Health Smoking and the Health Care System

Smoking causes ischemic heart disease, cancer, stroke, and chronic lower respiratory diseases which are the leading causes of death and disability among adults. Smoking-attributed diseased are an economic burden due not only to health care expenses, but also productivity losses related to disability or early death.

~California Department of Health, 2010

Smoking is a major health hazard, and since nonsmokers are healthier than smokers, it seems only natural that not smoking would save money spent on health care. Yet in economic studies of health care it has been difficult to determine who uses more dollars -- smokers, who tend to suffer more from a large variety of diseases, or nonsmokers, who can accumulate more health care costs because they live longer.

~Barendregt et al., 1997

There is now scientific proof that concludes that smoking cigarettes affects both the smoker and those in proximity of the smoker. These affects are physical. What smokers may not know is that smoking affects the costs of health care for them. Imaginably, the costs of health care for smokers are higher than those who do not smoke. Smokers are paying money for highly taxed cigarettes that will in turn affect their health negatively and eventually, with long-term, sustained use, smokers will incur health care expenses related to smoking. This paper will examine the effects of smoking, particularly the economic effects on smokers and health care in general.

The physical effects of smoking affect the physicality of the smoker, but those affects often spread from the smoking individual to larger communities. Smokers who suffer from health problems require medical care. Smoking begins as a voluntary action, before addiction sets in; therefore, it is arguable that the health care costs caused by smokers are avoidable. The health problems associated with smoking such as cancers and respiratory disorders, cost a great deal to treat because often the treatment requires extended periods of time. The facilities, equipment, and medical supplies used to treat smoking related problems could be spent in other ways, such as for people with involuntary conditions such as victims of car accidents. Smokers can choose not to smoke; smokers can seek assistance with smoking cessation, which in many cases is free or reasonably priced.

The costs of medical treatments related to smokers in America compares to what a major Hollywood Blockbuster film makes in its opening weekend. Therefore, this is not a minor issue; whenever there are funds spent in the tens of millions of dollars for any reason in any industry, there will be attention. Economists, physicians, scientists, and others in the academic community have researched the economic impact of smoking for nearly four decades.

The total adult health-related cost of smoking was estimated to be $18.1 billion in California in 2004. This estimate is half of the total expenditures allocated for health and human services in the 2008 -- 2009 California budget. This equates to an additional $500 health-related expenditure per California resident, or $3,400 per smoker. (CDPH, 2010)

This is just for California, which is a large and populous state in the United States. Imagine these figures across all fifty states. The costs are likely in the trillions. There is no doubt about the direct link between health care, money, and smoking. The research shows that smoking increases overall medical costs, raises health insurance premiums, and incurs related costs such as loss of profit in business and loss in productivity in business. A chronic smoker may not be in the hospital receiving treatment for smoking related health concerns, but the smoker still may be unhealthy. The chronic smoker may miss work habitually, may miss school, and may miss out on life. These effects have economic costs that are felt by society at large when studied over the course of time.

Chronic smokers may not have a long-term disease such as cancer due to smoking, but they do have increased risk of chronic...

Therefore, they may not be under medical treatment for long periods of time, but they will be under medical care regularly. This is another way that smoking economically impacts health care.
This study shows that although per capita health care costs for smokers are higher than those of nonsmokers, a nonsmoking population would have higher health care costs than the current mixed population of smokers and nonsmokers. Yet given a short enough period of follow-up and a high enough discount rate, it would be economically attractive to eliminate smoking. (Barendregt et al., 1997)

Again, smoking begins as voluntary. Smokers could choose to stop and/or seek help to stop and not have to allocate their money, whether from their personal income, the income of their family members, or even the health insurance provided by their employer to medical costs due to smoking. The economic impacts are not only the responsibility and burden of smokers, but also non-smokers bear the burden of the economic costs of smoking. Cessation of smoking lowers costs and increases health for chronic smokers and non-smokers. Chronic smoking additionally includes the increased probability of premature death as compared to the non-smoking counterparts. Family members or friends have to put up the fees to conduct funeral services. Funerals, even the most humble and stoic, can be a significant costs to the average middle class, working class, or poor citizen. This is another economic impact of smoking felt by those around the smoker.

The health problems directly linked to smoking cost a lot -- the smoker pays the price with his/her life and health, the family may pay the costs of the medical treatment, and society pays the costs by watching people die voluntarily. As much revenue as the tobacco industry generates, the tobacco industry generates an equally comparable amount in medical costs.

Interest in the medical costs of cigarette smoking derives from the desire to identify the economic burden that smoking imposes on a society. This burden is typically characterised as consisting of these medical costs plus productivity losses attributable to smoking related morbidity, disability, and premature mortality. Invariably large, the economic burden is frequently cited by activists campaigning in support of tobacco control policy measures. Recently, the medical cost estimates have gained more immediate and specific salience as most of the states in the United States, selected health insurers, and the governments of several countries have sued the tobacco industry to recover smoking-related healthcare expenditures. (Warner et al., 1999)

It is interesting that these authors described smoking as a burden upon society. It is more than a burden to the smoker with health ailments. The burden extends beyond the family and friends of the smoker with health problems. The problem of smoking is a societal issue, in an industry where sales are in the billions, just as the health care costs related to consumption of the product is in the billions. This is an issue that cannot be ignored for health reasons, business reasons, and economic reasons. The authors also state that the problem of smoking upon health care is something from which countries much "recover." People have to recover from injuries, diseases, and trauma; in this way, they indirectly name the tobacco industry and the subsequent health care problems it causes as an injury or wound from which the entire country must recover. It is a powerful thought that adds perspective regarding the scale of the problem. It is furthermore ironic that so often in American advertising, smoking is pictured as a sign of leisure, relaxation, and comfort. The real life effects outside of the ads show a different, harsher picture of smoking.

There is no doubt that smoking impacts health care economically, even if on a basic level that health care costs money. Smoking brings upon chronic and fatal diseases. Each time the smoker seeks treatment that is money that could go elsewhere. Smoking is a voluntary action that can stop if the smoker chooses.…