[Congressional Record Volume 163, Number 176 (Tuesday, October 31, 2017)]
[Senate]
[Pages S6932-S6934]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               HEALTHCARE

  Mr. SANDERS. Mr. President, let me begin by pointing out an op-ed 
that appeared in the Boston Globe today. It is an op-ed that I wrote. 
It is called ``The health care crisis no one is talking about.''
  Mr. President, I ask unanimous consent that this op-ed be printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                 [From the Boston Globe, Oct. 31, 2017]

       The Health Care Crisis No One Is Talking About

                          (By Bernie Sanders)

       The United States faces a major crisis in primary health 
     care, and unless Congress acts immediately it is likely to 
     become much worse.
       Millions of Americans are at risk of losing their access to 
     health care because Congress did not renew funding for the 
     community health center program at the end of the fiscal 
     year, Sept. 30. Unless we renew funding immediately, 70 
     percent of funding will be cut, the doors of 2,800 community 
     health centers will close, and 9 million patients will lose 
     access to quality health care. That is unacceptable.
       Our nation's community health centers provide affordable, 
     high-quality health care to more than 27 million people. This 
     includes not only primary health care, but also dentistry, 
     counseling, and low-cost prescription drugs. For the 13 
     million rural patients served, community health centers often 
     are the only health care provider for hundreds of

[[Page S6933]]

     miles. And they provide good jobs in communities that need 
     them the most.
       Community health centers not only save lives, they also 
     save money. Instead of people ending up in expensive 
     emergency room care, or in the hospital, they get the primary 
     care they need, when they need it, at high quality medical 
     centers. Compared to other providers, community health 
     centers save on average $2,371 per Medicaid patient and up to 
     $1,210 per Medicare patient. What's more, community health 
     centers have played a pivotal role in generating more than 
     $49 billion in savings to the entire health care system.
       Not only do we have to renew funding for the community 
     health center program, we must also improve and expand the 
     National Health Service Corps--the program that provides debt 
     forgiveness for young doctors, nurses, dentists, mental 
     health providers, and pharmacists who are prepared to work in 
     our nation's most underserved areas. Without debt 
     forgiveness, it is very hard to get new doctors to choose 
     primary care--an area of medicine that does not pay the big 
     bucks. It is also difficult to attract medical professionals 
     into the underserved areas of our country where they are 
     needed the most.
       It is widely acknowledged that we currently have the most 
     wasteful, inefficient, and expensive health care system in 
     the world. Despite spending almost $10,000 per capita on 
     health care, twice as much as any other country, 28 million 
     Americans have no insurance, even more are underinsured, with 
     high copayments and deductibles, and we pay the highest 
     prices in the world for prescription drugs. The rarely 
     discussed truth is that thousands of Americans die each year 
     because they cannot afford to get to a doctor when they 
     should.
       We must not allow a bad situation to get worse.
       We cannot tell millions of low-income and working people in 
     every state in this country that they will no longer be able 
     to access the health care, dental care, mental health 
     counseling, and low-cost prescription drugs they desperately 
     need.
       We cannot tell pregnant women that they will not be able to 
     get the necessary prenatal care they require in order to have 
     healthy babies.
       We cannot tell the young person addicted to opioids or 
     heroin that there is no treatment available.
       We cannot tell chronically ill senior citizens that they 
     will have to survive without the prescription drugs they have 
     used for years.
       We cannot force community health centers, which provide 
     some of the most cost-effective health care in the country, 
     to lay off the doctors, nurses, dentists, and administrators 
     who keep these centers going.
       Historically, the community health center program has 
     enjoyed widespread bipartisan support, and that support 
     continues. Today, along with almost all Democrats, there are 
     a number of Republicans who fully understand how important 
     these centers are to the well-being of their states and want 
     to see the program refunded.
       The time for delay is over. Congress must act immediately 
     to fully fund the community health center program and the 
     associated workforce programs that provide them with the 
     well-trained staffing they need.

