[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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