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From 1965 to 1977 the portion of men who smoke fell from 50 

 percent to 41 percent, but the portion of women who smoke barely 

 moved, from 32 percent to 31 percent. During the same period, the 

 smoking rate among whites fell from 40 percent to 35 percent, but 

 among blacks, African Americans, it barely budged, from 43 per- 

 cent to 42 percent. Today roughly 29 percent of the black popu- 

 lation smokes, compared to only 25 percent of whites and lung can- 

 cer has surpassed breast cancer as the leading cancer killer of 

 women in the United States. 



Tobacco is history's number one serial killer. Tobacco counts 

 among its victims some 9 million Americans who died from smok- 

 ing-related diseases between 1964 and 1994, the 30 years of con- 

 cealment and disinformation. 



This year, cigarettes will kill another 430,000 individuals. Cancer 

 and heart disease victims of cigarette smoking fill intensive care 

 units and hospital beds across the Nation. Some 54 million Ameri- 

 cans are addicted to cigarettes, and another 8 million are hooked 

 on smokeless tobacco. Today's tobacco users are tomorrow's car- 

 nage. 



You have asked the Center to help you quantify the cost to Medi- 

 care that could have been avoided had the tobacco companies re- 

 leased their own research in 1963 and publicly warned Americans 

 about the health consequences of smoking and the addictive nature 

 of nicotine. 



From 1965 to 1993, we estimate that Medicare spent $128 billion 

 on hospital inpatient care related to tobacco use. If 10 percent 

 fewer people were smoking during those years. Medicare could 

 have saved $13 billion. 



Looking forward, a 10 percent reduction in the number of Ameri- 

 cans who smoked could save $80 billion in Medicare hospital costs 

 over the next 20 years. While precise predictions are speculative, 

 Mr. Chairman, what we can say with certainty is that if we had 

 known then what we know now, we could have saved billions of 

 dollars in Medicare spending alone and we could have averted mil- 

 lions of premature deaths and disabilities. 



Today the case for increasing the excise tax on cigarettes and for 

 FDA regulation of tobacco is overwhelming. Congress should raise 

 the cigarette tax by at least $2 a pack. That would cut the number 

 of smokers by almost 8 million people and over time save almost 

 2 million lives. 



A $2 tax would raise at least $20 billion a year in revenues. 

 Some estimates run much higher. This would compensate the 

 American taxpayer who is paying a $19 billion tax that the tobacco 

 companies and tobacco use imposes on Medicare and Medicaid. 



The higher price of cigarettes would be most effective in deter- 

 ring children from smoking. Children are especially vulnerable to 

 the lure of cigarettes and the slick advertising of the tobacco com- 

 panies. As the Surgeon General recently confirmed and as Con- 

 gressman Wyden noted, virtually no one starts smoking after they 

 are 21 years of age and for too many teenagers cigarettes are a 

 drug of entry to the world of hard drugs. 



Using data derived from the National Institute of Drug Abuse 

 National Household Survey on Drug Abuse, the widest survey in 

 the country, the Center on Addiction and Substance Abuse has 



