We’re already 100% on the same page as far as the futility of the WoD and legalization of drugs or cigarettes or soda or whatever. However, barring a universal healthcare system that may or may not happen in some distant future, the few ways that I can think of to deal with the cost are
1. Simply deny care to the uninsured methhead or CAD’er who can’t pay
2. Offset some of the cost through taxes on said products. I.e., cigarette taxes go to cancer treatment/research and smoking prevention/cessation programs etc
3. Continue the current mishmash of a system where some combination of federal and state taxes offset the cost of charity/Medicaid care.
Assuming we as a society think 1. is an immoral idea, in any of the other scenarios somebody is paying for somebody else’s poor life decisions. Doesn’t it strike you (as a libertarian) that a direct tax that affects the people actually choosing to make poor life decisions ascribes more individual responsibility to them, as opposed to unfairly distributing their responsibility to everyone else?
That's a fair question. Directed taxes have a place.
A gasoline tax that pays for roads is quite reasonable. Your consumption of that item is very directly proportional to your use of the resource it funds. (Well, strictly speaking, commercial trucking gets a giant discount there.)
The big problem with sin taxes is that the link between "quantity of substance used" and "societal cost" isn't as direct as the tax proponents would have us believe. It's complicated.
While we physicians get a skewed view of the worst disease tobacco can cause, the truth is that the vast majority of smokers simply live normal lives characterized by an occasional URI or bit of bronchitis, and die without soaking up massive amounts of healthcare resources. Do they "deserve" the pre-emptive sin tax bill for services they never needed?
Smokers on the whole are sicker people than nonsmokers, but they also die a lot sooner. They cost a little more while they're alive, but they don't cost anything at all when they're dead. One of the beneficial-to-society things about being dead is that dead people don't get Social Security checks or soak up other (non-healthcare) government services and resources.
So, if the objective is to make the people who use the service pay more, maybe the correct tax would actually be one on tofu, gym memberships, and vehicles with the best crash ratings.
I'm being a little facetious here of course, but I hope you see my point. These lines of behavioral cause and financial effect used to justify sin taxes are not clear, and not even intuitive.
If fairness is the chief concern, the answer to your question could reasonably be either 1 or 3. Option 1 is fair (maybe - some people really do start life behind the 8 ball, even in the land of opportunity) but there's some inherent coldness and cruelty to a civilization that won't do anything to care for its sick and weak. Option 3 is also fair - everybody pays, and everybody benefits, if not from a direct return to their own healthcare expense, but from the pleasure of living in a civilization where sick homeless old people don't just die outside or alone. (I favor option 3.)
Option 2 is just too muddy, too vulnerable to manipulation, too vulnerable to abuse, and I admit I simply don't like it for the subjective reason of not wanting the government to be telling free people what to do, on the basis of a nebulous kinda sorta greater good, however well intended.
The road to hell is paved with good intentions.
As I said, I am not a big fan of governmental interventions either. I am also not an anarchist. I find the middle way is, many times, golden.
Like you, I am not an anarchist. Nobody really likes anarchists, but being a (small) minority party of individual liberty lovers, Libertarians are generally more accepting of harmlessly quirky and weird people, so they tend to gravitate toward the Libertarian party and we're not very good at showing them the way out.
I like civilization. I accept taxes as the cost of living in one. So do most libertarians. I want to live in a civilization where old and sick people don't die homeless in the gutter, even if their condition is largely self-inflicted. I'm reluctant to cast stones at anyone who does dumb self destructive things. The reasons why are too variable, and the truth is all of us do dumb things sometimes. I'm willing to pay something for their comfort and dignity.
I think trying to bill them directly in advance via sin taxes, as if society was trying to do separate checks for a 73 person dinner party, eleven years in advance when the restaurant hasn't even been chosen yet, is not the best approach.