[Congressional Record Volume 155, Number 76 (Monday, May 18, 2009)]
[House]
[Pages H5706-H5710]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      HEALTH CARE AROUND THE GLOBE

  The SPEAKER pro tempore (Mr. Minnick). Under the Speaker's announced 
policy of January 6, 2009, the gentleman from Illinois (Mr. Kirk) is 
recognized for 60 minutes.
  Mr. KIRK. Mr. Speaker, when I returned home from Afghanistan, I have 
been spending the last several months on the health care issue and the 
need for reform in this country.
  Before being elected to Congress long ago, I used to work for the 
American Hospital Association as a young researcher in their hospital 
research and educational trust. Now, with the service in the Congress 
and this background, I have been working for several weeks now 
intensively building a bipartisan and centrist agenda for health care 
reform. Our base for this is the Tuesday Group, 32 centrist GOP 
moderates, which I co-Chair along with Congressman Charles Dent. 
Tomorrow, we will outline a detailed health care reform agenda with 70 
representatives of patients, doctors, hospitals, employer and insurer 
groups.
  Our President has set three top goals for health care reform: to 
lower costs, to increase choice, and to expand access. But what model 
should the Congress use in providing the reform that our country needs?
  I want to talk tonight to provide some details on key issues that we 
are facing to review comparisons of health care systems in the United 
States and among our key allies and then to discuss detailed centrist, 
bipartisan solutions that we could put forward--especially in Senate 
health care legislation--that could make its way to the President's 
desk.
  First, on the details. Our system is built largely on private health 
care for people under age 65, and we have seen a tremendous explosion 
in defensive medicine. Defensive medicine is driving costs up in our 
country probably faster than other countries because, as you can see 
from this chart, the cost of defending across a lawsuit has been rising 
steadily in recent years, and this is unique to the United States. This 
chart alone shows that especially for obstetricians, gynecologists, and 
neurosurgeons, the need is clear for lawsuit reform to restrain the 
growth in medical costs, especially in health insurance.
  This chart shows a comparison in the critical issue, which I believe 
that our top focus is not in health care costs but in health care 
outcomes. The question should be whether you live or die in the system 
first, then how much does it cost.
  When we look at, for example, patient-reported health care outcomes 
in pap smears and mammograms, we see stark differences in coverage for 
Americans and in other countries. Here you see pap smears in the last 3 
years, women aged 25-64, 89 percent coverage for the United States; but 
among our British allies, only 77 percent, and probably the key model 
that many in Congress are looking at, Canada, falls well below the 
United States.
  Also in mammograms, key for long-term health status among women in 
the United States, 86 percent coverage for women aged 50-64, and much 
lower across the board in more status, government-controlled health 
care systems.
  We also looked at a key fact in health care, which is health care 
delayed is health care denied. The problem with waiting times is 
present in the United States, but it's much more acute in other 
countries. When we look at patients who waited more than 4 weeks to see 
a specialist doctor, we see in the United States it's about 23 percent, 
1 percent better, actually better, in the German Republic. But in the 
principal cases of Canada and the United Kingdom, which offer so many 
examples to many in this Congress for the kind of health legislation 
they would like to put forward, waiting times are double what they are 
in the United States. That means that the health care that they provide 
would be much poorer than for our country, especially during a long 
wait.
  This chart shows even a more serious situation. It shows the percent 
of patients that had to wait more than 4 months for health care. In the 
United States, just 8, even slightly better in Germany, but when you 
look at Canada, and especially the United Kingdom, now reporting 41 
percent of patients who have waited more than 4 months for health care.
  Health care outcomes are distinctly different for the United States 
and other countries, especially with breast cancer incidents. This 
chart shows mortality per 100,000 females of breast cancer, and it 
shows that the United States actually has the best numbers compared to 
Canada and the United Kingdom at 28 for the U.S., 29 for Canada, and 34 
for the United Kingdom.
  When we look at high-tech medical procedures in Britain, Canada, and 
the United States, the critical procedures necessary to actually 
survive key bits of morbidity are not available in Britain and Canada 
as compared to our country. In dialysis, and I speak especially as the 
co-Chair of the Kidney Caucus here in Congress, we can see access in 
Britain is far lower than in the United States. For coronary bypass, 
the United States is clearly much better. And in coronary angioplasty, 
we are significantly, by almost a factor of 6, better than other 
countries.
  One of the key differences between the United States and other 
countries is people ask, Why do we spend so much money? Why do we have, 
in some areas, lower health outcomes? And part of it might be the 
health practices of Americans themselves.
  This shows obesity across countries, and we know that, in general, 
Americans will be heavier than people from other countries.

