[Congressional Record Volume 155, Number 51 (Wednesday, March 25, 2009)]
[Senate]
[Pages S3787-S3788]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HARKIN (for himself, Mr. Isakson, Mr. Bingaman, and Mr. 
        Lieberman):
  S. 693. A bill to amend the Public Health Service Act to provide 
grants for the training of graduate medical residents in preventive 
medicine; to the Committee on Health, Education, Labor, and Pensions.
  Mr. HARKIN. Mr. President, I am here today to lay the foundation for 
what I hope will be a broad effort to reform our health care system. In 
these troubled economic times, it has never been more clear that our 
current system is broken. I have said many times that we do not have a 
``health'' care system, we have a ``sick'' care system. If you are 
sick, you get care. We spend untold hundreds of billions on pills, 
surgery, hospitalization, and disability. But we spend peanuts about 3 
percent of our health-care dollars for prevention. There are huge, 
untapped opportunities in the area of wellness and prevention.
  Last fall, I was honored to be asked by Senator Kennedy to lead the 
Health, Education, Labor and Pension Committee's working group on 
Prevention and Public Health in our health reform efforts. I am a long-
time believer that prevention and wellness are the keys to solving our 
health care crisis. Our working group has already started looking at 
prevention and public health-based solutions. We have held three 
hearings so far. First, we laid down the case for why prevention and 
public health strategies are so important to improving health care. We 
heard from a variety of experts, including health economists and 
successful health promotion programs in the corporate world and in 
small communities. It was clear that prevention works and that we can 
not afford not to do it. Next, we heard from a number of States about 
the innovative things they are doing to improve public health and 
encourage wellness. We heard about universal coverage in Massachusetts, 
improving quality and reducing cost in North Carolina's Medicaid 
program, and emphasizing prevention and chronic care management in 
Iowa. Some truly groundbreaking efforts are already underway in many 
states. Finally, we held a hearing about access to public health and 
wellness services for vulnerable populations. We heard about some 
creative solutions addressing public health disparities for children, 
seniors, individuals with disabilities, and folks in rural areas. In 
all of our hearings, we have learned a great deal about what we are 
doing right to make prevention happen. But we have also learned about 
how far we still have to go in making sure that everyone has the 
opportunity to become healthier.
  What is abundantly clear to me is that we can and must do more. We 
have good science behind us, and we know that there are many proven 
techniques to make our population healthier. This is particularly true 
in preventive medicine, where health care providers have expertise both 
in medicine and in public health. These are the people we need to help 
tackle our growing obesity epidemic, the alarming trends in 
cardiovascular disease and drug-resistant bacterial infections. They 
can both treat patients and address public health concerns. They 
understand both the physiology of disease and the population effects of 
disease. They know how to provide the best care for the patient and the 
broader population.
  When tens of millions of Americans suffer from preventable diseases 
such as type 2 diabetes, heart disease, and some types of cancer we 
need experts in preventive medicine. And even

[[Page S3788]]

though the need is growing, our work force in preventive medicine is 
shrinking. We are not training enough preventive medicine specialists, 
and our capacity to do so is being limited. Though there were 90 
preventive medicine residency programs in 1999, today there are only 
71. Today, I am introducing legislation, along with Senators Isakson, 
Bingaman and Lieberman, to make sure that we train enough professionals 
in preventive medicine. The Preventive Medicine and Public Health 
Training Act will provide training grants to medical schools, teaching 
hospitals, schools of public health, and public health departments to 
fund existing programs and in some cases develop new residency training 
programs in Preventive Medicine. This bill is designed with one simple 
goal in mind: to improve and increase our prevention workforce. We have 
seen how an ounce of prevention really is worth a pound of cure, but we 
know that we need someone to provide that ounce of prevention. And our 
bill will help train future generations of experts in Preventive 
Medicine.
  This legislation is a small but vitally important part of our efforts 
at health reform. In the coming months, I will be working with HELP 
Committee Chairman Kennedy and other interested members to ensure that, 
as we craft legislation to provide health insurance to all, we do so in 
a way that guarantees that all Americans have access to and take 
advantage of exemplary preventive care. We must guarantee that our 
health care system will not just fix us when we are sick, but keep us 
well throughout our lifetimes. We must lay down a marker today to say 
that reforming our health care system means rejecting our current 
delivery of ``sick care'' and instead strengthening our ability to 
provide ``well care'' through preventive medicine. Today's legislation 
is just one part of that effort, and I look forward to working with 
other interested Senators to build on this legislation as health care 
reform moves forward.
                                 ______