[Congressional Record Volume 151, Number 133 (Wednesday, October 19, 2005)]
[House]
[Pages H8959-H8966]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CHILDREN'S HEALTH MONTH
The SPEAKER pro tempore (Mr. Kuhl of New York). Under the Speaker's
announced policy of January 4, 2005, the gentleman from Pennsylvania
(Mr. Murphy) is recognized for 60 minutes as the designee of the
majority leader.
Mr. MURPHY. Mr. Speaker, I am joined by my colleagues this evening to
talk about Children's Health Month. It is very important for all
families in our Nation, and certainly an issue that concerns all of us
on both sides of the aisle.
While the rhetoric of the House often echoes through these walls
about cuts and people being harmed, it seems to me that is the only
part of the discussion that we are taking away. Little offers are made
in terms of what is needed.
What we do often hear is discussions of who is paying. Should
individuals pay, insurance companies be taxed more, businesses be given
tax cuts, perhaps health savings accounts, association health plans, or
just have the Federal Government take over? But this should not just be
an issue of who is paying, for although that is important, and how much
we are paying is important, really much of this comes down to what we
need to have is an open discussion of what we are paying for.
According to the National Center of Health Statistics, 83 percent of
children in this country under 18 years of age have excellent to very
good health. That is good news.
Now 17 percent of America's children are in less than favorable
health, either to mild or severe levels. We have to make sure we do all
we can to help these children have a better health future and help the
rest remain healthy. According to the American Academy of Pediatrics,
6.3 million uninsured children, over two-thirds of all uninsured
children in America, are currently eligible either for Medicaid or for
the State health insurance programs, but they are not enrolled. There
are many opportunities. I know the State of Pennsylvania, where I
represent the 18th Congressional District, really has very good
services and insurance for children of a low income level but we need
to make sure that we expand enrollment and get those kids beyond. For
those who are uninsured or underinsured but beyond the level of
Medicaid, there are several things that we should be looking at to make
sure that they get the health care they need to maintain their health
to prevent higher expenses for emergency care.
But what this means is not just more discussions on we are cutting
money out of Medicaid or other aspects. Look at what has happened to
the growth of Medicaid. In 1995, and this is for all ages, Medicaid
spent $150 billion. We are now up to $300 billion. About half of
Americans are covered by some level of Federal insurance or health
care. But the system is growing, and the concern is it is growing out
of control.
While we are looking at such things as how do we pay for Hurricane
Katrina's outcome in this devastated gulf region, how do we take care
of so many needs, is it fair to just continue to say to the American
people we are going to continue to spend more without finding ways of
eliminating waste and fraud and abuse?
Let me give an example. The New York Times wrote recently about an
amount of some $4.4 billion in Medicaid fraud in that State. One
dentist billed for over 980 procedures in one day. Clearly these were
patients that were actually being seen. Another company used van rides
for supposedly disabled people, billing those rides to the government.
But these people when followed by a reporter clearly were not disabled.
They walked around just fine. There is example after example after
example.
I believe the American taxpayer wants to make sure that this waste,
this fraud, this abuse is removed from the health care system. But it
is not just a matter of that. When it comes to our children, we also
have to make sure the system works with these programs in ways that
optimize the health and outcome.
[[Page H8960]]
One of the things that I want to talk about today, along with the
gentleman from Georgia (Mr. Gingrey), is transforming our health care
system. We oftentimes use a tongue-in-cheek quote around here that says
one of the definitions of insanity is doing the same thing over and
over again and expecting different results. Indeed, in the health care
system where so much money is used inappropriately and wastefully, we
ought to have some changes.
From the Center of Health Transformation, they say we have this
current health care system and we are trying to come up with some
reforms within the network. We try things like so much money is going
to pay for diagnoses. We ask for some procedures to be done inpatient
and outpatient, all within that system. What happens is if this system
does not change, it will lead to some decay. The system cannot continue
to go the way it is. Anyone who owns a small business or a household
cannot continue to operate the way our health care system operates.
When we go into hospitals, inpatient/outpatient, you will see the
latest equipment, the greatest skilled personnel, MRIs, PT scans, CT
scans, but very often we also see that data is kept on patients on
pieces of paper. We have 21st century health technology kept on 16th
century monitors. What happens, people slip through the cracks. The
wrong prescriptions are ordered. Tests that are done have to be
repeated because someone cannot get them.
I was talking to one of our colleagues today and he was telling me
how a sonogram was done of his wife who is pregnant, but he cannot get
it from here back home to his wife because he has to carry it manually.
It cannot be e-mailed. We take e-mails for granted, but doctors have to
wait for papers to transfer locations.
What happens? Can we come up with some real changes to really help
our children? Yes, if we switch to an intelligent health system that
uses electronic prescribing, electronic medical records, real patient
care management for our children rather than having a system that gets
bogged down and collapses of its own expense and weight, we can come up
with success for our children and no longer be mired in failure.
Let me describe a little bit about what we mean by managing the whole
patient. A lot of what people think happens when they have an
individual or chronic disease is something common, like diabetes or
asthma in a child, the doctor will examine and make sure that the child
has the right medications, watches their diet and the environment
around them, and hope all goes well. As long as the parents are
monitoring that carefully and there is communication between doctor,
nurse, patient and child, you can have a pretty good system. What
happens if the information does not get to the parents, the patient
education is not quite there? Maybe they skip a prescription, maybe
they did not pick it up on time, maybe they do not fully understand all
the elements of diet and medications for complicated diseases. What
does that mean? You can end up with chronic diseases, repeat tests,
many hospitalizations, emergency care may be required, increasing
medications, going from doctor to doctor who may not know the other
medications the child is on, leading to further risks, and all of this
costs unnecessary money, unnecessary time in hospitals, increases the
risk for harm, and what happens, we end up paying for it.