                              {time}  2200

  And that leads to higher health care costs. The question is whether 
building a large State control which will restrict access to health 
care is the way to go, or whether a program, I think, that would have 
strong bipartisan support to encourage a reduction in obesity would be 
the more appropriate stand.
  When we look at how to address health care needs, that is primary 
through health insurance. Health insurance currently in the United 
States is governed by the States. Some States have a fairly modest 
threshold for offering health insurance and therefore their health 
insurance costs would be expected to be fairly low. Other States would 
have extremely high mandates for health insurance, making it more 
expensive. As you can see here, the pattern differs, and it sets up a 
way for Federal officials to compare outcomes of health systems in our 
countries.
  Probably the biggest difference that we see is in the difference of 
health care costs between New Jersey and California. In New Jersey, we 
see that health care costs are totaling $6,048 per patient, whereas in 
California they're down to $1,885. That roughly $5,000 difference is a 
tremendous barrier to access for medium- and low-income persons in New 
Jersey that is not present in California.
  It should be the policy of the United States to remove barriers so 
that we can offer low-cost insurance like what is offered to the people 
of California and not have a highly regulated, high-barrier system, 
like New Jersey, prevail for the United States.
  When we look at the uninsured, a number of people look just at the 
overall number, totaling $37 million in 2002,

[[Page H5707]]

totaling $49 million just afterwards. Obviously, with the recession 
that's going on, the number of uninsured has been rising. But we ought 
to look a little bit deeper as to who the uninsured are.
  As this data shows from the National Survey on America's Families, we 
see that out of the 49 million uninsured, 22 percent were uninsured for 
just less than 5 months. Another 25 percent were uninsured for 6 months 
to 11 months. Roughly half were the long-term uninsured--over 12 
months--that I think is very appropriate for Federal policy to look at.
  As you can see, this problem might be somewhat smaller than 
originally estimated. Also, when you look at the uninsured, you have to 
ask the question: Can people access or do people have a problem 
accessing health insurance because they can't afford it? Or, for some, 
is it because they simply have decided not to pay for it?
  When we look at the uninsured by household income, we find that 19 
percent are over $75,000 in income, who really should have paid for 
health insurance on their own with that kind of income. That is above 
average for the United States. Eighteen percent, $50,000 to $74,000. 
Then, for the modest- and low-income, we see roughly 60 percent. 
Especially for the plus-$75,000 income, we ought to ask: Should the 
State, should the taxpayer be paying for their health insurance, or 
should we instead look for them to make some of their own decisions?
  When we look at the very low-income uninsured, obviously we have a 
number of programs already addressing the needs of low-income 
Americans. This chart shows that a considerable number of low-income 
Americans are already eligible for public coverage. But as we have 
seen, for example, in the State of Massachusetts, for some of the very 
hardest to insure, with unsteady addresses, sometimes registering in 
the emergency room under different names, an insurance model may not be 
the best way to care for this group of people, our fellow citizens. A 
better way may be the public hospital approach that can take anyone at 
anytime, for a community in the 1 percent to 2 percent range that is 
very difficult in keeping solid addresses, solid identities, or keeping 
appointments.

