[Congressional Record Volume 140, Number 127 (Tuesday, September 13, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: September 13, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]


                              {time}  1050
 
                      HEALTH CARE FOR RURAL AREAS

  The SPEAKER pro tempore (Mr. Bacchus of Florida). Under the Speaker's 
announced policy of February 11, 1994, and June 10, 1994, the gentleman 
from Colorado [Mr. Hefley] is recognized during morning business for 5 
minutes.
  Mr. HEFLEY. Mr. Speaker, one of the almost forgotten areas of the 
health care debate is America's rural areas. I see our rural areas as 
the first test--the canary in the coal mine, if you will--of health 
care reform's success. I say that for two reasons.
  First, rural areas are most vulnerable to Government mandates. 
Minimum wages, Davis-Bacon requirements, and other Federal laws raise 
the cost of labor and hurt rural economies.
  Bill Clinton's employer mandate will have the same effect. A wage tax 
on employers, like the one included in the President's bill, will 
impact areas with low costs and labor intensive jobs--rural areas, in 
other words--the most. Employers in these areas don't have the 
resources necessary to cope with another wage tax. In the end, people 
will lose their jobs.
  Second, rural health care problems pose the greatest challenge to 
health care reform. Rural areas have large populations of uninsured, 
low-income people. If Bill Clinton is going to live up to his promise 
of universal coverage, he will have to solve the health concerns of 
rural areas.
  In that respect, I have before me a study conducted by the National 
Center for Policy Analysis conducted in 1991 which looks at rural 
health care availability around the world.
  One conclusion I draw from this study is that rural health care 
concerns are universal. The problems facing my constituents in eastern 
Colorado are similar to those experienced in rural Canada or England--
limited access, no specialists, poor equipment, etc.
  The other conclusion I draw is that national health care is no 
solution to rural health care's problems. Consider the following 
findings:
  People living in British Columbia's two largest cities receive 55 
percent more specialists' services per capita than rural residents. 
British Columbia's urban residents are 5\1/2\ times more likely to 
receive services from a thoracic surgeon, 3\1/2\ times more likely to 
see a psychiatrist, and 2\1/2\ times more likely to receive services 
from a dermatologist, an anesthesiologist, or a plastic surgeon.
  After 40 years of national health care, people in rural England still 
have to travel to urban areas to access CAT scans and other modern 
medical technology.
  In Norway, residents of Oslo are 15 times more likely to see a 
specialist than people living in the northern part of the country.
  In Brazil's free health care system, urban residents see doctors nine 
times more often than rural residents.
  Venezuela promises free health care to everyone, but all of 
Venezuela's free health care clinics are located in large cities.
  In Mexico, where free health care is a constitutional right, 85 
percent of the health care resources are consumed by 35 percent of the 
population, mostly residing in large cities.
  In other words, national health care does not solve the problems 
facing rural areas. Not only do rural areas remain underserved, but the 
quality of care in general deteriorates in these countries.
  Consider that both Canada and England have severely limited the 
access, of both rural and urban citizens, to such life saving 
procedures as open heart surgery and brain scans.
  For example, a Canadian is one-third as likely to have access to open 
heart surgery and one-eighth as likely to obtain a brain scan as an 
American.
  In England, which invented the CAT scanner and coinvented renal 
dialysis, has the fewest number of CAT scanners per person and one of 
the lowest dialysis rates in Europe.
  In Ontario, hospitals shut down their beds and operating rooms to 
meet severe government-imposed spending cuts last year during the 
holiday season.
  To save money, Canada is continuing the process of delisting certain 
cancer and other life saving services. Once they are delisted, 
Canadians must travel to the United States to receive these treatments.
  For Canadians and the English, national health care means lower 
quality and less quantity for everyone. For people in rural areas, they 
face a double whammy.
  Like their American cousins, living in rural areas means they have 
less access to health care. Unlike their American cousins, living in 
countries with national health care means the care they do receive is 
rationed and of lower quality.
  Rural areas pose special problems that we need to tackle in order to 
ensure quality health care for our rural populations. For the reasons I 
stated above, however, increasing the role of government in our health 
care system is not the solution.
  To the contrary, the record is clear that excessive government 
involvement in health care exacerbates the problems of rural areas, 
lowering access to care while reducing quality. To suggest otherwise is 
to ignore the experiences of Canada, England, and other countries that 
have experimented with national health care.

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