[Congressional Record Volume 154, Number 177 (Thursday, November 20, 2008)]
[Senate]
[Pages S10698-S10700]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. HARKIN. Mr. President, we do not intend to wait until the new 
Congress convenes in January to begin work on health care reform 
legislation. The fact is, health care reform was one of the signature 
changes promised by President-elect Barack Obama during the campaign. 
This legislation is too important and too urgent to put off until 
tomorrow, to wait until the new President and the new Congress are 
sworn in.
  I applaud both Senator Baucus, Chair of the Finance Committee, and 
Senator Kennedy, Chair of the Health, Education, Labor, and Pensions 
Committee, for plunging right into the ambitious and historic task of 
creating a comprehensive health care reform bill.

[[Page S10699]]

  Last week, Senator Baucus came forward with a 98-page white paper 
setting broad parameters for prospective legislation. Earlier this 
week, Senator Kennedy brought together members of the Health, 
Education, Labor, and Pensions Committee to kick off the long process 
of crafting a bill.
  At that meeting, Senator Kennedy designated three working groups to 
oversee the principal components of the bill. Senator Clinton was asked 
to chair the health insurance coverage working group. Senator Mikulski 
will chair the health system quality working group. I will chair the 
prevention and public health working group.
  As I said, the working group I will chair will focus on the wellness, 
disease prevention, and public health components of this 
legislation. Again, this has been a longstanding focus of mine. Indeed, 
in the past, I have already introduced comprehensive wellness 
legislation. Several elements of that bill, and others, have been 
enacted into law. Prevention and wellness as a component are absolutely 
critical to transforming the way we approach health care in the United 
States.

