[Congressional Record Volume 154, Number 64 (Tuesday, April 22, 2008)]
[House]
[Pages H2533-H2534]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Washington (Mr. McDermott) is recognized for 5 minutes.
  Mr. McDERMOTT. Mr. Speaker, reforming health care in America is not 
nearly as hard as the special interests would like the American people 
to believe. The special interests want to protect their profits, but 
Congress should concern itself with protecting the health and well-
being of the American people.
  There are two major news stories today that should be viewed side-by-
side. On their own, each story is powerful. Taken together, however, 
the stories offer compelling evidence of what happens when special 
initiates lobby against meaningful reform in the United States; while 
in France, people receive universal health care that is ranked number 
one in the world by the World Health Organization.
  A new study conducted jointly by Harvard University and the 
University of Washington in my district has yielded a startling 
conclusion. Reporter Tom Paulson has the story in today's Seattle-Post 
Intelligencer. Let me read an excerpt, ``One of every five American 
women and one of every 25 men are either dying at a younger age or 
seeing no improvement in life span. The lead authors told the PI, ``It 
is what you would expect to see in a developing Nation, not here in the 
United States,'' according to Dr. Ezzati, a Harvard professor. Dr. 
Chris Murray from UW called it a complete surprise, and said, ``It's 
remarkable in the history of the U.S.''
  We pay more for health care than any nation on Earth, yet life 
expectancy is declining for millions of Americans.

                              {time}  1930

  At the same time, for about half the cost, every French citizen has 
access to universal health care, rated the best in the world.
  ABC News Online carried the story of the French system. It includes 
data that shows that universal health care coverage works. In France, 
there is one doctor for every 430 people. In the United States, there 
is one doctor for every 1,230 people. The average life expectancy in 
France is 2 years longer than in the U.S. And the French system is one 
of the most expensive in the world at $3,500 per person, but it is 
nothing compared to the $6,100 we spend in the United States for every 
individual. And we have 47 million without any health care coverage, 
and millions more with less than adequate coverage because it is too 
expensive.
  When the American people face soaring costs for health care, it is 
time to create an American universal health care system. When millions 
of Americans face a declining life expectancy, it is time to create an 
American universal health care system. When the U.S. health care system 
is ranked 37th in the world by the World Health Organization, it is 
time to do something.
  We don't have one today, because special interests have used their 
influence to put profits ahead of people by perpetuating a broken-down 
system, and whenever someone tries to change it, they spend millions of 
dollars to try and scare people. They are not spending all that money 
to provide better health care; they are spending it to protect their 
profit margins. And they will try to scare us into thinking that the 
Americans can't develop a plan. That is not true.
  An American universal system is not only possible, it is imperative. 
These two stories, which I will enter into the Record, are stark 
reminders of a crisis that is growing because it is not being treated.
  In medicine, it would be as if all the tests showed that a tumor was 
growing inside a patient and we did nothing about it. It would be 
malpractice and it would needlessly endanger a patient. Without an 
American universal health care plan, that is exactly what we are doing 
to the American people. Ignoring the truth has never worked in 
medicine, and it won't work for health care in this country. We need an 
American universal health care system, and we need it now.

                 [From the Seattle Post-Intelligencer]

 Lifespan Shorter in Parts of U.S.--Obesity, Smoking Cited; State Not 
                            Immune to Trend

                            (By Tom Paulson)

