Who Should Pay for Tobacco-Related Health Costs?

[edonnelly]

Kopio's post about cigars got me wondering what people here think about society's obligation to pay for the ever-growing medical costs related to tobacco use (and abuse). While I am opposed to the government trying to tell adults they are not allowed to smoke, I do wonder if it should be society's responsibility to pick up the tab when these obviously poor choices lead to the inevitable (heart disease, emphysema, stroke and a whole host of cancers including oral cancer, lung cancer, etc.). Even the well-insured citizen can easily exhaust his/her benefits, and whether the hospital or the governemt picks up the bill, the costs ultimately go to the rest of society (through either higher insurance costs or taxes).

Does your right to smoke mean that I have to pay for your surgery, radiation therapy and chemotherapy?

Tobacco use, of course, is not the only poor choice people make that leads to escalating medical costs for society, but it is arguably the largest player and worthy of discussion, I think.

[ThomasGR]

The problem with smoking is that one cannot prove it with sufficiency that it creates diseases that could lead to death. We have only statistic analyses, which for a court are not any better than guesses. Otherwise one could go to a civil court and charge tobacco companies for compensations and the costs of medical care. There are times where I think that mighty tobacco lobbies hinder serious studies that could prove that. In the mean time, my proposal is, one should tax more tobacco products, that’s to say, smokers should pay for their medical costs alone.

[Sanskrit]

I think that it is stupid to smoke anything, but it's not necessary to let smokers pay extra money. They will die sooner, so they actually should get a discount on their retirement payments.

[edonnelly]

The problem with smoking is that one cannot prove it with sufficiency that it creates diseases that could lead to death.

It's been proven well beyond any doubt scientifically.

We have only statistic analyses, which for a court are not any better than guesses. Otherwise one could go to a civil court and charge tobacco companies for compensations and the costs of medical care.

Indeed, this has happened. That was the exact reasoning behind the major "tobacco settlement" (estimated to total around $246 billion over 25 years). Individuals have tried, as well, but it's much more difficult (if not impossible) to prove that any particular individual's disease was caused by tobacco. I think this is where you were going with what you said, and I agree. But my real question is not can it be done practically, but should it be done (assuming practical issues were resolved).

They will die sooner

There have been some interesting studies about this issue. One study found that indeed, smoking may actual be a benefit to society (financially) because the premature deaths prevent people from entering the medically-costly old age. Other studies, though, suggest that the medical costs to treat the diseases of the smokers well exceed the medical costs those people would have had if they had not smoked and lived to old age. It's an incredibly interesting (and not always politically-correct) issue. I honestly wonder how well this topic was addressed prior to the "tobacco settlement" -- that settlement may turn out to be just a bunch of states strong-arming money unjustly out of the tobacco companies (not that I'm opposed to that...)

[Misopogon]

I think that, in theory, it is right that the smokers should pay for the health costs, e.g. paying more taxes on tobacco products. However, the principle is that any habit or human activity that causes "illness" or other "social cost" should treated in same way.
It is clear that this doesn't happen in any country. In the last few years, smoking has become not "cool". Many countries, especially in Europe, have risen the tobacco taxes, or they have forbidden smoking in pubblic place (sometimes I read on the papers that in some parts of US you cannot smoke in the pubblic street, is it true?): as a moderate smokers I agree on that.
The social costs of diabethes are very high as well and the high consume of sugar (white, brown etc.) is strictly related to this illness, even it isn't the only cause. I do not see the governmentS taxing Coca Cola or put a warning on soft drink bottles. At the same way, social costs of alcohol are very high, but in many countries it is still a cheap stuff. So, I would like that the goverments would act in a logical and coherent way. Is it too much?

Regards
Misopogon

[ThomasGR]

I was not aware that it is proven beyond any slightest doubt that smoking kills. My second thoughts were Misopogon's remarks. Treating tobacco products equally to other foods (which lead also to deaths) like alkohol and sugar and vice versa, it could lead to an economic chaos. Somewhere I've read alkohol kills more people than tobacco, but no one speaks about that. It's interesting Sanskrit's aspect. I wonder.

[edonnelly]

I've read alkohol kills more people than tobacco, but no one speaks about that.

