Actually NE Journal of Medicine says that mass smoking cessation would increase total health care costs in long run. So not sure the logic for the disincentives, other than paternalism run amok.
"If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs."
Of course a rote analysis would show tremendous cost savings to just denying everyone health care or insurance coverage after the age of ___, if all you are counting is the dollars spent to extend life versus the economic productivity measured as annual income over the years that person's life was extended.
The glaring and obvious problem with such a naive analysis is the associated costs to society of actually implementing such a program.
We can conclude that smokers aren't exerting a net direct cost to the health care system due to their smoking, while simultaneously concluding that it's in the interest of public health and overall society to reduce smoking. Just don't tell me you're doing it as a cost saving measure!
Did you consider the possibility that taxes on cigarettes are intended as an incentive to stop smoking and thereby lower the health care costs of treating long term smokers' various ailments?
Many studies actually show that smokers are cheaper to care for over their lifetimes, likely because they die earlier. This study[0] shows a +7% for men/+4% for women increase in healthcare costs if all people stopped smoking. I'm too lazy to vet the epistemological quality of this study, but it seems like there are a bunch of these much along the same lines. One thing these studies seem to neglect is total value lost associated with smoking, instead focusing costs alone. By folding in some QALY-like model, you could come up with the overall impact of smoking on society in quantitative terms.
Hah that is interesting. I don't think it changes my point tho - maybe just makes smoking a bad example. However, I was using it as a proxy for "anything that increases your health-care costs".
Actually reducing tobacco use can increase public spending on health. Lung cancer tends to take people out pretty quickly, while those who live longer run up higher costs.
There is some evidence that smoking actually reduces total healthcare expenditure, as smokers die more quickly than non-smokers (who tend to linger in hospitals and cost a lot of money at the end of their lives). If true, does this mean smoking should be subsidized?
Edit: This is consistent with real-world observation. Anti-smoking policy is the greatest in the US where the plutocracy benefits from increased healthcare spending, and relatively lower in social welfare states in Europe.
"It looks unpleasant or ghoulish to look at the cost savings as well as the cost increases and it's not a good thing that smoking kills people," Viscusi said in an interview. "But if you're going to follow this health-cost train all the way, you have to take into account all the effects, not just the ones you like in terms of getting your bill passed."
I can't see anything ghoulish about it at all. Seems to me if you only count the direct negative costs (treating the lung cancers, lost productivity) and ignore any of the cost savings (no long term end-of-life care because you died from the lung cancer) that's just a failure of actuarial science and lack of a proper systematic analysis of the costs and benefits.
What makes accounting for the cost of treating a certain number of additional lung cancer cases any less "ghoulish" than accounting for the savings of not treating a certain number of alzheimers cases?
No one is saying the singular goal is to reduce cost, reductio ad absurdum, but if you're claiming smokers are a burden to society because you did the math wrong and it fits your world belief and sense of moral justice, that's no longer science, it's politics. We can do both well, but shouldn't pretend one thing is the other.
Most people will get cancer or some terminal illness that requires expensive treatment eventually. And if they don't then they will live long enough to require assistive living which is also very expensive. Lung cancer is particularly aggressive and trends to kill people right before retirement age so the argument has been made that smoking reduces overall costs because you don't have to spend money on as many retired people who otherwise would need assistance.
> It is the largest single expense to employers and to the [Canadian] healthcare system.
I've read numerous times that smokers are actually a net gain for a healthcare system, assuming the same system pays for the whole life of the patient.
The majority of medical costs are incurred by a small minority of patients, usually at the very end of their lives. Smokers die earlier and faster, usually without the slow and expensive deterioration many healthier patients will go through.
Very interesting. But I wonder if that takes into account the time value of money. If you saved that health care money up front, it could balloon to a lot more in the years leading up to what would have been an earlier death of the smoker.
And that also assumes we won't get better at treating and prolonging life for things like lung cancer.
Probably because it keeps people alive longer, so that they need more care. Smokers, allegedly, are much cheaper to care for in the long term than non-smokers, because they die early.
In the specific case of smokers, it doesn't actually increase health costs. Smokers die younger and often have a relatively short illness before they die. Compare this to someone who lives 95 and requires care in a care-home it's "cheap". You also save on things like pension costs because you don't pay them to dead folk, and income from taxes.
I'm not entirely sure about the numbers on things like obesity, drug use, etc. off-hand.
I agree with you as a matter of principle, so not that it really matters, but people sometimes say "smokers should pay the cost they inflict on society themselves!" and turns out they're not actually inflicting the huge costs people imagine they do.
"If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs."
http://www.nejm.org/doi/full/10.1056/NEJM199710093371506
reply