  Mr. SANDERS. Mr. President, the United States today faces a major 
healthcare crisis. I think we all understand that. In the midst of that 
healthcare crisis, we face an even greater crisis in primary 
healthcare, and that means that there are many, many millions of 
people, not just people who don't have any insurance, not just people 
who are underinsured, but people even with decent insurance, who cannot 
get to a doctor's office when they need to because there is not a 
sufficient number of primary care physicians in their area. This is a 
major crisis today, but unless Congress acts immediately, that crisis 
is going to become much, much worse.
  Millions of Americans are at risk of losing their access to 
healthcare because Congress has still not renewed funding for the 
Community Health Center Program, which expired on September 30. So we 
hear a whole lot of discussion about a whole lot of serious healthcare 
problems. This is one that we do not hear very much about, and that is 
that Congress has still not renewed funding for the Community Health 
Center Program, which expired on September 30. Unless we renew that 
funding immediately, some 70 percent of funding will be lost. Seventy 
percent of funding for community health centers will be lost. The doors 
of 2,800 service sites will close and 9 million patients will lose 
access to the healthcare they currently have. Nine million people will 
find that when they go to a community health center, that center will 
no longer be able to treat them. Clearly, this is unacceptable.
  Our Nation's community health centers provide affordable, high-
quality healthcare to more than 27 million Americans in every State in 
this country. This includes, by the way, in terms of community health 
centers, not only primary healthcare but also dental care, which is a 
major crisis in this country. It is very hard in many parts of America 
to find affordable dental care. It also includes mental health 
counseling, which is another major issue, especially within the context 
of the opioid and heroin epidemic we face. In addition to all of that, 
community health centers provide low-cost prescription drugs at a time 
when many Americans cannot afford the medicine they need.
  They play a vital role in community after community, State after 
State, in providing healthcare to some 27 million Americans. For the 13 
million rural patients served, community health centers often are the 
only healthcare provider for hundreds of miles in rural America. There 
are deserts in which Americans cannot access a doctor, and community 
health centers are the oasis in that desert. In addition to all of 
that, community health centers often provide a lot of good jobs in 
underserved communities that need them the most.
  Community health centers not only save lives, but they also save 
money. Every dollar we invest in strong primary healthcare saves us 
dollars in the long run. Instead of people ending up in expensive 
emergency room care--and emergency room care is the most expensive 
primary care in the country--or ending up in the hospital because they 
can't and do not go to the doctor when they should, community health 
centers provide the primary care people need at a fraction of the cost 
of an emergency room.
  Medicaid, in many cases, will spend one-tenth as much per patient for 
a community health center visit compared to an emergency room visit. So 
it is an opportunity not only to provide good quality care but to save 
substantial sums of money. Compared to other providers, community 
health centers save, on average, $2,371 per Medicaid patient and up to 
$1,210 for Medicare patients.
  What is more, community health centers have played a pivotal role in 
generating more than $49 billion in savings to the entire healthcare 
system. They provide quality primary healthcare. They save money by 
keeping people out of emergency rooms or keeping them out of the 
hospitals. Not only do we have to renew funding of the Community Health 
Center Program, we must also improve and expand the National Health 
Service Corps, which is a program that provides debt forgiveness for 
young doctors, nurses, dentists, mental health providers, and 
pharmacists who are prepared to work in our Nation's most underserved 
areas. Without debt forgiveness, without telling young graduates of 
medical school who often leave school $200,000, $300,000, and $400,000 
in debt--without giving them the opportunity to get those very large 
debts forgiven, it will be very hard to attract physicians and nurses 
and psychologists to rural areas or urban areas, where we have a 
significant ``underserving'' in terms of medical care.
  So we need to fund not only community health centers but the National 
Health Service Corps. We currently have 1,100 National Health Service 
Corps members who are in school or in residency programs who will not 
be able to complete their training and become primary care 
professionals. We need to provide the workforce for community health 
centers and other underserved areas in this country.
  Here is the very good news: The truth is, for many years, our 
community health centers, which are playing a vital role all over this 
country--urban areas and rural areas--have received bipartisan support. 
I know a lot of the bipartisan efforts of the past have kind of 
disappeared in the current political climate, but I am very happy to 
say there is a very strong piece of legislation introduced by Senator 
Roy Blunt, a Republican from Missouri, which has a number of Republican 
cosponsors on it.
  My own view is, I think every Member of the Democratic caucus would 
sponsor it, but I think there is a whole lot of Republican support for 
this community health center bill. So not only is Mr. Blunt the sponsor 
of the bill, we have Senator Capito, Senator Gardner, Senator Collins, 
Senator Wicker, Senator Fischer, Senator Boozman,

