[Congressional Record Volume 140, Number 7 (Wednesday, February 2, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: February 2, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           HEALTH CARE REFORM

                                 ______


                      HON. JAMES A. TRAFICANT, JR.

                                of ohio

                    in the house of representatives

                      Wednesday, February 2, 1994

  Mr. TRAFICANT. Mr. Speaker, I would like to insert the following 
testimony into the Record. The following statement is a summary of my 
views on health care reform, given before the Subcommittee on Health 
and the Environment on February 2, 1994.
  While recent reports suggests health care inflation is the lowest 
it's been in a decade, medical spending is expected to top $1 trillion 
dollars in 1994, with or without the enactment of a national health 
care plan. I believe wholeheartedly that every American should have 
access to affordable as well as responsible health care. My top concern 
in the consideration of a comprehensive health care reform package is 
the funding mechanism. The bottom line is, who's going to pay for it?
  The Department of Labor recently reported that, for the average 
American worker making $12.68 an hour, an employer has to come up with 
$5.20 in benefits. That's a 41-percent expenditure in addition to the 
average worker's pay, or $15,256 a year, according to U.S. Chamber of 
Commerce statistics. This trend is even higher for the Government and 
big business. I caution Members of Congress to be careful that we don't 
win the battle for health care and lose jobs in the process.
  I believe that any health plan considered by Congress should address 
the following: First, coverage, or incentive for the insurance industry 
to cover, the Nation's 37 million uninsured and underinsured.
  Second, Medicare waste and fraud must be eradicated. Fraud may 
account for $75 billion of America's annual health care expenditures.
  Third, tort reform. Physicians must cease the practice of providing 
unnecessary care which adds an additional $21 billion to the U.S. 
health care bill every year.
  Fourth, an emphasis on preventative care. The excessive costs of 
catastrophic care can be greatly deflated through early testing, 
nutrition counseling and education, prenatal care, et cetera.
  Finally, I strongly believe a comprehensive health care reform 
package should firmly address and provide for three additional 
provisions: First, it's a well-known fact that shifting the emphasis in 
the physician work force from specialists to generalists will improve 
access to health care and cut costs. In fact, the Council on Graduate 
Medical Education [COGME] under the Department of Health and Human 
Services has issued an extensive report supporting this fact called, 
``Improving Access to Health Care Through Physician Workforce Reform: 
Directions for the 21st Century.''
  America is in need of more primary care physicians. As a result, I 
have introduced H.R. 3220, the Health Professions Education 
Availability Act of 1993, to emphasize training in primary care 
education and to encourage students to enter a field in primary care. 
At this time, I would like to summarize COGME's findings on this issue.
  First, the growing shortage of practicing generalists; that is, 
family physicians, general internists, and general pediatricians, will 
be greatly aggravated by the growing percentage of medical school 
graduates who plan to specialize. The expansion of managed care and 
provision of universal care will only further increase the demand for 
generalist physicians.
  Second, increasing specialization in U.S. health care escalates 
health care costs, results in fragmentation of services, and increases 
the discrepancy between numbers of rural and urban physicians.

  Third, a rational health care system must be based upon an 
infrastructure consisting of a majority of generalist physicians 
trained to provide quality primary care and an appropriate mix of other 
specialists to meet health care needs. Today, other specialists provide 
a significant amount of primary care. However, physicians who are 
trained, practice, and receive continuing education in the generalist 
disciplines provide more cost-effective care than nonprimary care 
specialists.
  In its first report in 1988, COGME recommended increased numbers of 
physicians in family practice and general internal medicine to assist 
in meeting the problems of access to primary care services. However, 
interest by medical school graduates is rapidly increasing in 
procedurally oriented specialties, and similarly, interest in primary 
care is declining dramatically among U.S. medical students. Should 
these current trends continue we can conclude that primary care 
services will increasingly be provided by specialists who have had 
little or no education for primary care. Moreover, primary care 
provided by specialists can be expected to cost more. And finally, 
while an overall increase in the total physician-to-population ratio 
would further hinder efforts to reduce costs, an oversupply of 
specialists would be more costly than would an oversupply of 
generalists.
  The truth is, the medical education system must respond today to the 
Nation's health care and physician work force needs in the 21st 
century. These include the need for more minority and generalist 
physicians, more primary care research, and increased access to primary 
care, particularly in underserved rural and urban communities. Changes 
in the institutional mission, goals, admissions policies and curriculum 
are necessary to respond to these needs. My bill, H.R. 3220, does not 
increase the overall medical student population, rather, it directs 
health professions schools respond to the need for more minority and 
generalist physicians by shifting the current trends in the physician 
work force.
  Specifically, under H.R. 3220, a grant or contract to a health 
professions school can only be awarded if the school agrees to 
emphasize training in primary health care and encourage the students of 
the school to enter a field of primary health care as a career choice.
  Furthermore, foreign students are often accepted over American and 
legal alien students. As a result, America is exporting one of our 
greatest national resources--education--and taking away opportunities 
from qualified minority students. Under H.R. 3220, a grant or contract 
to a health professions school can be awarded only if the school agrees 
that, in considering applications for admission to the programs of 
health professions education operated by the school, the school will 
admit an individual who is not a citizen or permanent resident alien of 
the United States only if no qualified applicant who is such a citizen 
or alien is seeking admission.
  The final vote on health care reform legislation will usher a new era 
of health care for all Americans. It's time to prepare our physician 
work force for the 21st century, improve access, and cut costs.
  Second, of the 80 million Americans who suffer from chronic back pain 
each year, 4 out of 5 cases could have been prevented. Back problems 
are the most common work injury today, usually striking people between 
the ages of 20 and 50. According to ``The Power of Pain'' by Shirly 
Kraus, 100 million Americans are either permanently disabled or are 
less productive due to back pain. And those who work lose about 5 work 
days per year, a productivity loss of $55 billion.
  Evidence now suggests that a significant number of these ``failed 
backs'' are cases of adhesive arachnoiditis resulting from a myelogram, 
a diagnostic procedure that precedes surgery. In a myelogram, a 
radiopaque dye is injected into the spinal subarachnoid space. After 
the x ray, as much of the oil as possible is withdrawn. However, the 
amount left behind often causes irritation and leads to arachnoiditis, 
an inflammation of the subarachnoid.

