The other night I was watching an episode of Yes Prime Minister with the youngest, who is constantly amazed at how familiar it all seems with today. This episode, The Smoke Screen, dealt with the radical and absurd proposal by the Health Minister to eliminate smoking, which is regarded as an outrageous and absurd idea by everyone else, from the PM to the Sports Minister (a former tobacco lobbyist) – this is 1986 after all.

Sir Humphrey’s reaction is less outrage than vast amusement at this “extremely silly” idea, as he points out to the PM that, aside from the loss of ₤4 billion per year in taxes, there is another area where smoking helps the government’s fiscal state:

PM Hacker: It says here smoking related diseases cost the NHS one hundred and sixty five million pounds a year.
Sir Humphrey: Yes but we’ve been into that. It has been shown that if those extra 100,000 people had lived to a ripe old age they would have cost us even more in pensions and Social Security than they did in medical treatment, so financially speaking it’s unquestionably better that they continue to die at about the present rate.
…
PM Hacker: Humphrey we’re talking about 100,000 deaths a year.
Sir Humphrey: Yes but cigarette taxes pay for a third of the cost of the National Health Service. We’re saving many more lives than we otherwise could because of those smokers who voluntarily lay down their lives for their friends.

But what was played for laughs in 1986 has turned into moral outrage in 2025:

Deputy Prime Minister David Seymour’s comments to a London audience calling smokers “fiscal heroes” – and declaring people should “light up” to save their government’s balance sheet – are reprehensible and make light of addiction, tobacco researchers say.

… and here from one Ian Powell, former Executive Director of the Association of Salaried Medical Specialists:

David Seymour: bad taste jokes over ‘benefits’ of smoking

Both Yes Prime Minister and Seymour may indeed have been making “bad taste jokes”, but what was true when the fictional character of Sir Humphrey said it in 1986 is still true when Seymour says it today: smoking appears to have more positive than negative impacts on the fiscal state of a government.

The thing is that smoking is not the only thing that is saving the government money, The Perverse Economics of Assisted Suicide:

A 2017 research paper predicted that MAID could save Canada between $34.7 million and $138.8 million in health care spending annually. The British government released its own forecasts in the lead-up to the vote on the country’s more restrictive assisted dying bill, which showed that though initial staffing and training costs could be significant, the government could potentially save tens of millions of pounds per year once the scheme is established.

What’s the bet that the likes of Ian Powell and other “health experts” will show no moral outrage if that analysis is done here in New Zealand.

It effectively already has been, and is buried at the core of our healthcare system in the form of QALY, (Quality Adjusted Life Years), which estimates how many years of decent living (“Quality Adjusted”) you’ve got left on the planet, considering your age and health, and then turns that into dollars. QALY decides whether you get the surgery and drugs you need to stay alive – or whether you’re literally not worth the cost of them.

Something to remember the next time you hear people screaming about the profit-driven private healthcare industry vs the compassionate and caring public systems.