       For the first time since the 1918 Spanish flu pandemic, 
     life expectancy for a significant proportion of the United 
     States is on the decline largely because of an increase in 
     chronic diseases related to obesity, smoking and high blood 
     pressure.
       Although life expectancy for all other Western nations and 
     for most of the U.S. has continued to improve over the past 
     several decades, researchers at Harvard University and the 
     University of Washington say many of the worst-off here are 
     getting much worse.
       One of every five American women, and one of every 25 men, 
     are either dying at a younger age or seeing no improvement in 
     life span. Although this deadly trend is mostly centered in 
     the southern parts of the nation, several largely rural 
     counties in Washington--Cowlitz, Lewis, Benton and Grays 
     Harbor--are also on the verge of seeing a decline in overall 
     life span.
       ``It is what you would expect to see in a developing 
     country, not here,'' said Dr. Majid Ezzati, a Harvard 
     professor and lead author of a study published in the open-
     access journal Public Library of Science Medicine.
       ``This was a complete surprise,'' said Dr. Chris Murray, 
     co-author of the study and director of the UW's new Institute 
     for Health Metrics and Evaluation in the Department of Global 
     Health. ``It's remarkable in the history of the U.S.''
       Between 1961 and 1999, life expectancy in the U.S. 
     increased overall for men from 67 to 74 years and from 74 to 
     80 years for women.
       Most of this improvement is attributed to a decline in 
     deaths from heart disease and strokes.
       Beginning in the early 1980s, however, life expectancy in 
     some of the nation's ``worst-off' counties (based on overall 
     health indicators) either stayed the same or declined by 1.3 
     years for both sexes. For those living in those counties, men 
     on average die about 11 years earlier and women die 7.5 years 
     earlier than people in better-off counties.
       Nothing like this trend has been observed in this country 
     since the massive deaths caused by the 1918 flu pandemic, 
     Murray said, and nothing like it appears to be happening in 
     any of the other industrialized nations around the world.
       ``And I don't think you can take any comfort if you happen 
     to be living in an area today without an overall decline,'' 
     he said. ``It appears to be a problem that is spreading.''
       Ezzati, Murray and their colleagues initially performed an 
     exhaustive analysis of county mortality data between 1961 and 
     1999 (the latest year for which the data were available) 
     looking for health disparities. They did not anticipate 
     discovering that so many Americans, especially women, were 
     dying at an earlier age.
       ``We started noticing this period, starting in the early 
     1980s, where the gaps between the best-off and worst-off were 
     getting wider,'' Murray said. Not only were the disparities 
     getting worse, he said, but those with the worst health 
     indicators were dying earlier.

[[Page H2534]]

       ``It was pretty shocking to us,'' Ezzati said. And contrary 
     to what might be expected, he said the observed declines in 
     life expectancy did not seem to correlate with race or 
     income. Ezzati emphasized this wasn't just a trend affecting 
     poor minorities.
       ``This appears to be something beyond race and income,'' he 
     said. Most of the worst-off counties were lower-income in 
     comparison with other counties, Ezzati said, but the decline 
     in life expectancies did not simply correlate with income. 
     ``For example, the data for low-income whites in northern 
     Minnesota looked quite different than low-income whites in 
     Appalachia,'' Ezzati said. ``The geographical differences 
     here are capturing something significant.''
       The researchers found that the diseases most closely 
     associated with the observed declines in life spans appeared 
     to be related to smoking, obesity and high blood pressure. 
     Women probably have suffered more significant declines, 
     Murray said, because of increased rates of smoking and 
     obesity, compared with men.
       ``But that's still just speculation,'' he said. ``We really 
     don't know all the reasons for this.''
       Both Ezzati and Murray said it would be wrong to simply 
     conclude these declines in life expectancy in certain regions 
     are attributable to poor lifestyle choices--smoking, poor 
     diet or lack of exercise.
       ``If this was just a matter of bad individual choices, you 
     would expect to see these declines in life expectancy evenly 
     distributed around the country,'' Ezzati said.
       ``I don't think it's as simple as lifestyle,'' Murray said. 
     Having high blood pressure or diabetes isn't really a matter 
     of choice or lifestyle decisions, he said.
       In the 1960s, when traffic deaths were increasing, Murray 
     said the nation launched a safe-driving campaign that failed 
     to reduce deaths or accidents. When policymakers instead 
     began treating that as an engineering and regulatory 
     problem--requiring cars to have seat belts, later air bags 
     and improving the safety of the roads themselves--``that's 
     when the deaths started to go down,'' Murray said.
       Likewise, he and Ezzati said they hoped their findings will 
     spur policymakers to both improve chronic disease 
     surveillance and explore methods aimed at curbing this 
     disturbing, deadly trend.


                             in washington

       Over the past four decades, life expectancy in the U.S. has 
     increased overall for men from 67 to 74 years and from 74 to 
     80 years for women. But in certain locations, starting in the 
     early 1980s, researchers say life expectancy began to stall 
     or decline--especially for women. In Washington State, four 
     counties (Lewis, Cowlitz, Benton and Grays Harbor) are among 
     those places where life expectancy has not declined, but also 
     has not improved much since the early 1980s.
                                  ____


               The Health Care System I Want Is in France

                            (By Mary Cline)