This could not possibly have been referring to the US. Here are some numbers (US deaths in the year 2000):

Smoking: 435,000 deaths (18.1% of all deaths)
Alcohol: 85,000 (includes alcohol-related traffic accidents)

The number of alcohol-related deaths could be as high as 140,000 by making assumptions about former drinkers and speculating whether their former drinking contributed to their death, but even this number pales in comparison to that of smoking.

Some interesting comparisons:
Car Accidents: 43,354 (16,653 of which were alcohol-related)
Firearm-related incidents: 28,663
HIV: 14,578
Illicit drug use: 17,000

I don't have data for other countries.

(data from JAMA. 2004 Mar 10;291(10):1238-45.)

[ThomasGR]

I see, again I was wrong, though I could swear I've read it somewhere and also there was a TV program dealing with alkohol addiction saying the same. What I find remarable of your statistics is that the victims of illicit drugs are so low. I expected them to be more.

[Misopogon]

Smoking: 435,000 deaths (18.1% of all deaths)
Alcohol: 85,000 (includes alcohol-related traffic accidents)

Probably these data are correct, even if the tobacco's deaths seem to me excessive: in Switzerland, the Federal Health Dept. calculate 8000 death per year (http://www.bag.admin.ch/themen/drogen/0 ... ml?lang=it sorry only in Italian, French and German), that means half of the US figure, but daily smoking are more common there than in the US (http://www.nationmaster.com/graph/hea_d ... ly-smokers), so it sounds a bit strange. Anyway, I am not a doctor or an expert in statistics and I believe that smoking is a important cause of death - maybe the most important - and a high cost for society as well. Said that, my point if alcohol is a social cost, then the drinkers and other people with "bad habits" should pay for that as well as the smokers.
Have a look to the "big killers" at http://en.wikipedia.org/wiki/Big_killer: Ischaemic heart disease is the second "killer" and it can be caused by smoking but also by , too muche caffeine, a wrong diet, like eating too many fats. Should we tax butter more? Should we closed the McDonalds'? Even if I believe that the Big Mac is crime again human gastronomy , I am not sure.
If the problem is the people's health and the social costs, it does not matter if an habit causes 80000 or 400000 deaths, because it's still a cost for all us.

By the way the social cost of alcohol it isn't just the deaths, but also the cost to have the police force monitoring certain areas, psycological problems for familes, low productivity, etc. You could find a similar argument for firearms, pollution, obesity or whatever. I am not sure the statistics can combine all these factors. Again, this is just an opinion.
Disclaimer: I don't know how reliable are the sites I cited, please take them cum grano salis.

[Kasper]

I'm very supportive of the idea of making smokers pay extra for health benefits in respect of smoking related illnesses. I think the problematic issue is when do we classify someone as 'a smoker'? Many smoking related illnesses also arise from other causes, be they genetic or life-style related.

Eg. I smoked between ages 17-21. Suppose that in my 61st year I developed lung cancer. In order to charge me additional fees for treatment, there would have to be a proven link (most likely on the balance of probabilities) between my 4 years of smoking and the interlying 40 years of non-smoking.

Do we suggest that you if you smoked once, that's it - you're paying extra fees, or do we need a mininum time/quantity limit?

How do we check whether a person smoked? Passive smoking may also cause lung cancer. If I deny I ever smoked, how can a definite diagnosis be made?

Should we further take work-cultures into account? It is a reality that in most unskilled jobs there is often a culture of smoking. Do we charge people for "going along with the group"? The human being is a political animal afterall - going along with the group is what we do.

etc., etc.

It's not a simple issue.

[GlottalGreekGeek]

Quite frankly, I think the best way to make smokers pay for the medical costs they impose on society is through excise taxes on tobacco. It increases revenues for the government which pays some of the medical cost, and it also discourages people from buying tobacco (especially poorer people who are less likely to be able to afford medical care). Education is important too, but where I live I think expanding education would have diminishing returns - almost everybody I know who is my age who smokes has been told since they were little kids that smoking is royally unhealthy, but they *still* took up smoking.

I feel the same way about alchohol.

However, unless you count the fact that men can sometimes reap a health benefit from red wine, smoking and alchohol are proven to almost always have a *bad* impact on health. Other products, such as sugar, do not. If somebody was about to starve to death, sugar could be a life-saver. While the obese outnumber the starving in the USA, this caveat makes it much more difficult to put on a tax for health purposes. Of course, sugar is already pretty heavily taxed since it has one of the highest tariffs for just about any product in the United States (I believe this is the case), but that tariff is not there for health purposes.

