(Note: This analysis was prepared in 1994 before the successful actions against tobacco companies and increases in tobacco taxes. It is presented as an example of how panetic analysis can be applied.)

When cigarette taxes go up, pain and suffering go down. Surprising numbers of smokers quit when the price per pack goes up. Political decision makers need an assessment of this reduction in pain and suffering caused by smoking. It may well be a more powerful argument for higher cigarette taxes than increased government tax revenues. It may even be a more persuasive argument than the enormous reduction in health care costs caused by those smokers who become non-smokers.

Decisions will be made soon and again in future years regarding the amount of added tax to be applied to a pack of cigarettes. Aside from the economic effects of this taxation, these other, larger effects on the population must not be overlooked by the decision maker. First is the reduction in pain and suffering induced by smoking. And secondly, the immense medical costs avoided by the people and the government. These beneficial effects occur if smokers react as they have thus far in the U.S. (a percentage quit smoking with each tax increase).

The decision-maker should have in hand at least a close estimate relating tobacco tax revenue dollars with lives lost and suffering caused by nation-wide smoking under (1) present conditions, (2) after imposing a 50 cent added tax per pack, and (3) after imposing a $1.25 added-tax per pack. The general trend is that with a higher tax (within wide limits) the number of smokers declines, the health services cost less, the number of deaths from stroke, emphysema, heart and lung diseases decreases. Others have done many studies of the dollar implications, and these numbers will be used. The main thrust of this analysis will be an examination of the panetic efforts: the change in pain and suffering within this large community of smokers, herein assumed to be 46,000,000.

Although smoking appears to be a matter of individual choice, cultural acceptability bred from persistent advertising and peer pressures on children start what can be a lifelong addiction to nicotine. The aggravation of respiratory diseases, common cold, headaches builds up in this vast population toward severe pain and anxiety about eventual stroke, heart attack, cancer, emphysema and other severely debilitating illnesses. Smoking also causes increased job absenteeism, and lowered productivity as well as shortened lifespan. In 1990, a Federal report (1) estimated approximately 390,000 earlier deaths per year due to smoking.

The Coalition on Smoking OR Health, composed of the American Heart, American Lung and American Cancer Societies produced figures on the effects of added tax on cigarettes. A 50 cent tax increase per pack will reduce smokers by 2.5 million or 5.4%. They also estimated reduced number of smokers with a $1.00 tax. Extrapolating these numbers to $1.25 tax increase, a currently popular number, gives us a 5.4 million reduction in smokers.

An estimate of the annual direct pain and suffering caused by smoking over that experienced by the remaining population would be 46 million smokers times an intensity level of 2 times (allowing 8-hours sleep per day) 365 days per year, or 32.6 billion dukkhas or:

(46,000,000) x (2) x (365) x (0.67) = 32.6 billion dukkhas/yr.

The intensity level of two is on a scale of 1 to 9. A level of two is 'bothersome' discomfort. The dukkha is found by multiplying the intensity level times the number of days it is experienced. The intensity level of 2 is estimated for this large population to recognize, beyond nonsmokers, the increase in coughing, colds, sinusitis, headaches, digestive problems, etc., accentuated by smoking. It also includes high intensity suffering leading to the annual 390,000 deaths due to smoking.

Consider this the baseline of discomfort experienced by the nation's smokers over nonsmokers. In general, this will not be reduced by the cigarette tax levels being considered. The large group of smokers who quit will be the great source of relief from suffering and costs to themselves and to society.

Cost of the death of a smoker with an average age of 40 is estimated at $650,000, including loss of earning power, etc. Health services cost, nation-wide, due to smoking is estimated at $25 billion (based on experience in Maryland).

In the case of a 50 cent tax 2.5 million smokers will quit. These millions would experience a reduction in pain and suffering due to less frequent colds, headaches, aches and pains in the joints and to the extreme distress of emphysema, fright and pain of heart attacks,, the extreme pain associated with lung cancer, surgery, chemotherapy treatments and, in many cases, terminal illness. Most of the expected 21,000 annual early deaths due to smoking in this group will be avoided. Estimating across this spectrum one might conclude that two dukkhas times 365 days times 2.5 million new nonsmokers, allowing eight hours of sleep, might encompass the reduced pain and suffering by 1.25 billion dukkhas. Of these 2.5 million new non-smokers, avoidance of early death by 21,000 per year at an average cost to society of $650,000 each would save $12.7 billion. (Avoided losses per person include average wages of $30,000/yr. and taxes for average of 20 years.) Additionally, health service costs would be reduced (based on experience of the Maryland Dept. of Health) by about $1.35 billion per year gradually toward zero dollars over the following 5 years. Absenteeism costs caused by smoking would be saved: calculated as 15 days/year at an average salary of $30,000 for 2.5 million smokers equals $5.0 billion/yr.

In the case of a $1.25 tax , we might expect a reduction of smokers by 5.4 million using the same method of calculation as shown above.With respect to pain and suffering, these 5.4 million would be spared an estimated 2.65 billion dukkhas per year induced by smoking. This reduction in pain and suffering is so large it cannot be ignored as a major factor in the minds of political and government officials. About $30.4 billion will be saved by avoidance of death by 46,800 of this group, and about $3.0 billion in health costs would be saved. The cost of absenteeism due to smoking would be saved: $12.9 billion. (These savings are to society. Partly they will be lost wages saved and partly costs to industry saved by avoidance of lowered efficiency and salaries paid in absentia. Both should be very important to the decision maker.)

IN SUMMARY: An added 50 cent cigarette tax avoids 1.25 billion dukkhas of pain and suffering and 21,000 early deaths due to smoking and saves $19 billion dollars cost from all smoking related problems for the ensuing year.

A $1.25 added cigarette tax per pack avoids an estimated 3.65 billion dukkhas of pain and suffering and 46,800 early direct burden on smokers but the deaths from smoking and saves families around them (not estimated). $46.3 billion in health and other costs for the ensuing year.

A principal purpose of the proposed tax may be to increase government revenues. Within limits, the higher these revenues, the lower will be the dukkhas of suffering by smokers. Based on the panetic analysis presented above, from coast-to-coast, this suffering is immense, not only as a direct burden on smokers but on the families around them (not estimated). The added tax would be of great value by reducing this, even when added government revenue is not considered. To spare the smoking population this very large self-induced but unwelcome suffering should be incentive enough to increase the proposed tax as far as politically feasible.

Reprint from: Panetics(3)2, pp. 8-11. 1994.

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