The Cost of Smoking

Today’s Managing Health Care Costs Indicator is $40

Click Image to Enlarge.  Source

I’m taking a break from this month’s Health Affairs today to highlight some posts from The Incidental Economist blog – which has grown to be among my favorites.

Don Taylor, author of “The Price of Smoking” reprises his calculations for the real cost of smoking per pack.

These are

• $33.00 – the cost of lost life years, lost wages and disability due to smoking  
• $5.50 – the cost borne by the family – mostly through increased spouse mortality
• $1.50 – the external cost, which includes increased health care costs (a mere $0.48), nonsmoker subsidy of smoker life insurance ($1.78), lost Social Security contributions ($1.02) and productivity losses ($1.00).   You might notice that this sum is equal to far more than a buck and a half – that’s because smokers ‘save’ the system money through lower pension and Social Security payouts and through taxes they pay for cigarettes. 

Here’s a link to the post.  

Smoking is the most important remediable cause of lost life years – and we should use all the arrows in our social policy quiver to get people to quit smoking.   That includes powerful choice architecture decisions to make smoking inconvenient, and higher taxes to discourage price-sensitive teens from getting hooked.   But the US has among the lowest smoking rates of developed countries, but the highest health care costs.  

Click image to enlarge.  Source 

By Taylor’s calculation, elimination of smoking alone would not solve our health care cost crisis.

Orthopedist vs. Anesthesia and a Pair of Articles Putting the ACA in Historical Perspective

Extranormal produces great 'homemade' videos.  Some of the pronunciation of medical terms is rough (asystole = the heart has stopped for my nonmedical readers. Temperature of 29= 84 degrees F, and normal pH is 7.4)

By the way, a nicely paired set of articles by perceptive NY Times journalists today and tomorrow.

Today, David Leonhardt reminds us that this quote

“We are against forcing all citizens, regardless of need, into a compulsory government program,” said one prominent critic of the new health care law. It is socialized medicine, he argued. If it stands, he said, “one of these days, you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”


is from Ronald Reagan talking about Medicare in the 1960s.   He goes on to discuss the tension between Americans who believe in individual responsibility (the laissez fair conservatives) and those who believe in a minimum standard of living (progressives.)  Both traditions have played a role in America's success; the tension remains


Tomorrow, Matt Bai reminds us that Social Security started collecting premiums in 1935 but didn't pay out pensions until 1941 - and was under siege for decades until it became a critical part of our social fabric (and until most families were getting some benefit from the program).  He suggests that the final analysis of the Affordable Care Act can't be written for a generation.