DON’T GET ME wrong. The last thing I want to do is throw cold water on the state’s plan to start paying for smoking cessation products for Medicaid recipients. Not only will this new initiative save countless people from painful diseases and early death, but it also will more than pay for itself, by reducing the amount of money taxpayers have to spend to treat those painful diseases for those too poor to afford their own medical care.

It’s a wonderful idea.

It’s long overdue.

And it’s not enough.

Even the most aggressive smoking cessation programs — the ones that combine medicine with intensive therapy — have a less-than-desired success rate. And while nearly all smokers want to quit, and up to 40 percent try every year, few use the combined-therapy approach.

Success rates vary according to the method used. Fewer than 5 percent of smokers who try to quit without any drugs or counseling succeed. Some studies have found that free telephone help lines, particularly when combined with drug treatment, can boost the success rate above 50 percent (although there is disagreement in the smoking-cessation community on whether the drugs — which range from gum and patches to inhalers and pills — help or actually hurt). But on average, fewer than 10 percent of the attempts to quit actually succeed. That shouldn’t come as a surprise, since nicotine is one of the most addictive substances on earth, and cigarette manufacturers deliberately manipulate nicotine levels to make their products as addictive as possible.

The price of individual products and services to help smokers quit isn’t astronomical, particularly when compared with the cost of cigarettes themselves — let alone the cost of treating smoking-caused illnesses: $25 a week for patches or gum, $65 a week for nasal sprays or inhalers, $100 a month for pills; hypnosis treatment can start at $250, and the cost for counseling varies widely. But since most people try several methods several times before they succeed (if they ever do), the costs mount quickly. That serves as a deterrent for smokers and makes smoking cessation a less-than-ideal option for taxpayers — although still much better than doing nothing.

How quickly do those numbers add up? Earlier this year, the Journal of the National Cancer Institute reported that an eight-year, $128 million demonstration project called the American Stop Smoking Intervention Study reduced smoking by nearly a percentage point more in the 17 states where it was implemented than in the rest of the states. Study co-author Elizabeth A. Gillian noted that since nearly 11,000 fewer people were smoking at the end of the study than would otherwise have been expected, the reduction cost an average of $1,200 per person.

“Most smoking cessation programs will spend that” for each smoker, she told The Associated Press. “That’s just for a few hours of a counselor’s time.” And most of the smokers won’t succeed in kicking the habit.

What’s different about the National Cancer Institute program is that it wasn’t built around convincing smokers to quit smoking, although some no doubt did. The numbers improved primarily because there were fewer new smokers to replace the already-addicted smokers who were dying off every year.

That is a critical difference.

Smoking cessation programs will help reduce our state’s smoking rate — and thus save tax money and human lives. But the only way we’re going to make a major dent in our spiraling Medicaid costs (not to mention the private insurance premiums most of us pay) is to focus on prevention. If people never start smoking, we don’t have to spend a dime to treat smoking-related diseases, and we don’t have to spend a penny on nicotine patches, stop-smoking drugs or behavior-modification therapy.

Once we accept that, the only question is how best to prevent people from taking up smoking.

The National Cancer Institute program had two main components: an anti-smoking public relations effort, designed to counter the estimated $47 billion a year tobacco companies spend to lure people into addiction; and training for local advocacy groups, which then lobbied for higher cigarette taxes and laws that restrict or outlaw smoking in public places.

By themselves, effective public relations campaigns, restrictions on smoking and higher cigarette taxes all have been shown to help reduce the number of new smokers, and so any or all would make good sense from a public health perspective. But with tax dollars in short supply, it seems inconceivable from a public policy perspective that we would spend money on the PR approach before passing anti-smoking laws, and even more inconceivable that we would try that before raising cigarette taxes.

For the past couple of years, the cigarette-tax crowd has tried to convince legislators to raise our state’s embarrassingly low 7-cent-per-pack tax by talking about the need to have more money to spend on Medicaid. That overlooks an even more important fiscal message: Raising the cigarette tax will reduce the amount of money that the state has to spend on Medicaid. This would be a no-brainer even if we literally burned the dollars we collected from the higher cigarette tax.

Ms. Scoppe can be reached at cscoppe@thestate.com or at (803) 771-8571.