Agreed with your comments. Two things to consider:
So while you make eminent sense when talking about governments gathering increased excise taxes being gathered while simultaneously paying out less for social security / pensions, I know of no cases where the increased taxes are being placed directly in a medicare/medicaid account, much less being funneled to a commercial insurance company to offset their expenses.
Likewise, I know of no linkage between the OASDI fund and the Medicare fund where savings achieved as the result of a smoker's early death are funneled into the Medicare fund. (Or where other pensions that stop paying early as well)
As they say, different colors of money.
Correct, however, if you check the price schedule for your available plans, before commie care, you had age, sex, and zip code. Pre existing conditions were typically handled by either exclusion or delay, meaning you would not get a policy, or they would not pay for treatment associated w/your condition for the first year.
So if there is no scaled pricing plan based on condition, any actuarial computations made to that effect are irrelevant, other than to define who is excluded from a policy.
Post commie care, it was by statute that the gov indicated policies w/preexisting conditions could be charged 150% of base policies, and those without “wellness” (smokers, obese) could be charged 130%. Again, no actuarial computation driving the actual price.
It’d make perfect sense to me to have actuarial computations drive the cost for all lifestyles. If it’s based on that reality, it’s simply a market price. I have absolutely no prob w/that - as long as you run that calculation on all lifestyles, not just the ones you dislike!
Per the distribution of tax money, that is an abuse of the taxation to begin with. It is simply a cash cow.
On a population basis, as with social security, dying earlier ultimately means less expense so Medicare and Medicaid benefit from smokers just like SS does. This is because payroll taxes include medicare and you are taxed 2.9% on wages, with the employer covering half of it (so you only see a 1.45% draw from your check). Medicaid is partially covered w/state income tax and partially reimbursed by the feds.
You are right about insurance companies not being reimbursed through tobacco taxes. To me this is simply an abuse of tax authority. I mention it as an argument in response to the argument of “the cost of smokers”. I.e., if you are worried about that cost, then, INSTEAD of using that cost as the basis for excluding them from treatment, you SHOULD argue that tobacco tax be funneled to either insurance companies or hospitals.