       Paris, April 15, 2008.--Shortly after we moved to Paris, my 
     son, Luke, cut his lip in a fall at school. I rushed him to 
     the emergency room of a suburban Paris hospital, where a 
     nurse asked my name and address and a doctor quickly stitched 
     up his cut. When I tried to pay, the cashier asked me to call 
     the following week because the ``computer is slow.'' A bill 
     eventually arrived in the mail for the equivalent of $60.
       The same week I took Luke to have his stitches removed at a 
     clinic where a doctor spent nearly an hour with him first 
     softening a scab on the cut. This time, the clerk was 
     apologetic as she handed me the bill, explaining she was sure 
     my American health insurance would reimburse some of the 
     cost. The total bill: $7.50.
       As presidential candidates hammer out proposals to deal 
     with the increasing millions of uninsured Americans, I know 
     which health plan I'll choose: the French one.
       The World Health Organization has named the French health 
     care system the best in the world. (The U.S. ranked 37th). 
     It's physician-rich, boasting one doctor for approximately 
     every 430 people, compared with a doctor for every 1,230 
     residents in the U.S. (and French docs tend to charge 
     significantly less). The average life expectancy is two years 
     longer than the U.S. And while the system is one of the most 
     expensive in the world, costing $3,500 per person, it's far 
     less than the $6,100 spent per capita in the U.S.
       I've had a unique opportunity to see both systems up close 
     and personal: I had breast cancer in California nine years 
     ago and a recurrence in Paris this year. I received excellent 
     care in both places, though looking back now my California 
     oncologist's office was a bit of a meat market--always packed 
     with patients, from the seemingly not-so-sick to some a step 
     from the grave--a time-consuming disadvantage of living in a 
     much larger country with a lower doctor-to-patient ratio.
       My French doctors and nurses have been sensitive, skillful, 
     caring--and not so harried. But the biggest difference has 
     been money.
       My top-level health insurance paid for most of my U.S. 
     care, but it was often a struggle to shake loose the money. I 
     was frequently stuck in the middle of disputes between the 
     company and my hospital and doctors over ``agreed to fees.''
       Continually dunned by the hospital for fees and facing 
     multiple complaining phone calls to my insurance company, I 
     sometimes simply caved in and wrote checks to cover bills 
     that I knew were the insurance company's responsibility--part 
     of a wearing-down strategy I was convinced was deliberate.
       Here in France I have a green carte vitale--literally a 
     ``life card'' or social security card that provides entree to 
     the system. It's funded by worker contributions and other 
     taxes. My husband (and our family) is covered through his 
     work with a French subsidiary of a U.S. company, and so is 
     everyone else; coverage is universal. The French are 
     responsible for co-pays, but some 80% of them have 
     supplemental private insurance to cover the co-pay. People 
     least able to pay and those with chronic or serious illnesses 
     often have the best coverage. Because I'm being treated for 
     cancer, I'm cent pour cent--100%--covered.
       The effect of a system where hospitals and doctors don't 
     worry about getting stiffed by a patient or an insurance 
     company seems to be a far more relaxed, generous system. When 
     my surgeon discussed breast surgery here, he suggested that I 
     stay in the hospital five days. ``Of course I can do it the 
     American way, kind of an outpatient situation,'' he told me, 
     apparently not wanting to sound unsophisticated. ``But I 
     don't like pain.''
       Maternity stays for a normal delivery are a minimum of five 
     days, not the 48 hours mandated by U.S. federal legislation 
     in 1998 after many insurance companies insisted stays be even 
     shorter.
       I've always had health insurance in the U.S. And yet the 
     few times I'd had to walk into an American emergency room 
     I've always felt a thief who seems to be expected to sign 
     over all worldly goods before any medical care can begin, 
     regardless of the state of agony someone might be in. French 
     doctors address problems immediately and aren't constrained 
     by approvals from some medical decision maker in a distant 
     insurance office.
       Years ago, my husband had to wait several hours in a 
     Manhattan emergency room as administrators tracked down 
     someone in our out-of-state insurance company who would 
     approve (and therefore agree to cover the bill for) 
     antibiotic treatment for a horrifying infection in his face 
     that doctors were concerned could have been flesh-eating 
     strep.
       There's no question you'll be treated in France. Everyone 
     is. The nation pays the bills and the hospitals don't get 
     stiffed. It's an all-encompassing cradle-to-grave system. My 
     fear now is that I won't be able to even get insurance when 
     and if I return to the states, much less be able to afford 
     it.
       ``The French health care system has a lot of lessons for 
     the U.S.,'' said Northern Arizona University Professor Paul 
     V. Dutton, who has studied both extensively for his book 
     ``Differential Diagnoses: A Comparative History of Health 
     Care Problems and Solutions in the U.S. and France.''
       ``There seems to be a feeling that Britain's socialized 
     health system is the only one we can look at because it's 
     English, it's the mother country. But in fact, the French 
     share many of the same values that American consumers seek, 
     like choice of physician and freedom from insurance company 
     authorization of medical decisions. The French system is 
     already far more similar to the American ideal,'' Dutton 
     said.
       Except it works.

                          ____________________