One way to save on health care costs

In Massachusetts, we once had a strong tobacco control program, funded at a level of about $50 million per year using taxes on tobacco products. However, former Governor Mitt Romney, in the interest of fiscal responsibility, eliminated the program.

Now Lightwood, Dinno and Glantz, in PLoS Medicine, find that the California tobacco control program reduced health care expenditures by 7.3% by 2004, saving about $86 billion over four years, compared with its total cost of $1.8 billion -- about a 50-fold return on investment.

There are substantial uncertainties in these estimates, of course, but still -- it's just one more example, particularly obvious and straightforward, I suppose, of how public investment in public health can have huge payoffs, which private economic activity cannot produce. Indeed, in this case, the public health enterprise is to combat the (fictitious) "free market," in which investors spend billions to market tobacco products, thereby sickening and killing people and costing both public and private payers hundreds of billions of dollars every year.

Think about this as you contemplate (if you can stomach it) Mr. Romney's speech last night.