[Congressional Record Volume 159, Number 113 (Thursday, August 1, 2013)]
[Senate]
[Pages S6215-S6216]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CARDIN (for himself, Mr. Crapo, Mr. King, Mr. Udall of New 
        Mexico, and Mrs. Shaheen):
  S. 1422. A bill to amend the Congressional Budget Act of 1974 
respecting the scoring of preventive health savings; to the Committee 
on the Budget.
  Mr. CARDIN. Mr. President, I rise to introduce legislation to 
modernize the Congressional budget scoring process with respect to 
health spending and the effects of preventive health care.
  Although the United States spends more than any other Nation in the 
world on health care, $2.6 trillion in 2010, our citizens' health 
status lags behind that of most developed countries, and we have the 
highest rate of preventable deaths among 19 industrialized nations. One 
reason is that the United States' expenditures for the treatment of 
disease far exceed our investments in preventive health.
  Our neglect of prevention has been costly. Spending on the treatment 
of chronic diseases is overwhelming our health care budgets, 
particularly those of the Medicare and Medicaid programs. The following 
statistics come from the U.S. Centers for Disease Control and 
Prevention: 7 out of 10 deaths among Americans each year are from 
chronic diseases. Heart disease, cancer and stroke account for more 
than 50 percent of all deaths each year.
  In 2005, 133 million Americans almost 1 out of every 2 adults had at 
least one chronic illness.
  About \1/4\ of people with chronic conditions have one or more daily 
activity limitations.
  Arthritis is the most common cause of disability, with nearly 19 
million Americans reporting activity limitations.
  Diabetes continues to be the leading cause of kidney failure, 
nontraumatic lower-extremity amputations, and blindness among adults, 
aged 20-74.
  Excessive alcohol consumption is the third leading preventable cause 
of death in the U.S., behind diet, physical activity, and tobacco.
  CDC also tells us that four health risk behaviors--lack of physical 
activity, poor nutrition, tobacco use, and excessive alcohol 
consumption--are responsible for much of the illness, suffering, and 
early death related to chronic diseases.
  More than \1/3\ of all adults do not meet recommendations for aerobic 
physical activity based on the 2008 Physical Activity Guidelines for 
Americans, and 23 percent report no leisure-time physical activity at 
all in the preceding month.
  In 2007, 22 percent of high school students and only 24 percent of 
adults reported eating 5 or more servings of fruits and vegetables per 
day.
  More than 43 million American adults, approximately 1 in 5, smoke. 
Lung cancer is the leading cause of cancer death, and cigarette smoking 
causes almost all cases. Compared to nonsmokers, men who smoke are 
about 23 times more likely to develop lung cancer and women who smoke 
are about 13 times more likely. Smoking causes about 90 percent of lung 
cancer deaths in men and almost 80 percent in women. Smoking also 
causes cancer of the voicebox, mouth and throat, esophagus, bladder, 
kidney, pancreas, cervix, and stomach, and causes acute myeloid 
leukemia.
  Excessive alcohol consumption contributes to over 54 different 
diseases and injuries, including cancer of the mouth, throat, 
esophagus, liver, colon, and breast, liver diseases, and other 
cardiovascular, neurological, psychiatric, and gastrointestinal health 
problems.
  Binge drinking, the most dangerous pattern of drinking, defined as 
consuming more than 4 drinks on an occasion for women or 5 drinks for 
men, is reported by 17 percent of U.S. adults, averaging 8 drinks per 
binge.
  By addressing just these four behaviors, we can alter the trajectory 
of chronic disease and the health costs associated with them. That is 
the power of prevention. As Dr. Albert Reece of the University of 
Maryland School of Medicine once said, ``Lifestyle is primary care.''
  Prevention also means early screening. In addition to increasing 
survival rates, identifying diseases early reduces health care costs. 
In the case of colorectal cancer, Medicare will pay under $400 for a 
colonoscopy, but if the patient is not diagnosed until the disease has 
metastasized, the costs of care can exceed $58,000 over the patient's 
lifetime. A screening mammography costs the Medicare program a small 
fraction of the tens of thousands of dollars that treatment of breast 
cancer costs, depending on when the cancer is found and the course of 
treatment used. One drug used to treat late stage breast cancer can 
cost as much as $40,000 a year.
  Research has shown that increasing to 90 percent the number of women 
aged 40 and older who have been screened for breast cancer in the past 
two years would save more than 100,000 lives each year in the United 
States.
