Jan 30, 2004 (United Press International via COMTEX) -- To smokers, the economics of tobacco are simple: A single pack that cost less than a dollar in 1964 now costs four times as much. But on a national scale, the numbers become much more complex: Each p

That $7 price tag is the latest estimate from the Centers for Disease Control and Prevention in Atlanta. The agency also says the national tobacco price tab keeps climbing. For example, 10 years ago the CDC estimated annual tobacco-related health costs at $50 billion, but by 1998 those costs were put at $75.5 billion, of which roughly half are billed to Medicare and Medicaid -- and therefore to U.S. taxpayers. The CDC and the Office of Technology Assessment estimate the nation lost $47 billion in "mortality-related productivity losses" in 1990, and those losses nearly doubled -- to $82 billion -- by 1999. The annual, per-smoker economic cost is estimated at $3,400. Moreover, the American Lung Association reports the CDC estimates do not include costs associated with such factors as diseases caused by environmental smoke, burn care from fires caused by cigarettes, and perinatal care for low-birthweight babies born to smoking mothers. Yet tobacco also provides income for farmers as well as tobacco workers -- points often made by the industry to fend off control efforts. But a 1992 report from Price Waterhouse, "The Economic Impact of the Tobacco Industry on the U.S. Economy," indicated even as tobacco production rose during the 1980s and early 1990s, the number of tobacco jobs in the United States -- both manufacturing and farming -- actually declined as the industry relied more on imported tobacco and moved manufacturing overseas. Dr. C. Everett Koop, a former surgeon general and now senior scholar at Dartmouth College in Hanover, N.H., said the economics of tobacco fueled the landmark legal fight brought by various state attorneys general. "By the time the suits were filed in 1997," Koop told United Press International, "it was very clear that we could calculate the costs of tobacco. Just in medical bills, smoking was costing taxpayers about $90 billion, and that didn't count things like lost time at work. The tobacco settlement was really a milestone because it mandates payments to the states for 25 years." One of the lesser known aspects of the settlement, Koop said, was the tobacco industry agreed to fund the Legacy Foundation, "primarily as a mechanism whereby the truth is told to youngsters who are the people we would like to stop first in the smoking chain." But the funding of the foundation was contingent on the major tobacco companies continuing to control about 96 percent of U.S. tobacco sales. In 2004, however, Koop said, because of the growth of generic cigarettes and small cigarette companies popping up, the major companies' share could drop below the 96-percent threshold. "The tobacco industry is saying it will no longer pay money into the Legacy Foundation," he said, adding that activist groups are circulating a petition to the tobacco companies asking them to continue funding the foundation because of the damage they have caused. "One of the things I've always said about the tobacco industry," Koop commented, "is that they are much more foresighted than the government, a lot smarter than the government and they are richer than the government so they can do anything they want, and they are clever at what they do." Ironic, but the tobacco companies no longer might be the biggest threat to smoking prevention. Rather, it is the harsh economics of the 21st century. In state after state, where legislatures and governors are grappling with the tightening budgets, the $290-billion tobacco settlement, earmarked to be paid to state treasuries through 2022, looms large. "The states have never been in such poor financial status with deficits that they can't pay," Koop said. As a result, tobacco settlement money is being used to balance budgets and eliminate deficits. "So this year, for example in ... New Hampshire, not one penny of the tobacco settlement money goes even to health, let alone to tobacco control, and every single person that I knew in the state -- 23 people -- who was involved in tobacco control (and) paid using those monies is out of a job." Koop said the smoking-prevention infrastructure, which took years to put together, either has fallen apart or is in the process of falling apart across the country. "I think that doesn't bode well for our ability to control tobacco (including) preventing kids from starting and treating the 46 million Americans who are tobacco addicts," he commented. "If the money from the tobacco companies was used for its intended purpose," Koop said, "we would be able to get half the people who want to quit smoking, who realize they are addicts, to quit. Any time you get people to quit early enough in life you are adding about 15 years of life expectancy." The flip side of those extra 15 years is the argument put forth by some that tobacco use actually saves money by shortening life. Dead smokers do not collect Social Security, nor do they add to the nation's health care bill. Using that same logic, however, "we wouldn't treat heart disease or cancer or even infections because saving lives would cost money," Dr. Augustus Grant, a Duke University cardiologist and president of the American Heart Association, told UPI. "We stand on the cusp of a wave that at once is a public health victory and secondly a public health defeat and the only thing that stands in our way is being able to get the money we need to get those addicts out there under treatment," Koop said.

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