[Congressional Record Volume 154, Number 79 (Wednesday, May 14, 2008)]
[Senate]
[Pages S4126-S4127]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. DURBIN. Mr. President, free market fundamentalism tells us that 
all we have to do is get Government out of the way and the miraculous 
powers of competition and supply and demand will solve all our 
problems. This is a cardinal principle of the administration now in 
power. They have had 7 \1/2\ years to test their theory, and the 
results--for our economy and America's working families--has been a 
disaster. They have put their theory to work, and it has thrown 
Americans out of work. The middle class in America is shrinking and 
suffering. Today, more Americans are falling out of the middle class 
than are working their way into it.
  A new poll by the respected Kaiser Family Foundation provides a 
sobering look at the economic situation and the reality of economics in 
America today. The Kaiser Foundation asked people about seven economic 
trends or changes that they considered serious problems. Forty-four 
percent of Americans said problems paying for gasoline is a serious 
problem for their family's financial well-being. Twenty-nine percent 
said problems getting a good-paying job or a raise are serious. Twenty-
eight percent of Americans said problems in paying for health care and 
health insurance were serious and hurting their economic well-being. 
Those are the top three economic strains on family budgets: The price 
of gasoline, jobs--good-paying jobs--and paying for health care.
  They also rated serious problems when they were asked about the 
strains and problems their families face. Problems paying for mortgage 
or rent: One out of five. Problems paying for food and credit card 
debt: One out of five. Losing money in the stock market: About one out 
of six.
  We have heard a lot said about the strain the record gas prices are 
placing on families and our economy. Yet in the midst of all this, with 
the knowledge of what it is doing to our economy, to families, to 
businesses, to farmers, big oil companies continue to rake in record 
profits at the expense of the American economy.
  I wish to take a few minutes to talk about another economic problem 
that is hurting America's families and businesses: out-of-control 
health care costs. A recent essay in Newsweek magazine contained an 
eye-opening title: ``The Myth of the Best in the World.''
  I ask unanimous consent that the full article be printed in the 
Congressional Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                     [From Newsweek, Mar. 22, 2008]

The Myth of `Best In The World'--A Spate of New Research Shows the U.S. 
      Behind Other Countries in Cancer Survival and Diabetes Care

                           (By Sharon Begley)