[bellum paxque]

smoking and alchohol are proven to almost always have a *bad* impact on health.

I've never heard that drinking in moderation has a bad effect on the health. Are there any references or articles that you could refer me to about this?

(Obviously, alcoholics have serious health complications, including cyrrhosis of the liver. But I'm referring to those who drink more sparingly.)

David

[IreneY]

We should also make fat people pay for the bills when they have an artery clogged or a heart-attack or anything of the kind shouldn't we?

[edonnelly]

We should also make fat people pay for the bills when they have an artery clogged or a heart-attack or anything of the kind shouldn't we?

That same article I referenced above also found that the #2 killer in the US is "poor diet and physical inactivity" at 365,000 deaths per year, and it predicts that this problem may soon overtake that of smoking in terms of number of deaths; (but, and the article doesn't address this) it may well exceed smoking already in terms of health care dollars.

[GlottalGreekGeek]

I've never heard that drinking in moderation has a bad effect on the health. Are there any references or articles that you could refer me to about this?

Well, I oversimplified. I have read in a magazine (I don't remember which one) that moderate consumption of wine can have a good health impact on men, but not women, hence my caveat. Supposedly, if someone has a strong liver and drinks enough water to compensate for the dehydration effect of ethanol, moderate ethanol drinking has no bad effect (women have weaker livers than men, so that may be why the wine-effect isn't supposed to work for women). However, ethanol is a poison, which is why the liver has to do something about it when it enters the body. The reason why ethanol is the only consumable alcohol by humans is because it is the only one the [healthy] liver can fully process into non-damaging chemicals (unlike ethanol's brother, methanol). I have seen in the news that even a little alchohol drinking by pregnant women can result in deformities in the child, and while unborn children are particularly sensitive, I cannot help but think what is bad for a fetus probably have even a little bad impact on an adult.

On the other hand, the liver has to transform the ethanol several times before its safe to the body, and one of the intermediate chemicals is a carcinogen. If sombody's liver has some defect which prevents it from doing even one part of the complex process (such as a weaker capacity to break down the whatever carcinogen produced by breaking down ethanol) any ethanol consumption will have a bad effect. But, ironically, people with this lesser liver capacity are less likely to suffer from ethanol because even low levels of ethanol will make them feel bad, hence they avoid it. The people who become heavy drinkers are usually people who have stronger livers in the first place, and get drunk so slowly they aren't aware that they are exceeding their liver's capacity to process the ethanol.

On the other hand, it is easy to lead a healthy life without ethanol. It is much more difficult to lead a healthy life without carbohydrates.

[Deudeditus]

hey, i'm new to this thread.. trespassing, really. Really, what ever happened to people reaping their own consequences? If people want to smoke, then they should have the fortitude to deal with the cancer they inhale. I smoke occasionallly, self-rolled Buglers if you want the full glory of it, ... If'n I get cancer, I don't expect society to deal with it; nor would I want them to.

hmm. just a thought.

-Jon

[IreneY]

If people want to eat enough to amass extra fat they should reap the consequences too!

If people go out improperly dressed/prepared and catch a pneumonia should reap the consequences!

If anyone goes skiing where there's a known danger for potential avalanche and they get buried they should reap the consequences too (ok, let's save them and then ask them to foot the rescue team's expences)

Same goes with anyone venturing or not leaving on time when there's a flood.

I bet if I think a bit I can find more cases where people get hurt because of what they choose to do. Let them all pay!!!!

[Kasper]

hey, i'm new to this thread.. trespassing, really. Really, what ever happened to people reaping their own consequences? If people want to smoke, then they should have the fortitude to deal with the cancer they inhale. I smoke occasionallly, self-rolled Buglers if you want the full glory of it, ... If'n I get cancer, I don't expect society to deal with it; nor would I want them to.

hmm. just a thought.

-Jon

Hey John

let me ask you this: if the next time you went to buy a packet of cigarettes/tobacco and you were asked to sign a form to register that you agreed to pay the medical costs for all smoking related illness you may contract in the future, would you sign it?

