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Raising smoking age will cost LA more

If Louisiana intends to raise the age of tobacco use and possession to 21, it needs to do it for the right reason.

Prefiled HB 38, by state Rep. Frank Hoffman, would do this, and includes alternative nicotine products including vaping material. A few states and a number of local governments already have put this limit into law.

The bill resurrects arguments pitting exercise of personal liberties against the state’s duty to protect its citizens. Already the prohibition applies to alcohol, and with the U.S. Supreme Court pontificating that states can’t automatically sentence to life imprisonment those under 18 who commit horrific crimes because their brains may not have developed enough to distinguish right and wrong in all instances, consistency dictates increasing the age.

Benefits of raising the age also include guarding against externalized costs onto society. Evidence indicates that few smokers pick up the habit after 26, and 80 percent have started by 18. By legally discouraging smoking until 21, that could have prompted a significant portion of the present smoking cohort never to have initiated tobacco use. In turn, this bill serves a defensible paternalistic function that not only steers more people away from tobacco-associated diseases but also means the public health system must deal with fewer such cases.

All this could commend the bill’s enactment into law, outweighing its attenuation of the personal freedom of 18, 19, and 20 year-olds to fulfill an addiction. But Hoffman also sells the idea on a link between health care costs and smoking, alleging that if fewer people end up smoking, which would happen if raising the legal age for tobacco consumption, health care costs will decline.

However, that’s not exactly what the scientific literature reveals. Studies where anti-smoking measures have occurred do show a dip in the short run in health care costs, but over the long term costs actually increase. This happens because, bluntly, smoking appears to kill people at a younger age with less-costly medical interventions. People who live longer not only have a greater chance of encountering maladies that cost money, but then they often die from conditions more costly than ailments to which smokers succumb.

Further, this particular method of reducing the proportion of the population that smokes would have the least likelihood of enjoying short-term savings. The affected group is the healthiest group with the least smoking experience, and thus the least likely to develop problems in the near future.

Thus, Hoffman and others will have to understand that this law would make people healthier, but it also in the future will cost Louisiana more, as healthier Medicaid clients live longer to require more services and many when they do expire will use costlier interventions. Of course, this population – although many of its able-bodied adults don’t work – also could contribute more years in the workforce, increasing the state’s level of economic activity and therefore tax revenues.

Still, such a move likely would produce a net negative fiscal outcome over the years, So, while you can sell the law on it creating better health for more people, it’s disingenuous to say it will save taxpayer dollars.

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