327 



Mr. Califano. Well, the issue is — there are two issues. One is 

 the issue of disease and what those diseases cost. That is what lays 

 the tremendous burden on the Medicare program, not the deaths, 

 it is the taking care of somebody with emphysema, it is the taking 

 care of somebody with lung cancer, it is the taking care of some- 

 body with cardiovascular disease or chronic bronchitis, and it is the 

 disability that often goes along with that. 



These costs, for example, do not include the cost of disability. The 

 Social Security disability system pays, I am sure, at least $2 billion 

 a year as a result of people disabled by smoking. This study — it is 

 the diseases that are the most relevant factor in terms of the cost 

 of the Medicare. 



We do lay out as clearly as we know how the exact methodology 

 we do to do this as part of our study, and your staff can examine 

 it. We would be happy to answer any questions. As I said, there 

 is a bibliography of the articles used, but it wasn't based solely on 

 the epidemiological medical information, it was also based on an 

 examination of the hospital records of inpatient Medicare patients. 



I also maybe could take this opportunity — I noted that Mr. Bliley 

 mentioned that we indicated in our methodology that we found the 

 elderly population not the focus of medical or epidemiological re- 

 search; in lieu of elderly-specific relative risks, we use relative risks 

 for the general population. 



The fact is that is one of the reasons why these numbers are 

 probably conservative, because the risks for the elderly who have 

 accumulated much — many more years of disability and disease 

 from smoking are more — are likely to be a more expensive popu- 

 lation. 



Mr. McMillan. When we have had a chance to really study your 

 report, would you be willing to come back and testify on the sub- 

 stance within it instead of the conclusions? 



Mr. Califano. I would be happy to testify on any aspect of this 

 report or help this committee and you, Mr. McMillan, any way we 

 can, to provide any information you would like. 



Mr. Waxman. Thank you, Mr. McMillan. 



Mr. McMillan. Thank you. 



Mr. Waxman. Mr. Califano, we heard from researchers who, in 

 the early 1980's, were doing work on addiction. They had been told 

 by Philip Morris that they, because of a contract with Philip Mor- 

 ris, couldn't disclose their research. They had a confidentiality pro- 

 vision in their agreement as employees of Philip Morris. Now they 

 were able to come before us because we asked the executive from 

 Philip Morris to release them from that confidentiality agreement, 

 and we got some testimony. 



Now that is, those confidentiality agreements, are one of the 

 other ways tobacco companies use to try to keep information that 

 they had in-house about tobacco. We have heard about a court 

 order on some documents which evidently a judge in Kentucky 

 feels shouldn't be revealed, but you don't have those documents, do 

 you? 



Mr. Califano. Mr. Chairman, I have no documents. I have never 

 seen any documents. I never heard of this judge or this order real- 

 ly, and I also — all I know is, as I can say, is what I read in the 

 newspapers, in the New York Times or the Washington Post. 



