[Congressional Record Volume 150, Number 118 (Monday, September 27, 2004)]
[Senate]
[Pages S9692-S9695]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         HEALTH CARE IN AMERICA

  Mr. FRIST. Mr. President, I rise to speak on an issue we discussed 
last week that I will shed further light on, which is the broad topic 
of health care in America. I listened last week with some 
disappointment to the comments made in the Senate by the distinguished 
Democratic leader regarding health care costs. The senior Senator from 
Massachusetts repeated some of the Democratic leader's critique of the 
President's policies on health care. Because both of my colleagues left 
an incomplete picture, I take a moment to step back and give a more 
realistic assessment of where we are today and where we should be 
going.
  America has the best doctors, the best nurses, the best hospitals, 
the best medical technology, the best medical breakthrough medicines in 
the world. There is absolutely no reason we should not have in this 
country the best health care in the world. The time has come for common 
sense--not Washington--to determine how patients interact with doctors 
and with hospitals. The time has come for health care professionals, 
not Government or HMO bureaucrats, to make health care decisions. The 
time has come to put patients and consumers back in charge.
  Under the leadership of President Bush, we have taken measurable, 
concrete steps toward making quality health care more affordable, more 
available, and more reliable. Although much work remains to be done, a 
comprehensive, independent study confirms that we are, indeed, moving 
in the right direction.
  One report released last week by the highly valued Lewin Group 
examined the costs of health care proposals put forward by President 
Bush and by Senator John Kerry. This is the second nonpartisan 
independent analysis in recent weeks to compare the Presidential 
candidates' proposals side by side. It is the second independent study 
to find that the price tag of Senator Kerry's plan is twice--two 
times--what he claims. The Lewin Group study finds Senator Kerry's 
proposals would cost $1.25 trillion--not billion but trillion--over the 
next 10 years and still leave 20 million Americans uninsured. This is 
similar to the findings of another independent study released 2 weeks 
ago by the nonpartisan American Enterprise Institute. That study put 
the price tag of Senator Kerry's plan at $1.5 trillion.
  We all know it is difficult and, yes, next to impossible to project 
the accurate cost of major Federal Government programs. We know all too 
well Washington has that annoying habit of underestimating the cost of 
just about everything it does and sticking taxpayers at the end of the 
day with that tab. However, if these two independent studies are even 
mildly accurate, Senator Kerry's estimates are off by half a trillion. 
Let me say that again: Senator Kerry's estimates for his health care 
proposals are off by half a trillion dollars. Talk about fuzzy math. To 
put that in perspective, that is more than the cost of the WIC Program, 
the Low Income Energy Assistance Program, the Ryan White Program, and 
the School Lunch Program combined. In

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fact, it is more than the annual cost of the entire Medicare Program 
today.
  So we are left with the perennial question, how will Senator Kerry 
pay for all of this? Who is going to get stuck with the tab this time? 
For starters, nearly all of the tax relief passed by Congress during 
the past 2 years would have to be repealed--all of that tax relief: No 
more marriage penalty relief; no more child tax credit; no more middle-
class tax relief; no more death tax reduction. That means if you are a 
taxpayer, you will be paying a lot more and keeping a lot less of your 
hard-earned dollars. Yet still today Senator Kerry is telling the 
American people that his health care plan will save you money.

