The difference between American and European health care costs is not due to smoking.
Walk around any major European city and you run a gauntlet of smoking.
It's not discrete like American smoking, either – a single cigarette placed over the ear, anticipating the hit of nicotine. This is old-school smoking, great clouds of smoke wafting from the faces of people walking down the sidewalks, one cigarette followed quickly by another.
There are concessions. The Munich train station features small smoking cells, yellow lines painted on the station platform defining where you can light up. But smoke does not respect the lines. And of course the reason the streets are filled with smokers is that they can't light up indoors, anywhere.
Near the Munich city center (above), a pedestrian mall defined by medieval walls, wide roads are needed to feed the shops, restaurants and visitors. We found a pedestrian mall under one road, the Karlsplatz, and used it often because (a miracle) it's a no-smoking area.
All this means that Europe's toll from cancer, heart attack and emphysema is close to that of America. You can't explain the difference in health care costs between Germany and the USA by smoking.