Smoking is at historic lows [1] (~10-15%). Screening doesn't stop smoking, poor people will still be poor, smokers will still smoke, although GLP-1s may fix this [2] [3] (certainly, if this proves out, use cigarette taxes to help pay for GLP-1s for everyone to impair the dysfunctional reward center loop). There doesn't seem to be political will to simply ban cigarettes, so here we are. Making cigarettes expensive for poor people who smoke destroys demand, no? Otherwise, we accept the cancer rates for their choice and freedom to smoke knowing the consequences (~5k deaths/year in Iowa from this risk).

[1] https://www.radioiowa.com/2026/01/02/iowa-smokers-can-save-m... (“Increasing the cost of tobacco products is one of the most effective ways to reduce use,” Cale says, “and in turn, to lower Iowa’s lung cancer rates.”)

[2] GLP-1 drugs may fight addiction across every major substance - https://news.ycombinator.com/item?id=47280797 - March 2026

[3] GLP-1 medications get at the heart of addiction: study - https://medicine.washu.edu/news/glp-1-medications-get-at-the... - March 4th, 2026

(i have personal experience with a loved one who will not quit smoking, so I am not unsympathetic to this risk and harm incurred)