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Notes -
I don't buy this. Everyone dies of something. The efficient way to reduce medical expenses is to die of something that kills you relatively fast. Any claim that people's actions "cause them to have medical expenses" has to be seen in this light. It's by no means clear that some activities cause medical expenses at all just because they lead to early illness and death (I believe cigarette smoking reduces medical expenses for this reason). And even if they do, are they really something we wish to discourage? (do we want to blame people for being nonsmokers because that increases their medical expenses for old age care?)
Why it would even work?
I expect that smokers are more likely to die due to prolonged lung-related diseases rather than something acting quickly. And therefore increase costs.
But they also die much earlier and without elderly care, which is on a totally different level of cost. Also significant savings on social security: the state loves a man who dies on his 65th birthday and covers payments for a lawyer who lives to 98.
the claim was
which seem very unlikely to be true. Pension is surely not a medical expense?
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Fair enough. I was definitely being too strong in my language. If anything, it sort of highlights how difficult it is to even know how to compute it. Upon further reflection, I'd say that it's probably highly nonlinear and complicated, perhaps somewhat resistant to traditional methods (let's be honest; it's going to be a variant on OLS). For example, suppose two people use very similar amounts of fentanyl (to hit another topic in the OP), but just different enough or the people being just different enough in size or whatever that one of them dies and the other one is left alive, but with major organ issues or whatever. Maybe they're scared straight or are physically unable to go out and get drugs anymore, but their life just drags on for a long time, with ever-increasing medical bills. How, then, does one account for this risk factor in the calculus?
I think this actually brings me back to my initial position, though. I don't want to have to solve these wicked estimation problems in order to do public policy. I shouldn't have to. It should be mostly a meaningless question, at least for the purposes of public policy, if we were focused on setting things up so that folks internalized the costs of their choices rather than doing everything we can to externalize everything and transfer incomes.
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