[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
[[Page S3968]]
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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