[Congressional Record Volume 151, Number 66 (Wednesday, May 18, 2005)]
[Senate]
[Pages S5446-S5447]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HARKIN:
  S. 1074. A bill to improve the health of Americans and reduce health 
care costs by reorienting the Nation's health care system toward 
prevention, wellness, and self care; to the Committee on Finance.
  Mr. HARKIN. Mr. President, for more than a decade, I have spoken out 
about the need to fundamentally reorient our approach to health care in 
America--to reorient it towards prevention, wellness and self care.
  I don't think you'll find too many people who would argue with the 
statement that if you get sick, the best place in the world to get the 
care you need is here in America. We have the best trained, highest-
skilled health professionals in the world. We have cutting-edge, state-
of-the-art equipment and technology. We have world-class health care 
facilities and research institutions.
  But, when it comes to helping people stay healthy and stay out of the 
hospital, we fall woefully short. In the U.S., we spend in excess of 
$1.8 trillion a year on health care. Fully 75 percent of that total is 
accounted for by chronic diseases--things like heart disease, cancer, 
and diabetes. And what these diseases have in common is that--in so 
many cases--they are preventable.
  In the United States, we fail to make an up-front investment in 
prevention. So we end up spending hundreds of billions on 
hospitalization, treatment, and disability. This is foolish--and, 
clearly, it is unsustainable. In fact, I've long said that we don't 
have a health care system here in America, we have a ``sick care'' 
system. And it is costing us dearly both in terms of health care costs 
and premature deaths.
  Consider the cost of major chronic diseases--diseases that, as I 
said, are so often preventable.
  For starters the annual cost of obesity is $117 billion. For 
cardiovascular disease is about $352 billion. For diabetes it's $132 
billion. For smoking it's more than $75 billion. And for mental illness 
it's $150 billion; indeed, major depression is the leading cause of 
disability in the United States.
  Now, if I bought a new car, drove that car off the lot, and never 
maintained it--never checked the oil, never checked the transmission 
fluid, never got it tuned up--you'd think I was crazy, not to mention 
grossly irresponsible. The common-sense principle with an automobile 
is: ``I pay a little now to keep the car maintained, or I pay a whole 
lot later.''
  Well, it's the same with our national health priorities. Right now, 
our health care system is in a downward spiral. We are not paying a 
little now; so we are paying a whole lot later.
  For example, we are failing to address the nation's growing obesity 
epidemic. Today 65 percent of our population is overweight or obese. 
Obesity is associated with numerous health problems and increased risks 
of diabetes, heart disease, stroke, and several types of cancer, to 
name just a few.
  Another contributing factor to our health crisis is tobacco. We don't 
hear as much about the dangers of tobacco use, today, as we used to. 
That's because there is a perception that we've turned the corner--that 
we've done all that we need to do. But that perception is not accurate. 
In 2002, 46 million American adults regularly smoked cigarettes--that 
26 percent of our population. Nearly 40 percent of college-aged 
students smoke. What this means is that after decades of education and 
efforts to stop tobacco use, more than one in every four Americans is 
still addicted to nicotine and smoking.
  Mental health is another enormous challenge that we are grossly 
neglecting. Mental health and chronic disease are intertwined. They can 
trigger one another. It is about time we stop separating the mind and 
body when discussing health. Prevention and mental health promotion 
programs should be integrated into our schools, workplaces, and 
communities along with physical health screenings and education. 
Surely, at the outset of the 21st century, it's time to move beyond the 
lingering shame and stigma that often attend mental health.
  Seventy percent of all deaths in the U.S. are now linked to chronic 
conditions such as heart disease, cancer, and diabetes. In so many 
cases, these chronic diseases are caused by poor nutrition, physical 
inactivity, tobacco use, and untreated mental illness. This is 
unacceptable.
  After many months of meetings and discussions with Iowans and experts 
across the nation, today I am re-introducing comprehensive legislation 
designed to transform America's ``sick care'' system into a true health 
care system--one that emphasizes prevention and health promotion.
  I am calling this bill the HeLP America Act, with HeLP as an acronym 
for Healthy Lifestyles and Prevention. The aim is to give individuals 
and communities the information and tools they need to take charge of 
their own health.
