I think the argument that you're making is that smoking is a net-negative economically, which strikes me as plausible, if not obviously true. There you'd also

I think the argument that you're making is that smoking is a net-negative economically, which strikes me as plausible, if not obviously true. There you'd also need to go a step further and consider the economic contributions of the tobacco industry. You're right that it's very complicated (and macabre). But that's a broader question than whether or not their relative costs (vs. payments) into a healthcare system. The reason I brought up retirement is that most people in the west pay into health care systems until retirement, and only (or mostly) draw from it once retired.