About 10 percent of the cases that show up in an emergency room are
someone who has no ability to pay, but it is estimated that 60 percent
or more, 60 percent or more of patients who show up in emergency
departments are nonemergencies. If in such cases the care was given
ahead of time, whether it is through a community health center, a
clinic, direct patient care with a physician, if we monitored and kept
a careful eye on those children with chronic conditions, we could save
massive amounts of money.
This is not cutting care, it is improving care. Emergency care can
cost five to eight times more than outpatient care, and we can actually
save billions of dollars in the system. This is where we can find
savings, and in so doing we save lives as well as money. But this means
we use a chronic care model and not the inefficient going to a doctor,
another disease, go to another doctor.
What this involves is not just the health system, it really involves
the community, the resources. What takes place, the support systems,
the families, the individuals helping to make sure they are watching
their children, they are educated and they know what to do. It is
making sure we have a delivery system involved with making sure doctors
are notified if someone does not pick up their prescriptions. A lot of
this can be done with electronic prescribing notification. It is making
sure that clinical information systems are there so that if X-rays are
done, procedures and tests are done, that information is communicated
back to the doctor.
One study I looked at said something like 14 percent of the charts
reviewed the physician found that they were missing some important
data. Perhaps the physician referred the patient on to have some
testing done, and it was never done. In the majority of these cases,
the doctor said it would affect what diagnosis they had and future
tests called for.
This is not a matter of just saying we are going to cut care, this is
improving care. But this also means that clinical information systems
must be there. They are a critical component of health care, of having
the physician and nurse and family work together. What does that do? It
is a matter of having productive interaction between everybody
involved. You have an informed, active patient and you have a prepared,
proactive practice team.
No longer the passive system, the doctor says here is your diagnosis,
here is your prescription, good luck, call me if there is a problem. If
that prescription is not filled, there is a call from the doctor. It is
a system of interaction between the patient and doctor to make sure
they are going back and forth.
Mr. Speaker, I am not talking about things that take place only in
families that have access to computers and finances to do this. A lot
of this is done in areas of low income levels, of high risk populations
where we really find it is much more affordable. What we need to be
looking at here as Congress is when we are reviewing such things as the
Medicaid system, it is not just saying we are going to lop off $8
billion or $10 billion and see what happens. It is a matter of doing
more effective work.
Much like a household that says our spending is going out of control,
they do not just say let us not spend any more. Every small business
and family does this. They look at what they are spending, but you have
to change some of your habits and make habits more effective.
The system that seems to be adapting the slowest is our health care
system, perhaps because we just keep doing the same thing over and over
again and expecting different results.
What the Federal Government is going to do and what we are doing here
in the Republican Conference is asking those questions and demanding
some answers of changing some of that system.
What I would like to do is call upon the gentleman from Georgia (Mr.
Gingrey), who as an obstetrician has worked with many families,
particularly in the area of prenatal care. One of the critical areas in
cutting costs and being more effective in health care is dealing with
prenatal care in an effective and positive way.
Mr. Speaker, I yield to the gentleman from Georgia (Mr. Gingrey) to
talk about these aspects of prenatal care, and he can tell us about
some of the elements of saving money by doing more effective patient
care management.
Mr. GINGREY. Mr. Speaker, I thank the gentleman from Pennsylvania
(Mr. Murphy) for leading this hour during this week of Children's
Health Care Initiative and calling attention to the health of our
children. The gentleman from Pennsylvania (Mr. Murphy) has worked
extensively in the field of psychology, particularly child psychology.
He has actually written a book and has another coming out soon on the
subject. I think as we get further into the hour, we probably will
discuss a little about bit about how important a child's not only
physical health but their mental health is.
{time} 1730
But I do appreciate the opportunity that the gentleman has given me,
Mr.
[[Page H8961]]
Speaker, to share some of this time with him.
My background in a prior life, my professional experience was for 30
years in the practice of medicine, and the specialty that I enjoyed
practicing was obstetrics and gynecology; and we have that opportunity
in that field of medicine to see a child at the very beginnings of life
and know how critically important a good start is. We talk about some
of the things that this Republican majority has done, some of the very
good programs since President Bush has been in office, certainly not
the least of which is No Child Left Behind regarding our K-12 education
program. But it is so important from the health care perspective that
no child is left behind from the moment of conception.
So I do want to talk a little bit about the importance of prenatal
care and actually call my colleagues' attention to this one poster that
I have here regarding prenatal care, entitled ``Proper Prenatal Care
Leads to Healthy Children.'' No question about it. Some of the bullet
points, these may be a little bit difficult to see, Mr. Speaker, but
hopefully we can focus the camera in on the bullet points.
First of all, 1 million, 1 million, American women deliver babies
annually without receiving prenatal care. Secondly, in the United
States, more than 250,000 low birth weight infants are born each year.
More than 250,000. Now, for my colleagues' understanding, a low birth
weight infant is one that weighs less than 2,500 grams. That is about
5\1/2\ pounds. Those children are not all premature. In some instances
they are unhealthy children who are near term, but low birth weight.