  As a doctor, as a Senator, I am here to tell you it simply won't. For 
starters, he would have to raise an average of $1,115 per family in 
taxes for his proposal--unless, of course, he plans to add $1 trillion 
to the deficit. As a defender of the American taxpayer, both options 
are unacceptable. American families simply deserve better. This is one 
Washington-imposed solution we do not need. When it comes to health 
care, as a matter of principle, it should be about you. It should be 
about your doctor; it should be about your hospital, period. It should 
focus on you, the patient, the consumer. Senator Kerry's proposal is 
not a prescription for progress; it is a prescription for more 
Government-controlled health care.
  Consider another finding from the Lewin report released last week. 
More than 21 million of the 25.2 million who would get health insurance 
under the Kerry plan would be forced into the Government-run Medicaid 
Program. As we all know, and it has been documented again and again, 
expanding Government-controlled programs can force people with good 
private health insurance coverage to lose it. In fact, an analysis 
released by the National Center for Policy Analysis concludes that 8 
million people who are currently privately insured will lose this 
private coverage because of Senator Kerry's expansion of Medicaid. This 
is plain wrong. America deserves better.
  In sharp contrast, we have the policy of President Bush, including 
those already enacted by this body and by Congress. They are focused on 
the patient. They are focused on the consumer. They are focused on you. 
As a matter of principle, we believe patients should be able to see the 
right doctor at the right time. As a matter of principle, we believe 
nothing should interfere with that doctor-patient relationship. As a 
matter of principle, we believe all Americans deserve affordable, 
available, and reliable quality health care.
  Health care costs are soaring. We must address the root causes of 
these soaring costs. There are countless commonsense reforms we can 
pursue today to control your rising health care costs. At the top of 
that list is a reform all Americans can agree upon. We need to reel in 
personal injury trial lawyers whose frivolous lawsuits are crippling 
health care in communities all across America. The fact is, too many 
lawyers and too many frivolous lawsuits are making medicine much too 
expensive. This lawsuit abuse is driving good doctors out of practice 
and discouraging our very best and our very brightest from entering the 
profession. Doctors literally today are telling their children: Because 
of lawsuit abuse now and in the future, maybe it is best that you not 
even enter the profession of medicine. That presents a crisis.
  Worse yet, lawsuit abuse is now threatening people's access to 
critical health service and is occurring in communities all across 
America. Did you know there are countless counties across this country 
where Americans no longer have access to their obstetricians to deliver 
babies? There are counties across this country where Americans no 
longer have access to trauma centers. Can you imagine?

  According to the American Medical Association, this situation has 
reached true crisis proportions in 20 States, and that includes some of 
the most populous States in this country: Florida, Ohio, Pennsylvania, 
New York. Families in these States are not getting the quality care 
they deserve. I will tell you why. Out-of-control litigation is leading 
to out-of-control medical liability premiums, which leads to out-of-
control costs. Too many doctors are being forced to close their doors 
simply because they can no longer afford to keep the insurance to keep 
their doors open.
  If you have no doctor, that ultimately means no care; it means loss 
of access; it means loss of availability of care. If you want your baby 
delivered, it means an obstetrician may not be around. If you have an 
accident driving home from work today, the trauma center may not be 
open. That is a crisis. It is a crisis of cost; it is a crisis of 
access; it is a crisis of availability; it is a crisis of reliability.
  Mr. President, I ask unanimous consent to have printed in the Record 
a recent article.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               [From American Medical News, May 3, 2004]

              Liability Crisis Ends Century of Deliveries

                           (By Tanya Albert)

       Perhaps one day the children of family physicians Jim 
     Schwieterman, MD, and Tom Schwieterman, MD, will pick up 
     where medical liability rates have forced the brothers to 
     leave off.
       The duo is scheduled to deliver their last baby in 
     September, stopping a more than 100-year run of their family 
     bringing children into the world in Mercer County, Ohio.
       An in an ending that wouldn't have been more perfect if 
     Hollywood had written the script, the brothers' last delivery 
     will be the baby of a woman their father delivered.
       The grandfather delivered the woman's mother. And the 
     doctors' great-grandfather who founded the Maria Stein, Ohio, 
     family practice, delivered the woman's grandmother.
       But the Schwietermans--who their patients call Dr. Jim and 
     Dr. Tom--don't want people to interpret their fate as a 
     ``woe-is-me'' story.
       They are saddened that they're being forced to give up a 
     part of their practice that they love. But they'll continue 
     to provide the cradle-to-grave primary care that patients in 
     their rural county of 40,924 need.
       They're telling their story because they worry that 
     patients who need obstetrical care may not be able to get it 
     in the future.
       ``Something is wrong when a legal situation is preventing 
     us . . . from doing a service for very little income and when 
     we have good outcomes,'' Dr. Tom said.
       The brothers want people to know that even rural doctors in 
     a practice with no lawsuit payouts in more than 100 years can 
     be forced to cut back services to patients because of 
     unaffordable medical liability rates. Only one lawsuit has 
     ever been filed against the practice, and it was dropped a 
     few days later.
       ``We've fallen victim to another outside force,'' Dr. Jim 
     said.


