Diane, Daniel Moore, and dhanson:
You have taken this thread into a very interesting domain. If I understand your recent posts correctly, you are asking what are the actual costs of smoking, and how will we, as a society, benefit from decreases in smoking? As with many important issues, the answers to these questions are difficult to obtain to everyone’s satisfaction. One attempt, I think a good one, was made by the CDC in 1994. Please check out:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00031803.htm
I am no HTML stud, so I’ll just have to put a few quotations from this report in normal text below:
First:
. . . estimated smoking-attributable costs for medical care in 1993 were $50.0 billion. Of these costs, $26.9 billion were for hospital expenditures, $15.5 billion for physician expenditures, $4.9 billion for nursing-home expenditures, $1.8 billion for prescription drugs, and $900 million for home-health-care expenditures.
And then, from the Editorial Note:
The findings in this report indicate that cigarette smoking accounts for a substantial and preventable portion of all medical-care costs in the United States. For each of the approximately 24 billion packages of cigarettes sold in 1993, approximately $2.06 was spent on medical care attributable to smoking. Of the $2.06, approximately $0.89 was paid through public sources.
If I understand this paragraph correctly, the health care costs from smoking cannot be recaptured from the current taxes on cigarettes - those costs, estimated at $2.06/pack, amount to more than the entire pack.
More from the editorial note:
The smoking-attributable costs described in this report are underestimated for two reasons. First, the cost estimates do not include all direct medical costs attributable to cigarette smoking (e.g., burn care resulting from cigarette-smoking-related fires, perinatal care for low-birthweight infants of mothers who smoke, and costs associated with diseases caused by exposure to environmental tobacco smoke). Second, the indirect costs of morbidity (e.g., due to work loss and bed-disability days) and loss in productivity resulting from the premature deaths of smokers and former smokers were not included in these estimates. In 1990, estimated indirect losses associated with morbidity and premature mortality were $6.9 billion and $40.3 billion, respectively (3); these estimates suggest that the total economic burden of cigarette smoking is more than twice as high as the direct medical costs described in this report.
To sum up then, and here I quote immodestly from a recent book chapter of mine:
Annual health care costs attributed to cigarette smoking have been estimated at 50 billion dollars each year, with an additional estimated 50 billion in indirect costs related to premature death and disease . . . Smoking cessation decreases an individual’s risk for smoking-related disease, and can be expected to produce subsequent decreases in smoking-related health care costs . . .
No matter how you slice it, $100 billion in U.S. health care costs is a pretty big slice of the economic pie. And, not to be callous, lets remember that the cost in lives of U.S. citizens (estimated at 419,000 annually) is also substantial. Do we really want to stand idly by and allow this preventable loss of lives and dollars to continue?
To Diane:
Your clinical experience is indeed interesting and thought-provoking and I thank you for contributing it. I would like to note thought that your statement that “I can’t imagine that my clientele is unique and not a reflection of recipients nationwide” is surprising given your otherwise obvious thoughtfulness. There are over 220 million people in this country - the probability that your non-random sample (non-random by virtue of a variety of selection factors, including location, disease-state etc. etc. etc.) could legitimately be used as a representative sample is extremely small. Consider - do you really believe that your sample matches the national breakdowns in terms of race, religion, income and smoking status? It is possible, but I doubt it.
Also, in response to your calling estimates regarding the falloff in smoking caused by increased taxes “pure speculation”, I must disagree strongly. These estimates are based on well-considered and published analyses of laboratory and real-world experiments, including (but not limited to) Canada’s well-publicized cigarette tax increases and decreases. You are correct that no one can possibly predict the actual number of kids who won’t smoke or who will quit smoking due to a tax increase. However, the numbers cited are the best estimates based on the known facts. The label “pure speculation” is an indefensible descriptor.
Finally, I think that the article that stated “Successfully preventing people from acquiring an addiction they do not want to have – by effectively combating youth smoking – is a free lunch with real benefits for our economy . . .” may have been a bit unclearly worded. I believe that the intent of that line was something like: if and when we can effectively combat youth smoking we will reap real benefits for the economy. I don’t think anyone in the field believes that we have settled on an effective strategy yet, and you are correct to note that youth smoking is, alas, on the rise.
Apologies for the long post; serious questions deserve serious answers.
Eissclam.