[Congressional Record Volume 140, Number 141 (Monday, October 3, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         ADDITIONAL STATEMENTS

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                        FAILURE, BY THE NUMBERS

 Mr. SIMON. Mr. President, the New York Times of September 24, 
1994, had an article by Paul Spector, president of the Institute for 
International Research, which my colleagues should read.
  It included some statistical comparisons in the United States with 
other countries.
  Let me mention just a few of those statistics:
  In Canada, seventh among the wealthy nations in life expectancy, the 
average life span is 77.2; in the United States, 18th among the 
nations, it is 75.6. These are all 1992 figures based on a United 
Nation's 1994 Human Development Report.
  The total expenditure on health care as a percentage of the gross 
domestic product [GDP]: Canada, 9.9 percent; United States, 13.3 
percent.
  Expenditure on health per capita: Canada, $1,847; United States, 
$2,932--1991 figures.
  In 1989, 14.1 percent of the Canadian population was admitted to a 
hospital, at one point or another; and in the United States, 13.7 
percent. This suggests that the image created of many Canadians being 
unable to get into hospitals is simply incorrect. And the next 
statistic is even more meaningful.
  In 1989, the median stay in hospitals in Canada was 11.4 days, and in 
the United States 6.5 days.
  In Canada, there is one physician for each 450 people; and in the 
United States, there is 1 physician for each 420 people.
  In addition to these figures, two other observations should be made.
  One is that the most recent poll I have seen shows only 3 percent of 
the people in Canada are willing to have a health care system like the 
United States. The second is that not a single Member of the Canadian 
Parliament has introduced a bill to repeal the Canadian health care 
system. If it were such a terrible system, I can assure you that 
politicians would be running over each other in Canada or any other 
democracy to try to repeal the system.
  I ask that the article be placed into the Record at this point 
together with the tables.
  The article follows:

               [From the New York Times, Sept. 24, 1994]

                        Failure, by the Numbers

  (The United States is the world's richest nation, and it spends far 
 more of its income on health care than any other. Yet people in other 
 countries live longer and get more care. Here is a partial listing of 
  nations where babies born in 1992 could expect to live 75 years or 
 more, according to the United Nations' 1994 Human Development Report)

                           (By Paul Spector)

       Arlington, Va.--Congress's dismal failure to approve even a 
     modest health care reform program cannot change one fact: in 
     every industrial nation but ours, universal health care has 
     become an inherent right. In the United States, 38 million 
     people lack health insurance, and health care for all but the 
     most privileged may be deteriorating.
       Americans fervently believe that the U.S. has the best 
     health care in the world. But we all need to be aware of the 
     data in the accompanying tables, which show that in fact we 
     have a lot of catching up to do with other nations.
       If Americans get the best health care in the world, that is 
     not reflected in our average life expectancy, which ranks 
     behind 17 other nations. Life expectancy is not solely a 
     function of health care, of course; factors like diet and 
     highway fatalities push a nation's average up or down. But it 
     is widely accepted as the best proxy.
       Table I--a partial list of the 22 countries with a life 
     expectancy of 75 years or better for people born in 1992--
     shows that even though the U.S. is the world's richest nation 
     in terms of real gross domestic product per person, we can 
     expect shorter lives than nations with a total population of 
     450 million.
       And Table II shows that other industrial countries deliver 
     more health care than we do. From 1972 to 1989, for example, 
     hospital use went up in 19 of the 22 nations. It went down in 
     only three: Canada, Italy (not shown) and the United States. 
     In 1989, the average stay in countries for which data were 
     available was twice as long as in ours: 12.9 days compared to 
     6.5 days. Hospitalization is not necessarily an index of the 
     quality of care. Still, the numbers make it clear other 
     nations provide more care than we do.