  To be honest about it, we don't have a health care system in America; 
we have a sick care system in America. Well, think about it. If you get 
sick, you get care, either through insurance, Medicare, Medicaid, 
community health centers, charity--one way or the other--but that is 
the most expensive way to do things. That is sort of trying to patch it 
up later on. We have spent untold hundreds of billions of dollars a 
year on pills, on surgery, hospitalization, disability, but we spend 
peanuts--3 percent--less than 3 percent of our health care money for 
prevention and wellness.
  Again, there are huge untapped opportunities in this area of wellness 
and prevention. If we think about where we are right now, we will see 
that we spend a staggering $2 trillion annually on health care--more 
than any other nation in the world and more than most nations put 
together. Yet the World Health Organization ranks U.S. health care 37th 
among the nations of the world--37th. We are 20th of 21 industrialized 
nations in the quality of health care for children. We are No. 20--20 
out of 21 industrialized nations--in terms of the quality of children's 
health care.
  If you want evidence of the failure of our current sick care system, 
consider these facts: Tens of millions of Americans suffer from 
preventable diseases, such as type 2 diabetes, heart disease, and, of 
course, some forms of cancer. In tandem with a childhood obesity 
epidemic now, we have new guidelines from the American Academy of 
Pediatrics advising that some children as young as 8 years old should 
be put on cholesterol-lowering drugs. That is the American Academy of 
Pediatrics. We have an epidemic of children with adult-onset diabetes--
unheard of until just recently. Unheard of until just recently. We are 
now seeing young Americans, as young as age 25, getting heart bypass 
surgery because of clogged arteries. So again, it is almost as though 
we have lost our capacity to be shocked when we hear these statistics. 
How much evidence do we need that America's approach to health care or, 
as I say, sick care is simply not working?
  The good news is that President-elect Barack Obama, Senator Baucus, 
Senator Kennedy, and other key players here in the Senate and in the 
House kind of get it when it comes to real health care reform. It is 
not enough to just talk about how to extend insurance coverage or how 
to pay the bills, as important as those things are. That is not enough. 
If all we are going to do is figure out a better way to pay the bills, 
we are sunk. We have to start keeping people healthier and preventing 
disease in the first place.
  Again, I would lay down this marker right now. If we pass a health 
care reform bill that greatly extends health insurance coverage but 
does nothing to implement a national prevention and wellness structure 
and agenda, then we will have failed the American people. It simply 
makes no sense to legislate broader access to a health care system that 
costs too much, delivers too little, largely because it neglects 
wellness and prevention. We need to craft a bill that mobilizes our 
society to prevent these unnecessary diseases and conditions, including 
obesity, type 2 diabetes, heart disease, and some forms of cancer. It 
is time to recognize obesity as a disease that needs to be attacked--
not cured but prevented.
  A robust emphasis on wellness is about saving lives and saving trips 
to the hospital and saving money. It is the only way--the only way--we 
are going to get a grip on these skyrocketing health care costs. As I 
said, there are a lot of opportunities here in terms of cost savings 
but also in terms of helping people live healthier, happier, and more 
productive lives. We want to be more productive in this country. Not 
all of this is going to come under what we think of as the health care 
umbrella. Not all will come under what I would say we think of as 
medicine and doctors and hospitals and things such as that. A lot of 
this is going to be outside of that sort of health care regimen.
  I think of things such as schools. The Presiding Officer and I serve 
on the Agriculture Committee in the Senate. Next year, we are going to 
be reauthorizing the child nutrition bill. This is a bill that 
basically sets up the parameters for school lunch, school breakfast, 
school snacks, the WIC Program, the Women, Infants and Children 
Program.
  It seems to me this ought to be thought of also as a part of 
preventive health care. Our kids in school have to start eating better, 
more wholesome foods, less starches, less fats, less sugars, less 
sodium. I just mentioned the onset of type 2 diabetes and childhood 
obesity. We have to get a grip on this. We can't continue to do the 
things with our school lunch and school breakfast programs as we have 
been doing in the past.
  Obviously, another component of this--it doesn't fall within our 
Agriculture Committee jurisdiction, I say to the Presiding Officer, the 
Senator from Colorado--we also have to start making sure that schools 
that get any sort of Federal funds have exercise programs. Schools are 
being built in America today without a playground, without a gym, 
without any kind of exercise equipment for kids. It is nonsense.
  I don't know about the Senator from Colorado, but I would wager that 
when he was in grade school, he had to go outside and run around for a 
half an hour or so a day. In my grade school, we had 15 minutes in the 
morning, 15 minutes in the afternoon, and a half hour after lunch. One 
hour a day we were out running around, sometimes in the snow, and it 
was pretty cold in the wintertime. We always had exercise. We were 
always doing something. Of course, we didn't have Game Boys and a lot 
of TV and things such as that at that time.
  My point is that schools--as we attack feeding programs and the 
vending machines and what goes into vending machines in schools--again, 
when the Senator from Colorado was in school, I bet they didn't have 
vending machines. Now we see Pepsi and Coke and candy bars and all 
sorts of things in vending machines. Why should that be so? School is 
where you go to learn, to be healthy, not to get stoked up with junk 
food and sugar and starches and sodium.
  So I digress a little, but that is another component of it that we 
have to be thinking about. It may not be in the health care reform bill 
as such. I intend to have it in the health care reform bill as guidance 
directions for other committees that are involved in other things to be 
able to start looking at wellness and prevention components.
  I would go this far: I think we need a direction in this health care 
reform bill to every committee of Congress that whatever you are 
working on, you have to think about how it impacts prevention and 
wellness--does it add to that or does it subtract from that and are 
there things we ought to be doing in this legislation?
  Again, I digress a little bit, but take the recent highway 
reauthorization bill. That was 3 or 4 years ago, and now we are going 
to reauthorize it again in 2010. I offered an amendment which didn't 
succeed, but I think, over the passage of the years, the more I have 
talked to others about it and we have conferred about it, I hope it has 
a good chance on the next reauthorization bill. It was simply this: any 
community or region or State that uses Federal highway monies, the 
Federal gasoline tax monies for road improvements

[[Page S10700]]

and such, if they are building roads, improving them, or building 
bridges or whatever, they have to incorporate in their planning bike 
paths and walking paths along with them. I am not saying they have to 
build those; I am just saying that at least they ought to have them in 
their plans. Again, thinking about kids going to school, they ought to 
have sidewalks along their streets going to school so they can walk to 
school. Many places don't have sidewalks and bike paths and walking 
paths.
  My point is that there are a lot of things outside of the health care 
environment we normally think of that can be very helpful for 
prevention and wellness--workplaces, workplace wellness. There are some 
companies in this country doing a great job with this. They have set up 
wellness programs, nutrition guidance programs, antismoking programs 
for employees, and in every case I have ever looked at where you have 
the incentives and the company really goes to work at this, they find 
some amazing results. They find their absenteeism goes down, they find 
workers are much more productive than they had been in the past, and 
they find their health care costs going down. Now, we need to make this 
available to every business in this country--small businesses, people 
who employ 10 people or more. There has to be something including a 
component of prevention in the workplace.

