80-90% of lung cancers deaths are due to smoking
80-90% of lung cancers deaths are due to smoking

The U.S. Preventative Services Task force has issued a new recommendation: annual CT scan screening for lung cancer for high-risk smokers between the ages of 55 and 80.

Who is a high risk smoker? Anyone with a 30-pack year smoking history (meaning a pack a day for 30 years or 2 packs a day for 15 years etc) and either currently smokes or quit within the last 15 years. Anyone with a significantly reduced life expectancy or someone who couldn’t medically handle the surgery for lung cancer is excluded from screening.

All I can say is wow, because this translates into at least 7 million additional CT scans a year for the healthScreen shot 2014-01-02 at 12.11.35 PM care system. A low dose CT of the chest is supposed to be $300 or so and FairHealthConsumer.org quoted me $282.03 for a cash price in my zip code. Multiply $300 by 7 million (some people say up to 10 million) every year and the amount is astronomical. This affects all of us, via our premiums for health insurance as well as our taxes, which pay for Medicare.

The task force indicates that this screening could prevent 20,000 smoking-related lung cancer deaths a year in the United States. I’m not arguing with this (although I do wonder how many cancers 20 or more chest CT scans could cause, and in my opinion this fact was glossed over in the article that looked at benefits vs. harm), but I just think we need a more creative model to cover tobacco-specific health screening expenses.

Since the only risk factor for this screening guideline is cigarette smoking, the obvious answer is a cigarette tax to pay for screening (I propose $2 a pack). The tax would have to be federal as many states have shown an extreme reluctance when it comes to cigarette sales taxes. The screening could be performed at  accredited CT screening centers to prevent price escalation/gouging. If these centers only performed lung cancer screening maybe they could be even more cost effective?

The other upside of my proposed tax is cigarette price has the biggest impact on deterring younger smokers (ages 18 to 39), so down the road we would see fewer 30-pack year smokers. Never having a population who needs this screening would truly be a wonderful thing.

We already tax cigarettes, so the idea of adding a screening tax is nothing new. This tax wouldn’t affect health care premiums or deter anyone from seeking medical care, although it might deter someone from smoking. My $2 a pack tax should be more than enough to cover the cost of the CT scans, but I admit I’m no economist so it might need to be a little higher or lower.

If any other commercial product killed more than 23,000 people a year it would surely be banned (I’m adding the more than 3,000 deaths/year due to lung cancer from second-hand smoke), but we are so much at Big Tobacco’s mercy that we can’t even get graphic ads on cigarette packages.

I don’t believe in punitive health premiums or rationing care, but I do object to Big Tobacco laughing all the way to the bank on the backs of Americans. It’s time to build the cost of screening into the price of cigarettes.


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  1. See England – increasing tax really isn’t that big of a deterrent, but it does benefit the country. As an ex-smoker it annoys me no end when people attack smokers for putting a strain on the NHS, however given the huge tax added to cigarettes it means that smokers here in England likely pay for their own NHS care…and sadly their early deaths also likely save the country on NHS costs, benefits, pensions, etc. (especially as those who are under-class or working-class are more likely to be smokers). It’s a popular belief that this is why our government so strongly support NRT such as nicotine patches and long-term or permanent NRT via the likes of e-cigarettes, because it keeps anti-smoking groups happy by appearing to do something about smoking but between failure rates of NRT for smoking cessation, taxation on e-cigarettes, and rising popularity of e-cigarettes introducing younger people to nicotine addiction, it means people remain addicted and so money keeps rolling in.

    In the US increased taxes on cigarettes makes sense, it would likely do exactly what it should; help pay for for costs of smoking to the country, and discourage smoking.

  2. I lost my older brother to lung cancer 12 years ago, and then my younger brother to lung cancer last year. My sister has emphysema, and my parent’s deaths (heart disease and stroke) were both arguably complicated and hastened by the effects of long smoking. Because they smoked, all 4 children grew up in smoke, and then (pretty predictably) started up the habit themselves. I was lucky – I quit after 7 years, after spending 3 months caring for a smoker who took that long to drown from her disease. I bear the traces, but I hope I saved myself in time.

    My husband never smoked, but he might as well have: he has inadequate lung function because his father smoked like a chimney. In the end, his father looked like a kippered herring. His mother died of esophageal cancer, a CA strongly associated with tobacco smoke. His three siblings were all smokers, much to their detriments, and the detriments of their children. I keep expecting to get the terrible “I have lung cancer” call from one or more of them, sooner or later – or maybe they will get “lucky”, like their dad, and just have wreaked destruction on other people.

    Did I mention the epigenetic changes? You know, the legacy you can leave your descendants down through the ages?

    Anyone who thinks that corporate greed – in any arena, tobacco, food, resources – is only about money, has his or her head up a very dark place. It’s about misery, and suffering, and death widespread, imposed by a stupid uncaring so profound that it beggars description.

  3. I heard a recent piece on NPR about “sin taxes”, particularly cigarettes. Economists did a study/review to see which taxes were more of a deterrent.: taxing the corporation vs. taxing the consumer (a tax on the pack). Taxing the corporation was better because they will include the tax into the price (passing the cost onto the consumer), while taxing the consumer, the price on the shelf appears lower, and they only get the tax at checkout. Taxing the corporation allows the consumer to see the price directly, and being more expensive, is more of a deterrent than having the tax added at check out.

  4. I personally will always support high commodity taxes for cigarettes. If you’re going to continue smoking, the least you can do is pay the state more because of it, and have that money go towards helping the people that you’re affecting with your secondhand smoke.

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