  When we look at the uninsured and how much the Federal Government 
already pays, by one estimate in 2004, the Kaiser Commission on 
Medicaid and the Uninsured estimated that we already commit about $35 
billion on coverage for lower-income Americans. And the question that 
we may ask, which may not be fully explored in this Congress, is: Is 
that sum of money substantially above the gross domestic product of 
many of the members of the United Nations? Is that sum of money being 
wisely used already, or is there a system which would provide a more 
flexible and effective coverage for low-income Americans, which would 
in fact return a considerable amount of authority and power to them in 
making their own health care insurance decisions?
  Now, in briefly reviewing the key details and issues before us, I 
want to also compare health care in the United States to that in other 
countries, especially the two principal models that many here in the 
Congress are looking to, Canada and the United Kingdom, for what they 
can tell us about how health care could be changed for the better or 
the worse in the United States.
  In my view, our country should work towards providing a universal 
access to health care. While a nationalized government HMO could prompt 
tax increases, inflation, and a decline in quality, I think this 
Congress can enact policies to dramatically expand health care access 
for Americans.
  When we reform health care, in my view, we should follow key 
principles, first and foremost, that reform should enhance the 
relationship that you have with your doctor. Insurance companies 
already interfere too much with our care. But a government HMO might do 
far worse.
  Second, reforms should reward the development of better treatments 
and cures. Americans strongly support treating diseases like diabetes, 
heart disease, or cancer, but they are passionate about a cure.
  Finally, reforms should be sustainable, because especially the 
sickest and most elderly of our citizens will depend for their very 
lives on these reforms.
  The worst thing that we can do is to enact a health care program that 
the Federal Government cannot afford to keep. In considering United 
States health care reforms, many Americans look to Canada and Britain 
as our model. But Canadians have a very different view.
  While over 60 percent of Americans are actually satisfied with their 
health care plan, only 55 percent of Canadians report the same 
satisfaction. Over 90 percent of Americans facing breast cancer are 
treated in less than 3 weeks, but only 70 percent of Canadians get such 
treatment. Meanwhile, thousands of Canadians come to U.S. hospitals 
instead.
  The average Brit waits even longer--62 days. And Britain now has 
fewer oncologists treating cancer than any other Western European 
country. It may be no wonder that Britain ranks 17 out of 17 
industrialized countries for surviving lung cancer.
  Similar statistics tell a tale of lower quality care for coronary 
heart disease, where 94 percent of Americans are treated, versus 88 
percent of Canadians; or emphysema, where 73 percent of Americans are 
treated versus just 53 percent of Canadians.
  The most dramatic differences come in the field of cancer, where 
Britain's most respected medical journal, The Lancet, published the 
details of a very broad review of cancer and its survival rates in 
Europe and America. In short, here is what the Lancet reported:
  The cancer survival rate for American men in September of 2007 was 66 
percent. For European men, just 47 percent. The cancer survival rate 
for American women was 63 percent. For European women, just 56. Of the 
16 cancers studied, only Sweden showed survival rates that were close 
to the American rates, but still well below our level.
  We know that diabetes is one of the principal causes of senior health 
care problems. In the United States, 93 percent of Americans are 
treated within 6 months, while in Canada, less than half--43 percent--
see a doctor in the same time. In Britain, it is even worse. Only 15 
percent of British diabetics are seen within 6 months.

                              {time}  2210

  Over 80 percent of American women receive a mammogram, while only 73 
percent of Canadians receive one.
  Hip replacements offer a very stark contrast between the countries. 
In the United States over 90 percent of seniors are treated with a hip 
replacement within 6 months. In Canada, less than half of patients are 
treated in the same time, but many Canadians wait for a hip for over a 
year. Britain is not the place to break a hip because only 15 percent 
of patients are treated within 6 months, and many die during the wait.
  Many advances of 21st century medicine come from MRI scans. Most 
Americans wait less than a week for an MRI. Most Canadians wait for 
over a year. In the United States, doctors use 27 MRI scans per million 
people. In Canada and Britain, it's less than a fifth of that at just 
five MRI scans per million.
  The care for children also varies. Newborns most at risk need the 
close care of a neonatal specialist. In the United States there are 
over six neonatologists per 10,000 live births. In Canada they have 
fewer than four, and Britain has fewer than three. In our country we 
have over three neonatal intensive care beds per 10,000 births, just 
two and a half in Canada and less than one in Britain. It may be no 
wonder that babies in Britain have a 17 percent higher chance of dying 
compared to 13 percent a decade ago. Overall, the life expectancy of a 
British woman below the poverty line is falling.
  The starkest difference in care between the countries comes when you 
are the sickest. In Britain, government hospitals maintain just nine 
intensive care beds per 100,000 people. In America we have three times 
that number at 31 per 100,000. In sum, Britain has less than two 
doctors per 1,000 people, ranking it next to Mexico and Turkey.
  Even dentists are in short supply. The average American dentist sees 
12 patients a day while the average British dentist must see over 30.
  Stories of poor care under a government-only system are common in 
Britain. Last February, the Daily Mail reported Ms. Dorothy Simpson, 
age 61,

