The taxes of sin. Do smokers and drinkers pay their way?

JAMA. 1989 Mar 17;261(11):1604-9. doi: 10.1001/jama.261.11.1604.


We estimate the lifetime, discounted costs that smokers and drinkers impose on others through collectively financed health insurance, pensions, disability insurance, group life insurance, fires, motor-vehicle accidents, and the criminal justice system. Although nonsmokers subsidize smokers' medical care and group life insurance, smokers subsidize nonsmokers' pensions and nursing home payments. On balance, smokers probably pay their way at the current level of excise taxes on cigarettes; but one may, nonetheless, wish to raise those taxes to reduce the number of adolescent smokers. In contrast, drinkers do not pay their way: current excise taxes on alcohol cover only about half the costs imposed on others.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Alcohol Drinking*
  • Costs and Cost Analysis
  • Health Services / economics
  • Health Services / statistics & numerical data
  • Humans
  • Insurance / economics
  • Life Expectancy
  • Pensions
  • Smoking / adverse effects
  • Smoking / economics*
  • Smoking / mortality
  • Taxes
  • Tobacco Smoke Pollution / adverse effects
  • Tobacco Smoke Pollution / economics
  • Value of Life


  • Tobacco Smoke Pollution