290 



Mr. Waxman. Well, thank you, Mr. Califano. That was a very 

 powerful statement. I don't think anybody who listened to you can 

 just be in a state of numbness recognizing the price we are paying 

 for 30 years of not knowing and not acting on the dangers of ciga- 

 rettes. 



I appreciated the statement you made when you stated that you 

 got a letter trying to intimidate you from giving your testimony 

 today. The tobacco industry has been engaged in a pattern of trying 

 to intimidate people. You have been sent a letter of warning, law- 

 suits have been filed all over the place against media figures and 

 networks to try to keep them from feeling free to tell the story 

 about what is going on today in these hearings and in this inves- 

 tigation, and as I indicated in our opening statement, there have 

 been unreasonable requests — in fact, legal requests to this sub- 

 committee — which will not be permitted to keep us from doing our 

 work. 



Our responsibility now is to pick up from what we know today 

 and try to make public policy that is appropriate to the dangers of 

 cigarettes, and we know now that cigarette smoke is the leading 

 cause of premature death and disease. We are paying a price be- 

 cause, as you indicated, these figures are absolutely astounding. 

 Nearly $1 out of $4 Medicare spends on inpatient hospital care is 

 attributable to substance abuse, $20 billion in fiscal 1990 — 1994; 80 

 percent of that amount is due to the long-term effects of smoking 

 cigarettes, including lung cancer, strokes, heart disease, and res- 

 piratory ailments. 



We are looking at this Congress to reform our health care sys- 

 tem, but our health care system can't be reformed if we are not 

 going to do something to try to prevent these kinds of cost for the 

 future. Can we hope to hold down health care costs, human suffer- 

 ing, premature death, without regulating tobacco? 



Mr. Califano. Mr. Chairman, I think that health care reform is 

 doomed unless substance abuse across the board is attacked front 

 and center, and I think it is essential tobacco now be regulated. 



All the health care reform is, in a sense — most of the conversa- 

 tion, unfortunately, tends to be on what I would call sick care re- 

 form: How do we treat people? That is really closing the door of the 

 armory after the destructive weapons are already out there, and we 

 have got to move aggressively in this area. 



Mr. Waxman. One of the results of not knowing for the last 30 

 years about the dangers of cigarettes to the full extent that we now 

 know is that cigarettes, to everyone's amazement when they hear 

 it, are virtually unregulated. They are not regulated by the Food 

 and Drug Administration; they are not regulated by the Consumer 

 Product Safety Commission. 



There is a law at the Federal level that says that States refrain 

 from selling cigarettes to minors. Is that law being enforced, and 

 are there steps we can take to make sure that cigarettes are not 

 sold to minors? 



Mr. Califano. I think the enforcement is very spotty, Mr. Chair- 

 man. It is interesting to note that in situations in which it is en- 

 forced, relatively modest fines on small businessmen who run 

 candy stores or newspaper stands that sell cigarettes has resulted 

 in their changing their conduct. I think it is imperative to enforce 



