National health care [was Re: Medical technology and cryonics]

Robert Bradbury rbradbur at hardy.u.washington.edu
Thu Jun 4 14:43:12 EST 1992

In article <1992Jun4.090537.464 at mala.bc.ca> apland at mala.bc.ca writes:
>>Dollars spent on smoking
>> prevention reduce long term health care costs many times over.  
>	Sorry about the diversion, but I have heard the opposite - that
>many diseases caused by smoking are acute and kill the smoker quickly at 
>a younger age thereby reducing long term health care costs.  Which is it?
>I have read/heard both as opinion (without evidence).  Is there data out
>there on this point?  I would be very interested in any study(ies) that has
>looked at this question if someone could point to it.  Thanks.
Like most things the problem is very complicated.
The definitive scoop as far as I have been able to determine follows.

Many diseases associated with smoking result in relatively quick deaths
at a "young" age (50's-60's).  These "early" deaths avoid the long term
costs which are associated with prolonged heart disease and especially
Alzheimer's which can get very expensive.  When this is factored into
the equation with the savings one gets from reduced social security
payments one comes up with the net conclusion that early deaths due
to smoking actually save us money.  People at the NCI responsible for
figuring things out for congress have told me directly that they no longer
try to "sell" smoking prevention as a "money saver" for these reasons.

I would argue this is equivalent to government support for addicting people
and causing their premature deaths and that it is an immoral thing for
governments to do.  (Governments should do everything possible to keep
harmful substances out of the hands of young people who are not qualified
to judge their long term potential negative consequences.)

If everyone in the country stopped smoking tomorrow, the combined loss of
tax revenues and increased social security and health care costs for the
extreme-elderly would force some *significant* adjustments in how we fund
things.  So the shallow analysis would dictate that we should encourage
people to smoke.

This analysis does not however take into account the impact of smokers on
non-smokers (40,000 deaths / year due to secondary smoke).  It also doesn't
take into account that the long term health care costs for teenagers
today due to heart disease and Alzheimers will most likely be greatly
reduced as we come to understand and develop treatments for these
diseases over the next 50 years.  If you presume these diseases will
be cost-effectively treatable and that some kind of social security
reform will clean up the mess it now is, then one reaches the conclusion
that the government should adopt policies which minimize long term
damage to DNA.  If you have "intact" DNA you are much more likely
to live a long and healthy life.  On the other hand if you have
damaged it in random ways, the proceedures to correct the problems
that result will probably be difficult and expensive even if they
are possible.  The bottom line is that you should not do things
having potential negative health consequences if you can avoid them.

That is the basis behind my statment that "smoking prevention reduces
long term health costs".  The statement was also made within the
context of health care programs which are cost effective and
assist the "poor".  Taxes and poor health from tobacco
product consumption falls disproportionately on their shoulders.
Programs which discourage tobacco consumption are one very effective
way to reduce their tax burden and raise their overall health.

Then of course the idea that the USDA is spending our tax money to
increase exports of US tobacco products to less-developed countries
*really* ticks me off.  Lets export more death and destruction to
people who are unable to see it for what it is!!!  (Do the people
of North Caroline who keep electing Jesse Helms realize that this
man promotes murder?!?)

Robert Bradbury		uunet!sftwks!bradbury or rbradbur at u.washington.edu

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