       Not to be heartless or anything, but let's leave aside the 
     dead babies. In international comparisons of health care, the 
     infant mortality rate is a crucial indicator of a nation's 
     standing, and the United States' position at No. 28, with 
     seven per 1,000 live births worse than Portugal, Greece, the 
     Czech Republic, Northern Ireland and 23 other nations not 
     exactly known for cutting-edge medical science--is a tragedy 
     and an embarrassment. Much of the blame for this abysmal 
     showing, however, goes to socioeconomic factors: poor, 
     uninsured women failing to get prenatal care or engaging in 
     behaviors (smoking, using illegal drugs, becoming pregnant as 
     a teen) that put fetuses' and babies' lives at risk. You can 
     look at 28th place and say, yes, it's terrible, but it 
     doesn't apply to my part of the health-care system--the one 
     for the non-poor insured.
       That, in a nutshell, is why support for health-care reform 
     is fragile and shallow. Yes, many people of goodwill support 
     extending coverage to the 47 million Americans who, according 
     to the Census Bureau, had no insurance for all or part of 
     2006. An awful lot of the insured, though, worry that messing 
     with the system to bring about universal coverage, even if it 
     allows more newborns to survive, might also hurt the quality 
     and availability of care that they themselves get (``If I 
     have trouble getting my doctor to see me now, what will 
     happen when 47 million more people want appointments?''). 
     This is where you start getting the requisite genuflection to 
     the United States' having ``the best health care in the 
     world.'' One problem: a spate of new research shows the 
     United States well behind other developed countries on 
     measures from cancer survival to diabetes care that cannot 
     entirely be blamed on the rich-poor or insured-uninsured 
     gulf. None of this implies a specific fix for the U.S. 
     health-care system. It does, however, say that ``the best in 
     the world'' is a myth that should not be an impediment to 
     reform.
       How widespread is the ``best in the world'' view? In a 
     survey of 1,026 U.S. adults, the Harvard School of Public 
     Health and Harris Interactive reported last week, 55 percent 
     said they thought the United States has the best quality care 
     of any country. (Fewer called the U.S. system the best 
     overall, due to poor access and high costs.) ``Health-care 
     reform has failed before and will fail again if middle-income 
     people with insurance think it will make quality go down,'' 
     says Harvard's Robert Blendon.
       One thing Americans love about their system is the 
     availability (for the insured) of high-tech equipment and the 
     latest procedures. But there is abundant evidence that these 
     are not necessarily beneficial. I remember breast-cancer 
     patients screaming bloody murder in the 1990s when they were 
     denied access to bone-marrow transplants. Sadly, once the 
     treatment was subjected to rigorous study, it was shown not 
     to extend life. But it made women who worked the system to 
     get it (some private insurers agreed to cover it) suffer even 
     more than they already were. In a centralized system such as 
     Medicare, science more than the market shapes what treatments 
     are available. ``Some of the things patients scream for,'' 
     says Blendon, ``aren't going to help them.'' Though they do 
     run up the U.S. medical bill. At $6,697 per capita in 2007, 
     it is the highest in the world (20 percent more than 
     Luxembourg's, the next highest) and more than twice the 
     average of the 30 wealthy countries in the Organization for 
     Economic Cooperation and Development.
       If only it bought better care. Only 55 percent of U.S. 
     patients get treatments that scientific studies show to work, 
     such as beta blockers for heart disease, found a 2003 study 
     in The New England Journal of Medicine. One reason is that 
     when insurance is tied to employment, you may have to switch 
     doctors when you change jobs. In the past three

[[Page S4127]]

     years, says Karen Davis, president of the Commonwealth Fund, 
     32 percent of Americans have had to switch doctors. The 
     result is poor continuity of care--no one to coordinate 
     treatment or watch out for adverse drug interactions. Such 
     failures may contribute to the estimated 44,000 to 98,000 
     annual deaths from medical mistakes just in hospitals, and to 
     ``amenable mortality''--deaths preventable by medical care. 
     Those total about 101,000 a year, reports a new study in the 
     journal Health Affairs. That per capita rate puts America 
     dead last of the study's 19 industrialized countries.
       Other data, too, belie the ``best in the world'' mantra. 
     The five-year survival rate for cervical cancer? Worse than 
     in Italy, Ireland, Germany and others, finds the OECD. The 
     survival rate for breast cancer? You'd do better in 
     Switzerland, Norway, Britain and others. Asthma mortality? 
     Twice the rate of Germany's or Sweden's. Some of the U.S. 
     numbers are dragged down by the uninsured; they are twice as 
     likely to have advanced cancer when they first see a doctor 
     than are people with insurance, notes oncologist Elmer Huerta 
     of Washington Hospital Center, president of the American 
     Cancer Society. But the numbers of uninsured are too low to 
     fully explain the poor U.S. showing.
       It isn't realistic to expect America to be the best in 
     every measure of medical quality. And none of this tells us 
     how to reform the U.S. system. But it does say the ``best in 
     the world'' is misguided medical chauvinism that should not 
     block attempts at reform.

