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The information from the Quality and Outcomes Framework is perhaps higher because smoking status has not been updated for all patients if their smoking status has changed
And the harmful effects of smoking are much more costly than any potential benefit, as smoking is linked to a long list of health problems, including heart disease, stroke, chronic obstructive pulmonary disease (COPD), all types of cancers (especially lung cancer), cataracts, macular degeneration, type-2 diabetes, periodontal disease, and weak bones
Many top-earners are already leaving high-tax states for Florida, North Carolina, and other low-tax jurisdictions
Illegal cigarettes are also widely available in corner shops and groceries