Trump shuttering the CDC Office on Smoking and Heath and decapitating the FDA Center for Tobacco Products will not only increase tobacco-caused disease but will also make the federal budget deficit worse (and cost American people and businesses a lot of money in avoidable medical costs). The only winners will be the big tobacco companies who gave millions to the Trump campaign.
The reason for this is that smoking and other tobacco use cause a lot of disease and, contrary to what most people (including policy makers) assume, these costs start to appear quickly. Jim Lightwood and I used modern econometric analysis of 17 years of national data on how smoking and healthcare costs changed between 1992 and 2009 and found that 1% relative reductions in current smoking prevalence and average number of packs
smoked per smoker are associated with 0.118% reductions in per capita healthcare expenditure. (Economists call 0.118% the elasticity.)
0.118% doesn’t seem like much, but in 2022 U.S. healthcare spending was $4.5 trillion. (That’s $12,474 per capita.) So just a 1% relative reduction in smoking — from 11.6% to 11.5% (1% of 11.6% is 0.116%) — would result in $5.3 billion (0.118% of $4.5 trillion) in healthcare savings the following year.
Even if Trump didn’t care about what individuals and businesses pay in healthcare costs, the reality is that the federal government pays 47% of all healthcare costs through Medicare, Medicaid, the VA and other federal programs … $2.1 trillion.
So a 1% relative reduction in smoking would reduce federal medical costs by $2.5 billion the next year.
Commpare that to the Office on Smoking and Health’s annual $240 million budget.
These savings are real
Lightwood and I did a similar analysis of the California Tobacco Control Program from 1989 through 2019, the three decades after California voters passed Proposition 99 creating the Program. During this time, California’s adult smoking prevalence fell from 21.8% in 1989 to 10% in 2019. Our analysis found that the anti-tobacco program accounted for 2.7 of those percentage points. Those who didn’t quit smoking cut back by an average of 119 packs per year in response to the program. The total healthcare savings came to $816 billion in 2019 dollars.
During that same time, the Program cost a total of $3.5 billion, yielding a return on investment of 231 to 1.
These benefits accrued because Californians smoked 15.7 billion fewer packs of cigarettes than would have been expected without the Tobacco Control Program. The only loser was Big Tobacco, which lost $51.4 billion in sales.
That’s really why Trump is trying to kill the program, not to save taxpayers money. He will cost Americans money, both as taxpayers and individuals. And make the deficit worse by billions.
What about the FDA Center for Tobacco Products?
The FDA CTP is also contributing to bringing tobacco use down at no cost to taxpayers. The entire CTP budget is paid by user fees on the tobacco industry. So, gutting CTP and firing its effective leaders doesn’t reduce the deficit by a penny!
(Trump’s actions are especially galling coming the day before a unanimous Supreme Court Decision upholding CTP’s authority to prohibit the sale of flavored e-cigarettes.)
The attack on tobacco is not the only example of how Trump’s cuts are increasing the deficit
Trump is firing IRS auditors who track down rich taxpayers who are defrauding the government by underpaying taxes and abusing the rest of us by not paying their fair share. USA Today reported that, “For every dollar spent auditing an earner in the top 1%, for example, the IRS reaps more than $4 in recovered tax dollars, research shows.”
So what should we do?
First, stop accepting (and repeating) the claim that these cuts are about saving money, increasing efficiency, and reducing the deficit. They’re not. If Trump and his friends were serious about saving money, increasing efficiency and reducing the debt, they would be increasing funding for tobacco control. Trump’s actions are about dismantling government programs that protect the public (and reduce profits for big business and the Republican Party’s wealthy supporters). We need to be explicit about that.
Second, support litigation against these cuts on the grounds that most efforts are Congressionally mandated and press to ensure that victories for the public interest are enforced.
Third, continue pressure on lawmakers to do their jobs and stand up to Trump.
Fourth, do what you can to support our colleagues and institutions who are under attack.
Stanton Glantz blog 
Smoking: “The Goose that Laid the Golden Eggs”
Firstly, smokers pay a large amount of taxes (on average 80% of cigarette price in most EU countries, not to account taxes from the industry and tobacconists’ business).
Secondly, smoking may yield cost savings due to their premature death. Biases come from cross-sectional studies failing to account for total life-span. Indeed, prevention can increase health-care spending as healthcare expenditures increase with age: average spending at 60 years old is twice as high as the spending at 40 years old and at 80 years expenditures are six-times higher than at 40 years.( Furthermore end-of-life costs, last 12 months of life, account for a modest fraction of total medical spending: 8.5 percent in the US. As people who smoke die an average of 12 years earlier than non-smokers total medical expenditures for people who smoke may hardly be higher than non-smokers, and the contrary is feasible. Of note, those who smoke are frequently from low-income/education, populations with limited access to care.
Thirdly, premature death results in less long-term nursing care, a major issue in our ageing societies, and less pension payment.
Last, the FDA has always protected the interest of the tobacco industry (no menthol ban, no reduction nicotine content, allwoing the marketing of e-cig and new products .. not to account the scandal of revolving doors
Braillon A. Smoking-attributable medical expenditures: Time biases and smokers’ social role. Prev Med. 2015;81:294. doi:10.1016/j.ypmed.2015.09.013
https://www.sciencedirect.com/science/article/abs/pii/S0091743515002984?via%3Dihub
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Analyses I have seen from the United States show that the long run tradeoff between shortened lifespan and pension costs vs medical costs has shown it to be a wash. While smokers on average die younger, they incur medical costs over a longer time than nonsmokers.
More important, politicians make fiscal decisions based on short run (not lifetime) considerations. That’s why we did the dynamic time series analysis that captures short as well as long run changes.
As for the FDA being a tool of the tobacco industry, the industry certainly doesn’t act like they think the FDA is their friend. They spend a lot of money suing them. FDA made a valiant effort (recently) to ban menthol, but were blocked by the Biden, then Trump, White Houses. See https://profglantz.com/2023/12/12/biden-follows-obama-and-trump-by-caving-to-industry-pressure-to-delay-menthol-ban/ This is, however, another example of how the industry doesn’t agree. The Supreme Court unanimously rejected several e-cigarette companies’ lawsuit against the FDA for refusing to authorize the sale of flavored e-cigarettes. https://www.politico.com/news/2025/04/02/fda-vapes-supreme-court-ruling-00006170
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“Smokers pay a large amount of taxes so they pay for their disease” is right out of tobacco industry PR. As with most industry PR the framing is convenient for the industry. The cigarette never appears in the frame. It’s “smokers”.
Of course there’s no reason to accept that frame. A more accurate frame: this product used exactly as intended creates massive costs. These costs fall on the customers, their families, their communities, companies, society, the healthcare system, government at all levels. Everyone ends up paying those costs except the industry that created the product, aggressively markets it, and engineers it for addiction. These are the externalities of this product. We all end up paying.
This is why shuttering CDC and FDA tobacco offices will increase the deficit. The increased healthcare costs alone are massive. And the government will get hit with that:
Healthcare spending in the U.S. attributed to cigarette smoking as much as $170 billion per year (2010 figures; probably a lot more now). More than 60% of the attributable spending was paid by public programs, including Medicare, other federally sponsored programs, or Medicaid. https://pmc.ncbi.nlm.nih.gov/articles/PMC4603661/
That increases the deficit. This product used exactly as intended increases the deficit.
Oh but those tobacco taxes pay for that? Nope. Not even close.
https://mitpress.mit.edu/9780262693455/the-price-of-smoking/
And you know the industry isn’t paying.
The tobacco industry: they take home the profit, we take home the loss.
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