Skip to main content
Log in

How Good a Deal Was the Tobacco Settlement?: Assessing Payments to Massachusetts

  • Published:
Journal of Risk and Uncertainty Aims and scope Submit manuscript

Abstract

We estimate the increment in Massachusetts Medicaid program costs attributable to smoking from December 20, 1991 to 1998. We describe how our methods improve upon earlier estimates of analogous costs at the national level. Current costs to the Massachusetts Medicaid program approximate the payments to Massachusetts under the tobacco settlement of November 1998. Whether these payments are viewed as appropriate compensation for Medicaid costs over time depends upon the rate of increase in future health care costs, the rate of decline in smoking, the proportion of smoking that should be attributed to the actions of the tobacco companies and the likelihood the state would have prevailed at trial. The costs to the Medicaid program are dwarfed by the internal costs to smokers themselves.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Basu, Joy. (1996). “Data View: Border Crossing Adjustment and Personal Health Care Spending by State,” Health Care Financing Review 18(1), 215-236.

    Google Scholar 

  • Becker, Gary S., and Kevin M. Murphy. (1988). “A Theory of Rational Addiction,” Journal of Political Economy 96, 675-700.

    Google Scholar 

  • Becker, Gary S., Michael Grossman, and Kevin M. Murphy. (1991). “Rational Addiction and the Effect of Price on Consumption,” American Economic Review 81, 237-241.

    Google Scholar 

  • Becker, Gary S., Michael Grossman, and Kevin M. Murphy. (1994). “An Empirical Analysis of Cigarette Addiction,” American Economic Review 84, 396-418.

    Google Scholar 

  • Cederlof, R., Lars Friberg, and T. Lundman. (1977). “The Interactions of Smoking, Environment and Heredity and Their Implications for Disease Etiology. A Report of Epidemiological Studies on the Swedish Twin Registries,” Acta Medica Scandinavica Supplementum 612, 1-128.

    Google Scholar 

  • Congressional Budget Office. (1998). “The Proposed Tobacco Settlement: Issues from a Federal Perspective,” Washington, DC: CBO.

    Google Scholar 

  • Court TV. (1998). “States Announce Settlement with Tobacco Companies,” http:/ /www.courttv.com/ trials/ tobacco/ national/ 111698 _ctv.html. November 16.

  • Cutler, David M., Mark McClellan, and Joseph P. Newhouse. (1999). “The Costs and Benefits of Intensive Treatment for Cardiovascular Disease.” In Jack Triplett ed., Measuring the Prices of Medical Treatments. Washington, DC: Brookings Institution.

    Google Scholar 

  • Cutler, David M., Arnold M. Epstein, Richard G. Frank, Raymond S. Hartman, Charles King, and Joseph P. Newhouse. (1998a). “The Impact of Smoking on Medicaid Spending in Massachusetts: 1970-1997: Methods.” June 15.

  • Cutler, David M., Arnold M. Epstein, Richard G. Frank, Raymond S. Hartman, Charles King, and Joseph P. Newhouse. (1998b). “The Impact of Smoking on Medicaid Spending in Massachusetts: 1970-1998: Results from the Inclusive Approach for Adults.” July 1.

  • Cutler, David M., Arnold M. Epstein, Richard G. Frank, Raymond S. Hartman, Charles King, and Joseph P. Newhouse. (1998c). “The Impact of Smoking on Medicaid Spending in Massachusetts: 1991-1998: Results from the Disease-Specific Approach for Adults and Overall Summary.” July 11.

  • Cutler, David M., Jonathan Gruber, Raymond S. Hartman, Mary Beth Landrum, Joseph P. Newhouse, and Meredith B. Rosenthal, “Some Measures of the Economic Impacts of the Tobacco Settlement,” forthcoming.

  • Doll, R., R. Gray, B. Hafner, and R. Peto. (1980). “Mortality in Relation to Smoking: 22 Years' Observations on Female British Doctors,” British Medical Journal 280, 967-971.

    Google Scholar 

  • Doll, R., and R. Peto. (1976). “Mortality in Relation to Smoking: 20 Years' Observations on Male British Doctors,” British Medical Journal 2, 1525-1536.

    Google Scholar 

  • Doll, R., R. Peto, K. Wheatley, R. Gray, and I. Sutherland. (1994). “Mortality in Relation to Smoking: 40 Years' of Observations on Male British Doctors,” British Medical Journal 309, 901-911.

    Google Scholar 

  • Duan, Naihua. (1983). “Smearing Estimate: A Nonparametric Retransformation Method,” Journal of the American Statistical Association 78, 605-610.

    Google Scholar 

  • Duan, Naihua, Willard G. Manning, Carl N. Morris, and Joseph P. Newhouse. (1983). “A Comparison of Alternative Models for the Demand for Medical Care,” Journal of Business and Economic Statistics 1(2), 115-126.

    Google Scholar 

  • Frank, Richard G., Thomas G. McGuire, Elizabeth H. Notman, and Rebecca M. Woodward. (1996). “Developments in Managed Behavioral Health Care.” In R. Mandersheid and M. Sonnenschein eds., Mental Health U.S., 1996. Washington, DC: U.S. Government Printing Office.

    Google Scholar 

  • Gravelle, Jane, and Dennis Zimmerman. (1994). Cigarette Taxes to Fund Health Care Reform: An Economic Analysis. Washington, DC: Congressional Research Service.

