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The high taxes for cigarettes (and similarly alcohol) should also be taken into account when considering net gains/losses. According to this [1] in the uk at least the taxes more than cover it for tobacco

[1]https://fullfact.org/economy/does-smoking-cost-much-it-makes...

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Here in the US the taxes are much lower for a large portion of the country [1] so it probably doesn't come out so much in favor. Though long term health care is also more expensive here so it might all come out as even or similar enough.

[1] http://taxfoundation.org/blog/state-cigarette-tax-rates-2014

It creates enormous social pressure to increase cigarette and alcohol taxes. In Canada both are quite high and the general population supports it due to the public healthcare burdens.

For health issues I think this type of pressure is a positive social force.

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