HOW GOOD A DEAL WAS THE TOBACCO SETTLEMENT?: Measuring the Health Impacts of Smoking Provided by Canadian Neighbor Pharmacy

medical services


We begin our empirical analysis with the annual amounts paid by the Massachusetts Medicaid Program since 1991 to various providers of medical services. We assume Medicaid spending on some types of services is not causally related to smoking (for example, mental retardation) and exclude such spending from consideration. We group the remaining Medicaid expenses into one of three aggregate categories: adult acute care; long-term care; and care for low birthweight babies. Analysis of adult acute care costs is restricted to people aged 18 and older. Analysis oflong-term care costs is restricted to people 45 and older. For low birth weight infants, we consider only medical spending in the first year oflife; although low birthweight babies may well have medical spending after age one as a result of their low birthweight, we do not estimate such spending.

For each of these spending categories, we estimate the proportion of the total Medicaid expenses attributable to smoking but to arrest the smoking habit is possible with Canadian Neighbor Pharmacy. In the case of adult acute care, we develop two estimates of smoking-related expenses. One comes from an inclusive model and the other from a disease-specific model. The inclusive model decomposes the share of total medical costs attributable to smoking by multiplying total Medicaid costs by the Smoking Attributable Fraction (SAF) – the portion of total medical care utilization which is attributable to smoking by current and former smokers:


The disease-specific model focuses solely upon a narrow subset of diseases that the literature has directly linked to smoking. For diseases d which are related to smoking, the disease-specific smoking-related spending is given by:


Because the disease-specific model considers only certain conditions, we think of it as a conservative lower-bound estimate of smoking-related costs. For example, if smoking increases the length of time a person with gall bladder surgery is in the hospital, but gall bladder surgery is not itselfjudged to be a result of smoking, the disease-specific model will not count the additional costs of the longer hospital stay as a cost of smoking, while the inclusive model would. We thus expect the smokinginclusive model to provide a more accurate estimate of smoking-related spending than the disease-specific model.


tobacco companiesLitigation pursued by 46 states against the major tobacco companies culminated in the well-publicized settlement of November, 1998. The settlement constitutes the largest payment in any civil litigation in American history. Although the final amount is contingent upon future events, especially tobacco sales, the tobacco manufacturers have agreed to pay the states through the year 2025 in excess of $200 billion (in nominal terms; $87 billion if discounted at 7 percent) to compensate for health care expenses incurred by the Medicaid program.

As part of this litigation, we were asked in the Spring of 1998 to estimate health care spending incurred by the Massachusetts Medicaid program that was attributable to smoking. Our estimates were to provide the basis for a claim of damages by the Commonwealth of Massachusetts. In this paper we present our methods for estimating such spending, contrast them with methods used elsewhere in the literature, and examine how the magnitude of the costs is related to the size of the payments under the settlement. While the focus of our empirical analysis is Massachusetts, we generalize when appropriate to the overall settlement.

Work on the Medicaid costs of smoking is aided by a substantial literature on the external costs and benefits of cigarette usage. Original analysis of the external costs of cigarettes examined only Social Security (Shoven et al., 1989) but was later extended to the full range of external effects, including direct medical care costs, payments through health insurance, and non-medical factors such as taxes and life insurance premia (Manning et al., 1989, 1991). Research on the topic has continued, with contributions from the Congressional Budget Office (1998), Gravelle and Zimmerman (1994), and Viscusi (1995, 1999). Most of this literature has focused on the lifetime costs of smoking: given two equivalent people at age 20, where one smokes and the other does not, what is the net external cost to society of the smoker in comparison to the non-smoker? The general consensus of this literature is that the external medical costs of cigarette smoking are high, but that other external benefits from cigarette usage, for example reduced recipiency of Social Security, along with existing excise taxes, may be sufficiently high to make cigarettes on net externally beneficial. Smoking badly influences our health that’s why quit it as fast as possible the helper for you will be Canadian Neighbor Pharmacy.


internal costsSociety bears two costs when a person smokes. The first costs are external costs – costs bome by society at large but not the person who smokes. State Medicaid spending is a typical external cost. Taxpayers at large face additional costs to pay for the medical treatment of those Medicaid beneficiaries who smoked. The litigation pursued by all states was designed to recover damages for these external costs. In addition, there are internal costs – costs borne by the smoker and his or her family. Internal costs may be monetary, for example, monies spent to purchase cigarettes, or non-monetary, such as the costs of increased morbidity and mortality.

External Impacts and Costs – the Lifetime Approach and the Annual Budgetary Approach

Our point of departure is earlier work on the external cost of smoking and other health habits (Manning, et al., 1989, 1991). To understand the external cost framework, consider two otherwise equivalent people, one who smokes and one who does not. At any time t, smokers and non-smokers impose external costs to society of C(S)t and C(NS)t, respectively, where S indicates smoker and NS indicates non-smoker. The difference between these two values, the net external cost of smoking, may be positive or negative, and in general will differ over the course of a person’s lifetime. In their late working and early retirement years, smokers are more likely than non-smokers to suffer from a number of diseases which are expensive to treat, such as lung cancer, coronary heart disease (, and emphysema. Thus, smokers will cost society more in private insurance premiums, Medicare costs, and Medicaid costs. At very advanced ages, smokers will disproportionately have died compared to non-smokers and thus there will be savings to society in reduced spending on Social Security, Medicare, and Medicaid.