[edonnelly]

I bet if I think a bit I can find more cases where people get hurt because of what they choose to do. Let them all pay!!!!

Hang-gliding, motocycle riding, speeding, flying, crossing the street, leaving the house...

[bellum paxque]

Okay, but there's a difference between high risk activities and low risk activities. Clearly, any action carries with it some level of risk.

David

[bellum paxque]

On the other hand, it is easy to lead a healthy life without ethanol. It is much more difficult to lead a healthy life without carbohydrates.

Point taken, GGG. And thank you for your very informative response. Admittedly, alcohol is not exactly a healthy substance, but the fact that many, many years of excessive alcohol consumption are often necessary to produce any sort of serious health problem suggests to me that my weekly three pints of beer is a manageable risk. Besides, it seems pretty clear that the most pernicious effect of alcohol is not upon the body, but upon the judgment, especially when it leads to drunk driving or abusive relationships.

David

[GlottalGreekGeek]

As long as your liver is healthy and you are not behind a wheel, I don't think that should be much of a problem.

As for let people smoke if they want to and pay for it later, there are some complications. For example, second-hand smoke. According to my chemistry teacher, second-hand smoke is even worse than first-hand smoke since it has had time to mix with oxygen, which makes some of the toxic chemicals even more toxic (though whoever recieves the second hand smoke is probably getting a lesser dosage of the smoke than the smoker). Therefore, I think laws against smoking in public indoors places is perfectly justified. Also, at present all of the United States has Medicare, and almost every state has its own health funding program, so the government is funding a lot of health care costs with tax money. Since smokers are making the state pay more money because of their choices, let them pay more taxes. If the government did not have any kind of subsidy for health care, I might have a different point of view. And if they are still willing to smoke away from other people after paying a high excise tax, well, it's their right.

[Bert]

According to my chemistry teacher, second-hand smoke is even worse than first-hand smoke since it has had time to mix with oxygen, which makes some of the toxic chemicals even more toxic (though whoever recieves the second hand smoke is probably getting a lesser dosage of the smoke than the smoker).

The smoker gets both first AND second hand smoke.

[Deudeditus]

Hey John

let me ask you this: if the next time you went to buy a packet of cigarettes/tobacco and you were asked to sign a form to register that you agreed to pay the medical costs for all smoking related illness you may contract in the future, would you sign it?

Yeah. It's only fair. Whose fault would (probably will ) those illnesses be? Sure, most companies add extra junk in cigarettes to make them more addicting/kill you faster/last longer, etc., but tobacco causes cancer anyway. Heck, any kind of smoke inhaled with enough regularity will mess you up. I mean, smoking is basically controlled asphyxiation... anyway, any smoking related ilnesses would be my own fault and I think it wrong for me to but the blame and pecuniary stress on someone else just because I might (will) suffer some sort of consequence for my actions/mistakes.

I probably wouldn't have started smoking, though, if I would have had to sign such a charta. We shall call it the [/i]Mala Charta in honor of King John.

-Jon

[IreneY]

How about drug addicts?

[Kopio]

We should also make fat people pay for the bills when they have an artery clogged or a heart-attack or anything of the kind shouldn't we?

Dang it!! I'm kinda chubby AND I smoke....man, at some point this is really going to cost me! Oh yeah....and I'm a recovering drug addict...Man!

In all seriousness though....the cigar thing is largely a passing fancy at the moment....once my school starts back up I have to quit (damn ethics code), and I have been trying to keep in shape walking and hiking (to my favorite fishing spots). As for drugs....I haven't had a drink or drug in over 10 years...so I think my liver has found the time work things out and forgive me!

As for who pays the bills.....hike the taxes on smokes....they do that pretty regularly...they make enough money off the dang things to do that. ALSO....have the major tobacco companies start a fund or something of the like.

[edonnelly]

....once my school starts back up I have to quit (damn ethics code)

Your school has an ethics code that forbids smoking (even when you are home)? Is such a thing common? I don't think I've ever heard of it before. I'm all for not smoking, but I'm not sure I would consider it "unethical." Sure, if kids would see, that's one thing. But otherwise, does anyone here think it is unethical to smoke?

Maybe it's unethical because it supports the tobacco companies which then prey on minors, but that's a bit of stretch.

