Letters Smokers and surgery

The best time to die (to help fellow taxpayers)

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39094.388588.1F (Published 18 January 2007) Cite this as: BMJ 2007;334:110
  1. Robert A Da Prato, physician
  1. 1Portland, OR 97229, USA dapratorobert@msn.com

    Not too long ago an accountant told me that, from a financial perspective only, a patriotic citizen should die the moment he or she changes from a net taxpayer (a net tax asset of the state) to a net tax consumer (a net tax liability of the state).1 For many people this means one should drop dead on the way home from one's retirement party. A brother and sister acquaintance illustrate this quite well. The sister, a non-drinker, non-smoker, responsible eater lived to be 85. Since age 65 she received 20 years' retirement as a government worker, 20 years social security payments, had Medicare paid pharmaceutical charges for almost two decades of diabetes, hypertension, and raised cholesterol, outpatient office visits, and hospitalisation costs for a pneumonia, fractured hip, and sub-endocardial infarction. Her brother, a heavy smoker and drinker, literally dropped dead at 60. Up to that point he paid for medical expenses out of his own pocket. One sibling cost the taxpayers probably close to a million dollars (far greater that she ever paid into the system), the other nothing (in fact it was a great financial gain since he had a high paying job and paid taxes for years.)

    When I am asked, the advice I give to smokers is this: “As a physician I can tell you that if you smoke you will probably die of heart disease or cancer. If you don't smoke you will probably die of heart disease or cancer, but usually some years later. During the extra time non-smoking gives you, you may develop the infirmities, disabilities, illnesses, and aches and pains which go along with old age, and then die. My overall recommendation is not to smoke, however, because it really does increase the risk of dying from emphysema which is a very unpleasant way to die. As a taxpayer, however, I applaud your decision to smoke since you will probably be much less of a financial burden to taxpayers because you will die sooner. You might even be a financial asset to them if you time it right.”


    • Competing interests: None declared.