Following on from yesterday's post on the pervasive acceptance of both aging to death and centralized control over society, here is another item that illustrates how state control of medical services and their funding via taxation distorts ethics in the matter of life and death. It quickly becomes acceptable to talk about structuring countless deaths to reduce costs - the power of perverse incentives at work. In industries not so dominated by the state, growth in customer needs and outlays is a boon, an opportunity for growth to meet the challenge, but where the state runs things it inevitably means rationing: the incentives operate to make us all worse off.
We become inured to this, disturbingly. So you won't find much outrage in response to this sort of thing, and especially not the relevant sort of outrage - that this is what centralized control over medicine and health brings us to, a complete reversal of the eagerness to serve and develop new products that is the characteristic of a free market.
Past successes in reducing smoking have paid off in slower spending growth on associated medical conditions. Has smoking reduction has also slowed the rate of growth in total health care spending? Maybe, but maybe not. [One] component of outlays declines over time due to a healthier population with lower per capita health care costs. However, another component labeled "Effects of greater longevity on outlays" increases over time as smoking-related deaths are averted and more individuals are alive to collect Social Security and consume federally funded health care. After about twelve years, the longevity effect begins to outweigh the per capita spending effect, and federal outlays are actually increased by the reduced prevalence of smoking brought about by the excise tax!
Too bad that not smoking couldn't just keep us healthier without prolonging life! Without this dreaded longevity effect, we could unambiguously claim to be saving money in addition to producing greater health. Seriously though, the narrow question of whether reduced prevalence of smoking saves federal dollars hinges on the number of extended life years. Because some policy-makers will evaluate tobacco control programs on whether they save federal dollars, the delayed-mortality effect of reduced smoking is a negative from this perspective. This perverse result is no knock on the CBO study; it simply answers the question asked and is careful to note that "consequences for the federal budget are only one factor that lawmakers may consider when developing policies to promote health."