Ten Miles Square


December 10, 2012 11:46 AM Not Everything Good Saves Money

By Aaron Carroll

I’ve taken a lot of heat for my stance on preventive care. Unlike a lot of politicians, I’ve often held that it doesn’t necessarily save a lot of money. It might, sometimes, but it doesn’t always. After all, if you reduce spending in one area, it may increase in another. Also, extending one’s life often means increased lifetime medical expenses.

None of this means prevention isn’t important. Increasing people’s lives, and the quality of them, is not only an outcomes-good, it’s likely a moral-good. I think we should do it. I just think it should be pitched in that way instead of a bottom line-good.

I bring this up because a recent study published in Health Affairs is right on point. “Simulation Of Quitting Smoking In The Military Shows Higher Lifetime Medical Spending More Than Offset By Productivity Gains“:

Despite the documented benefits of quitting smoking, studies have found that smokers who quit may have higher lifetime medical costs, in part because of increased risk for medical conditions, such as type 2 diabetes, brought on by associated weight gain. Using a simulation model and data on 612,332 adult smokers in the US Department of Defense’s TRICARE Prime health plan in 2008, we estimated that cessation accompanied by weight gain would increase average life expectancy by 3.7 years, and that the average lifetime reduction in medical expenditures from improved health ($5,600) would be offset by additional expenditures resulting from prolonged life ($7,300). Results varied by age and sex: For females ages 18-44 at time of cessation, there would be net savings of $1,200 despite additional medical expenditures from prolonged life. Avoidance of weight gain after quitting smoking would increase average life expectancy by four additional months and reduce mean extra spending resulting from prolonged life by $700. Overall, the average net lifetime health care cost increase of $1,700 or less per ex-smoker would be modest and, for employed people, more than offset by even one year’s worth of productivity gains. These results boost the case for smoking cessation programs in the military in particular, along with not selling cigarettes in commissaries or at reduced prices.

Quite simply, this study modeled what would happen to adult smokers in the TRICARE health plan who quit smoking. They found that quitting, even if it led to weight gain, increased the average person’s life by 3.7 years. That’s great! It also led to some nice decreases in health care spending due to improved health. But these savings were more than offset by increased health care spending due to a longer life.

The study goes on to try and say it’s still worth it because they would have increased productivity in an economic sense. It also makes the point that the increased spending is modest. I think that’s besides the point. We should get people to quit smoking because it will make their lives better and their lives longer. If that causes them to cost the health care system more eventually, so be it. I’m a doctor, and making lives better and longer is why I got into this. It’s also what the health care system is for. That should be the focus. It’s not always about saving money.

[Cross-posted at The Incidental Economist]

Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.


  • phillygirl on December 11, 2012 8:06 PM:

    These findings are totally unsurprising, and not new. More than a decade ago, the Congressional Research Service reminded us: "The alternative to death from a smoking-related illness is not immortality and perfect health -- it is later death, and perhaps from a more costly illness." But risk assessment and economic analysis are no match for the moral superiority of the anti-smoking movement, and politicians are happy to line up behind any bad science that suits the public mood. The real shame, though, is that researchers are discouraged from stating easily ascertainable facts. So we do the right thing for the wrong reason, which is only somewhat better than doing the wrong thing for the wrong reason.

  • bluestatedon on December 17, 2012 10:03 AM:

    Having watched firsthand the debilitating slide into dependence, senescence, and helplessness of my two parents—both of whom had healthy lifestyles their entire adult lives—I know that the pursuit of permanent, everlasting health is a chimera. One of the unintended consequences of our amazing medical capabilities is that where once heart attacks and strokes took us quickly in our 60s and 70s, we now can look forward to outliving our health in an agonizingly slow manner, dying in our 80s or 90s as shells of our former selves. No thank you.