But most of them, most of these 250,000 low birth weight infants are
actually born premature as well.
And the third bullet point, low birth weight infants are more likely
to suffer from disabilities, things like heart defects and respiratory
illnesses. They are four times more likely to prematurely die than
infants with a normal birth weight.
I have had many situations, Mr. Speaker, as an obstetrician having
delivered over 5,000 children, where women come into the emergency room
having had no prenatal care. And they are clearly the ones who are more
likely to deliver these low birth weight babies and deliver them
prematurely. That is why I think it is so important, and I know the
gentleman from Pennsylvania (Mr. Murphy) would agree with me, that when
we emphasize the issue, the immigration issue, of securing our borders
and want to make sure that every immigrant that comes into this country
comes here legally and has an opportunity to get prenatal care, as, of
course, many of those who come in an illegal manner are afraid or do
not now how or where to get prenatal care and will just show up in the
emergency room having delivered an unhealthy premature low birth weight
infant, the cost of taking care of a child in that situation in the
very expensive setting of an intensive care nursery, a 2-month stay,
and that would not be uncommon for a very small infant, could approach
easily $750,000 to $1 million worth of health care. And that, Mr.
Speaker, is really just the beginning.
That is just the beginning of the cost, because if there is a
disability that is long lasting or maybe even lasting a lifetime, and
that is often the case, whether it is a heart defect or a
musculoskeletal deformity or a mental defect as a result of lack of
oxygen, sometimes even blindness, the cost is just astronomical. So it
is so important, it is so important, that we do things in this Congress
at the Federal level to encourage that women get prenatal care and that
children are born healthy and that, indeed, no infant, not just no
child left behind, but no infant is left behind.
So I just wanted to go over with my colleagues some of the things in
regard to prenatal care that are so important that I always stress to
my patients: of course, encouraging immunizations and vitamin
supplements, monitoring of diet, increased physical activity, clearly
to avoid smoking and alcohol use during pregnancy and drug use.
Certainly any drug use that is nonprescription or not under the
jurisdiction and guidance of a physician is to be discouraged.
Environmental factors are hugely important. As I say, a healthy diet, a
regular weight check, physical activity, all of these things are so
important. And then to come see the physician on a regular basis during
the pregnancy. This is how we avoid, Mr. Speaker, these 1 million
American women delivering babies annually either without receiving
prenatal care or ending up with premature deliveries.
I want to, if the gentleman would allow me, to expand on this a bit.
It is not just being born healthy and well; but the first 5 years of
life, what happens to the child after that is tremendously important as
well. I have a grandson, little Grey Collins. He will be a year old
soon. And it is so much fun to see him, and I often have that
opportunity to see him, watching the little Baby Einstein tapes, that
he is hugged many times a day and loved by his parents and grandparents
and his aunts and uncles and how important it is to provide that love
and affection to a child and let them know that they are loved, and we
will get into that. I am sure the gentleman from Pennsylvania (Mr.
Murphy) will talk about that later in the hour as he discusses things
like childhood obesity and childhood mental health.
But I wanted to speak a little bit about a program that we just
reauthorized in the last couple of weeks here in this 109th Congress,
and what I am talking about is the Head Start program. Sometimes we get
criticized, we, the Republican majority, that we do not care enough
about social programs and we do not care enough about the poor and
underprivileged and people that do not maybe have the same opportunity
that the upper middle class society has.
But let me tell the Members we do care. We do care. And this
reauthorization is proof of the pudding.
Just a little historical perspective on that. Head Start and its
cousin, Early Head Start or comprehensive child development programs,
serving children from birth to age 5, as I stated, as well as pregnant
women and their families, the critical component of the Head Start
program is that it is child focused with the overall goal to increase
school readiness of young children in low-income families, Mr. Speaker.
The Head Start program has a long tradition of delivering comprehensive
and high-quality services designed to foster healthy development in
children that need our help the most.
The program provides a range of individualized services in areas of
education, early childhood development, but not stopping there. It also
offers medical, dental, and mental health services to these children
and to their families. It even goes a step further by providing
nutritional counseling and encouraging parental involvement in their
child's development. It is a rich program. I have got a lot of
statistics, and as we continue the hour, I will relate some of those
specifics, particularly in regard to the reauthorization and how much
we are doing in that program.
But I just wanted to point out, as I know the gentleman from
Pennsylvania (Mr. Murphy) agrees, how important it is that we do
everything we can to make sure that our children get a good start in
life. And as I have stated at the outset, the prenatal care aspect
is hugely important. Programs like the Early Head Start and Head Start
program so that the children, all children, when they get to that 5-
year-old kindergarten class or get to the first grade, that they have
an equal opportunity with their peers and they are not starting school
with one hand tied behind their back. So it is hugely important that
they are healthy, that they are happy, that they are loved and they
have an opportunity, as we all want, in life.
At this point I will continue to be here with the gentleman from
Pennsylvania (Mr. Murphy) during this hour.
Mr. MURPHY. Mr. Speaker, reclaiming my time, I thank the gentleman
for his learned information for our colleagues to be aware of not only
Head Start but about prenatal care.
One program I want to mention, the National Nurse-Family Partnership,
is a great example of success. It is a public-private nonprofit center.
I believe it is centered in Colorado, with over 700 nurses delivering
in-home prenatal care and early infant care to more than 13,000 low-
income families throughout the Nation. Interestingly enough, they were
able to demonstrate they could
[[Page H8962]]
return $4 savings for every $1 invested in these services by the time
the children reach age 15 by reducing expenditures for such things as
special education, emergency room visits. Again, when we use a more
comprehensive patient care model, we look at the whole family and not
just the individual disease, we can save money and provide care.
