabout route the country has taken toward a patchwork of regulations. The settlement has been remarkably effective in reducing smoking, especially among teenagers, and in prodding municipal and other governments to enact clean air regulations that ban smoking in most indoor public spaces. Still, the federal government has yet to officially recognize that it can do more — much more — to control an industry that continues to use ingenious marketing to hook new smokers.

The latest tactic, for example, uses one of the tobacco industry’s oldest lures.

In the past two years, the industry has stepped up efforts to get more young women to smoke by returning to the marketing theme that smoking is fashionable, glamorous and indirectly helps keep women thin. In October, Philip Morris introduced a sleeker version of Virginia Slims cigarettes, distributed in colorful “purse packs” resembling cosmetic cases and meant to be popped into the smallest of handbags. Two years ago, R.J. Reynolds introduced Camel No. 9, a feminine version of its Camel brand. Camel No. 9 features black packaging outlined in hot pink and teal. Its promotional materials, often distributed at “ladies nights” in nightspots catering to young adults, have included lip balm, glittery decorations for cell phone cases and other trinkets, and urge young women to “Bling it on.”

“They’re sort of up to their old tricks when it comes to women and girls,” says Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids.

So are industry supporters in Congress. Sensing that a threatened filibuster in the Senate will fail to stop the FDA regulation, North Carolina’s two senators, Republican Richard Burr and Democrat Kay Hagan, have introduced legislation that spares the industry from the strict oversight envisioned in the FDA measure that is expected to clear the House soon. It is just another smoke screen to keep an industry thriving even as it promotes a product that has absolutely no safe use.

The political urgency for tobacco regulation may seem to have faded in an era when even Virginia has just toughened indoor smoking regulations. It’s true that the tobacco industry’s clout is diminished. But its cleverness cannot be underestimated.

Outsmarting it now is the easiest, smartest vote that lawmakers can cast.

Marie Cocco’s e-mail address is mariecocco(at)

© 2009, Washington Post Writers Group

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