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Do Smokers and Drinkers Pay Their Way?

Willard G. Manning, PhD; Emmett B. Keeler, PhD; Joseph P. Newhouse, PhD; Elizabeth M. Sloss, PhD; Jeffrey Wasserman, PhD

JAMA. 1989;261(11):1604-1609.

Abstract
We estimate the lifetime, discounted costs that smokers and drinkers impose on others through collectively financed health insurance, pensions, disability insurance, group life insurance, fires, motor-vehicle accidents, and the criminal justice system. Although nonsmokers subsidize smokers' medical care and group life insurance, smokers subsidize nonsmokers' pensions and nursing home payments. On balance, smokers probably pay their way at the current level of excise taxes on cigarettes; but one may, nonetheless, wish to raise those taxes to reduce the number of adolescent smokers. In contrast, drinkers do not pay their way: current excise taxes on alcohol cover only about half the costs imposed on others.

(JAMA. 1989;261:1604-1609)

Author Affiliations
From The University of Michigan, Ann Arbor (Dr Manning); The RAND Corporation, Santa Monica, Calif (Drs Manning, Keeler, Newhouse, Sloss, and Wasserman); the Division of Health Policy Research and Education, Harvard University, Cambridge, Mass (Dr Newhouse); and SysteMetrics/McGraw-Hill, Santa Barbara, Calif (Dr Wasserman).

Footnotes
The opinions and conclusions expressed herein are solely those of the authors and should not be construed as representing the policies or opinions of The RAND Corporation or any agency of the US Government or any of the individuals named herein.

Reprint requests to the Department of Health Services Management and Policy, The University of Michigan, 1420 Washington Heights, Ann Arbor, MI 48109 (Dr Manning).

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