Secondly, I also applaud my colleague for bringing up those aspects
about Head Start and Early Head Start, so critically important for
families who are struggling to make ends meet to have this system that
really puts the parent at the center of the child's care, making sure
they are involved in all the decisions, making sure they have the
information they need to have, making sure that they are, in essence,
put into the role of parent and not government in the role of parent;
and that makes all the difference in the world.
Let me shift into another area here, however, that is also critically
important and something we dealt with today. At any point if my
colleague has comments he wants to make, I certainly would encourage
him to do so. But this is the area of childhood obesity. Today, we
passed a bill out of the House that said that we cannot just be blaming
restaurants and fast-food companies and food manufacturers when someone
has obesity problems. Indeed, it is something we all have to work on
and have responsibility for because whether they are healthy snacks
that a person eats too much of or unhealthy snacks, whatever that is,
we have to make sure that we watch our diet and have proper exercise.
Unfortunately, what has happened in this Nation, I believe it may
only be the State of Illinois that still requires gym class in school,
and as such, children spend much more sedentary time at home, playing
video games or in front of the television, less active, and eating more
during that time. This is a major contributor to childhood obesity. And
what has happened in the last 10 years, and look here, the proportion
of obese children has tripled since 1970. It has doubled in the last 10
years, tripled among teenagers actually during this time period, and
increased incidences of disease associated with that, including such
things as now we see adult onset diabetes showing up in our children.
We also see heart problems showing up. We see the risks that take place
with blood pressures that are showing up in children who really did not
have these problems before.
This is an estimated annual cost of obesity-related diseases in the
United States: $100 billion. $100 billion annual cost of obesity-
related diseases. This is not something that is cured by simply having
government come in and tell people what they can and cannot eat.
Something has broken down in our families and our communities where we
are no longer telling kids they have had enough to eat or they are not
going to eat any more of that or they need to get out and play.
The annual hospital costs for obesity-related disorders in children
ages 6 to 17 years of age increased from $35 million to $127 million
between 1979 and 2000. It is a lack of physical exercise; 38.6 percent
of United States adults report they have no leisure-time physical
activity at all. The annual estimated cost for diseases associated with
this physical activity in 2000 was $76 million, but we know that daily
participation in physical ed classes by high school students has
dropped from 42 percent in 1991 to 29 percent in 1999 and continues to
decline.
{time} 1745
Even though we have data that continues to tell us physical exercise
is critical and important, not just for a child's physical health, but
really, as we are looking at ways of managing this, we cannot continue
to just pump money into the Medicaid system and into our insurance
systems to cover the costs of the outcome at the end of the line.
We need to go upstream and work on some basic prevention, and that
means, quite frankly, mothers and fathers across America have to work
on these issues of teaching their children to be responsible for their
own bodies, making sure that we, as Members of Congress, are talking
about these issues, but making sure as we monitor how money is spent we
are much better off looking at ways that funding could be given to
communities, programs, to schools, to hospitals to help make sure we
are working on prevention of obesity rather than paying the high costs
at the end of the line for so much of the increases in health care
because obesity has continued to climb.
Now, with obesity often comes behavioral disorders as a matter of
fact. Many a child I saw in my clinical practice as a psychologist
oftentimes came in a child who was well overweight, teased by their
peers, struggled with this on top of their other physical problems.
They oftentimes got in this downward spiral, less activity, more
socially isolated. Perhaps they were teased by other kids, the butt of
jokes, a sad condition, and many of these children also suffered
problems with mental health.
What happens in the area of mental health is sometimes in this
Chamber and our Nation, we look down upon it from a couple of different
angles. We see perhaps mental health problems are some sign of
softness, that perhaps people should be a little tougher, take it on
the chin, not be so sensitive. Sometimes I am not sure we have advanced
from the days of the Salem witch trials, and blame those who suffer
from mental illness and say somehow you should have done more.
Sometimes we ridicule those who are on medication. Jokes still abound
on television calling people crazy, loony, out of control, retarded, in
derogatory terms, for something that we continue to see in this Nation
as a sign of weakness instead of a real disease.
Again, if we are going to deal with things in the health care area,
to truly reduce costs and deal with patients, we have to understand in
the area of children's mental health psychological disorders are real.
They are not made up. They are not indications where someone is weaker
and ineffective.
There is a very strong and consistent scientific basis to say that
the myth of psychological disorders and psychiatric disorders has to be
debunked. Kids do have real problems. Adolescents have more problems.
Adults have even more problems, and all these grow when we do not deal
with these problems at an early level.
There are biological and environmental causes. It is interesting, you
can have some children face tremendous difficulties in their life and
they do not seem to show problems in mental outcomes, but that does not
mean that those who do have problems are simply weak. Just like some of
us may be exposed to the flu, some of us may eat different, and be
around those who smoke and never develop any symptoms at all, where
others are susceptible to them as part of their own biological genetic
makeup.
