ANY effort to contain the costs of health care in the United States is ``doomed to failure'' unless it ``mounts an all-fronts attack on substance abuse,'' says Joseph Califano.
Mr. Califano, a former US secretary of health, education, and welfare under President Carter and now president of the Center on Addiction and Substance Abuse at Columbia University in New York, cites some jarring statistics. Out of the $1 trillion spent by Americans each year on health care, he says, ``a minimum of $140 billion'' can be attributed to the abuse of drugs, both illegal and legal.
That estimate is a ``minimum,'' he continues, because it embraces only illnesses and accidents experienced by people actually using drugs, including alcohol and tobacco. It does not, for instance, include care for the victims of drunk drivers, which would be a huge added cost.
Califano is a tireless campaigner on this issue and was in Boston last week to address a meeting of regional state legislators who are considering ways to include drug policy in their health-care reforms.
With regard to getting significant substance-abuse elements into the national health-care package, ``we're just beginning,'' says Califano. He is hopeful the House Ways and Means Committee's subcommittee on health, chaired by Rep. Pete Stark (D) of California, will put ``more substantial'' measures into the administration's health reform bill.
The Clinton health-care reform plan covers residential drug-abuse treatment for up to 30 days a year, or intensive non-residential care up to 60 days. Califano applauds this as an important step - the first time such treatment has been included in health legislation. But he would like to see the coverage expanded to include follow-up care after treatment and less stringent limits on the number of days of treatment.
Califano sees a battle ahead. ``People don't yet understand how substance abuse ripples through the health-care system, and other systems'' - such as the legal and education systems.
One problem, he says, is ``the little bit of stigma attached to drug abuse'' as a policy area. ``It's dirty,'' he explains. ``Cancer's OK. You can spend a fortune on that, but the cigarettes or alcohol ... don't spend money on that!''
Califano sees the tobacco industry facing major tests in bills to make all public buildings smoke-free and to hike the excise tax on a pack of cigarettes up to $2, far beyond the administration's proposed 75-cent hike. One version of the tax-hike measure was defeated last week in the House subcommittee on health. But a separate piece of legislation to boost the levy to $2, sponsored by Congressman Stark, is still alive.
``[A $2 cigarette tax] should be a slam dunk,'' says Califano. ``That's the one thing that would start to price cigarettes beyond the lunch money of these elementary school kids.''
And if kids can get through their teens without taking up smoking, he says, the US could eventually be a smoke-free society, since almost no one starts smoking in adulthood. Furthermore, says Califano, recent research has confirmed that tobacco use is closely tied to other drug use.