also , it is related to , my understanding is yet so many other aspects come from this that you may find in such children also eating disorders and diabetes and cancer risks even if that child never themselves smoked cigarettes .  but the risks are huge .  i believe a direct and indirect medical cost of smoking in this nation is about $ 138 billion per year .  of course , another reason why i believe it is so important not only for the government but really for individuals and businesses to focus so much on helping to change that is the state of california , for example , estimates that their statewide tobacco prevention program during the 1990s resulted in overall cost savings of $ 8.4 billion in health care .  that is pretty remarkable .  again , unfortunately , the way the congress scores things with the congressional budget office , when we talk about starting programs that would actually save money , my colleagues are aware of this , we never can get an accurate measure of what it actually saved because of the way the cbo , the congressional budget office , scores things .  it is not how much you save , but how much you spend .  so if we would do similar things that would lead to a smoking cessation during pregnancy , and it might cost x number of dollars , the cbo would score that but never tell us how much money it would save over time .  that is something that frustrates all of us because the things we are talking here tonight really require some expenditures to get these savings .  businesses are picking up on this .  a recent review of health promotion and disease and management programs in businesses that provided health education to their employees , including exercise , health-risk screening , weight control , nutrition information , stress management , disease screening , and smoking cessation , found a significant return in investment , saved about $ 1.50 to about $ 5 for every dollar spent in the program .  for example , motorola , their wellness program saved the company about $ 4 for every dollar invested .  northeast utilities ' program in its first 24 months reduced some of the claims by about $ 1.4 billion .  caterpillar company , they had a program that saved about $ 700 million .  johnson and johnson 's health and wellness program saved about a couple hundred dollars per employee per year .  what is interesting here is how much we can save and what we have to look at here .  and i call upon my colleagues , we need to make some fundamental changes in how cbo scores these things .  we have got to stop just looking at how much it costs up front and look at how much it saves in the long run .  again , i look at such things as if we are able to have more people go to federally approved health centers , community health centers in their community instead of showing up in the emergency departments , yes , it may cost money ; the president called for a couple billion dollars to put into those community health centers .  but if it is one-fifth of the cost of going there rather than the cost of going to the emergency departments , that is a massive cost savings .  certainly i call upon my colleague , too , it is one of those things you have seen as well , how do we get these prevention issues begin to be scored .  it is of fundamental importance to health care .  