Again, it does not mean they are weak or ineffective. It means a
combination of the biological and environmental factors that caused
this. You cannot simply say if we take care of these environmental
causes it will never occur. Sometimes people say, well, maybe it is
poverty that causes some of these difficulties with mental illness, and
that is not the case at all. Depression, bipolar disorders, attention
disorders, anxiety disorders occur at all lines of children. Boys
sometimes have more than others, but there is this link between
biological and environmental causes. Boys have more problems, for
example, with attention disorders. Girls may have different symptoms
with depression, but in all cases we also see there is a commonality
between parents and grandparents having some of these diagnoses that I
mentioned for anxiety, bipolar disorder, attention disorder, depression
and their children. Not always children, but certainly some where you
have significant environmental stresses and reactions which interact.
We may see, for example, as the outcome of the hurricanes in the gulf
coast that there will be some children who live through tremendous
trauma, and they may have some post-traumatic stress reactions, but it
may never reach the level of post-traumatic stress disorder. It becomes
a longer term debilitating factor, exhibited, for example, as such
things as depression, trouble concentrating, nightmares, et cetera. It
may never reach that level because they may in their own biological
factors have resilience, but their family may be there to support.
The other things here is to understand that psychological disorders
do
[[Page H8963]]
respond to treatment. This may be pharmaceutical; that is, medication,
and it certainly is also matters of counseling and therapy. This is not
just a matter of talking to someone, giving common-sense ideas. This is
a matter of very strategic, scientifically based things such as
cognitive behavioral therapy to work with patients.
We know, for example, that children with depression respond fairly
well, pretty well, to some of the talk therapy or counseling to help
them understand strategies to deal with problems in their life,
recognize the symptoms and do their own intervention themselves to
change those symptoms.
But we also know when people move from moderate to more severe levels
of depression, medication, it is pretty darn helpful and sometimes
almost necessary for them to have that. It does not help when we have
movie stars out there saying there is no such thing as mental illness,
an irresponsible statement. It does not make things go away just
because you wish it to be so. I do not want situations put upon our
country where we see that, again, people from Hollywood are saying,
well, there is no such thing as mental illness, and therefore, we do
not treat it. That is wrong. We do know that they can respond to
treatment, and it is important we continue to fund in areas of Medicaid
and everywhere else, Medicare, psychological, psychiatric treatment
because it is helpful.
We also need to, however, carefully evaluate the treatment, the
planning and follow-up assessment of these. I will give you a couple of
examples.
Last year, there was a lot of discussion about some anti-depressant
medication, and when some children took it, there was a higher risk for
suicidal thinking, suicidal ideations we call it. What did not come up
in those discussions are a couple of important factors. One, 75 percent
of psychiatric medications are prescribed by nonpsychiatrists. They may
be highly qualified physicians. In many cases, they may be general
practitioners, pediatricians, family doctors, obstetricians. Seventy-
five percent, however, and they may or may not be doing the other
follow-up that is necessary.
What anti-depressant medications do is they can change a person's
mood. They can help change the chemical, biological reaction that a
person's central nervous system and brain of how they process stresses
that can lead to the debilitation of depression, but it does not change
the way a person thinks. That is why it is so important that we make
sure we are funding programs that also provide the psychological
therapy for children to help them understand what these thoughts are,
to help them change the way they are thinking about the world so as
they start to feel better they do not have more suicidal risks.
Interestingly enough, one of the things we oftentimes taught medical
students in medical schools is once patients start getting better with
symptoms of depression, the risk for suicide may increase because the
support systems back off and they say Johnny's feeling better, we do
not need to have him in the hospital or do not need to be around him as
much. Perhaps people are no longer monitoring the person 24 hours a
day. They start to go back to school, face more stresses.
As they are getting their energy up, as they are back in the world
and thinking if we do not change the way they think with depressive
thought patterns, if we do not interrupt that and change it, you can
actually increase the risk for suicide. That being the case, we have to
make sure that as we are looking for more effective ways of spending
money, the taxpayer dollars in Medicaid and Medicare and Head Start
that we are working comprehensive care with the patient, with mental
illness as well, such problems as I said before about bipolar; that is,
manic depressive illness, attention deficit disorder, anxiety
disorders, all of these with a strong genetic component and elements
where we can make huge changes in people's lives.
It is something that we need to make sure we are no longer just
criticizing about overprescribing or perhaps saying that too many kids
are getting stimulant medication with attention disorder; we should or
should not do this.
Here is the crux of this. It really is a matter of having accurate
diagnosis and treatment and making sure that we are not overmedicating
or undermedicating our children. Somehow in this Chamber we politicize
this to somehow think we are doing something wrong in both areas of the
conservative far right, the liberal far left, somehow accuse maybe
there is some conspiracies involved in this, and there is not. It is a
matter of making sure the physicians have the training to deal with
this. They are interacting a comprehensive care model, a patient care
model, disease management model, together with people of various
professions and working closely with the families.
We see this in the area of children's health when you start to look
at so many aspects here that you really can make some huge differences.
I would like to point to a couple of things here and then call upon
the gentleman from Georgia (Mr. Gingrey), my colleague, on a couple of
questions. But one of the things to keep in mind about depression,
which is one of the most common mental illnesses affecting more than 19
million Americans each year, that it can cause longer lasting forms.
You can lose pleasure in life, complicate other medical conditions, can
lead to suicide, but it is also associated with many other medical
issues.
For example, cancer has a higher incidence of depression, stroke.
Diabetes, people with diabetes have a 25 percent chance of having
depression. That is higher than the rest of the population. Depression
also affects as many as 70 percent of patients with chronic diabetic
complications. People with heart disease, 40 to 65 percent of them will
have depression, and what is interesting is untreated depression in
these patients can lead to complications, such as the health care costs
can double.
