[Congressional Record Volume 145, Number 140 (Friday, October 15, 1999)]
[Senate]
[Page S12726]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     SUPPORT OUR TEACHING HOSPITALS

 Mr. BIDEN. Mr. President, I rise today to express my strong 
support for this country's teaching hospitals.
  These institutions provide the critical experiences of internship and 
residency by which raw medical school graduates, who have learned the 
science of medicine, are converted into seasoned physicians who have 
learned the art and practice of medicine. We are all going to face 
illness at one time or another in our lives, and we want to make sure 
that there will be well-educated, conscientious, and compassionate 
physicians to care for us during those periods. The critical role of 
the teaching hospitals in molding the doctors of the future cannot be 
overestimated.
  These teaching hospitals also serve as key participants in the 
medical research advances from which we all benefit enormously. We tend 
to forget that medicine is a relatively young science. Antibiotics, 
which we all take for granted, have been in use for only about 50 
years. Heart bypass surgery and kidney transplants, procedures so 
commonplace that we hardly give them a second thought, were virtually 
unheard of 40 years ago. These and other medical advances have led to a 
tremendous increase in life expectancy in this country over the past 
100 years. Yet all of these innovations would have been virtually 
impossible without the ongoing participation of teaching hospitals in 
programs of medical research and development.
  Finally, these teaching hospitals provide a tremendous service to our 
communities. For many of the most vulnerable among us, the teaching 
hospitals represent their major, and often only, source of medical 
care. The homeless, the indigent, the elderly, the new arrivals to our 
country: for many in these groups, there would be no medical care at 
all if not for the care provided by the teaching hospitals, such as 
Christiana Care in my home state of Delaware.
  So we should all agree that teaching hospitals are an absolutely 
essential resource for our society; we don't want to go back to 19th 
century medicine, we want to move ahead to 21st century medicine.
  But there is a problem: the teaching hospitals' financial 
underpinning has become very precarious, and a number of the most 
reknowned teaching hospitals in this country are now losing money each 
year. We have come somewhat late to the unsurprising realization that 
the time and resources which the teaching hospitals devote to the 
education of future physicians, the research we need for better and 
healthier lives, and the care of the indigent and working poor, costs a 
lot of money.
  These costs are going up every year for our teaching hospitals: new 
technology costs money, dedicated employees must be paid a living wage, 
and so forth. But the income of teaching hospitals is not coming close 
to matching these cost increases. Health insurance companies are 
reducing their payments to health care providers, including teaching 
hospitals. Teaching hospitals, with their obligatory high costs, are 
not able to compete financially for contracts to take care of HMO 
patients. A significant percentage of teaching hospital costs has been 
paid in the past by Medicare, but as Medicare finds itself facing 
future insolvency, its payment to teaching hospitals for training 
interns and residents has also declined. We in Congress contributed to 
the decline in teaching hospitals' income with several provisions in 
the Balanced Budget Act of 1997, particularly the reductions in 
payments for indirect medical education and disproportionate share 
hospitals.
  Everybody who gets health care in this country benefits from the work 
of teaching hospitals, but in the face of the financial straits that 
have overwhelmed our health care system, nobody wants to pay for them.
  Mr. President, it is absolutely essential that this country's 
teaching hospitals remain vital and viable. Medicare may no longer be 
in a position to continue paying a disproportionately large share of 
teaching hospital expenses. In the long run, we must carefully 
reevaluate the funding mechanism for teaching hospitals to ensure their 
stability; if we all benefit from them, then perhaps we should all pay 
part of their costs.
  These long-term changes are important, but we in the Senate must also 
be concerned about the here and now. Teaching hospitals that are 
currently losing money may not be able to wait for the ``long run''; 
they need help in the next few months. Senator Daschle has just 
introduced the Medicare Beneficiary Access to Care Act, which contains 
provisions that would benefit the teaching hospitals and their 
patients, and I understand that the Senate Finance Committee is 
currently working on proposals to address some unintended consequences 
of the Balanced Budget Act of 1997, including those that have impacted 
on teaching hospitals.
  But time is of the essence, and the key word is urgency. Next year 
may be too late. The Senate is working furiously to pass the necessary 
appropriations bills in the few legislative days we have remaining this 
session, but I implore my colleagues not to move to adjournment until 
we take action to make sure that the teaching hospitals will still be 
around next session. The teaching hospitals spend 24 hours a day, 365 
days a year, working to make sure we live long and healthy lives, and 
it's time for us to return the favor. If we don't have enough time this 
session to complete the necessary major surgery on the payment system 
for teaching hospitals, the least we can do is set aside the few hours 
or days it would take to administer a little life-saving financial 
CPR.

                          ____________________