[Congressional Record Volume 150, Number 49 (Thursday, April 8, 2004)]
[Senate]
[Pages S3967-S3968]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      NATIONAL PUBLIC HEALTH WEEK

  Mr. DASCHLE. Madam President, I recently learned the story of a young 
Indian girl from South Dakota. Last year, when she began to lose weight 
and feel stomach pains, she traveled to a nearby Indian Health Service 
clinic. She was diagnosed with heartburn, and since IHS clinics often 
don't have the resources to treat patients unless their lives are at 
immediate risk, she was told to go home.
  Over the course of the next several months, as her condition 
worsened, she returned to the clinic several times only to be turned 
away each time. Because she was never given a full checkup, the clinic 
failed to discover that her symptoms were not caused by heartburn but 
by stomach cancer. By the time her condition became critical, it was 
too late. Her cancer had spread, and there was nothing any doctor could 
do. Not long afterward, she died.
  Perhaps the saddest aspect of this story is that it is another 
example of what happens each and every day. For Native Americans and 
other minority communities across the country, the miracles of modern 
medicine--and sometimes even the most basic primary care--are beyond 
their reach. The disparities within our health care system have reached 
a crisis point, and the consequences for America's minority communities 
are staggering.
  The death rate for African American cancer patients is 30 percent 
higher than for whites. African Americans are also one-and-a-half times 
more likely to have coverage for an emergency room visit denied. 
Hispanic Americans are more than twice as likely as whites to die from 
diabetes. American Indiana are 670 percent more likely to die from 
alcoholism and 650 percent more likely to die from tuberculosis.
  This sad litany of statistics goes on and on and it tells a story of 
a health care system that, for a significant and growing portion of our 
Nation, is simply broken.
  This week is National Public Health Week. Appropriately, the American 
Public Health Association has chosen to focus the Nation's attention 
this week on the disparities in our health care system and how we can 
fix them.
  I am grateful for its efforts. America faces few more important or 
complex challenges than building a world-class health care system for 
everyone, regardless of race, income, or geography. There are no quick 
fixes. The factors that have led to this two-tiered health system are 
complex and interrelated.
  Minorities are far less likely to have health insurance or a family 
doctor, making regular preventive visits less likely. And many of those 
who do have insurance report having little or no choice in where they 
seek care. Minority communities are more frequently exposed to 
environmental risks, such as polluted industrial areas, cheap older 
housing with lead paint, or asbestos-laden water pipes.
  For Hispanics, Native Americans, and others who do not speak English 
as a first language, the lack of translators and bilingual doctors 
makes it more difficult to communicate with doctors and nurses. The 
American Indian community has been forced to cope with a system 
suffering from decades of neglect and underfunding of the Indian Health 
Service.
  The IHS has consistently grown at a far slower rate than the rest of 
the HHS budget, and at only a fraction of health care inflation. As a 
result, sick people are turned away every day from IHS hospitals and 
clinics in this country unless they are in immediate danger of losing 
their life or a limb.
  Life or limb isn't a figure of speech at IHS clinics. It's an actual 
standard of care. IHS's funding crisis is not just in clinical 
services. Prevention efforts, facilities, personnel, mental health 
care, substance abuse programs, and contract support costs are all 
drastically underfunded, too.
  I have said this on the floor many times. Our country spends an 
average

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of $5,100 for every man, woman, and child in America. In every Federal 
prison, we spend an average of $3,800 for every prisoner. On every 
Indian reservation, we will spend $1,900 total for every man, woman, 
and child, one half of what we spend for Federal prisoners. So it is no 
wonder that people die at a rate hundreds of times greater on the 
reservation than they do anywhere else.
  America is obligated, by law and by treaty, to provide free health 
care for American Indians--a commitment the U.S. Government made to the 
Indian people in exchange for their lands. America is not honoring that 
commitment.
  The White House's budget this year included only $2.1 billion for IHS 
clinical services. That is more than 60 percent below the bare minimum 
needed to provide basic health care for people already in the IHS 
system.
  The problems run still deeper. Even when both groups have roughly the 
same insurance coverage, the same income, the same age and the same 
health conditions, minorities receive less aggressive and less 
effective care than white Americans.
  The racial and ethnic disparities in our health care system are not 
merely a minority issue or a health care issue. The high incidence of 
diabetes, asthma and other diseases among minorities as a result of 
this health care gap costs our Nation billions of dollars every year.
  But most importantly it is a moral issue. A health care system that 
provides lesser treatment for minorities offends every American 
principle of justice and equality. We have been promised that we would 
address these issues at some point in the future, but we have seen no 
action whatsoever. We have attempted to pass the Healthcare Equality 
and Accountability Act of 2003, and no action has yet been taken.
  This legislation would reduce health disparities and improve the 
quality of care for racial and ethnic minorities. The bill would expand 
health coverage by expanding eligibility and streamlining enrollment in 
Medicaid and the State Children's Health Insurance Program; it would 
remove language and cultural barriers by providing additional funding 
for cultural and language services; it would offer incentives to 
improve health workforce diversity; it would offer new funding to 
State, local, and tribal initiatives that take innovative approaches to 
reducing the disparities; and it would increase minority health 
research and data collection.
  The bill would also strengthen and hold accountable the government 
institutions responsible for ensuring health care equity. And finally, 
the bill would provide adequate funding for the Indian Health Service--
so that we can finally reach some adequate funding level and stop the 
shameful underfunding of Indian health needs.
  This legislation would represent a strong first step, moving us 
closer to the goal of ensuring equal access to quality health care.
  Last year, the majority leader said:

       Inequity is a cancer that can no longer be allowed to 
     fester in health care.

  I agree completely. We know what happens when cancer is allowed to 
spread.
  Too many Americans in minority communities have lost their lives 
because they are subjected to a two-tiered health care system that 
keeps them from getting the care they need. We cannot afford to wait 
any longer to confront the minority health gap in our country. 
Americans are asking for our leadership on a challenge that is quickly 
becoming a national emergency. We have an obligation to answer their 
call.
  I yield the floor.

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