Now, I ask the gentleman from Georgia (Mr. Gingrey) on this, he
certainly treated many a patient who had medical complications as well
as some of the psychological ones, and I would like to ask him, in
looking at some of these more comprehensive chronic care models, of how
we need to be moving forward in a modern system of health care and not
be just looking at individual disease, but how looking at more advanced
forms of bringing technology and changing the system, how he sees that
affecting the patient in a cost-effective way.
Mr. GINGREY. Mr. Speaker, as the gentleman pointed out, and he is so
right, we need to move into the 21st century in regard to our health
care system and modeling. Just trying to come up with better drugs and
the latest surgery techniques to treat complicated illness is not
enough. We really need to focus on preventive care.
You are talking about in the last few minutes, of course, your
specialty, in talking about mental illness, and as it relates also to
childhood obesity, and I could not help but think as I was listening to
your discussion, and as you know, this week we just passed H.R. 554.
H.R. 554 is the Personal Responsibility in Food Consumption Act of
2005. This is a bill my colleagues are aware of the fact it would not
allow someone to sue a fast food manufacturer because they have gorged
themselves with a multiple number of Big Macs or any other kind of fast
food, or sometimes what we refer to as junk food. It is not the fault
of the food industry.
I used a little analogy when I was talking about this on the floor
yesterday in discussing the rule of my belt, which is a size 36. That
is, I hate to admit, the size of my waist, but if I wanted really out
of blind pride to suggest that I had a 24-inch waist and I cinched that
belt down a couple of notches, in doing so, I put pressure, compression
on something referred to as the lateral femoral cutaneous nerve, it
would result in a condition of numbness and lack of feeling on the
anterior thigh. Then should I go out and sue the belt company because
they are at fault because I misused a product?
This is what this bill, of course, is all about, a common-sense type
bill.
Parenthetically, Mr. Speaker, I also want to mention the gentleman
from Florida (Mr. Keller), the author of the bill, our good friend and
colleague, is actually in the hospital now and recovering hopefully
from a fairly minor condition, but we want to pay tribute to him. I
know he is proud that we passed this bill this week.
[[Page H8964]]
The comment that I wanted to make is this issue of personal
responsibility, and parents should have that personal responsibility
obviously in the way they conduct themselves in regard to how they eat
and a healthy diet and exercise, but even more importantly is the
responsibility that they have to give a good example and instruction to
their children.
I think it is probably the worst form of child abuse to let these
youngsters that at a very early age overeat and become obese. You have
talked about the issue of poor mental image, self-image, and of course,
I also see you talked about Hollywood and, of course, this issue of
there is no such thing as mental illness. I think probably they might
predominate in some of those diseases, which we categorize as mental
illness.
But quite honestly, when a child goes to school and there is this
emphasis on thinness and you see these youngsters wearing these Britney
Spears' jeans and that sort of thing, a child even a little bit
overweight and certainly one that is significantly obese, of course
they are going to have a poor image of themselves. They are going to
withdraw, and they are going to become shy. It is very likely they are
going to be picked on. How in the world can they grow and develop with
a healthy self-image? No wonder they end up needing to be counseled and
treated by the gentleman from Pennsylvania (Mr. Murphy) and other
mental health care specialists.
Yes, unfortunately, some even go on to harm themselves and possibly
even commit suicide. So I guess the most important thing that I would
want to say as a physician Member is that we need to prevent this.
{time} 1800
We need to make sure that parents get the message that they have an
obligation, not just to take care of themselves, but first and foremost
to take care of these precious children that they bring into the world.
It is their responsibility to make sure that they are from the very
beginning, when they start eating at the table, to make sure that they
are healthy and stay healthy so you do not have to have them ending up
in your office treating them for not only mental illness but also the
many complications of obesity.
You mentioned them. You mentioned diabetes, high blood pressure, so
many things. And talk about the cost to this health care system of
ours. We always talk about waste, fraud, and abuse in the Medicare and
the Medicaid programs and wanting to eliminate that, and we are very
diligent and will continue to be so. But this is almost a no-brainer.
It is like we heard former Speaker Newt Gingrich say to a group of us
earlier today, and the gentleman from Pennsylvania was a part of that
as we had him come to speak to Members of the House. We are not talking
about low-hanging fruit here in regard to saving money and saving
lives. We are talking about fruit that is lying on the ground sitting
there rotting waiting for us to pick it up. So clearly that is what my
message would be in regard to that.
Mr. MURPHY. I thank the gentleman. I asked about another issue, too,
which is one that is so critically important for children. My colleague
from Georgia had mentioned before, during pregnancy, smoking being one
of the risk factors. I believe that the sad statistic is that the
Pittsburgh region has some of the highest maternal smoking rates during
pregnancy in the Nation. My understanding is a lot of complications can
come when you have a mother who smokes during pregnancy. Certainly an
important part of prenatal care for our children is understanding the
importance of helping a mother to stop smoking during that time.
I wonder if the gentleman can comment on some of the complications
that might come for that mother and that baby not only during labor and
delivery but the long-term effects for that child when the mother
smokes during pregnancy.
Mr. GINGREY. Without question probably the most common condition that
we see in smoking moms is something called toxemia of pregnancy.
Toxemia, by the very word, it is a poison. We do not know exactly what
that poison is, but something occurs in those moms that develop
toxemia. It is not always because of smoking, but frequently it is. And
also so often that condition will lead also to pre-term labor and
delivery and one of these low birth weight infants.
