[Congressional Record Volume 154, Number 152 (Wednesday, September 24, 2008)]
[Senate]
[Pages S9381-S9382]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. CRAIG. Mr. President, I have come to the Senate floor often over 
the last good number of years to speak about a variety of issues. In 
the last 4 or 5 years, I spoke of my concern over a lack of a national 
energy policy and the productivity of the great private sector in our 
country to produce energy for the American consumer and the inability 
of public policy or political figures to allow that to happen for all 
kinds of reasons, and obviously we have now experienced one of the 
greatest energy shocks in our country's economy. Yet we still stand 
still today, immobile in our ability to deal with it for a variety of 
reasons.
  Today, I do not come to the floor to speak about energy. I am here 
today to speak about two health care issues that are important to our 
Nation: accessibility to health care services and health care for 
veterans.
  As chairman of the Veterans' Affairs Committee, I had the opportunity 
to learn more about the phenomenal job the Department of Veterans 
Affairs does to provide health care to our Nation's veterans. VA runs 
facilities across the country that employ some of the finest doctors, 
nurses, and other health care professionals.
  These are dedicated men and women who provide world class health care 
to our Nation's heroes. The VA is also a training ground for many of 
our Nation's health care professionals. According to the American 
Association of Medical Colleges, more than half--yes, that is right, 
more than half--of our Nation's physicians receive some part of their 
medical training in VA hospitals.
  Over 28,000 residents and nearly 17,000 medical students rotate 
through the VA health care system each year. Clearly, VA has become an 
invaluable piece of the health care system for all Americans.
  At the same time, the VA is a separate health care system within our 
Nation and creates a certain disconnect. The focus of the VA has been 
on establishing a system that is dependent upon bricks and mortar and a 
fixed location.
  In the vast majority of situations, veterans enrolled in the VA 
health care system must receive health care at VA facilities unless 
they want to pay for care through private insurance or out of their own 
pockets. This means that veterans who do not live near a VA facility 
have a more difficult time accessing VA care because of where they 
choose to live.
  To address this, VA aims to build facilities in strategic locations 
to serve the greatest number of veterans. I am pleased that in the past 
few years VA increased the number of outpatient clinics in my State of 
Idaho. Unfortunately, these new clinics cannot completely resolve all 
of the issues or serve veterans in a total way.
  I am sure all of my colleagues, and particularly those who represent 
rural States such as my home State of Idaho, have heard from veterans 
who wish they could utilize their VA health care benefits at a facility 
closer to their home. It is a significant barrier to care when a 
veteran has to drive for several hours to reach a VA facility.

  An elderly veteran, possibly in his or her seventies or eighties, 
driving literally hundreds of miles to get to that VA facility, is in 
itself not only impractical, in many instances it is impossible for 
that veteran. We also need to consider health care access for the 
general population. It is no surprise that our Nation is facing a 
crisis when it comes to having an adequate supply of health care 
professionals.
  According to a July 2007 report of the American Hospital Association, 
U.S. hospitals need approximately 116,000--that is right, 116,000--
registered nurses to fill vacant positions. This is a national RN 
vacancy rate of about 8.1 percent.
  Another study estimates that the shortage of RNs could reach 500,000 
by 2025. I did the math on my age and determined that is about when I 
am going to start needing possibly more health care provided by health 
care professionals. At this moment, we are suggesting this will be the 
period of time when there will be potentially the greatest shortage.
  An aging workforce, a shortage of slots in nursing schools, and an 
aging population that is living longer and therefore requiring more 
health care services are all contributing to this nursing shortage. 
This shortage in health care providers is not limited to nurses. In the 
2006 report by the Health Resources and Services Administration, they 
project a shortfall of around 55,000 physicians by 2020. In addition, 
various studies have indicated current

[[Page S9382]]

or impending deficiencies in various specialties, including cardiology, 
rheumatology, and neurosurgery, as well as primary care.
  I think most Americans understand the significance of this situation. 
We can build all of the medical facilities we want, but they serve no 
purpose if there are not enough medical professionals to work in these 
hospitals and clinics.
  That is where the VA and other medical facilities, be they public, 
private or nonprofit, run into each other. They are all competing for a 
pool of health care professionals that is not growing, and that is not 
growing as quickly as it is needed. I am concerned that ultimately this 
will diminish the quality of health care that is delivered to our 
Nation's veterans and, of course, to all Americans.
  So how do we address the health care needs of all Americans when 
faced with these challenges? I think we need to examine how we can 
integrate VA facilities with other health care facilities to better 
serve not only veterans but entire communities. Is there a way that we 
can utilize existing VA facilities to serve all of those living in 
rural communities that struggle to recruit health care professionals 
without compromising care for veterans? Is there a way we can change 
the VA health care system to enable veterans to receive care at their 
local non-VA health care providers?
  I know these kinds of changes will not happen quickly and they will 
not happen easily. Earlier this session I introduced two pieces of 
legislation that proposed dramatic changes in the VA health care 
system. I will say that these proposals were not enthusiastically 
welcomed by many of those entrenched in the veteran advocacy community. 
S. 815, the Veterans Health Care Empowerment Act, would allow veterans 
with a service-connected disability to receive hospital or other 
medical care at any Medicare or TRICARE-eligible facility.
  When I introduced this legislation last March, I stated my belief 
that most veterans would choose to continue to receive health care at a 
VA facility. I still believe that is true. But I also know this 
legislation would enhance access of care for veterans who do not live 
near a VA facility by serving them in the communities in which they 
live.
  I also introduced legislation, S. 441, the State Veterans Home 
Modernization Act, which would allow, instead of building veterans 
homes, noninstitutional care and daycare and respite care for our 
veterans. I know my time is now limited, so let me close with this 
thought.
  Earlier this year, a group of young Idaho Iraqi and Afghan vets came 
to my office concerned about health care. One of them pulled from his 
pocket a credit card and said: Senator, why cannot this become a VA 
health care card that allows me access to health care in my community 
paid for by the Veterans' Administration because I have, upon my 
service and upon my disability, been granted access to the VA health 
care system? I live in rural Idaho. But why must I travel miles when 
there are hospitals and clinics all around me? I cannot have access to 
them.
  What is wrong with that picture? What is wrong with that picture is 
that this wonderful, marvelous VA health care system is a static, in-
place system that does not have the flexibility that modern health care 
speaks to and that it must have in the future.
  I am retiring from the Senate, so these pieces of legislation will 
not be introduced again. But I am challenging my colleagues, as you 
stand and so proudly speak of your concern for veterans and your 
concern for their care, that you step away from the bricks and mortar 
and from the rigidity of the activist advocacy groups who think that 
health care for veterans can only be delivered in one form. Modernize 
it. Change it. Give it flexibility if we want to give ultimate health 
care to our veterans, and if we want to integrate nonveterans into that 
quality health care system in a way that strengthens it, improves it, 
and sustains it in an economical fashion.

  I yield the floor.

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