SECRETARY OF THE U.S. AIR FORCE, DONALD RICE, OFFERS A COMPREHENSIVE JUSTIFICATION FOR THE B-2 BOMBER, ARGUING THAT IT IS AN ESSENTIAL COMPONENT OF THE U.S. STRATEGIC TRIAD. WITHOUT THE B-2 THE U.S. BOMBER FORCE WILL DWINDLE. HE ARGUES THAT THE USSR WILL LACK THE CAPABILITY FOR A SURPRISE SLBM ATTACK. HE ALSO SUGGESTS THAT ESTIMATES OF THE COST OF THE B-2 ARE INFLATED.
Surveys have provided magnificent information about the health of the American people, but they rarely contribute to our understanding of how medical services affect people's health. The authors explore the opportunity to harness the medical services system to provide information that clarifies the relationship between people's health and the services they receive. They also note the risk posed by managed care-that competition and cost-cutting may pit the health industry against access to and standardization of health services data--but see hope in recent legislation.
OBJECTIVE: To estimate state-by-state totals of medical expenditures attributable to cigarette smoking for calendar year 1993. METHODS: The smoking-attributable fractions (SAFs) of total state medical expenditures, by type of expenditure, were estimated using a national model that describes the relationship between smoking and medical expenditures, controlling for a variety of sociodemographic, economic, and behavioral factors. Employing data from the Behavioral Risk Factor Surveillance System, the authors used the national model to estimate SAFs for the 50 states and the District of Columbia, then applied these SAFs to published state medical expenditures, by type of expenditures, to estimate total 1993 state medical expenditures attributable to smoking. National estimates are the sums of state estimates. RESULTS: In 1993, the estimated proportion of total medical expenditures attributable to smoking for the U.S. as a whole was 11.8%, with a range across states from 6.6% to 14.1%. By type of expenditure, SAFs ranged from a low of 8.0% for home health expenditures to a high of 15.9% for nursing home expenditures for the nation as a whole. Total U.S. medical expenditures attributable to smoking amounted to an estimated $72.7 billion in 1993 (95% interval estimate $48.0-$97.4 billion). Estimates of total smoking-attributable state medical expenditures (SAEs) ranged from $79.6 million to $8.72 billion. CONCLUSIONS: Cigarette smoking accounted for a substantial portion of state and national medical expenditures in 1993, with considerable variation among states. The range across states was due to differences in smoking prevalence, health status, other socioeconomic variables used in the model, and the magnitude and patterns of state medical expenditures.