In the extreme, toxemia of pregnancy before birth results in a very,
very high blood pressure. It can cause a stroke, a deep coma, one from
which sometimes the mother never recovers and the child is lost. So we
are talking about one of the worst complications of pregnancy other
than just out and out exsanguination from bleeding, which is also a
possibility in any pregnancy.
But smoking, we see that condition more often. And then, of course,
childhood asthma, which I am sure the gentleman has seen plenty of
cases of that, youngsters that come in because there is that secondary
smoke situation. Not only do they have to suffer with it during the 9
months of pregnancy of their mom; but once they are born, that smoking
continues in the household. So it is a huge complication, no question
about that.
Mr. MURPHY. Also, it is related to, my understanding is yet so many
other aspects come from this that you may find in such children also
eating disorders and diabetes and cancer risks even if that child never
themselves smoked cigarettes. But the risks are huge. I believe a
direct and indirect medical cost of smoking in this Nation is about
$138 billion per year.
Of course, another reason why I believe it is so important not only
for the government but really for individuals and businesses to focus
so much on helping to change that is the State of California, for
example, estimates that their statewide tobacco prevention program
during the 1990s resulted in overall cost savings of $8.4 billion in
health care. That is pretty remarkable.
Again, unfortunately, the way the Congress scores things with the
Congressional Budget Office, when we talk about starting programs that
would actually save money, my colleagues are aware of this, we never
can get an accurate measure of what it actually saved because of the
way the CBO, the Congressional Budget Office, scores things. It is not
how much you save, but how much you spend. So if we would do similar
things that would lead to a smoking cessation during pregnancy, and it
might cost X number of dollars, the CBO would score that but never tell
us how much money it would save over time. That is something that
frustrates all of us because the things we are talking here tonight
really require some expenditures to get these savings.
Businesses are picking up on this. A recent review of health
promotion and disease and management programs in businesses that
provided health education to their employees, including exercise,
health-risk screening, weight control, nutrition information, stress
management, disease screening, and smoking cessation, found a
significant return in investment, saved about $1.50 to about $5 for
every dollar spent in the program.
For example, Motorola, their wellness program saved the company about
$4 for every dollar invested. Northeast Utilities' program in its first
24 months reduced some of the claims by about $1.4 billion. Caterpillar
Company, they had a program that saved about $700 million. Johnson and
Johnson's health and wellness program saved about a couple hundred
dollars per employee per year.
What is interesting here is how much we can save and what we have to
look at here. And I call upon my colleagues, we need to make some
fundamental changes in how CBO scores these things. We have got to stop
just looking at how much it costs up front and look at how much it
saves in the long run. Again, I look at such things as if we are able
to have more people go to federally approved health centers, community
health centers in their community instead of showing up in
the emergency departments, yes, it may cost money; the President called
for a couple billion dollars to put into those community health
centers. But if it is one-fifth of the cost of going there rather than
the cost of going to the emergency departments, that is a massive cost
savings.
Certainly I call upon my colleague, too, it is one of those things
you have seen as well, how do we get these prevention issues begin to
be scored. It is of fundamental importance to health care.
[[Page H8965]]
Mr. GINGREY. The gentleman is so right, and I appreciate the
opportunity to weigh in on this issue.
This issue of scoring, as the gentleman is talking about, it reminds
me of course of the debate during the Medicare Modernization and
Prescription Drug Act that we passed in December of 2003. Of course,
that part D will go into effect and the modernization piece is already
in effect for Medicare, but part D, the prescription drug part, will
start January 1. But all we heard and continue to hear, particularly
from the other side and for those nay-sayers who keep wanting to talk
negative about really a very good program that is going to be a Godsend
for our neediest seniors, I talked about this on the floor, my
colleagues I know heard me last night. But the talk, the emphasis is on
the cost of part D, and the cost estimate is based on the number of
seniors that participate ultimately.
I do not think anybody really knows, Mr. Speaker, what that number
will be; but at one point it looked like the CBO said, well, it is
going to be $400 billion additional Medicare cost over a 5-year period
of time. Then those numbers were revised, and then we were hearing as
much maybe as $750 billion. That is the scoring that the gentleman from
Pennsylvania is talking about, and my colleagues understand what he
means. You get no credit for the fact that many people who sign up and,
yes, there will be an additional Medicare cost for them on this part D
program, but the fact that they are able to take those medications,
they can finally afford to take that statin to lower their cholesterol
and that medication, that insulin to lower their blood sugar or
whatever antihypertensive to lower their blood pressure, guess what, we
get less spending on part A, the hospital part, when you end up in the
emergency room with a stroke because you could not take your medicine,
or you end up on the operating table for your coronary bypass or maybe
even worse an amputation or a kidney transplant, and then you have this
huge cost to the physician under part B.
The truth of the matter is, and what the gentleman was emphasizing,
is that you get no credit for saving those costs, not to mention the
fact that it is so much more compassionate to spend money on prevention
rather than treatment, particularly when the treatment sometimes is not
very successful and a person could ultimately be in a nursing home for
years and disabled for the rest of their lives.
I will take it a step further before turning it back over to my
colleague. It is the same thing, this scoring issue, in regard to the
tax cuts that this Republican leadership has effected over these past 3
years. The scorers, the CBO, the number crunchers say, well, these tax
cuts, the elimination of the marriage tax penalty, increasing the child
tax credit from $600 an infant to $1,000 a child, giving small business
men and women an opportunity to more rapidly depreciate investment in
bricks and mortar and creating new jobs, all of these things,
elimination of the death tax, no taxation without respiration I firmly
believe in, the scorers said that was going to cost us $1.3 trillion.