                           the outside forces

       Maria Stein's small-town atmosphere hasn't changed much 
     over the years, Dr. Jim's and Dr. Tom's father, Don 
     Schwieterman, MD, said.
       Churches still stand in the community of crossroads. And 
     Dr. Don said the town still clings tight to the values of the 
     thrifty, hardworking German farmers who settled it.
       ``It's still an area where we have a very close 
     relationship with patients,'' said Dr. Don, who retired in 
     1997.
       But the practice of medicine has changed.
       In Ohio, like so many other states, an increasing number of 
     physicians have had to give up ``high-risk'' aspects of their 
     practice because insurance has become unaffordable.
       An Ohio State Medical Assn. survey released April 15 found 
     that 80% of the state's physicians agree that rising premiums 
     have directly impacted their patients.
       The survey found that 34% of Ohio doctors expect to close 
     their practices in the next two years if rates continue to 
     climb. When asked to look forward three years, 58% plan to 
     close.
       ``If only 10% of that happened, that's a huge crisis,'' 
     said Bill Byers, OSMA's government relations director.
       For the Schweitermans, giving up obstetrics was purely a 
     business decision. When the fax for this year's premium came 
     through, the insurance company was asking for $80,000 for the 
     brothers to keep delivering the 60 or so babies a year that 
     they average. That's a premium hike of about 150% over the 
     past six years.
       ``It was a financial no-brainer,'' Dr. Jim said.
       And given how long their family has been in the community, 
     neither wanted to move 20 miles west to Indiana where tort 
     reform is established and rates would have been 75% less.
       ``It doesn't make any sense that geography can play such a 
     role,'' Dr. Tom said. ``[Rates] have nothing to do with the 
     medicine you practice.''


                       savoring every last moment

       It's beginning to hit the doctors that they only have five 
     more months of deliveries left, and they find they're soaking 
     up every moment in the delivery room.
       ``It's giving up one part of a job where there are tears of 
     happiness,'' Dr. Tom said.
       While both brothers would love to be able to offer 
     obstetrics again, they realize that once they are out of it 
     for a couple of years it will be difficult to go back. ``I 
     feel like I'm

[[Page S9694]]

     a baseball player stepping up to bat for the last time,'' Dr. 
     Jim said.
       Family physicians have been giving up deliveries for years. 
     In 1978, 46% had hospital privileges to deliver babies, 
     according to the American Academy of Family Physicians. In 
     2003, only 24% of FPs did deliveries.
       While premiums have been an issue in some states, Thomas S. 
     Nesbitt, MD, MPH, said there are a number of reasons for the 
     decline, including the fact that more FPs are joining groups 
     where the scope of practice is already established.
       Dr. Nesbitt, associate dean for graduate education, 
     continuing education and outreach at the University of 
     California, Davis, said it's a loss to family medicine. ``The 
     real tragedy is that family care is being fragmented.''
       Dr. Don hopes the climate shifts so that one or more of his 
     grandchildren may be able to enjoy the special experience of 
     helping deliver children into the world.
       ``I would love that,'' he said.

