[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.
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