  Symptoms of arachnoiditis include chronic nerve pain and a burning 
sensation which may attack the back, groin, leg, knee, or foot and can 
result in loss of movement of almost total disability. Other symptoms 
include bladder, bowel, thyroid, and sexual disfunction.
  Harry Feffer, professor of orthopedic surgery at George Washington 
University states that patients who have had two or more myelograms 
stand a 50-percent chance of developing arachnoiditis. Furthermore, 
animal studies confirm the devastating effect of Pantopaque, an oil-
based contrast medium, on the myelin sheath and nerve cells.
  For several years, Members of Congress have repeatedly asked the Food 
and Drug Administration [FDA] to recall the use of Pantopaque. In 1987, 
Alcon, a subsidiary of Eastman Kodak, voluntarily stopped producing the 
drug due to public pressure. Pantopaque has a 5-year shelf date. The 
last batch of the drug was due to expire April 1, 1992. However, use of 
Pantopaque has continued, with reported usage as recent as September 
1993. This evidence leads me to believe that Kodak is once again 
manufacturing Pantopaque. One final point I would like members of the 
committee to know is that Pantopaque is still commonly used in 
veterans' and military hospitals across the Nation.
  The bottom line is, the FDA clearly has not reviewed the safety of 
Pantopaque as well as water-based dyes, in spite of medical evidence. 
My bill H.R. 2079, would recall the use of Pantopaque, Amipaque, 
Omipaque, and Isovue in the myelogram procedure. My bill does not ban 
myelograms altogether, nor does it ban the use of these dyes outside 
the myelogram procedure.
  I understand that my bill, as written, is stringent. However, I would 
be willing to make compromises, wherever necessary, based on committee 
findings. To this end, I have called for a hearing in the Subcommittee 
on Health and Environmental which would include the participation of 
medical experts, the FDA, and sufferers of this disabling condition. It 
is through committee hearings on this issue, which are well overdue, 
that I hope we can be educated, come to an agreement, and move forward 
to address the cause of these new cases of needless suffering every 
year.
  Additionally, H.R. 2079 provides for a thorough Government study that 
would determine the number of Americans suffering from myelogram-
related arachnoiditis and would explore medical findings showing this 
cause-and-effect relationship.
  As I have previously mentioned, every year chronic back pain is 
responsible for billions of dollars in lost revenues and millions of 
dollars added to the Nation's health care bill. Unfortunately, people 
who develop arachnoiditis eventually become totally disabled and cannot 
work at all. They become permanent fixtures on the rolls of Social 
Security, disability, welfare, Medicaid, and Medicare. As we undertake 
the reform of health care in America, it's time to protect unsuspecting 
Americans from this debilitating and preventable condition.
  Third, studies show 20 percent or more of total medical costs go to 
maintain our current recordkeeping system. The average hospital 
shuffles 5 million pieces of paper a year. A health card is inevitable.
  No Federal laws protect the privacy of medical records except those 
related to treatment for drug and alcohol abuse and psychiatric care, 
and few States have medical privacy laws. A health card could be used 
for numerous nonmedical purposes. For example, a prospective employer 
could discover that your family has a history of heart disease and 
decide not to hire you. And as history has shown, during times of 
perceived crises, the Government can and often does trample on 
individual liberty.

  I have an amendment to the Clinton health care reform legislation 
that will protect consumers and cut Government waste. My amendment 
proposes to combine the health card and Social Security card into a 
dual purpose card. All persons with access to medical or Social 
Security information should have a feature in their system that would 
block personal identifiers as well as block the use of Social Security 
or medical benefits should an individual qualify for one of the 
benefits and not the other.
  Furthermore, based on the principle that people have the right to 
control information about themselves, information collected should not 
be used for surveys or polls without an individual's consent. Likewise, 
information that needs to be shared between agencies, companies, 
hospitals, et cetera should be stripped of all personal identification, 
such a name, address, et cetera, unless the information is vital or 
needed in case of emergency.
  Ideally, we should be trusted as citizens to maintain our own medical 
database, much as we do our own credit card. Medical information could 
be backed up in an encrypted form at a private database company of 
choice. Doctors or hospitals could have access to this information with 
patient approval, or in case of an emergency.
  My amendment also provides for an analysis of database companies 
currently able to provide this service or convert easily and what the 
conversion time factor would be. Under the study, an estimated cost to 
individuals should they want their records maintained, as well as the 
cost of a Government program that would subsidize or cover these costs 
for individuals who cannot afford to maintain their records but wish to 
do so. An analysis of projected participation and the cost to the 
Government is also included.

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