[[Page S6934]]

Senator Murkowski, and Senator Cochran--who are all Republicans--
onboard this legislation.
  I believe, if that bill came to the floor today as a stand-alone 
bill, it would pass overwhelmingly because people in rural America, 
people in urban America--Democrats, Republicans, and Independents--
understand the very important role community health centers are 
playing. What this bill is about, significantly, is funding for 5 years 
not quite at the level I would like to see but at about 4 percent a 
year which, in terms of medical inflation, really means level funding. 
Now, that is in contrast to a bill that is being discussed in the 
House, which is simply not satisfactory. The House bill is talking 
about 2 years of funding, which means it is level-funded, which means 
it is a significant decline in real dollars for community health 
centers. Also, there are pay-fors for the bill which are totally 
unsatisfactory. It is a question of taking money from Peter to pay Paul 
and taking money from very important healthcare programs to put money 
into this important program.
  It is widely acknowledged that we currently have the most wasteful, 
inefficient, and expensive healthcare system in the world, despite 
spending almost $10,000 per capita on healthcare, which is twice as 
much as any other country. I just returned from Canada the other day. 
They spend about 50 percent per capita of what we spend of guaranteed 
healthcare to all of their people, and many of their healthcare 
outcomes are, in fact, better than they are in the United States. So we 
spend a whole lot of money, and we are not getting particularly good 
value.
  One of the areas where we are getting good value is in the area of 
community health centers. We need to not allow a bad situation to get 
worse. We have a very serious crisis in this country with primary 
healthcare, dental care, and certainly, mental health counseling. We 
are in deep trouble. If we do not immediately fund the Community Health 
Center Program, the National Health Service Corps, and the other 
workforce programs, a very bad situation will become tragically worse. 
We cannot tell millions of low-income and working people in every State 
in this country that they will no longer be able to access the 
healthcare, dental care, mental health counseling, and low-cost 
prescription drugs they desperately need. We cannot tell pregnant women 
they will not be able to get the necessary prenatal care they require 
in order to deliver healthy babies. We cannot tell the tragic number of 
people who are struggling today with opioid or heroin addiction that 
there is simply no treatment available to them because community health 
centers do a lot of that treatment. We cannot tell chronically ill 
senior citizens they will have to survive without the prescription 
drugs they have used for years. We cannot force community health 
centers--which provide some of the most cost-effective healthcare in 
this country--to lay off doctors, nurses, dentists, and administrators 
who keep these centers going.
  Historically, the Community Health Center Program has enjoyed 
widespread bipartisan support, and I am glad to say that for this 
program, that support continues. What I am asking today is for strong 
support for the Blunt legislation. Let's get it onto the floor of the 
Senate as quickly as we can. Let's pass it. Let's demand that the House 
work with us to pass strong legislation. The time for delay is over. 
Congress must act immediately to fully fund the Community Health Center 
Program, the National Health Service Corps, and the Teaching Health 
Centers Program today.
  We know these programs work. We know they save money and lives. These 
programs must be funded for 5 years, which is what the Blunt bill does. 
We should not continue to ignore this very serious problem for another 
day.
  I yield the floor.

                          ____________________