Smoking and health care

Scott, in objecting to Megan's semi-defense of Giuliani's health-care plan, raises an important point:

it's far from clear that smokers are more expensive consumers of health care; smokers consume more health care when they're alive but also die earlier, which saves expenses later on. And then when you consider that as a class smokers are also much less expensive in terms of Social Security ... this argument is pretty clearly specious.

Right. Additionally, if all smokers were magically transformed into non-smokers and were given new leases on their damaged organs, it does not stand to reason that they'd all end up living normal lives of normal lengths, incurring normal health care costs along the way. If things worked that way, then major changes like miracle disease cures or outlawing cigarettes would result in major increases in life expectancy, which just doesn't happen. Instead what we see is the Taeuber paradox, which dictates that the elimination of a particular death risk (cigarettes say) makes little impact on cohort lifespan because it in effect exposes the people that would have died to a whole new set of death risks. So even if we assume that smokers die about 10-or-so years earlier than non-smokers, there's still no way to know what horrifying (and indeed expensive) ailments they would have otherwise suffered in old age if they'd never picked up a cigarette to begin with.

One could argue that, ceteris parabus, taking smoking out of the mix would result in lower net costs because the would-have-been smokers would flip into the pool of non-smokers with, on average, cheaper end of life care. But that doesn't take into account the 10 years of incidental costs from things like infections and broken hips that ultimately have no bearing on end of life care anyhow.

This is not to say that everybody should light up. Smoking is bad for children and other living things. I'd recommend instead that everybody go out and buy themselves a delicious pack of Chewlies gum.