In this commentary, responding to research by the National Commission on Prevention Priorities (NCPP), the authors make the case for a more systematic approach to improving the delivery of cessation counseling. Evidence from the NCPP study highlighted the potential impact of clinicians on smoking cessation. Tobacco use screening and intervention for adults, aspirin chemoprophylaxis for adults and childhood immunization were the three most cost-effective and far-reaching preventive services that doctors could provide. But commentators noted that an effective system for helping smokers quit will involve support from leaders at many different levels. While clinicians help with counseling, health system leaders, payers, tobacco control leaders and other policy-makers are better suited to create systems-level cessation strategies because of their involvement in reimbursement rates and legislation. At the same time, counselors from community and state cessation hotlines can help patients by providing assistance and follow-up support outside the clinician's office. Improving the identification and counseling of smokers would save an estimated $500 per smoker and 1.3 million quality-adjusted life years. Thus policy-makers, purchasers and health care decision-makers are poised to receive big returns by building a better system for tobacco cessation counseling.