  Mr. DURBIN. This column points out that the United States spent 
almost $7,000 per person on medical care last year--$6,697 per capita. 
That is the highest in the world. It is 20 percent more per person than 
the next highest spending nation of Luxembourg, and it is more than 
twice as much as the 30 wealthiest countries around the world.
  In a survey of over 1,000 adults, the Harvard School of Public Health 
and Harris Interactive found that 55 percent thought the United States 
had the best-quality care in the world.
  The fact that we spend so much per person may lead people to that 
conclusion--that we have the best care. After all, we spend the most 
money. Yet the facts tell us otherwise. The highest cost doesn't mean 
the highest quality. We rank below other nations in many critical 
health outcomes. There is no doubt in my mind if I were seriously ill 
in any part of the world, I would try to find my way to the United 
States. There is no question we have the very best doctors, the very 
best medical professionals, hospitals, and medical technology.
  But when you take a step back and look at the outcomes for the 
American people, it tells a different story. The 5-year survival rate 
for cervical cancer in the United States--cervical cancer--is worse 
than Italy, Ireland, Germany, and many others. The survival rate for 
breast cancer in the United States is worse than the survivor rate in 
Switzerland, Norway, Britain, and other nations. Our asthma mortality 
rate is twice the rate of Germany and Sweden. True, we have the best 
hospitals but not the best outcomes, in many instances.
  Only 66 percent of U.S. patients receive treatments that scientific 
studies show to work, such as beta blockers for heart disease, 
according to the New England Journal of Medicine.
  According to a 2007 survey by the Independent Commonwealth Fund, 
adults in the United States are more likely to forgo needed health care 
than adults in Australia, Canada, Germany, Netherlands, New Zealand, 
and the United Kingdom. Nearly one out of five American adults surveyed 
said they have serious problems paying medical bills. That is more than 
double the rate in the next highest country. Nearly a third of those 
surveyed had spent more than $1,000 out of pocket in the last year on 
medical costs not covered by insurance. Only one out of five 
Australians and one out of eight Canadians spent that much money on 
out-of-pocket health expenses. No other nation came even close.
  Seven years ago, the World Health Organization made the first major 
effort to rank the health systems of 191 nations. The top two nations 
in the world: France and Italy. The United States did not even make the 
top 10; not even the top 20. We ranked 37th in the world, according to 
the World Health Organization, when it came to our health care systems. 
We have this vanity in the United States that because we spend so much 
money on health care, we must be the best in the world. It is not true.
  More people die each year from medical and surgical mistakes in the 
United States than in any other industrialized nation. Incidentally, 
more Americans die of medical mistakes each year than die from AIDS, 
breast cancer, and automobile accidents combined.
  In health information technology, we lag far behind. By 2005, the 
United Kingdom had invested 450 times more per person in public funding 
of health information than the United States. We rank the highest in 
infant mortality among 23 nations and near the bottom in healthy life 
expectancy at age 60. We are 15th among 19 countries in deaths from a 
wide range of illnesses that would not have been fatal if treated 
timely and in an effective way. We do well in reducing smoking, but we 
still have the worst rates of obesity.
  When you get beyond the myths and look at the studies, it becomes 
clear. The quality of a nation's health care is determined not by how 
much we spend but by whether we provide universal care that works. The 
United States is the only major industrialized nation without universal 
health coverage. We cannot give an assurance to every single American 
that they will have a doctor at hand when they need one. We can't give 
them the assurance that they can have basic access to needed health 
care when they absolutely need it for their family. Other nations have 
met that responsibility. We have not.
  Ironically, the persistent and unfounded belief that Americans 
receive the best health care is a major reason why we don't move toward 
change and don't move toward providing the peace of mind which every 
American and every American family deserves. The health care and 
insurance companies spend millions of dollars to frighten Americans 
into thinking that covering everyone with health insurance will somehow 
mean less coverage for others and less choice for Americans who already 
have health insurance. That is a scare tactic. Look at all the other 
countries in the world that have better health care at much lower cost. 
By the way, when it comes to health care choice--especially choice of 
doctors--a third of Americans with health insurance say they had to 
change doctors in the last 3 years because their insurance company 
insisted on it. One out of three Americans. So the idea that consumers 
are in charge of their own health care choices is belied by that 
statistic.
  There is no reason why we can't build a better health care system in 
America that lowers costs, covers everybody, and makes us a healthier 
nation. One of the first steps is to get beyond the myths and the 
vanity and actually look at the facts.
  I yield the floor and suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. CORNYN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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