Sunday, April 17, 2005

Smoking - Cost Benefit Reduced to Absurdity

BrooklynDodger has maybe blogged that the rash of CDC pronouncements about the "epidemic" of obesity was an early barrage to soften opposition to cutting medicare and medicaid benefits. Smoking has recently appeared in a series of attacks on employee health insurance benefits in the news media.

Don't mistake the Dodger's point here - the Dodger thinks everyone who now smokes should never have started and should stop now. [And not having this habit to kick, everyone now overweight to start exercising and lose weight, not so easy to do sitting at the computer].

The adverse impact of smoking on health care costs is not as clean as people assume. That's because a lifetime insurance system makes money on early death.

Based on Netherlands numbers, the investigators concluded: Health care costs for smokers at a given age are as much as 40 percent higher than those for nonsmokers, but in a population in which no one smoked the costs would be 7 percent higher among men and 4 percent higher among women than the costs in the current mixed population of smokers and nonsmokers. If all smokers quit, health care costs would be lower at first, but after 15 years they would become higher than at present. In the long term, complete smoking cessation would produce a net increase in health care costs.

These estimates ignore the savings to pensions from early death. This cost benefit also assumes that quitting smoking is free.

The important take home lesson goes beyond victim blaming. Life saving interventions will mostly fail a cost benefit test from an employer perspective: pension savings and retiree health insurance savings from early death will outweigh the cost of providing protection.


N Engl J Med. 1997 Oct 9;337(15):1052-7.

The health care costs of smoking.

Barendregt JJ, Bonneux L, van der Maas PJ.Department of Public Health, Erasmus University, Rotterdam, the Netherlands.

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