[[Page H5708]]

had an irregular heartbeat. Officials at the National Health Service 
denied her care because she was ``too old'' at age 61. The Guardian 
reported in June that one in eight British NHS hospital patients wait 
more than a year for treatment.
  We know that governments regularly run out of money, and this can 
have a real impact if they are in charge of you or your family's health 
care. Ontario canceled funding for childhood immunizations, routine eye 
exams and physical therapy services when they ran out of money. 
Government unions also regularly go on strike. In British Columbia they 
had to cancel 5,300 surgeries during a health care worker strike. The 
Fraser Institute, an independent Canadian research organization, 
reported that the average wait for surgery is now up from 14 to 18 
weeks. Queen Elizabeth Hospital in Halifax reports that its X-ray 
machine--by the way, no MRI available--was installed during the Nixon 
administration. To compare, Northwest Community Hospital in Arlington 
Heights, Illinois, flunks its own publicly reported quality standard if 
a patient does not receive a PCI test within 90 minutes of surgery.
  In Washington there are many proposals to have the government take 
control of health care. Some bills in Congress even call for pushing 
all uninsured people, including illegal aliens, into Medicare. We 
should look very carefully at such proposals.
  Remember, Medicare covers 40 million Americans at a taxpayer cost of 
$400 billion annually. Adding another 40 million patients to Medicare's 
costs would likely cost taxpayers an additional $400 billion annually. 
Knowing the government will run a $2 trillion deficit this year during 
the worst recession in living memory, can we enact an enormous tax 
increase, or do we just have to borrow the money from China?
  Seniors and low-income Americans will absolutely depend on the 
Congress's promises, and I believe the worst thing that we can do is 
make commitments that are too expensive and then pull the rug out from 
those who can least afford to cope. Instead, we should back bipartisan 
reforms that the government can afford to keep.
  There are a number of steps Congress should take to expand access to 
care and bring down the cost of medicine. First, we should expand the 
number of Americans who have access to employer-provided health care. 
One of the best ways to do this is to allow small businesses to band 
together to form larger pools of insurable employees to share risks and 
administrative costs. We should also allow franchises to offer national 
health care plans so that their members, working at Starbucks or 
AlphaGraphics or Subway, can create one large national insurable pool 
of their generally younger and currently uninsured employees.
  Second, Congress should expand access to care for millions of self-
employed Americans who do not have insurance. A refundable tax credit 
for individuals and families equal to the same tax credit large 
employers get would help millions buy insurance. Individuals could be 
eligible for a credit of up to $5,000 annually, and lower income 
families would be eligible for a credit worth up to $8,000.
  Third, as jobs become more portable, so should health insurance. We 
should protect Americans who lose their jobs, and their families, who 
are excluded from coverage by pre-existing conditions. Congress should 
also remove the current 18-month time limit on COBRA continuing health 
insurance coverage. This would give families the option of always, if 
they wanted to, at their own expense, sticking with the health 
insurance plan they like and currently have. This expanded coverage 
should also act as a bridge for retirees who may not yet be eligible at 
age 65 for Medicare.
  Fourth, we must pass commonsense measures to bring down health care 
costs. The Veterans Administration already uses fully electronic 
medical records to care for 20 million patients while saving lives and 
cutting wasteful spending.
  We also need lawsuit reform. State supreme courts controlled by the 
plaintiff's bar, like in my home State of Illinois, are expected to 
strike down local lawsuit reforms that cap noneconomic damages in 
medical liability cases. We need Federal lawsuit reforms to lower 
insurance rates across the country, keeping doctors in the practice of 
medicine.
  Finally, the Federal Government should mandate and enforce the right 
to see in-house infections caused by hospitals. Nearly 2 million 
Americans contract hospital infections every year, costing Medicare 
about $5 billion annually. We should create incentives for hospitals to 
reduce their infection rates and to publish their results.
  In sum, there's a great deal that the President and Congress could do 
without making the mistake of Xeroxing the 40 years of mistakes made in 
Canada and Britain.
  So having described some of the issues that we face, let's look in 
detail at one of the key numbers driving the debate here in 
Washington--the uninsured. According to last year's Census, there are 
45.7 million uninsured in America. But according to CRS, 9.5 million of 
those are illegal aliens, 6 million are children now covered by the 
SCHIP program that I voted for that was signed into law by President 
Obama in January, about 10.8 million have above-average incomes in the 
United States, and about 9.1 million are only temporarily uninsured. 
That means that if we focus on the problem of U.S. citizens who are of 
lower income, who have not been insured for longer than a year, it is 
10.3 million folks, hardly a number that justifies a government 
takeover of health care, but one that a bipartisan centrist agenda 
could address to make sure that those family members have the health 
insurance they need.
  Yesterday I took a survey of voters in Illinois. We received 3,400 
responses, and the question we asked was this, ``Should Congress raise 
taxes to fund a new government health care plan?''

