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Jim, that typically is an American approach to trying to understand it. All is tax related and a negative approach.
In the Netherlands we have a system in place where everyone is mandatory insured for healthcare. For those costs which are not possible to be insured for (for long term disabled, mentally handicapped and such) everyone pays part of their salary to cover the entire costs. This solidarity is currently under pressure due to continueing increase in costs... That part is currently about 20% of the total wage, but might increase to being 40% if the current demographics are going to continue (more elderly, less working class people).
No, many europeans smoke indeed, but it's on decline. Productivity in the Netherlands is one of the highest in the world, which in turn raises stresslevels. People seek ways to cope with that is my idea on smoking.
Many effort is put into making less people smoke. From many non smoking area's, high taxes on cigarettes and likewise articles, age limits to buying them, and a change in attitude towards smoking by the public (less accepted).
But as it is on decline, people have found better ways to cope with stress.
Driving a BMW318i with LPG at the moment. Had a 2.0 RAV4.1 1997 3drs 4WD euro model w/ABS dual sunroof blue two tone previously.