What is the financial cost to our society from the use of tobacco products?

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There is currently a major debate ongoing in our society as to how the problem of continued funding of the Medicare administration can be accomplished. Currently, each working citizen contributes 2.9 % of his salary to fund Medicare. It is now predicted that the Medicare administration will become bankrupt sometime during the first decade of the twenty-first century. In an effort to prevent such a catastrophe, multiple potential solutions are being tried. Managed care medicine is sending patients home within hours after childbirth or major surgery. Patients with cancer and other life threatening diseases are being denied new experimental treatments. There is serious discussion of rationing expensive care for elderly patients. Despite public dissatisfaction and the fact that consumers are already in revolt over cuts in health services, no action is being taken by our leaders to reduce the health and fiscal consequences of the number one preventable disease causing factor in our country. No, it's not drunk driving, alcohol, heroin, cocaine, marijuana, guns, prayer in school or pornography. It is tobacco, the single most expensive cost item on the Medicare budget.

There is incontestable data from thousands of different medical and epidemiological sources all over the world, that cigarettes and other tobacco products kill three million people each year, including approximately 430,000 U.S. citizens. This carnage does not seem to move our elected representatives, and they have done almost nothing to change this lamentable situation.

Perhaps, consideration of MONEY, rather than loss of human LIFE and suffering is needed to catch the attention of our politicos.

The financial consequences of cigarette smoking are truly mind-boggling. The cost of tobacco related diseases including coronary artery disease, cerebrovascular accident (stroke), peripheral artery disease, chronic bronchitis and emphysema, lung cancer and cancer of the lip, mouth, larynx, esophagus, pancreas and bladder has been calculated by conservative estimates derived from data collected in the National Medical Expenditures Survey. This data indicates that the direct cost of tobacco use is approximately $50 billion dollars each year. Direct costs include hospitalization, doctors bills, medications, and home and nursing home care. 43.3% of this amount is paid for by Medicare and Medicaid (MediCal in California). Put in different terms, the medical cost of each pack of cigarettes sold in the U.S. each year (24 billion packs) is $2.06, and the government pays $0.89 per pack of cigarettes. Before you become adjusted to these huge numbers, let me add that the indirect costs due to cigarettes including such things as fires, premature births, loss of productivity secondary to premature death adds up to another $50 billion or more.

State governments are also becoming increasingly aware of the adverse effects of tobacco on their local economies. The state of Texas, for example. reports (Texas Medicine, November 1993 p56-60) that it lost $4.2 billion in direct and indirect losses in 1990. This realization has led the attorney generals of a number of states, cities and counties to file suits against the tobacco industry for recovery of these losses.

Former Surgeon General Joseph A. Califano has called tobacco related diseases the largest single financial drain on Medicare, and estimates that these diseases will cost Medicare $800 billion dollars by the year 2010.

MacKenzie et al have reported the Human Costs of Tobacco Use in the New England Journal of Medicine March 31 and April 7, 1994 and noted the following facts.

• "The estimated average lifetime medical costs for a smoker exceed those for a non-smoker by more than $6,000."
• Insurance companies owned by tobacco companies charge smokers nearly double for term life insurance. (I am sure that they have a perfectly reasonable explaination for this given that they deny that cigarettes kill people.)
• Cigarettes are the leading cause of civilian fire deaths and injuries in the U.S. and cause $552 million in direct property damage annually.
• Smokers take an average of 6.5 sick days per year more than non-smokers.

Howard Barnum of the World Bank estimates that tobacco products cost the world economy $200 billion each year.

"This then, is a simple message: Tobacco consumption provides a net economic loss, and anti-tobacco policies are a cost-effective way to save lives and benefit the economy."

Despite these well known facts, the very politicians who prophesy the demise of Medicare, do nothing to regulate this public health hazard. It would therefore seem logical, that if we are truly interested in fiscal responsibility, balancing the budget and saving Medicare, then effective action will have to be taken to reduce this staggering financial loss.

Instead, our elected representatives, 79% of whom take political contributions from the tobacco industry, routinely gut effective tobacco control legislation. The most recent example, is the recently passed legislation to continue to subsidize tobacco farmers, to the tune of $34 million of your tax dollars each year to continue to grow the etiologic agent (tobacco) causing all of this physical and fiscal damage! What insanity!

My congressman, Republican David Dreier, from a district at least 1000 miles away from the nearest tobacco farmer, voted FOR the subsidy. A NO vote would have resulted in a tie vote that would have forced Newt Gingrich to show his true colors.

A number of obvious solutions have been proposed. The cost of a pack of cigarettes is lower in the U.S. than in any other Western nation with the exception of Spain. The tax on cigarettes needs to be drastically raised. This would have multiple saluatory effects. It would help to pay for the health damages caused by the product. It would also reduce the number of smokers. A high tax in Canada reduced the number of teenage smokers (those least able to pay the increased price) from 43 to 17%.

Strong measures also need to be taken to prevent the tobacco industry from seducing our young into becoming the next generation of smokers and excess consumers of health care dollars. Our record in this regard is abysmal, poorer than any other First World nation than Japan.

The measures advocated by President Clinton, FDA chief David Kessler and Congressman Henry Waxman need to be passed. This will prevent cigarette product giveaways, vending machines, billboard and other sleazy advertising to glamorize smoking and attempt to spread the smoking vector.

Legislation allowing the FDA to treat cigarettes as the dangerous drug that they represent needs to be passed.

Most important, we need to send a clear message to the politicians like Congressman Dreier, Newt Gingrich and ex-Senator Robert Dole, that we will no longer accept their anti-social behavior. If your congressman of senator takes money from the tobacco industry and votes with them, against tobacco control legislation, let him know that he can expect to see you supporting and voting for his opponent in the next election. In this way we can save not only thousands of lives, but also billions of dollars.

For further information on this topic try these two sites.

Per capita cost of cigarette smoking

Cost of Smoking