4 ms·

"It looks unpleasant or ghoulish to look at the cost savings as well as the cost increases and it's not a good thing that smoking kills people," Viscusi said in

by zaroth 9y ago

"It looks unpleasant or ghoulish to look at the cost savings as well as the cost increases and it's not a good thing that smoking kills people," Viscusi said in an interview. "But if you're going to follow this health-cost train all the way, you have to take into account all the effects, not just the ones you like in terms of getting your bill passed." I can't see anything ghoulish about it at all. Seems to me if you only count the direct negative costs (treating the lung cancers, lost productivity) and ignore any of the cost savings (no long term end-of-life care because you died from the lung cancer) that's just a failure of actuarial science and lack of a proper systematic analysis of the costs and benefits. What makes accounting for the cost of treating a certain number of additional lung cancer cases any less "ghoulish" than accounting for the savings of not treating a certain number of alzheimers cases? No one is saying the singular goal is to reduce cost, reductio ad absurdum, but if you're claiming smokers are a burden to society because you did the math wrong and it fits your world belief and sense of moral justice, that's no longer science, it's politics. We can do both well, but shouldn't pretend one thing is the other.

jbob2000 9y ago
It is ghoulish. It stupid obvious that people dying saves the healthcare industry money, but it's not a thought you should entertain because it offers no solutions. It's ghoulish because it promotes the idea that letting people die is "better" than trying to save them. "Here Steve, smoke another pack so you can go quickly instead of slowly". Why have a healthcare industry at all? It would cost us nothing at all to let people just die instead of trying to save them. Diabetes costs hundreds of thousands of dollars to treat over a lifetime, why not save the cost and just let diabetics OD on sugar?
- zaroth 9y ago
  I think it's childish to consider it ghoulish. Yes, if you only hold one thought in your mind at a time and can't consider complex systems with multiple variables, it might scare you to consider that we spend a lot of money on end-of-life care, and whether that money is being put to good use. Critical thinking demands that we can hold those thoughts in our minds, understand the economic reality that yes, absolutely, extending a life at 90 years old is actually costing lives elsewhere in the system, but yet despite this realization, after reflecting on the kind of society we want to be[come], we realize it's so much more than just a mathematical optimization problem. That realization -- that we must do more than just that which optimizes outcomes for everyone as a whole, but also work to optimize individual outcomes even when it costs the whole -- is it not a core philosophical tenant of humanity?! How could the logical steps to such a beautiful and powerful realization be in any way ghoulish! To your last point, the cost of having no healthcare system at all would be extraordinary -- there's no question that our healthcare even at 20% of GDP is a net positive for society as a whole (that's not to say it can't be improved, but clearly removing it would be an economic catastrophe). And we're not talking about evaluating the net economic value of providing a given treatment, the context was specifically that of making a claim that smoking is/isn't a net cost to society. The studies intentionally ignored basically half the equation, so in my estimation they flat out lied in claiming that smoking was a net cost, which I'd say is academically fraudulent.
- mistermann 9y ago
  > Why have a healthcare industry at all? To stop people from dying. I think the point of the article is that the economic factors given in anti-smoking propaganda are false.
  - dragonwriter 9y ago
    > To stop people from dying. To improve people's quality × duration of life is probably more accurate; stopping people from dying (if you maintain positive quality of life, which is a big if) is the limit case of that, but not really the purpose of healthcare; real healthcare systems may delay death but don't stop it and remain valuable.
mistermann 9y ago
> No one is saying the singular goal is to reduce cost But that is exactly what the argument is for why we must(!) eliminate smoking from society. Well that, and the also false claim that you will get lung cancer from a whiff of second hand smoke. Like religion, gender, and sexuality, there is something about smoking that seems to make it nearly impossible for people from Western cultures to have a reasonable and honest, fact-based discussion on topics that have any association whatsoever with any of the above.

by zaroth 9y ago

jbob2000 9y ago

It is ghoulish. It stupid obvious that people dying saves the healthcare industry money, but it's not a thought you should entertain because it offers no solutions. It's ghoulish because it promotes the idea that letting people die is "better" than trying to save them. "Here Steve, smoke another pack so you can go quickly instead of slowly". Why have a healthcare industry at all? It would cost us nothing at all to let people just die instead of trying to save them. Diabetes costs hundreds of thousands of dollars to treat over a lifetime, why not save the cost and just let diabetics OD on sugar?

zaroth 9y ago
I think it's childish to consider it ghoulish. Yes, if you only hold one thought in your mind at a time and can't consider complex systems with multiple variables, it might scare you to consider that we spend a lot of money on end-of-life care, and whether that money is being put to good use. Critical thinking demands that we can hold those thoughts in our minds, understand the economic reality that yes, absolutely, extending a life at 90 years old is actually costing lives elsewhere in the system, but yet despite this realization, after reflecting on the kind of society we want to be[come], we realize it's so much more than just a mathematical optimization problem. That realization -- that we must do more than just that which optimizes outcomes for everyone as a whole, but also work to optimize individual outcomes even when it costs the whole -- is it not a core philosophical tenant of humanity?! How could the logical steps to such a beautiful and powerful realization be in any way ghoulish! To your last point, the cost of having no healthcare system at all would be extraordinary -- there's no question that our healthcare even at 20% of GDP is a net positive for society as a whole (that's not to say it can't be improved, but clearly removing it would be an economic catastrophe). And we're not talking about evaluating the net economic value of providing a given treatment, the context was specifically that of making a claim that smoking is/isn't a net cost to society. The studies intentionally ignored basically half the equation, so in my estimation they flat out lied in claiming that smoking was a net cost, which I'd say is academically fraudulent.
mistermann 9y ago
> Why have a healthcare industry at all? To stop people from dying. I think the point of the article is that the economic factors given in anti-smoking propaganda are false.
- dragonwriter 9y ago
  > To stop people from dying. To improve people's quality × duration of life is probably more accurate; stopping people from dying (if you maintain positive quality of life, which is a big if) is the limit case of that, but not really the purpose of healthcare; real healthcare systems may delay death but don't stop it and remain valuable.

mistermann 9y ago

> No one is saying the singular goal is to reduce cost But that is exactly what the argument is for why we must(!) eliminate smoking from society. Well that, and the also false claim that you will get lung cancer from a whiff of second hand smoke. Like religion, gender, and sexuality, there is something about smoking that seems to make it nearly impossible for people from Western cultures to have a reasonable and honest, fact-based discussion on topics that have any association whatsoever with any of the above.