164 



who have the same primary diagnosis but do not have a substance 

 abuse problem. 



This week the Center on Addiction and Substance Abuse at Co- 

 lumbia University is releasing the first study of the costs of sub- 

 stance abuse to the Medicare program. I have provided copies of 

 the study to the committee and ask that it be entered in the record. 



Mr. Waxman. Without objection, that will be the order. 



Mr. Califano. The study found that nearly $1 out of every $4 

 of Medicare spent on inpatient hospital care is attributable to sub- 

 stance abuse, $20 billion in fiscal 1994. This study is based on the 

 epidemiological medical evidence, 321 footnotes cited in the mate- 

 rial backing up this, Mr. Bliley, and also on the inpatient hospital 

 records of Medicare which are available throughout — for the year 

 1991; 80 percent of that amount — 80 percent of that $20 billion — 

 is due to the long-term effects of smoking cigarettes, including lung 

 cancer, strokes, heart disease, and respiratory ailments. The risk 

 factors were adjusted to avoid taking into account the problem of 

 fat or what-have-you. 



And, finally, I would note that for the study we had an advisory 

 committee which included some extraordinary people like Dorothy 

 Rice, probably the greatest health statistician in the United States 

 of America. 



Over the next 20 years, substance abuse and addiction will cost 

 the Medicare trust fund more than $1 trillion for inpatient hospital 

 care. Smoking is the largest single drain on the Medicare trust 

 fund, poised to take $800 billion over the next 20 years. 



The April 11, 1994, report by the trustees of Medicare warn that 

 Medicare will run out of money in 7 years. During that time, $128 

 billion of Medicare inpatient hospital costs will be due to cigarettes. 



The prevalence of smoking among Medicare recipients is high. 

 More than 36 percent of Medicare recipients are former smokers, 

 and nearly 20 percent currently smoke. Three out of five current 

 smokers, about 58 percent, and one-third of the quitters smoked 

 more than 10 cigarettes a day for more than 35 years. 



This puts the Medicare population at much higher risk of getting 

 smoking-related diseases because people over 65 who have smoked 

 tend to have done so more heavily and for longer periods of time 

 than younger Americans. 



The high prevalence of smoking among the elderly is especially 

 disturbing in light of the documents reported in the New York 

 Times and the Washington Post over the past several days. These 

 reports revealed that in the early 1960's the cigarette companies 

 knew that nicotine was addictive and that smoking caused cancer 

 and heart disease but kept their knowledge secret in order to sell 

 their products. 



Had the American people known 30 years ago what the tobacco 

 companies kept from them about the deadly and addictive nature 

 of cigarettes, hundreds of thousands of premature deaths and bil- 

 lions in related health care costs among today's elderly population 

 could have been avoided and billions of taxpayer dollars could have 

 been saved. 



The evasions, lies, and transfer of documents overseas by the to- 

 bacco industry to prevent any Government agency or cigarette-in- 



