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Cigarettes' Cost in Dollars and Lives

Consider Medicaid, the government-run health insurance for the poor. The program, whose costs are split by states and the federal government, reimburses doctors, hospitals and other providers at a rate substantially below the cost of medical care.

When a smoker goes into the hospital for cancer treatment -- smokers are statistically more likely to need medical care earlier and longer than nonsmokers -- Medicaid covers 75 cents of every dollar in expenses. Taxpayers and patients with private insurance make up the difference.

"That is a hidden, extraordinary, regressive tax on everybody's insurance premiums," Sartoris said.

That's why anti-smoking advocates had pushed for a bigger tobacco tax: to narrow a $148 million gap in Virginia's Medicaid funds that is expected to grow. Along with the smoking ban, the tax would pay further dividends by inhibiting people from starting to smoke and forcing others to cut down, advocates said.

Research shows that for every 10 percent increase in the price of cigarettes, tobacco use drops 7 percent among youths and 2 percent among adults.

Forman, who grew up in Howard County, sees the human consequences of smoking every day. At least half of his patients are smokers or former smokers.

Forman can easily spot the signs of blocked airways: Patients purse their lips, puffing and hyper-inflating their chests in an effort to empty their damaged lungs. After a few minutes with a CT scan, he finds a spidery white speck that means a cluster of cancer cells has taken root in a person's lung.

Then he must break the news to people such as Don Eason.

"I said, 'What you're telling me is, I'm going to die,' " recalled Eason, who underwent surgery about three years ago to remove his right lung and a chunk of his left.

Like many smokers, Eason, 70, an easygoing man with white hair, a Southern accent and a persistent cough, knows what led to this. He was 15 years old and stocking shelves at the A&P in Franklin, Va., when he first smoked. It was a Pall Mall then, and later Salem menthols.

Eason enlisted in the Air Force, became a traveling salesman, ran a barbershop, married, had children and divorced. But cigarettes were a constant. He smoked a pack, maybe a pack and a half, every day.

"Back then, a cigarette and a radio were your buddies," Eason said, remembering the days on the road peddling farm equipment.

After doctors told Eason that he had a year to live, he put his affairs in order. He did not want to leave debts for his daughters to pay. He gave away belongings. He picked out a coffin.

Tatem, a wisecracking former dental hygienist, also started smoking young. As a teenager in Norfolk, she and some girlfriends pilfered Lucky Strikes from her mother's purse. Soon, she became a pack-a-day smoker. Her favorite ritual centered on a morning cigarette, a freshly brewed pot of coffee and a chocolate cookie.

These days, Tatem must be connected to the oxygen supply at all times, a nuisance when the tubes irritate her nostrils or get tangled underfoot in her living room. Her skin, gray and fragile, rips as easily as wet paper, one of the effects of a medication that helps her breathe. Another makes her bones brittle, causing painful fractures.

Two years ago, Tatem was rushed to the hospital. Doctors put her in the hospice unit.

"They said there wasn't anything they could do for me," Tatem said. She rallied, but she said she knows that her prognosis is grim. And she, too, wishes she had never smoked.

"I feel angry at myself for doing it, because no one made me do it," she said.

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