    Google Scholar 

  • Hammond, E. Culyer. (1966). “Smoking in Relation to the Death Rates of One Million Men and Women,” National Cancer Institute Monograph 19, 127-204.

    Google Scholar 

  • Kahn, H. A. (1966). “The Dorn Study of Smoking and Mortality among U.S. Veterans: Report on Eight and One-Half Years of Observation,” National Cancer Institute Monograph 19, 1-125.

    Google Scholar 

  • Kramer, M. S. (1987). “Intrauterine Growth and Gestational Duration Determinants,” Pediatrics 80, 502-511.

    Google Scholar 

  • Lamphere, JoAnn, Normandy Brangan, Sharon Bee, and Rafael Semansky. (1998). Reforming the Health Care System: State Profiles 1998. Washington, DC: American Association of Retired Persons.

    Google Scholar 

  • Manning, Willard G., Emmett B. Keeler, Joseph P. Newhouse, Elizabeth M. Sloss, and Jeffrey Wasserman. (1989). “The Taxes of Sin: Do Smokers and Drinkers Pay Their Way?” Journal of the American Medical Association 261, 1604-1609.

    Google Scholar 

  • Manning, Willard G., Emmett B. Keeler, Joseph P. Newhouse, Elizabeth M. Sloss and Jeffrey Wasserman. (1991). The Costs of Poor Health Habits. Cambridge: Harvard University Press.

    Google Scholar 

  • McGinnis, J. Michael, and William H. Foege. (1993). “Actual Causes of Death in the United States,” Journal of the American Medical Association 270, 2207-2212.

    Google Scholar 

  • McIntosh, I. D. (1984). “Smoking and Pregnancy: Attributable Risks and Public Health Implications,” Canadian Journal of Public Health /Revue Canadienne de Sante Publique 75(2), 141-148.

    Google Scholar 

  • Meyer, M. B., B. S. Jonas, and J. A. Tonascia. (1976). “Perinatal Events Associated with Maternal Smoking During Pregnancy,” American Journal of Epidemiology 103, 464-476.

    Google Scholar 

  • Miller, Leonard, Xivlan Zhang, Thomas Novotny, Dorothy P. Rice, and Wendy Max. (1998). “State Estimates of Medicaid Expenditures Attributable to Cigarette Smoking, Fiscal Year 1998,” Public Health Reports 113 March-April.

  • Miller, Vincent P., Caroline R. James, Carla Ernst, and François Collin. (1997). “Smoking-Attributable Medical Care Costs: Models and Results.” Berkeley: Berkeley Economic Research Associates. September 3 (available at www.bera.com).

    Google Scholar 

  • Miller, Vincent P., Caroline R. James, Carla Ernst, and François Collins. (1999). “Measuring the Medical Costs of Smoking in the USA,” Social Science and Medicine 48, 375-391.

    Google Scholar 

  • Napier, K. (1996). “Cigarettes: What the Warning Label Doesn't Tell You. The First Comprehensive Guide to the Health Consequences of Smoking.” New York: American Council on Science and Health.

    Google Scholar 

  • Newhouse, Joseph P. (1992). “Medical Care Costs: How Much Welfare Loss?” Journal of Economic Perspectives 6(3), 3-21.

    Google Scholar 

  • Newhouse, Joseph P., and the Insurance Experiment Group. (1993) Free for All? Lessons from the RAND Health Insurance Experiment. Cambridge: Harvard University Press.

    Google Scholar 

  • Rosenthal, Meredith B., David M. Cutler, Richard G. Frank, Raymond S. Hartman, Mary Beth Landrum, and Joseph P. Newhouse, “Estimating the Costs of Public Health Evils Using Observational Data,” forthcoming.

  • Rubin, Donald. (1998). State of Minnesota District Court, Second Judicial District, Transcript of Proceedings, pp. 14852-15087. May 1.

  • Shoven, John B., J. O. Sundberg, and John P. Bunker. (1989). “The Social Security Cost of Smoking.” In D. Wide ed., Economics of Aging. Chicago: University of Chicago Press.

    Google Scholar 

  • Stellman, S. D., and L. Garfinkel. (1986). “Smoking Habits and Tar Levels in a New American Society: Prospective Study of 1.2 Million Men and Women,” Journal of the National Cancer Institute 76, 1057-1063.

    Google Scholar 

  • Tobacco Control Resource Center, Northeastern University. 1998. “The AG Settlement.” http://www.tobacco.neu.edu/Extra/analysis_of_MSA.htm. November 18.

  • U.S. Department of Health, Education and Welfare. (1979). Smoking and Health: A Report of the Surgeon General. DHEW Publication no. PHS 79-50066. Washington, DC: U.S. Public Health Service.

    Google Scholar 

  • U.S. Department of Health and Human Services. (1989). 1989 Surgeon General's Report. Washington, DC: U.S. Public Health Service.

    Google Scholar 

  • Viscusi, W. Kip. (1995). “Cigarette Taxation and the Social Consequences of Smoking,” Tax Policy and the Economy 9, 51-101.

    Google Scholar 

  • Viscusi, W. Kip. (1999). “The Government Composition of the Insurance Cost of Smoking,” Journal of Law and Economics XLII October, 575-609.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cutler, D.M., Epstein, A.M., Frank, R.G. et al. How Good a Deal Was the Tobacco Settlement?: Assessing Payments to Massachusetts. Journal of Risk and Uncertainty 21, 235–261 (2000). https://doi.org/10.1023/A:1007863408004

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1007863408004

Navigation