  So I mentioned schools, workplaces, communities. Communities have to 
be involved. We need to promote community wellness programs.
  The Trust for America's Health earlier this year came out with a 
study they had done on community-based wellness programs and the return 
on investment. Most times when you talk with people about prevention 
and wellness, they say: Oh, that is all fine, but you don't get a 
payback for 20 or 30 years. The Trust for America's Health did a study 
State by State and they showed that in these cases where the 
communities had community wellness programs, that actually, in the 
first year--in the first year--there was almost a 2-to-1 return. For 
every dollar they invested, they got $2 back the very next year, and it 
increased every year after that. So we have to think about how we 
promote community-based wellness programs.
  The elderly. I can't think of how many times I have been to senior 
citizens centers, congregate meal sites, some independent living 
centers, and those types of places where we see so many elderly on 
drugs. They are on so many drugs. They can't keep track of the 15 pills 
they have to take every day. Well, there have been some very good 
studies done, on the fact that if you give the elderly better 
nutrition, better exercise, better social ability, you can get them off 
some of those drugs--maybe not all of them, but you can get them off of 
half of the drugs or more that they are taking. So there are a lot of 
things we can do just, as I say, outside.
  Within health care, there are a lot of things too. Students are going 
to medical school today, taking all of these courses on medicine and 
drugs and pharmacology year after year; very intensive, very hard 
studies. I think I would not be wrong in saying that most medical 
school students today, at most they might have one 3-hour credit course 
at the end of their study where they take something dealing with 
prevention. It is just not a factor in medical schools. It should be. 
It should be a factor in nursing schools. Any health care professional, 
any health care profession should have that component, including 
physicians assistants, nurse practitioners, and anyone involved in the 
health professions. So that is another part also.
  We need to be thinking about how we can beef up our public health 
service in this country. When I was a young kid going to public school, 
we had school nurses, and they came around and made sure we had our 
vaccinations and things such as that, and that we exercised. We don't 
do that anymore. We have to restructure our public health service in 
this country, to think about how we better utilize the public health 
service.
  If you go to medical school now, Medicare is one of the biggest 
funders of medical schools now, or if you go into the military, the 
military will put you through medical school and then you pay it back 
in 8 to 10 years for your medical school training. But what if you 
wanted to be a public health service officer, you wanted to go to 
medical school and maybe take one of the courses in public health? 
Well, that would apply there too. Why not pay their way through 
college, and then they pay it back for working in the public health 
service for a number of years.
  We think about the several hundred community health centers we have 
in this country, doing a great job. Why aren't they a part of the 
Public Health Service Corps in America, and utilize them for prevention 
and wellness, diagnostics? Quite frankly, people should not have to pay 
a copay or a cost share to get a colonoscopy, or breast cancer 
screening or a host of other things for diagnosis. Annual physical 
checkups; there shouldn't be a copay or cost share for that. That is 
just keeping people from doing it. When you detect things early and you 
can intervene early, that is part of prevention also, earlier 
diagnostics.

  Again, this has to be a big part--I think the centerpiece--of health 
care reform because it is the only way we are going to actually save 
money. Well, you may save money in a bigger pool and better insurance, 
that type of thing, yes, but the big bucks we will save and will make 
our people more productive and healthy is to have prevention and 
wellness.
  Yesterday, I convened a meeting of the key groups that have been 
active in the wellness and prevention field, including the Trust for 
America's Health, the Partnerships for Prevention, the Robert Wood 
Johnson Foundation, the American Diabetes Association, the American 
Heart Association, the American Cancer Society, the YMCA, the American 
Medical Association, and many others. This was yesterday. It was an 
excellent session, with a room full of people who all realize this is 
the time for bold thinking and real change. In addition, I intend to 
hold additional hearings in December.
  This working group that Senator Kennedy asked me to chair will reach 
out broadly. We wish to capture the best ideas, the best practices. Our 
goal is nothing less than to transform America into a genuine 
``wellness society.''
  To borrow a phrase, that is change you can believe in. It is also 
change that is long overdue.
  To date, wellness and prevention have been the missing pieces in the 
national conversation about health care reform. It is time to make them 
the centerpiece of the conversation--not an asterisk or a footnote but 
centerpiece of our conversation on health care reform.
  As chair of the Prevention and Public Health Working Group, I look 
forward to working with my colleagues on both sides of the aisle to 
solicit ideas and input. Promoting wellness and preventing disease is 
not about party or ideology; it is about pragmatism and common sense. 
It is about what works--keeping people healthy and keeping costs down, 
making people more productive in their daily lives.
  We have a big job ahead of us, but I am confident the new President 
and the new Congress can deliver on health care reform, and we can do 
it in the next calendar year. Yes, we can greatly expand access to the 
health care system--or as I call it, the ``sick care'' system. At the 
same time, if that is all we do, we will have failed. We can and must 
transform America's sick care system into a true health care system, 
one that makes preventing illness and staying well every bit as 
important as curing the illness later on.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. REID. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Nelson of Nebraska). Without objection, it 
is so ordered.

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