  Mr. FRIST. Mr. President, this article is about Dr. Jim Schwieterman 
and his brother, Dr. Tom Schwieterman. Both are family physicians who 
practice in Mercer County, OH. This month ``Dr. Jim'' and ``Dr. Tom,'' 
as their patients call them, will deliver their last baby, bringing an 
end to a distinguished 100-year run of their family providing care in 
delivering babies in their community in this corner of Ohio. The 
brothers' final delivery will be the baby of a woman who their father 
delivered. Their grandfather delivered the woman's mother, and their 
great-grandfather, who founded the family practice, delivered the 
woman's grandmother--a wonderful, rich tradition of caring in that 
community.
  Why will this long and honorable family history of physician service 
come to an end? Because of out-of-control medical liability costs. The 
Schwieterman brothers simply cannot afford to deliver children because 
of the skyrocketing insurance fees they must now pay. It is a tragedy, 
and we all suffer in one way or another.
  I was in Philadelphia earlier this month to speak to a group of 
physicians. Did you know that the average or the typical obstetrician/
gynecologist now pays over $134,000 a year for liability insurance just 
for that privilege of being able to deliver babies? That is a tripling 
of the cost just since 2000, a $100,000 increase in just 4 years. It is 
not surprising that Pennsylvania is on the crisis list and physicians 
are leaving the State. That means diminished access for the people of 
Pennsylvania. And it applies to orthopedic surgeons, to trauma 
surgeons, to obstetricians.
  The trial lawyer special interest lobby is next to impossible to beat 
at the State level, but, fortunately, some States are taking action. 
They see what is happening to their neighbors, and they know they could 
be next. Without restoring common sense to the legal system, it is just 
a matter of time before their health care is hijacked by the lawsuit 
lottery.
  Take California, for example. Because California has acted and 
adopted comprehensive medical liability reform, including limits on 
pain and suffering awards, liability insurance costs for OB-GYNs in the 
Los Angeles area are less than half of what their colleagues pay in 
Pennsylvania, Illinois, or Florida. Everything else is more expensive 
in California but not health care.
  Texas is another State pursuing comprehensive, commonsense legal 
reform. Recently, my distinguished colleague from Texas, Senator 
Cornyn, spoke passionately on the Senate floor about the need for 
lawsuit abuse reform. His State recently adopted medical liability 
reforms similar to those passed in California, and they are working.
  Texas Medical Liability Trust, the largest medical liability insurer 
in the State, is now decreasing its rates for the second time in the 2 
years since this reform was instituted. The new 5-percent cut comes in 
addition to a 12-percent reduction implemented earlier this year. These 
cuts are a direct result of Texas's constitutional amendment capping 
liability costs. According to the trust president and CEO, Thomas 
Cotton, 12,000 Texas doctors will save $34 million in a single year. 
This represents almost half of all Texas physicians. And when doctors 
pay less, patients pay less, premiums fall, and health care becomes 
more available for all. Before Texas passed the new liability law, the 
same insurer had raised rates over 146 percent between 1999 and 2003. 
Now that the medical malpractice insurance market has stabilized, 13 
new insurance companies have entered the Texas market and doctors are 
returning to their practices. That is the way it should be.