  Because if we are serious about getting control of health-care costs 
and health-insurance premiums, then we must give people access to 
preventive care . . . and we must give people the tools they need to 
stay healthy and stay out of the hospital.
  This will take a sustained commitment from government, schools, 
communities, employers, health officials, and the tobacco and food 
industries. But a sustained effort can have a huge payoff--for 
individuals and families, for employers, for society, for government 
budgets, and for the economy at large.
  As I said, the HeLP America Act is comprehensive legislation. It a 
very complex, multifaceted bill. But, this afternoon, I'd just like to 
outline the bill's major elements:
  The first component addresses healthy kids and schools. Prevention 
and the development of a healthy habits and lifestyles must begin in 
the early years, with our children. Unfortunately, today, we are 
heading in exactly the wrong direction. More and more children all 
across America are suffering from poor nutrition, physical inactivity, 
mental health issues, and tobacco use.
  For example, just since the 1980s, the rates of obesity have doubled 
in children and tripled in teens. Even more alarming is the fact that a 
growing number of children are experiencing what used to be thought of 
primarily as adult health problems. Almost two-thirds--60 percent--of 
overweight children have at least one cardiovascular disease risk 
factor. Recent studies of children have shown that increasing weight, 
greater salt consumption from fast food, and poor eating habits have 
contributed to the rise in blood pressure, higher cholesterol levels, 
and a shockingly rapid increase in adult-onset diabetes.
  The HeLP America Act will more than double funding for the successful 
PEP program, which promotes health and physical education programs in 
our public schools. I find it disturbing that more than one third of 
youngsters in grades 9 through 12 do not regularly engage in adequate 
physical activity. This is a shame, because studies show that regular 
physical activity boosts self-esteem and improves health.
  The HeLP America Act will also expand the Harkin Fruit and Vegetable 
Program to provide more free fresh fruits and vegetables in more public 
schools. The bill will also encourage give schools incentives to create 
healthier environments, including goals for nutrition education and 
physical activity.
  The HeLP America Act would also establish a grant program to provide 
mental health screenings and prevention programs in schools, along with 
training for school staff to help them recognize children exhibiting 
early warning signs. It will improve access to mental health services 
for students and their families.
  New to the HeLP Act this year is a strong focus on breastfeeding 
promotion. Sound nutrition begins the moment a baby is born and there 
is a vast body of scientific evidence that shows beyond a shadow of a 
doubt that mom's milk is the ideal form of nutrition to promote child 
health. But in the U.S. we don't do enough to encourage breastfeeding. 
The HeLP America Act seeks to remove some of those barriers and to 
encourage new mothers to breastfeed.
  The second broad component of the HeLP American Act addresses Healthy 
Communities and Workplaces. For example, the bill aims to create a 
healthier workforce by providing tax

[[Page S5447]]

credits to businesses that offer wellness programs and health club 
memberships. Studies show that, on average, every $1.00 that is 
invested in workplace wellness returns $3.00 in savings on health 
costs, absences from work, and so on.
  At a field hearing in Iowa last year, I heard from Mr. Lynn Olson, 
CEO of Ottumwa Regional Health Center. The Center offers a 
comprehensive wellness program for its employees, including reduced 
health insurance premiums for those employees who meet individual 
health goals. The Center has seen tremendous savings from their 
investment in health promotion.
  My bill also creates a grant program for communities, encouraging 
them to develop localized plans to promote healthier lifestyles. For 
example, we want to support efforts like those going on in Webster 
County and Mason City, IA, where mall walking programs have been 
expanded into community-wide initiatives to promote wellness.
  At the same time, the bill provides new incentives for the 
construction of bike paths and sidewalks to encourage more physical 
activity, especially walking. It is shocking that, today, roughly one-
quarter of walking trips take place on roads without sidewalks or 
shoulders. And bike lanes are available for only about 5 percent of 
bike trips.
  As my colleagues know, I have been a longstanding advocate for the 
rights of people with disabilities. So I have given special attention 
to health-promotion programs and activities that include this 
population. I just mentioned the bill's incentives to create bike lanes 
and sidewalks on newly constructed roads. This will make a big 
difference to people with disabilities, who often are forced to travel 
in the street alongside cars because there are no sidewalks or bike 
lanes available for wheelchairs.
