[Congressional Record Volume 148, Number 52 (Wednesday, May 1, 2002)]
[Senate]
[Pages S3594-S3595]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    THE FUTURE OF TEACHING HOSPITALS

  Mrs. CLINTON. I will speak on a very important issue that affects 
every single American. It affects people all over the world. That is, 
the future and viability of our teaching hospitals. We know we have the 
crown jewels of the global health care system in the teaching hospitals 
who train our doctors and nurses and provide research that gives 
breakthrough therapies and drugs that saves and lengthens lives. We 
know our teaching hospitals are often the treatment of last resort for 
the sickest of the sick and the poorest of the poor.
  Yet if we do not act by October of this year, our teaching hospitals 
nationwide will lose $700 million next year alone. I believe that would 
be a disastrous outcome. It certainly would undermine the ability of 
our teaching hospitals to continue to provide the funds in our health 
care system that all of our other hospitals, all of our entire health 
care infrastructure, rely upon.
  New York, because we have a plethora of first-class, world-renowned 
teaching hospitals, would lose about $230 million of that $700 million, 
with over half of that falling directly on our leading-edge teaching 
hospitals. In 1 year alone, New York teaching hospitals will lose $120 
million in Medicare payments because of the effects of the balanced 
budget amendment, which have slashed hospital reimbursements by $100 
billion more than the CBO originally estimated. That is a huge amount 
of money. It is often the difference between a hospital being able to 
continue to provide first-class service, training, and charity care, 
and having to shut departments, lay off people, and turn their backs, 
literally, on those who need the help. Congress has already softened 
and delayed some of those reimbursement cuts, including postponing the 
reductions in the so-called indirect medical education payments, 
sometimes referred to as IME.
  This October, the delay expires and Medicare will revert to the very 
harsh reimbursement levels that we all recognize cut much more deeply 
than anyone predicted. The cut would amount to an automatic 15-percent 
decrease in IME funding across the board, across all States. I oppose 
an automatic 15-percent decrease in home health payments, and I oppose 
such a decrease in medical education payments. That is why today a 
number of my colleagues and I are joining together to introduce a bill 
to call on the elimination of those cuts before they eliminate our 
academic medical centers.
  New York has a number of fine teaching hospitals. Everyone will 
recognize the names. It also has 60 rural hospitals, which is more than 
some rural States have altogether. I am always a little bit surprised 
when my colleagues and others do not understand that New York, with 19 
million-plus people, is not only the island of Manhattan or the five 
boroughs of New York City or the beaches of Long Island or the suburbs 
that I live in to the north. It is rolling countryside. It is dairy 
farms with 80, 100, 120 cows. It is apple growers with the orchards 
along the Great Lakes that form our northern and western borders. That 
is why I support a balanced package that will try to help both our 
teaching hospitals and our rural hospitals.
  I draw our attention to a provision in this legislation that deals 
directly with our great centers of biomedical innovation. If we go 
forward with the cuts as planned, I believe we set back the cause of 
clinical trials, of lab research that is going on right now that might 
hold out a cure for one of us or a loved one. Make no mistake, these 
cuts will not only close departments, lead to layoffs and furloughs of 
highly trained doctors, nurses, and other medical personnel, I believe 
it will also harm patients. If we do not act on the indirect medical 
education amounts we need to continue to function, the scheduled cuts 
will affect the quality of health care all over the country.

  It is not only New York that benefits from New York's teaching 
hospitals; our hospitals are filled with people from all over our 
Nation who are sent there because they cannot get what they need at 
home. We are proud of that. We have people from all over the world who 
come to New York's teaching hospitals. We train 20 percent of all 
physicians practicing in the United

[[Page S3595]]

States today. We provide both the medical education, the internship, 
the residency, the continuing education, that 20 percent of America's 
doctors take advantage of.
  I was surprised to learn that 14 percent of all of Arizona's doctors 
and 25 percent of Florida doctors were trained in New York. Moreover, 
the therapies developed and perfected in our academic medical centers 
offer hope to patients everywhere. Chances are, no matter where you 
live, you have been touched by the work that has occurred in a New York 
teaching hospital. We have been instrumental in developing treatments 
for heart disease, for HIV/AIDS, for developing the therapies on 
cardiac catheterization, the first to innovate new forms of laser 
surgery, and the new minimally invasive surgical methods.
  Many in this body support NIH funding. We want to double the amount 
of funding NIH has, but that funding is useless if the research grants 
cannot go to the top researchers to do the work we hope will come from 
additional NIH funding.
  The U.S. health care system delivers some of the highest quality care 
to be found anywhere. The reason that happens is because we have a 
partnership. We have our local community hospitals in small towns and 
rural areas. We have our larger hospitals in bigger cities in every 
State in the country. Then we have the so-called teaching hospitals 
that provide what is called tertiary care. When you are really sick, 
when you need extra special help, that is when everybody at home has 
said: There is nothing more we can do for you, go to Sloan-Kettering, 
go to New York Presbyterian, go to Mount Sinai. There is someone there 
who can give you the help you need. We are very proud to provide that 
service to our country.
  I hope we will be successful in the legislation we plan to introduce 
today to protect our academic medical centers. I am calling on our 
colleagues in both Houses to ensure the provision to eliminate these 
IME cuts in any Medicare package we enact this year. I hope what seems 
like an arcane, somewhat abstract issue, is understood as being the 
extremely important, critical concern that it is.
  If one looks at the number of physicians trained, the cures and 
therapies that have been invented, the last resort care that saves 
lives that others had given up on, there is no doubt that our teaching 
hospitals are absolutely essential to the quality of health care in 
America. We need to do everything we can to make sure they stay healthy 
and provide the kind of care we have come to take for granted.
  Mrs. CLINTON. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. REID. Madam President, I ask unanimous consent the order for the 
quorum call be dispensed with.
  The PRESIDING OFFICER (Mrs. Clinton). Without objection, it is so 
ordered.

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