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I am particularly interested in hearing from Mr. Califano about 

 his work on alcohol, drug, and tobacco misuse in relation to Federal 

 spending as it may impact Medicare and Medicaid, and I am de- 

 lighted that this committee is for once considering cost containment 

 in this area rather than cost expansion, which is usually what we 

 are engaged in. It is my conviction that we don't consider this issue 

 enough in a very constructive sense. 



Frankly, I would have expected that HEW would have long ago 

 addressed the issue of threats to health imposed by anything, any 

 substance, whether it is tobacco, alcohol, drugs, fat, or we could go 

 on and on. It seems somewhat ludicrous that we are all of a sudden 

 awakening here in 1994 and trying to find fault with others who 

 may have had some kind of information back in 1950's that pre- 

 sumably we didn't have access to. 



I think I first smoked in 1950. I understood perfectly well the 

 fact that smoking might be detrimental to my health; I think ev- 

 erybody who smoked understood that. Perhaps you did, Mr. Chair- 

 man. I think you used to smoke. I think we also understood the 

 fact that it was habit forming. Whether you want to call it addict- 

 ive or not addictive perhaps depends upon the individual. I think 

 we need to try to define that word more precisely and define more 

 precisely how we apply it to a whole array of substances. 



But for you to sit here and try to suggest that your decisions not 

 to act were because one company or one group of executives had 

 access to information that the public didn't have access to back in 

 the past that they conspired to withhold from the American people 

 is absurd. I think we all understand to some degree what the risks 

 are here, and I am perfectly willing to look at them, and I think 

 perhaps the industry is as well. 



I didn't receive the study that Mr. Califano was a part of until 

 yesterday and haven't had a chance to examine it in detail. The 

 first I heard of it was on the news media this morning, when it was 

 ballyhooed as to what number of deaths tobacco contributed to 

 among the Medicare population, which is a bottom line sound bite 

 kind of conclusion, which is exactly what was intended. 



I don't think this informs the public, it doesn't inform senior citi- 

 zens, it doesn't inform me, and I think we need to be taking a real 

 careful look at that because we run the risk of perhaps deluding 

 the senior population into thinking that if they only deal with to- 

 bacco and alcohol, that they are going to avoid the Grim Reaper. 

 That clearly is not the case. 



On a personal note, my mother, who was a smoker, passed away 

 of heart failure last summer. She smoked most of her life. Did she 

 pass away because of smoking or not? She was 1 month short of 

 90. 



You know, I think we need to — and I am as seriously concerned 

 about the facts here as anybody else, but what this committee can 

 do as a favor to the American people is to focus on facts instead 

 of perception, and I hope, Mr. Califano, that you will help us do 

 that this morning. 



Thank you. 



Mr. Waxman. Thank you, Mr. McMillan. 



Well, we are here to focus on facts, not perceptions and not anec- 

 dotes, and that is why we are pleased to have Mr. Califano as a 



