[Congressional Record Volume 141, Number 77 (Wednesday, May 10, 1995)]
[Senate]
[Pages S6457-S6458]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
NONPROFIT HOSPITALS
Mr. SPECTER. Mr. President, many may believe that health care reform
is not an issue in the 104th Congress. But I have been advocating
reform in one form or another throughout my now 15 years in the Senate,
and I continue to do so. I have come to the floor on 14 occasions over
just the last 3 years to urge the Senate to address health care reform.
On the first day the Congress was in session in 1993 and again on the
first day in 1995, I introduced comprehensive health care legislation.
The Health Care Assurance Act of 1995, S. 18, which I introduced on
January 4 of this year, is comprised of reform initiatives that our
health care system needs and can adopt immediately. They are reforms
which can both improve access and affordability of coverage and health
care delivery and implement systemic changes to bring down the
escalating cost of care. Today, I again address my colleagues on the
issue of health care access. I want to bring to the Senate's attention
a particular component of our health care delivery system which is
uniquely poised to provide innovative services which respond to the
particular needs of individual communities, but which is in jeopardy--
nonprofit hospitals.
In my view it is indispensable that there be comprehensive
affordable, accessible health care for all Americans. I believe the
essential question is whether we have sufficient resources, that is
medical personnel and hospital, laboratory, diagnostic and
pharmaceutical facilities to deliver services. I think we do; and
nonprofit hospitals are an important resource of innovative, community-
based care. Well over 80 percent of the hospitals in this country have
been and are nonprofit institutions. Most nonprofits were founded
decades ago and arose from religiously or ethnically identified groups
and so were dedicated to serving a particular community. Most have
adhered to this dedication to community and all of them serve without
restriction or preference. There are approximately 80,000 voluntary
trustees, leaders in their respective communities giving freely of
their time, their energies, and their money to raise the level of
health care in those communities. However, I am concerned that recent
trends in the health care market, including the growth of large for-
profit hospital systems, and the emphasis on costs and profits of many
managed care organizations as they become economically dominant,
threaten the community health focus of nonprofit hospitals.
We stand at the threshold of dramatic breakthroughs in understanding,
preventing, and treating a variety of diseases. Clinical application of
the breakthroughs in research will yield wondrous results which will
alleviate
[[Page S6458]] human suffering, prolong life, and produce enormous
savings in medical costs in the United States. Nonprofit hospitals are
essential to the application of these breakthroughs for the prevention
and treatment of disease. The community outreach programs typical of
nonprofit hospitals demonstrate their dedication to the needs of their
particular communities. They are uniquely attuned to the most fiscally
and personally debilitating diseases of a community and
therefore provide the services for treatment and prevention most
demanded in the community. Prevention is the most successful method of
containing the costs associated with disease as it is the first step
toward controlling disease. But the health care system today appears to
be making it more difficult for the nonprofit community hospital to be
dedicated to prevention and accessible treatment for the survival of
patients.
While the demand to be competitive is increasing, hospitals'
resources are dwindling. Changes in the health care system have reduced
hospital occupancy, and have therefore reduced revenue. The Washington
Post reported on March 14, 1995, that hospitals have quadrupled the
number of out-patient surgical procedures and same-day procedures now
exceed the number requiring overnight stays. Health care experts cite
technological advances as well as cost-cutting efforts by insurance
companies as two key factors which have encouraged the growth in
outpatient services. For-profit hospitals tend to exclude those from
coverage and service who cannot afford to pay and minimize nonrevenue
generating outreach programs.
On the other hand, nonprofits are committed to their missions to
provide high-quality service, thus increasing expense, but not
necessarily increasing revenue. The limited revenues which once could
be used for outreach and prevention are being reallocated to meet
today's specialized care needs, and at the same time hospitals are
being forced to compete with one another to maintain their existence.
As we continue to discuss the reform of our health care system, we
must reconcile the two forces which drive provision of hospital care
today, that is profitability and quality. Hospitals should be able to
continue to operate as a community resource, to provide preventive
medicine, not only curative medicine. As I have said, prevention is the
most economical cure for what ails our health care system, that is
escalating costs for short- and long-term treatment. Prevention and
early detection are the most successful methods of controlling costs
associated with disease as they are the first steps toward preventing
the inevitable need for costly treatment incurred by disease.
In S. 18 I have taken such steps through streamlining the statutory
provisions related to the right to decline treatment, increasing
Federal support for clinical trials at the National Institutes of
Health, and increasing public health programs at the State and local
levels. I look forward to working and reconciling the competing forces
in our health care system today to ensure the continuation of
community-based and -focused prevention and treatment services, such as
those historically provided by nonprofit hospitals.
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