[IreneY]

Kopio tsk tsk tsk! At least I hope you are always properly dressed and carry an umbrella when it looks like rain 'cause I refuse point blank to pay for any serious cold you might catch if you refuse to act properly.

[Kopio]

Your school has an ethics code that forbids smoking (even when you are home)? Is such a thing common? I don't think I've ever heard of it before. I'm all for not smoking, but I'm not sure I would consider it "unethical." Sure, if kids would see, that's one thing. But otherwise, does anyone here think it is unethical to smoke?

Yeah...well....I go to a very conservative Bible College. There is no smoking, drinking, or having sex (unless you are married) while ennrolled in classes. There are other parts of the code that are even more draconian. When I first started attending there, you couldn't dance (I know....that's sooo Footloose) and men were not allowed to wear earrings (which really peaved me because I have had one since 1990), and you weren't allowed to wear a t-shirt...only polo shirts or other button up shirts...oh yeah, and you still can't wear a hat in class! If it wasn't for the fact that they have an outstanding Greek program, I probably wouldn't have gone there!

I understand the ethics code, but I don't agree with it in most instances. The school is trying to promote solid "Christian" behavior. The only problem with it is that it takes away individual ethics, which I think they should really try to foster. Even the Apostle Paul said, "Everthing is permissable, but not everything is profitable". Granted if they let the kids decide for themselves, there would be a plethora of problems (which is why they have the code), but it would also allow people to mature spiritually on account of their own belief. Oh well....once I hit the Seminary I can smoke and drink. The Grad school isn't bound by most of the same rules.

Kopio tsk tsk tsk! At least I hope you are always properly dressed and carry an umbrella when it looks like rain 'cause I refuse point blank to pay for any serious cold you might catch if you refuse to act properly.

I have a sweet umbrella...my mom got it for me about 7 years ago for Christmas...it is quite fetching! It rains a ton here, so umbrellas are popular (especially when I have my books and laptop). Mine has a nice wood handle, and a brass tip...it's a Shedrain.

[Emma_85]

To take up the point IreneY makes... we have a tax for alcohol and tobacco - these pay towards the health care costs in the UK at least, I don't know if they do in the US, since a lot of health care seems to be private and not paid for by taxes. But assuming this is what those taxes are for (in the UK), shouldn't there also be a tax on sugar?

[Turendil]

I smoke. I'm not proud but I smoke. I think you guys are missing the boat on one important issue. WHO smokes. it isn't the type of person I'm trying to become (going to school on the GI bill want to go to law school). It's the type of person I left behind poor ignorant edge of the reservation style. choosing wether or not to Smoke in america isn't a sign of intelligence. It's a marker of where a person comes from.

[healthy]

i hate tobacco and the persons who take it knowing how much it is harmful for them. Chewing tobacco also contains nicotine and has a least 28 cancer causing chemicals. it has effects on oral mucosa, gingival and bone damage, damage to teeth local physiology, microbiology, esthetics.

[lombard]

I can not understand having such revulsion for someone who chooses to put something into their own mouths or bodies. What makes it your business?

Back to the question of the original post:

Why don't each just pay our own costs. Forget society picking up anyone's tab. If you choose to smoke then heaven help you if you can't pay for treatment. If you choose to overindulge on burgers then enjoy the heart attack or stroke. If you get sick, and find the money you put in Cable TV, Cell Phones, cars and the latest shoes and clothes should have gone into Health Insurance then too bad for you. If you can't get a job because you chose to forgoe the education because you preferred to party or because got knocked-up or knocked-up another, then bad choices should be your own responsibility.

If you need help after these bad choices then you should go to your family, your faith group or simply live with it. Why do we believe that society has the responsibility or even the right to interfere with another person's choices--bad or otherwise.

If countries with healthcare funded by society find themselves mired in these extra costs then I say: you made a national choice to institute the system, now you are stuck living with it.

He who pays the bills, makes the rules. I'll pay my own way because only inthis way can I maintain freedom to make my choices.

[nov.ialiste]

In Western Europe the typical tobacco smoker pays a very large amount of extra tax, without which e.g. the National Health Service in the UK would suffer enormously.

Furthermore not all smokers cost more than non-smokers. A heart attack can lead to a speedy (and cheap) death.

Everybody dies of something and most poeple cost most, in terms of healthcare, during the last 3 years of life: non-smokers too.