323 



ly seems to target young women, and so what you have is a situa- 

 tion where young women get addicted very early on, and then I 

 gather there is a prospect based on your report that this is a sig- 

 nificant factor in raising Medicare costs. Could you comment on 

 that aspect? 



Mr. Califano. I think it is a significant factor. We have to re- 

 member that the heavy smoking by women came almost a genera- 

 tion after the heavy smoking by men, and women who smoked a 

 lot are just beginning to enter the over-65 group, and that will un- 

 doubtedly have the impact of increasing costs on Medicare. 



There is an element here that really is truly disturbing. I noticed 

 in one of the news reports that the tobacco companies had evidence 

 of the ability, potential, I guess, of nicotine to suppress appetite, 

 and one of the things we didn't realize in 1978 was how relevant 

 being thin and continuing to smoke for a woman was because she 

 thought it would help her keep thin, suppress her appetite or what- 

 have-you. 



What the cigarette companies bought, what they really bought by 

 this campaign of suppression and disinformation, was the ability to 

 hook millions of American women over that 30-year period because 

 in the beginning of this period they were not smoking at the rates 

 they are smoking at now. 



Mr. Wyden. I think that is a very important point, and my con- 

 cern is that pattern of trying to target young women is continuing 

 today. What you are talking about is evidence that it took place 

 years ago, and my concern is, you look at the advertisements today 

 and how it seems to be the key to independence for young women 

 and the like seems to reflect a continuing pattern. 



Mr. Califano. I would hope, Mr. Wyden, that the committee 

 would give some consideration to looking at the marketing prac- 

 tices of the cigarette industry in this and other areas. 



Mr. Wyden. Let me ask you about the research — and I gather 

 over the last few years this research has accelerated — indicating 

 that when senior citizens who have smoked for a considerable pe- 

 riod of time, even in that kind of situation, when they stop, their 

 health can still improve significantly and that there is a prospect 

 for reduced Medicare expenditures. Is that correct, and what is the 

 state of that research? 



Mr. Califano. Yes, I think that is. There is research to that ef- 

 fect. I think the Department of Health and Human Services has a 

 lot of it. 



I think we have to recognize that what we are talking about is 

 keeping people healthy and independent for a longer period of their 

 life. That will both make the quality of their life much better and 

 reduce the cost to the Medicare program, so that if senior citizens, 

 if older Americans, if middle-aged Americans will quit smoking, 

 they are likely to have much longer periods of independent living 

 and quality living and longer periods in which they won't be a 

 drain on the Medicare trust fund. 



Mr. Wyden. You are absolutely right about this matter of pre- 

 vention. You know, the Medicare program really shows the insanity 

 of our priorities. Medicare Part A pays these huge checks for hos- 

 pital bills, the check goes from the Government, you know, to the 

 insurance company, then Medicare Part B pays virtually nothing 



