I will say that the study I posted was an unusual way to slice the data. Most of the time, people just look at, say, annual expeditures on medical care for an age matched population rather than lifetime studies. Per year, smokers cost more. And there are costs to society from the smoker who dies early - lost wages and productivity, second hand smoke, etc. If you do a cost-effectiveness analysis and include those costs (such as lost wages) then smoking looks much more costly. But those are society-wide costs, not costs specifically to a health care provider for the medical care of the smoker alone.
Health care is one of those difficult things - we value human life, but at what cost? Dialysis is generally held up as the line - it costs approximately $100,000 per life year saved and is a standard expected treatment. But yet it is a difficult concept to discuss - are we willing as a society to decide whether or not to pursue treatment based on cost? Are we willing to value the life of a promising 20 yro more than an elderly person? Some screening procedures are rejected as too costly, even if they are less costly per life year saved than dialysis, so our current system is really quite dyslexic about this issue. And when it is your loved one on the line, would you really be happy with saying, oh well, this treatment is too costly at $150,000 per life year saved, I guess that''s it for Grandpa?
Health care is one of those difficult things - we value human life, but at what cost? Dialysis is generally held up as the line - it costs approximately $100,000 per life year saved and is a standard expected treatment. But yet it is a difficult concept to discuss - are we willing as a society to decide whether or not to pursue treatment based on cost? Are we willing to value the life of a promising 20 yro more than an elderly person? Some screening procedures are rejected as too costly, even if they are less costly per life year saved than dialysis, so our current system is really quite dyslexic about this issue. And when it is your loved one on the line, would you really be happy with saying, oh well, this treatment is too costly at $150,000 per life year saved, I guess that''s it for Grandpa?