                              {time}  2220

  The answers came back: 2,730, or 80.3 percent, said ``no''; and only 
454, or 13.4 percent, said ``yes''; 214, or 6.3 percent, said they 
didn't know. Clearly, in the face of the deepest recession in modern 
memory, we should not raise taxes in a significant way throwing 
millions of families out of work for a government program that we 
cannot afford to keep.
  Therein comes the third part of my discussion tonight. Given these 
problems, given the comparisons to other countries, and given the 
fiscal constraints on the Federal Government, is there room for a 
bipartisan reform agenda in Congress? The answer is emphatically 
``yes.'' And we will outline that tomorrow in front of 70 different 
groups.
  In the view of the Tuesday Group reform agenda, our comprehensive 
reform agenda will accomplish eight major goals. Number one, we will 
guarantee the doctor-patient relationship. Number two, we will put 
forward reforms that will lower the cost of health insurance. Number 
three, we will increase the number of Americans who have insurance. 
Number four, we will allow Americans to keep insurance they like. 
Number five, we will improve quality and accountability. Number six, we 
will increase personal responsibility. Number seven, we will lower the 
demand for federal borrowing. And, finally, number eight, we will do it 
in a bipartisan and sustainable way so that momentum for this program 
will not just be built up during the Obama administration, but future 
presidencies, including Republican presidents.
  In this agenda, our primary objective is to guarantee your 
relationship with your doctor. That is why tomorrow we will be putting 
forward the Medical Rights Act. The Medical Rights Act will guarantee 
the rights of patients to carry out the decisions of their doctor 
without delay or denial of care by the government. This legislation 
will uphold the right of individuals to receive medical services as 
prescribed by their doctor and will not allow the government to 
restrict or deny care if the care is privately provided. We allow, of 
course, the government to run its own health care programs for the 
military, for TRICARE, for the VA, for the Indian Health Service and 
others. But if the health care is paid for by you, you should control 
it. And there should be no attempt to control your health care by the 
Federal Government.
  The reason why we think this is necessary is because in other 
countries it is illegal for patients to pay for the care out of their 
own pocket. The most infamous restriction comes against Canadian 
citizens that face this barrier.

[[Page H5709]]