  The Centers for Disease Control has funded a program called Living 
Well with a Disability, which has actually decreased secondary 
conditions and led to improved health for participants. The program is 
an eight-session workshop that teaches individuals with disabilities 
how to change their nutrition and level of physical activity. The 
program not only increases healthy activities for people with 
disabilities, but has also led to a 10 percent decline in the cost for 
medical services, particularly emergency-room care and hospital stays.
  In addition, my bill includes a Working Well with a Disability 
program, which will build partnerships between employers and vocational 
rehabilitation offices with the aim of developing wellness programs in 
the workplace.
  Mr. President, the third component of the HeLP America Act addresses 
Responsible Marketing and Consumer Awareness. Having accurate, readily 
available information about the nutritional value of the foods we eat 
is the first step toward improving overall nutrition. Unfortunately, 
because of all the gimmicks and hype that marketers use to entice us to 
buy their products, determining the nutritional value of the foods we 
buy can be problematic--especially in restaurants. This is why the HeLP 
America bill proposes to extend the nutritional labeling requirements 
of the National Labeling and Education Act, which currently covers the 
vast majority of retail foods, to restaurants foods as well, which were 
exempted from the NLEA when it first passed.
  The marketing of junk food--especially to kids--is out of control. It 
was estimated that junk food marketers, alone, spent $15 billion in 
2002 promoting their fare. And, I don't have to tell you, they are not 
advertising broccoli and apples. No, the majority of these ads are for 
candy and fast food--foods that are high in sugar, salt, fat, and 
calories.
  Children--especially those under 8 years of age--do not always have 
the ability to distinguish fact from fiction. The number of TV ads that 
kids see over the course of their childhood has doubled from 20,000 to 
40,000. The sad thing is that, way back in the 1970s, the Federal Trade 
Commission recommended banning TV advertising to kids. And what was 
Congress's response? We made it even harder for the FTC to regulate 
advertising for children than it is to regulate advertising for adults. 
My bill will restore the authority of the FTC to regulate marketing to 
kids, and it encourages the FTC to do so.
  The fourth component of the HeLP American Act addresses 
Reimbursements for Prevention Services. Right now, our medical system 
is setup to pay doctors to perform a $20,000 gastric bypass instead of 
offering advice on how to avoid such risky procedures. The bill will 
reimburse and reward physicians for practicing prevention and 
screenings. It will also expand Medicare coverage to pay for counseling 
for nutrition and physical activity, mental health screenings, and 
smoking-cessation programs. It also would establish a demonstration 
project in the Medicare program, long overdue in my opinion, under 
which we can learn how best to use our health care dollars to prevent 
chronic diseases rather than just manage them once they've occurred. 
Frankly, it's a little embarrassing that we haven't done this before.
  Finally, let me point out that the HeLP America Act will be paid for 
by creating a new National Health Promotion Trust Fund paid for through 
penalties on tobacco companies that fail to cut smoking rates among 
children, by ending the taxpayer subsidy of tobacco advertising, and 
also by reinstating the top income tax rates for wealthy Americans.
  It's time for the Senate to lead America in a new direction. We need 
a new health care paradigm--a prevention paradigm.
  Some will argue that avoiding obesity and preventable disease is 
strictly a matter of personal responsibility. Well, we all agree that 
individuals should act responsibly. I'm all for personal 
responsibility. But I also believe in government responsibility. 
Government has a responsibility to ensure that people have the 
information and tools and incentives they need to take charge of their 
health. And that is what the HeLP America Act is all about.
  Of course, this description of my bill just scratches the surface. 
The HeLP America Act is comprehensive. It is ambitious. And I fully 
expect an uphill fight in some quarters of Congress.
  But just as with the Americans with Disabilities Act 14 years ago, I 
am committed to doing whatever it takes--and for as long as it takes--
to pass this critically needed legislation.
  It's time to heed the Golden Rule of Holes, which says: When you are 
in a hole, stop digging. Well, we have dug one whopper of a hole by 
failing to emphasize prevention and wellness. And it's time to stop 
digging.
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