Smokers—what should we do with them?

We sometimes treat them like second-class citizens. Or do we? Certainly smokers hate it when we force them out into the cold for a butt. Here in Michigan, we’re thinking about restricting smoking in a lot of public places. There benefits are supposed to accrue to three groups: the smokers themselves, their co-workers who are exposed to second-hand smoke, and the public, who pays more for health care because of smoking.

I asked a simplistic question once about whether smokers should pay higher insurance premiums, that doesn’t really bring the same benefits to everyone as a more comprehensive approach. Now, outlawing smoking altogether seems foolish—you know, prohibition, black market, etc. But is it unreasonable to limit smoking to, essentially, the someones own private space?

How do we justify a potential limitation of individual liberties? Smoking is the biggest cause of premature (and preventable) death in the U.S., leading to about half-a-million deaths yearly. Data from 1998 showed smoking was responsible for about 76 billion dollars in health care expenditures, plus productivity loses of about 92 billion dollars per year. Smoking sickens and kills people, and costs are (very crappy) economy a lot of money. For both economic and public health reasons, we must make smoking cessation a paramount societal goal.

How do we do this?

I certainly don’t have all the answers (but evidence does exist), but any national health care reform must include smoking cessation as a main priority.

Eliminating smoking in public places has no negatives, and a great potential for good. It will reduce smoke exposure to the “innocent”, and will likely encourage smokers to cut back or quit, if only for economic reasons. Taxing tobacco is another strategy, and evidence does show that people will cut back to save money, but it is a regressive tax, as lower income Americans do more of the smoking. Of course, it’s also possible that smokers are lower income because of their smoking—they spend money on cigarettes, they don’t have access to higher paid jobs where smoking is not usually allowed.

But limiting available venues for smoking is an important strategy. If we are going to get serious about helping people quit, we are going to have to support cessation programs—medications, support groups, etc. This will ultimately save us money (er, and lives).

Smokers cost us a lot of money. It may be fair to charge them more for health care (or not), but it would be more responsible to help them quit. But we are very well justified in taking a bite out of their liberties in limiting where they can smoke, as their behavior always affects others.