For them, they at least have one out, because the drive is not too far 
to the United States. But if we have the government take over health 
care in America, where will we be able to drive? And how will we find 
care if it is denied by a government program? That is why we need the 
Medical Rights Act. And in my judgment, it fulfills the promise of the 
President that you will always have choice and control of your health 
care. It is a bill that he should support.
  Secondly, our goal is to lower the cost of health insurance. What we 
would like to do is allow alliances to form, for example, among the 
Libertyville Chamber of Commerce members or among national franchise 
members to build larger and larger insurance pools from self-employed 
or small employers to spread risks, lower cost and share administrative 
expenses.
  We would also like to equalize the tax benefits that the self-
employed receive so that small and self-employed individuals have the 
same tax break that large employers have when they provide health 
insurance to their employees.
  To lower the cost of health insurance, you also need lawsuit reform. 
And the proliferation of frivolous malpractice lawsuits, as 
demonstrated on late-night TV for all the ads that you see, would be a 
huge reform that would help us drive down the practice of defensive 
medicine and therefore the cost of health insurance.
  Doctors who practice in certain high-risk fields such as emergency 
medicine, general surgery, thoracic surgery and obstetrics and 
gynecology especially need this reform to stay in the practice of 
medicine. By one estimate, the cost of defensive medicine in the United 
States is over $100 billion a year. Our reforms will call for blame to 
be allocated responsibly among key parties, to stabilize the 
compensation for insured patients and to encourage the States to adopt 
innovative strategies, especially alternative dispute resolution 
incentives for doctors and hospitals, and new health care courts 
specializing in resolving medical injury disputes.
  We will also be calling for State innovation programs to reward 
States that reform insurance markets to provide a more flexible 
insurance product to meet the needs of patients. Instead of dictating 
and controlling health insurance from a new Washington national office, 
the Congress should follow the direction of the National Governors 
Association that said that States must have the flexibility to respond 
to justifiable variation in local conditions and costs. Obviously, 
health care in Alaska is very different from health care in Florida. 
And we should allow States to manage that flexibility in the most 
appropriate way. Programs that we focused on and looked at most 
intensely are Idaho's high-risk reinsurance program and the 
Massachusetts State insurance program. And these flexible programs 
should not be overridden by Congress.
  We also want to provide more control and flexibility, but most 
importantly, dignity to low-income patients. With 25 percent of people 
already eligible for public coverage, not even enrolling in the public 
plans currently offered, we should find ways to have patients be able 
to join lower-cost private plans that with a combination of subsidies 
and tax credits, lawsuit reform, health information technology and 
deductions would not only make their insurance more affordable but 
would suddenly give lower-income Americans the same control over their 
health care that middle- and upper-income Americans have.
  Another key point of our agenda reform is to increase the number of 
Americans who have access to health insurance. There is a key point of 
common sense here that lowering the cost of health insurance will 
expand access. As I outlined earlier, on average, health insurance in 
California costs about $5,000 less than health insurance in New Jersey. 
By permitting health alliances and pooling national resources, 
deploying health information technology and equalizing tax breaks for 
self-employed Americans, we will dramatically lower the cost of 
insurance and therefore expand access.
  We should also take some time to expand rural health care. In the 
Congress, the National Health Service Corps and the area health care 
centers should be reauthorized and expanded to make sure that we can 
address this critical rural need, especially in primary care.
  One of the items not talked about very much in the House or the 
Senate is the potential for damage that we could cause to the health 
insurance that Americans currently have. Legislation in the House and 
Senate called the Healthy Americans Act would end the tax break for 
employer-provided health insurance in the United States. That sounds 
like a technical phrase, but you should remember that employer-provided 
health plans cover 160 million Americans. And most of those plans are 
supported through the ERISA legislation and tax break that employers 
receive. Legislation like the Healthy Americans Act not only kills the 
Federal Employer Health Benefit Plan that covers every Member of this 
Capital, staffer, Senator, Congressman and all Federal employees, but 
it then goes on to wipe out the Federal tax break under ERISA for the 
other 155 million Americans that depend on this health insurance.

                              {time}  2230

  In fact, just yesterday, the Director of the Office of Management and 
Budget said we may need to look at cutting back the tax benefit that 
supports employer-provided health care. In my view, this is an idea 
whose time has never come.
  One of the key rules in health care is to do no harm, and for this 
Congress to attack employer-provided health care is an attack on the 
health care of every Federal employee and 155 million civilian 
employees who depend on employer-provided health care.
  Instead, our bipartisan agenda strengthens employer health care and 
continues the benefits under ERISA that cover 160 million Americans. We 
should not only allow Americans to keep the health insurance they like, 
we should also improve quality and accountability. One of the best ways 
to do that is to accelerate the deployment of health information 
technology.
  The Congress should accelerate the setting of standards and using 
payment incentives under Medicare, Medicaid, TRICARE, which covers 
military retirees, and the VA and Indian Health Service to encourage 
the more rapid deployment of health information technology to reduce 
medical errors, to limit the waste of defensive medicine, and to 
improve health outcomes. Many of these advances, especially with 
electronic medical records, have already been made at the Veterans 
Administration, leading to an 80 percent reduction in health errors.
  Key health information technologies also include e-prescribing, 
chronic disease registries, and clinical decision systems that will 
dramatically lower cost, improve outcomes, and eliminate errors.
  This Congress also needs to work on eliminating fraud, waste, and 
abuse in the current government health care systems. The Congressional 
Budget Office estimates that more than $10 billion in improper Medicare 
payments were made in 2008 alone. There is strong bipartisan support 
for a number of policies outlined in both the Ways and Means and 
Finance Committees to improve transparency, to prosecute fraud, and to 
require provider accountability.
  When we look to the future, I think we should emphasize research and 
not rationing. It was a bipartisan effort led by President Clinton and 
Speaker Gingrich that doubled the resources to the National Institutes 
of Health. In my view, we should accelerate that momentum on basic 
research.
  The Congress also approved funding for comparative effective 
research. Now, this research has the potential to help patients and 
doctors to make informed decisions. But many in the Congress would like 
to use the $1 billion recently approved for comparative effectiveness 
research to actually begin a system of restrictions and rationing in 
the United States. In my view, this takes us into the problems that I 
described earlier in my talk and would ruin some of the key advances 
that distinguish American health care among those of our allies.
  We should also foster public-private partnerships to avoid an 
innovation gap that is currently existing between where public 
research, especially funded by the NIH, ends and where real

