What would happen if Americans stopped smoking?

The number of New Yorkers who smoke dropped to an all-time low of 14 percent this year, Mayor Mike Bloomberg announced late last week. That’s down from 22 percent in 2002 and translates into 450,000 fewer adult New Yorkers who smoke than did a decade ago.
The New York drop mirrors a nationwide decline, where smoking rates have fallen by over half since the 1950s. But that still leaves 46 million American smokers — what if they all kicked the habit, too? That’s the world “After Tobacco,” a new book from economic researchers Peter Bearman, Kathryn Neckerman and Leslie Wright, tries to imagine.

The authors estimate that if all smoking ceased in 2006, 2.8 million premature deaths would be avoided between then and 2025. Health spending would decrease by $211 billion, or 1.52 percent, in that same time period.

The economic effect on public programs, however, would be more of a mixed bag. States’ Medicaid costs would noticeably decrease: lower-income populations have higher rates of smoking and the negative health outcomes that follow. But states would also lose revenue from cigarette excise taxes, which amounted to $13.75 billion in 2006. If Americans stopped smoking altogether, states could see a 1.4 percent decrease in revenue, according to a chapter from Hunter College’s Howard Chernick.

A similar, spilt-effect would be true for Social Security. With Americans living longer, Social Security would bear the increased cost of supporting people for a longer time. But those costs are slightly offset from an increase in healthy workers, who “tend to earn more and retire later,” leading to higher contributions. On balance, “After Tobacco” estimates the end of smoking means a slight, 1.58 percent increase in Social Security outlays.

The end of smoking would even ripple as far as corporate philanthropy. Between 1997 and 2005, the tobacco industry made over $143 million in charitable donations, 42 percent of which went to public health and community development programs. Much, if not all, of that giving would presumably dry up with tobacco manufacturers making smaller profits. Nationally, the impact wouldn’t be giant, with tobacco only currently making up about 3 percent of corporate giving. But the authors speculate that in cities where tobacco giants are headquartered, like Winston-Salem or Richmond, nonprofits would notice the decline.

This is by no means to say that lost tax revenue or higher Social Security outlays is a reason to rethink anti-smoking campaigns; the end of tobacco use would be a huge public health victory, one that stands to prevent millions of premature deaths. Rather “After Tobacco” illustrates how entrenched tobacco has become, and remains, in the American economy. Despite huge reductions in smoking over the past 50 years or so, a complete halt to tobacco use would touch just about every public program and private sector in many, varied ways.