[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
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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.
____________________