Cigarettes are heavily regulated in America. Federal and state cigarette taxes account for 44% of the retail price of cigarettes (Tax Burden on Tobacco 2011). This percentage is even higher if one accounts for local taxes like New York City’s $1.50 per-pack tax. (A pack of cigarettes retails for $6.01 on average.) Many local and state governments have also banned smoking in bars, restaurants, and workplaces.
Some libertarians oppose these taxes and regulations. They argue that consumers should have the freedom to make their own choices without interference from the government. Many public health officials oppose this viewpoint in the case of cigarettes. They argue that many consumers do not properly account for the negative future consequences of their smoking behavior, which causes them to consume too many cigarettes. In addition, second-hand smoke is a negative externality that annoys and potentially harms others. Finally, cigarettes may raise the cost of government healthcare systems like Medicaid and Medicare. These are all important points, but today I will focus on the last one.
Calculating the costs that a smoker imposes on society is difficult because we do not know for certain what would have happened if she were not a smoker. For example, smokers who die from lung cancer impose large costs on Medicaid and Medicare. However, if those individuals had never begun smoking then they may still have imposed costs on government healthcare systems by contracting a different disease such as Alzheimer’s. The analysis becomes further complicated if we try to account for the fact that smokers die about seven years earlier than non-smokers and thus tend to collect fewer social security payments. This is a morbid observation but it must be accounted for in order to estimate properly the effect of smoking on government spending.
These issues are addressed in a recent report from the Congressional Budget Office (CBO) that analyzes the effect of a hypothetical cigarette tax increase on the federal budget. The main effect is a large increase in excise tax receipts: a total of $38 billion within the first ten years. Because an increase in the cigarette tax decreases the smoking rate, and thus increases the health of the population, the researchers at the CBO also account for the tax’s effects on Medicaid, Medicare, and Social Security spending. They estimate that total government spending would decrease in the short run, mostly due to Medicaid savings resulting from better health among pregnant women and young children.
In the long run, however, the report estimates that the increase in longevity due to less smoking will cause a nontrivial increase in annual government spending equal to 0.012 percent of GDP ($1.8 billion using 2012 GDP) by 2085. The CBO’s finding that a reduction in smoking would actually increase spending on Medicare and Social Security is consistent with economist Kip Viscusi’s finding that smoking does not have negative financial externalities. The annual excise tax receipts are estimated to equal 0.018 percent of GDP ($2.7 billion using 2012 GDP), however, so the proposed tax is beneficial overall for the government’s budget.
Although it does not appear that cigarette smoking creates negative financial externalities for the government, there may be other reasons (mentioned above) to tax and regulate smoking. Regardless, Americans have largely accepted cigarette taxes and smoking regulations and thus these are likely to remain in place.
The issue of whether and how to best regulate consumer health, however, will continue to resurface for other products. For example, Mayor Bloomberg’s recent proposal to ban sugary drinks in containers larger than 16 ounces is justified by many on the grounds that consumers lack self control when making dining decisions and that obesity imposes costs on the government. (Sound familiar?) Sugary drinks, of course, are not the same product as cigarettes. There is no such thing as “second-hand drink” and the health effects of drinking soda every day are not as well known as the effects of smoking every day; quantifying the effect of a sugary drink ban on the government budget is therefore difficult. I expect we will see more research (and more debate!) on this topic in the future.