  One of the most compelling cases for prevention is in the area of 
oral health. The tragic, preventable death of 12 year-old Marylander 
Deamonte Driver in 2007 illustrated the consequences of poor access to 
oral health care. His untreated tooth abscess spread to his brain and 
after two extensive operations, he died. Although a tooth extraction 
would have cost about $80, the final total cost of his medical care 
exceeded $250,000.
  The American Academy of Pediatric Dentistry tells us that dental 
decay is the most common chronic childhood disease among children in 
the United States. It affects one in five children aged 2 to 4, half of 
those aged 6 to 8, and nearly \3/5\ of 15 year olds. But it is also the 
most preventable disease if basic oral care is provided starting at an 
early age.
  The good news in that for nearly every category of chronic disease we 
can reduce its prevalence by making preventive health care a priority. 
All around us are examples of why prevention is an essential part of 
health care

[[Page S6216]]

and why effective use of preventive measures, such as screening and 
smoking cessation can save lives and lower health care costs in the 
long run.
  But the current Congressional budget process has hindered our ability 
to get appropriate credit for the cost savings that prevention can 
bring. For this reason, investing in initiatives that can move our 
Nation forward toward optimal health often requires us to cut funding 
in other important areas because of the budget rules.
  Today, budget resolutions, budget reconciliation, and CBO scoring 
analyses use a ten-year ``scoring'' window. But the research performed 
at the National Institutes of Health in Bethesda, MD and at research 
centers across the nation has demonstrated that some expenditures for 
preventive services result in cost savings when considered in the long 
term. Unfortunately, Congressional budget scoring rules only permit 
taking into account the first ten years, a time frame in which savings 
may not be apparent.
  We want to change that. Today, with Senators Mike Crapo, Angus King, 
Tom Udall, and Jeanne Shaheen, I am introducing the Preventive Health 
Savings Act of 2013. It would allow the Chairman or Ranking Member of 
the House or Senate Budget Committee, or the health committees--HELP, 
Finance, Ways and Means, or Energy and Commerce--to request an analysis 
of preventive measures extending beyond the existing 10-year window to 
two additional ten-year periods.
  Re-evaluating our budget rules is not a new phenomenon. In recent 
years, Congress has increasingly looked for ways to assess long-term 
budget consequences. For example, Congress currently requests that CBO 
report on measures that would cause a large future increase in the 
deficit--more than $5 billion in the following four decades.
  The Preventive Health Savings Act would direct CBO to incorporate 
credible data on prevention. Because we want to ensure that CBO's 
projections are tied to scientific data, our bill would define 
preventive health as ``an action designed to avoid future health care 
costs that is demonstrated by credible and publicly available 
epidemiological projection models, incorporating clinical trials or 
observational studies in humans, longitudinal studies, and meta-
analysis.'' This narrow, responsible approach encourages a sensible 
review of health policy that Congress believes will promote public 
health, and it will make it easier for us to invest in proven methods 
of saving lives and money.
  CBO would be required to conduct an initial analysis to determine 
whether the provision would result in substantial savings outside the 
10-year scoring window and to include a description of those future-
year savings in its budget projections.
  The broad coalition of groups supporting this bill includes: the 
Academy of Nutrition and Dietetics, Aetna, Allscripts, American 
Association of Diabetes Educators, American College of Occupational 
Medicine, American College of Preventative Medicine, American Diabetes 
Association, BlueCross BlueShield Tennessee, Building Healthier 
America, Care Continuum Alliance, Council for Affordable Health 
Coverage, Dialysis Patient Citizens, The Endocrine Society, Healthcare 
Leadership Council, Healthways, IHRSA: International Health Racquet & 
Sportsclub Association, Johnson & Johnson, Marshfield Clinic, Memorial 
Care Health System, National Association of Public Hospitals and Health 
Systems, National Retail Federation, National Kidney Foundation, Novo 
Nordisk, the Partnership to Fight Chronic Disease, Sanofi, Texas Health 
Resources, and Weight Watchers.
  I also wish to applaud the bipartisan House sponsors of this 
legislation--two physicians--Representatives Michael Burgess of Texas 
and Donna Christensen of the U.S. Virgin Islands, for their vision in 
introducing the companion bill, HR 2663, which now has 19 cosponsors.
  I urge my colleagues to cosponsor this legislation, which will give 
our budget process the flexibility needed to dramatically bend the 
health care cost curve.
                                 ______