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Comment by riwsky | Hacker News Reader

We did that for tobacco, though? It was a huge public health win?

Actually, it's mixed. The states now get such a huge chunk of tobacco money that they're incentivized to keep people smoking. The more they smoke, the more the state gets.

Also, the companies are doing gangbusters in developing countries where people aren't as informed of the dangers of smoking.

This is not judgement, to be clear. I enjoy the occasional smokable like anyone else, but I do that with full understanding of the health risks associated with it.

> The more they smoke, the more the state gets.

The state "gets" tobacco tax revenue to help pay for the burden of medical treatment for those with smoking related illnesses. Lung cancer isn't free to treat.

I've read that smoking related illnesses cost less money overall to treat than average. As an extreme example, if someone went around disintegrating people with an orbital laser, this would clearly reduce overall heathcare spending. So in this analogy, smoking is the equivalent of an orbital laser that (plausibly) causes people to die before they develop an even more expensive-to-treat healthcare situation.

I don't think this analogy works, the space laser is instant and does not spread to non-targets. Smoking does reduce the average life span, but not to zero. In the remaining time, healthcare costs are increased on top of anything expensive they'd develop naturally. Smoking also causes serious diseases in non-smokers and kills 1.3 million non-smokers per year. https://www.who.int/news-room/fact-sheets/detail/tobacco

> I've read that smoking related illnesses cost less money overall to treat than average.

If you've read it, then please provide the citation.

Smoking not only has its own direct impacts (lung cancer, emphysema), but it also makes many other conditions far worse than they would be without smoking, and therefore more expensive to treat.

Yes, I'm sure all that money is perfectly tracked and the system is perfectly efficient so there's no money being burned somewhere along the way to line someone's pocket.

They have to treat them any way because of Medicare, Medicaid and Obamacare.

So it's all about tax revenue to defer this cost.

The alternative is to deny medical care to smokers. That would at the very least violate medical ethics, and possibly the law.

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