                                          LIFE SPAN, HEALTH AND WEALTH
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                                                         Life                   Real
                                                      expectancy  Population   G.D.P.      Total     Expenditure
        Countries in order of life expectancy          at birth,      in         per    expenditure   on health
                                                       1992, in    millions,   capita,   on health,  per capita,
                                                         years       1992       1991    % of G.D.P.      1991
----------------------------------------------------------------------------------------------------------------
1 Japan.............................................       78.6       124.5    $19,390         6.8       $1,771
4 Sweden............................................       77.7         8.6     17,490         8.8        2,372
5 Spain.............................................       77.4        39.1     12,670         6.5          877
6 Greece............................................       77.3        10.2      7,680         4.8          274
7 Canada............................................       77.2        27.4     19,320         9.9        1,847
8 Netherlands.......................................       77.2        15.2     16,820         8.7        1,664
11 Australia........................................       76.7        17.6     16,680         8.6        1,466
12 France...........................................       76.6        57.1     18,430         9.1        1,912
13 Israel...........................................       76.2         5.1     13,460         4.2          509
14 U.K..............................................       75.8        57.7     16,340         6.6        1,003
17 Germany..........................................       75.6        80.2     19,770         9.1        1,782
18 U.S..............................................       75.6       255.2     22,330        13.3        2,932
22 Ireland..........................................       75.0         3.5     11,430         8.0          886
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                                                               GIVING CARE, AND GETTING IT
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                                                            1972          1989                        1960          1989                        1990
                                                          hospital      hospital      1989 mean    psychiatric   psychiatric  1989 nursing   population
                                                        admissions *  admissions *  stay in days      beds          beds        home beds    per doctor
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Japan.................................................           5.6           8.1          44.9        95,067       355,743            NA           610
Sweden................................................          18.1          19.6            NA        18,588        15,539        74,400           370
Spain.................................................           7.7           9.7          12.7        32,741        29,634        47,916           280
Greece................................................          10.9          12.6          10.0         7,930        11,371         3,100           580
Canada................................................          16.8          14.1          11.4            NA            NA       232,520           450
Netherlands...........................................          10.8          11.0            NA            NA        24,466        51,110           410
Australia.............................................          21.8          23.0           5.4            NA         9,822        74,779           440
France................................................          14.9          22.8            NA            NA        99,942            NA           350
Israel................................................            NA            NA            NA            NA            NA        65,941           350
U.K...................................................          12.0          15.9            NA            NA        85,695        78,300           710
Germany...............................................          15.9          21.5            NA        51,209       103,987       587,226           370
U.S...................................................          15.8          13.7           6.5       722,000       161,000       456,000           420
Ireland...............................................          13.7          15.2           6.9            NA         9,041        17,952          681
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Not shown: Iceland (No. 2), Switzerland (3), Italy (9), Norway (10), Austria (15), Belgium (16), Finland (19), Denmark (20), New Zealand (21).
 
* People admitted as a percentage of population.
 
Sources: U.N. Development Program; Organization for Economic Cooperation and Development.

       From 1960 to 1989, the number of psychiatric beds in the 
     U.S. fell from 722,000 to 161,000. The rationale was that 
     most mental patients did not belong in costly and restrictive 
     state hospitals, that they could get better care in community 
     mental health centers and group homes. But in too many cases, 
     these promised alternatives never materialized, and mental 
     patients ended up on the street. Other countries have taken a 
     different path: Japan, for instance, increased its capacity 
     274 percent in the same period, from 95,000 beds to more than 
     355,000; Germany doubled its capacity. And homelessness in 
     those countries is negligible.
       Another telling indicator is care of the elderly. Canada, 
     with one-ninth of our population, has fully half as many 
     nursing home beds as we do. Germany, with one-third of our 
     population, has 29 percent more. Israel has one bed for every 
     77 people; we have one for every 560.
       Yet all these countries manage to spend considerably less 
     on health care than we do. The average health expenditure per 
     person in the 21 other nations was $1,603 a year in 1991; in 
     the U.S. it was $2,932. Multiply the difference, $1,329, by 
     our population of 250 million, and the total comes to $330 
     billion a year--a third of our total health care bill.
       Why do we spend so much for less service and shorter life 
     expectancy? A big part of the explanation is overhead, 
     inefficiency, waste and even outright fraud. The insurance 
     industry dominates health care in the U.S. as it does in no 
     other country. The administrative cost of health care in this 
     country is about 25 percent; in Canada it is about 10 
     percent. Average U.S. insurance company overhead is 14 
     percent--more than three times the overhead for Medicare and 
     Medicaid, our much-maligned Government health programs for 
     the elderly, poor and disabled.
       We can't install a Canadian-style Government plan 
     immediately without disrupting the entire health care 
     industry. But future administrations and Congresses will have 
     no choice but to move in that direction.
       The failure to write the insurance industry out of our 
     health care system is not just a matter of saving money. It 
     is leading to inferior care and shortened lives. Our 
     predicament is as clear as the numbers in these two charts. 
     Our people feel it, and eventually they will come to know 
     it.

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