  The lesson is clear. If we adopt Federal reforms based on the 
commonsense laws that are working in States such as California and 
Texas, we will dramatically lower health care costs, in turn providing 
more affordable and more accessible health care to our communities, to 
the American people. That means our precious health care dollars will 
be spent in the operating room and not in the courtroom.
  The Senate has tried three times during the 108th Congress to debate 
comprehensive medical liability legislation. We have tried three times 
to have a simple debate about the merits of ending the abuse of our 
health care system by personal injury trial lawyers and their frivolous 
lawsuits, and each time my colleagues on the other side of the aisle 
have filibustered, obstructed even consideration of this legislation. 
They block consideration of a solution. No action, no vote, no 
accountability, and no change is partisan politics at its worst. It 
hurts the doctor. It hurts the patient. It hurts the consumer. It hurts 
you. That is plain wrong and, again, America deserves better.
  Senator Kerry and Senator Edwards have made it clear that they oppose 
the laws that are working today in California and Texas. They have also 
made it clear that as long as they are in the Senate, they will not 
even allow a vote on real reform. Why, you ask? Why oppose reforms that 
provide more health care services than ever before? Why oppose reforms 
that ensure doctors and hospitals will be more involved in providing 
care? Why oppose health care services that are more accessible and more 
convenient? And why oppose health care services that will be there when 
you need them? America deserves an explanation.
  Finally, Mr. President, I want to comment on one other issue, and 
that is the new drug discount card available to seniors today.
  I will turn to some compelling testimony that was provided to the 
Senate Finance Committee, I guess it was 2 weeks ago. I had the 
opportunity to chair that Finance Committee hearing, and I listened 
very carefully as Dr. Mark McClellan, who is the Administrator for the 
Centers for Medicare & Medicaid Services, discussed the Medicare 
Modernization Act, which this body passed, which was signed into law by 
the President. In his testimony, Dr. McClellan said that 4.3 million 
seniors have already enrolled in the Medicare Prescription Drug 
Discount Card Program, which was signed into law by President Bush last 
year. Over 1 million low-income seniors are today, because of this new 
law, receiving an additional $1,200 of free prescription drugs on top 
of the already deep discounts available to all seniors who have signed 
up for this card.
  Those discounts are making a difference. They make a difference in 
the lives of those seniors. They make a difference in the health care 
of those seniors.
  It is beyond belief how anyone could tell seniors, don't get that 
card; it is too confusing. That is wrong. We should be encouraging 
seniors to sign up for the card. Why? A recent Kaiser Family Foundation 
study reported that the Medicare drug cards are providing a savings of 
17 to 24 percent off retail prices in urban and rural areas. That means 
if you have the card, you have a savings of 17 to 24 percent than if 
you don't have the card. How could anybody tell our seniors today, 
don't get the card, with those demonstrated savings?
  A Lewin Group study analyzing the 150 drugs most frequently used by 
seniors found that people participating in the Medicare drug discount 
program can, beginning this year, save an average of well over $1,200 
on their prescription drug purchases with this card.
  A study by Consumers Union found that in California, the Medicare 
prescription drug discount cards provided drug prices that are even 
lower than the State's Medi-Cal program. I say ``even lower'' because 
the Medi-Cal prices are 20 percent below those typically available at 
retail pharmacies.
  The Democratic leader indicated last week that too little has been 
done to control prescription drug costs in America. The facts--study 
after

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study--show otherwise. In my colleague's own State of South Dakota, 
40,000 Medicare beneficiaries who do not have prescription drug 
coverage stand to gain the most from that drug discount card; 28,000 
South Dakotans are eligible for an additional $1,200 over the next 14 
months. How can they be told not to sign up for that card?
  The discount drug card is only the beginning. In the year 2006, all 
Medicare beneficiaries will be eligible for prescription drug coverage 
under the Medicare program. Tens of thousands of South Dakota's seniors 
and citizens with disabilities will receive coverage with no premiums, 
no deductibles, no gaps in coverage, and copayments of no more than $2 
for generics and $5 for brand-name drugs.
  There is a better way to provide affordable prescription drugs and 
health coverage to the American people. Texas and California have 
chosen the right path. I ask: When will Senator Kerry and Senator 
Edwards choose theirs? Make no mistake, we need health care reform now. 
Costs are way too high today, and they continue to rise. Quality chasms 
and health care disparities exist in our health care sector today. But 
I can tell you from personal experience--both in medicine for 20 years 
as a physician and as a policymaker today--these are tough and 
challenging issues. Reform is a challenge that is not easy, but we have 
begun to address it and we will continue.
  The health care challenge is complicated, and it is much more 
complicated than a lot of politicians would have you believe. They 
simply are not going to be solved overnight.
  Let us pledge today to get it right the first time. Let us pledge 
today to give that power back to the patients. Let us pledge to tackle 
the challenges today and to stop the partisan politics and to stop the 
foot dragging that becomes an embarrassment to this institution and a 
source of frustration for the American people.
  With the President's leadership and the bipartisan reforms that we 
have enacted during the past several years, we are on the right track. 
A lot of work remains to be done. We need to pass medical liability 
reform. We need to expand those health savings accounts that are now 
the law of the land. We need to give small businesses the ability to 
ban together to buy more affordable health care coverage for their 
hard-working employees. Because as a matter of principle, every family 
deserves access to affordable, reliable, and quality health care that 
can never be taken away.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Florida.

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