My colleague remembers that. And a lot of people said, oh, we cannot
afford that. What are we doing cutting taxes? Well, after about a year
and a half, when we looked at our revenue stream, what was the result?
We had about 225 billion more dollars, which on the scoring side we get
no credit for.
So the gentleman is so right. So many of these things that we are
talking about tonight in this hour, these innovations, these community
health centers that the President has funded, recommended, and feels so
strongly about, on the scoring side you get no credit for; but we do
save money, as the gentleman points out. And just think, also, it is
the compassionate, conservative thing to do for the American people.
Mr. MURPHY. I am reminded of the story of the fellow who was on his
hands and knees late at night under a streetlight in the city, probably
had too much to drink, and a police officer sees him and says: Excuse
me, sir, what are you doing? The gentleman says: I am looking for my
car keys. And the police officer says to him: Well, where did you lose
them? He said: I lost them down at the end of that dark ally down
there. And the policeman says: Well, why are you not looking for your
keys at the end of that dark ally over there? And the gentleman says:
Because there is more light over here.
Sometimes I think the way we look at these medical issues, instead of
looking at the cost savings involved with prevention, we simply are
able to look at how much it costs us up front because it is easier to
find that data. It is tougher to pay attention to prevention.
My colleague brought up some great points. Prenatal care, Early Head
Start, Head Start, what that contributes to in helping save problems.
We talked about community health centers and spending money. I like the
President's plan of a community health center in every county in
America where there is poverty and an uninsured, can help reduce
emergency visits by four-fifths, the cost of the emergency visits. It
is an incredible amount of savings, but not one that we can get those
scores for. And it is one of those things where, unfortunately, the
political rhetoric comes through in this Chamber, and I do not know of
anybody who has ever been cured by a floor speech, but it certainly is
one where there is just so much talk that continues on, spending too
much here, spending too much there. We need to pay attention to
spending too much.
The problem is not what we are spending, but what we are spending it
on. And if we are continuing to spend on wasteful or fraudulent or
abusive or simply health care issues that are not taking care of the
disparity of outcomes between, for example, low socioeconomic families,
families that are struggling to make ends meet and feel they do not
have the money to pay for their doctor visits, and those that may be in
poverty, we need to work on those disparities of outcomes and make sure
that we take care of those children early on; and that is why the issue
of community health centers for our kids is so critically important.
But, again, some will say we are spending too much, causing the budget
to go up, and we cannot get the proper numbers.
Now, some of the public that may be listening is wondering why we are
even talking about the CBO. But that is, unfortunately, the way this
Chamber operates now and that people oftentimes look at those numbers.
We have seen tremendous inaccuracies in those numbers. My colleague
from Georgia spoke about those inaccuracies when it came to looking at
things such as the death tax and them being off over $1 trillion in
their estimates. But also it is one of those things in health care,
too.
Think about this: if you take a medication that costs you $50, but it
may prevent you from having a heart attack and further
hospitalizations, surgery, disability, workers comp, losing your job,
having the family require other care, that is a massive amount of cost
savings. But, instead, we may focus on only that aspect of the cost of
that medication, instead of all the other costs that are saved there.
When we look at what we are doing with children's health, it is so
critically important that we look at the big picture here as well.
Now, I am going to see if my colleague has any final comments to make
in this area of health care. Barring that, I just want to mention a
couple of final comments here.
{time} 1815
We are certainly the stewards of the people's money, and although we
are not here to take the place of the family, we are here to do
sometimes what Abe Lincoln said. President Lincoln said, ``Governments
should do that which the people cannot do for themselves.''
Now, in the areas of such things as food and consumption, people and
parents ought to be watching what they eat. Well, what we also ought to
be doing ourselves is working along with physicians and schoolteachers
and people in the community to make sure our kids are healthy and safe
and exercise and eat right.
But we also have to make sure we are working at comprehensive care,
real patient care models, that involves nutrition and exercise and
prevention and mental health, and integrated care of all of those
things together. If we are
[[Page H8966]]
truly going to do what is right and decent and honorable for the next
generation, it is a matter of doing what is right in health care.
It is a matter of pooling our resources together and looking at the
answers, to be science-based and not emotion-based on this. The science
tells us we have things we can do, but we are not yet doing. The
science tells us when it comes to managing the disease it is not
appropriate to just look at that individual disease, but to see how it
operates in the context of the child and their family.
This is true compassion. This is where we will save lives. This is
where we will save money. This is where if we do things like looking at
electronic medical records, and make sure that every hospital around
the Nation has this, and providers and pharmacists have these, you can
find out these things and work on them together.
That is what takes place in States like Nebraska and other hospitals
around the Nation. We have here an opportunity to make a huge
difference, to save lives by the hundreds of thousands, and to save
money by the hundreds of billions of dollars. We have that opportunity
before us.
The question is, will we have the courage to work together in a
bipartisan manner to do it? My hope is that our colleagues drop the
gloves on this, put down the swords, stop looking for opportunities to
send out sound bytes and to have people make phone calls and use it as
political fodder, but instead to be able to look our constituents in
the eye and say when we were all here, when we were all granted the
authority to do something about America, we took an opportunity to save
lives and save money, and we ought to start with our children.
I thank my colleagues.
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