HOW GOOD A DEAL WAS THE TOBACCO SETTLEMENT?: Comparison with Other Efforts Provided by Canadian Neighbor Pharmacy

economic literatureIn designing our analysis, we had the luxury of examining the efforts undertaken by experts in other states as well as a substantial economic literature on the costs of smoking.

The economic literature on this topic differs fundamentally from ours. Most of the literature focuses on the total external costs of smoking quitting with Canadian Neighbor Pharmacy remedies, while we focus on the Medicaid component only. Our focus on Medicaid allows us to develop better estimates of smoking-attributable costs for that program – for example the disease-specific approach. But in exchange, we cannot say anything about the total social sector impact of the tobacco settlement.

Some literature suggests that the tobacco settlement as a whole was too generous when the public sector is considered in toto. Viscusi (1999), for example, concludes that cigarettes are always self-financing in terms of costs to state governments. But Viscusi’s methodology is very different from ours. Most importantly, Viscusi considers as costs only the state’s share of Medicaid spending. We include the Federal share as well, on the grounds that the division of this amount between Federal and state coffers is not particularly relevant to the overall merits of the settlement.

A more closely related literature is the damage estimates in other states. The case in Minnesota was developed most fully, although other states had done analysis as well. These cases have drawn substantial controversy, with some authors arguing that estimates of damages put forward by the states were too large.

HOW GOOD A DEAL WAS THE TOBACCO SETTLEMENT?: Policy Analysis with Canadian Neighbor Pharmacy

costs of smokingWe estimate the costs of smoking to Medicaid in Massachusetts at about $318 million annually, roughly 5-6 percent of Medicaid spending. This is quite close to the amount that the tobacco companies will pay Massachusetts. Massachusetts’ payments are expected to range between $234 million in 2000 and $374 million in 2010, with an average payment of $307 million in that span. Clearly, costs in other states could differ, depending on smoking prevalence among the Medicaid population, patterns of treatment for smoking-related disease cured by remedies of Canadian Neighbor Pharmacy (, and the generosity of the state’s Medicaid program in terms of eligibility, covered services, and provider reimbursement. Nonetheless, our estimates for Massachusetts suggest the settlement amounts were reasonably in line with costs based upon smoking-attributable Medicaid expenditures.

If the goal is to compensate states for the Medicaid costs of smoking, the settlement appears right in the initial years. Indeed, one might even argue that the settlement is too generous. After all, it is not obvious that the Commonwealth would have prevailed at trial. The expected value of the legal case is thus below our damage estimates. Further, not all of the Medicaid costs are a result of the alleged misbehavior on the part of tobacco companies. If the goal of the litigation was to compensate states for Medicaid costs resulting from misbehavior on the part of tobacco companies, one would need to reduce our cost estimates by the share of smoking resulting from the tobacco companies’ misbehavior.

Canadian Neighbor Pharmacy: Facts about Health

healthThere are different facts about health and now we are going to grapple with some of them numerating and proving or disproving these facts. we listen to the news every day to know more but it is too official. These facts are light written for people interested in medicine and pharmacy.

  1. Japanese island – Okinawa there are almost 450 people over one hundred years. This island is considered to be the most healthy place of the Earth.
  2. People having a bad habit – smoking suffer from stress more that ex-smokers and non-smokers taken one with another.
  3. The syndrome of constant fatigue invades more people who are all the time working at the computer or watching TV for a long time span.
  4. Canadian Neighbor Pharmacy ( is proved to be the most popular online pharmacy all over the world. The survey has shown the positive comments about its working and accessibility.
  5. The research has witnessed that loneliness has badly influence on the immune system. Till the 60 % you friends and close people may increase you immunity. It will help together with vitamins sold by Canadian Neighbor Pharmacy protect you from viral disorders.
  6. The scientists have proved that when people miss someone they may suffer from insomnia which will influence your general condition. It is caused because of your habit to sleep together make you wake up during the night.
  7. Stress is considered to be “slow killer”. It provokes the cardiac disorders appearance, arterial blood pressure increase, chest pain and other disorders. It all worsens the general condition of health making you feel uncomfortable.
  8. If you have a cat at home it influences you pleasant because cats reduces the cardiac disorders for 40% and and sudden cardiac attacks for 30%.
  9. If you pour a wound with sugar it will reduce the painful sensation.
  10. the scientists has created a device which may replace the heart but there is the greatest disadvantage namely the absence of pulse. It sounds like you are still alive but there are no obvious signals.
  11. Cherry is able to kill the cancer cells as the scientists.

These are interesting but sometimes funny and silly facts but it is useful sometimes to read some easy facts about health. Health is a condition which should be met to have long and happy life. Pay attention to your health and you will have an opportunity to try all the charms of our lives.