[[Page H5710]]

health care delivery mechanisms can begin.
  Congress can use this opportunity to foster a new bridge for biotech 
companies, universities, patient advocacy organizations, pharmaceutical 
companies, and research institutions to accelerate the deployment of 
new research in the practice of medicine, an area where the United 
States has excelled, a country that has already received more Nobel 
Prizes in medicine than any other country on Earth.
  Finally, on the research side, we should look at compassionate 
access. With little to lose, many terminally ill patients can only hope 
for the very quick FDA approval of cutting-edge treatments and drugs 
for hope in their own case. Compassionate access can provide real hope 
to patients that need it most, can save their lives, and can accelerate 
treatments for nearly everyone, but especially the seriously ill.
  When we look at the key objectives of this bipartisan agenda, we also 
have to return to a basic principle, I believe, central to the American 
character, which is increasing personal responsibility. It's time, like 
the chart that I outlined here, to look at bad health habits, 
principally obesity, drinking, and smoking, and to encourage or reward 
Americans who do not exhibit these habits. Normally, we see 75 percent 
of the Nation's health care spending is dedicated to chronic diseases 
related to these three areas, all entirely preventable if we encourage 
the right habits.
  Also, we ought to expand the use of health savings accounts, because 
we know that Americans who directly control health spending from their 
own tax-deferred health savings account, much like an IRA, will take a 
much greater role in the health care decisions they make. Their patient 
compliance will likely be higher, and the choices they make will be 
more appropriate for end-of-life care. These health savings accounts 
are critical, not just to empowering patients, but also to eventually 
either becoming part of a patient retirement savings or an estate for 
their children.
  Finally, when we look at all of these reforms, we have to pay key 
attention to the bottom line. Health care reform in the United States 
has to lower the demand for Federal borrowing, now at what the 
President already describes as a completely unsustainable rate. Because 
many sick and elderly Americans will depend on the reforms that we 
make, the reforms instituted by this Congress must be fiscally 
responsible and sustainable over time.
  The Congressional Budget Office reports that we will borrow $1.18 
trillion just in fiscal year 2009 in a completely unsustainable way, 
and that new revenues for a health care bill that could be put forward 
by this House are simply not there.
  In its place, this Congress could look at an enormous tax increase or 
at faltering climate change legislation that already looks like it will 
not provide the revenues initially hoped for in its early drafts. In 
the face of this lack of funding, either on the borrowing side or the 
unwillingness of Americans to go through a new tax increase and 
faltering prospects for a climate change bill, it's essential that we 
return to the kind of reforms that I just outlined here tonight as a 
way to lower the cost of health insurance, expand access, and improve 
health care outcomes.
  I spent quite a bit of time here tonight talking about the situation 
in detail because, in my view, this is going to be the biggest subject 
this Congress deals with this summer. When we look at the worst angels 
of our nature, we might be able to expect a fairly fierce and partisan 
debate here in the House. That is predictable but unfortunate.
  My hope lies in the moderates of the Senate who can come forward and 
make sure that we have a bipartisan, modest, and sustainable set of 
health care reforms that will improve health care for every American in 
this country in a sustainable way across Presidential administrations 
and across parties, and not end up making the same mistakes as our 
allies in Canada and Britain.
  Well, those are the details. We will be providing further details in 
the Tuesday Group meeting tomorrow, and we look forward to joining with 
many Members on the Democratic side in building what can be one of the 
greatest opportunities for this Congress to affect the daily lives of 
the Americans that we represent.
  And I yield back the balance of my time.

                          ____________________