[Congressional Record Volume 165, Number 120 (Wednesday, July 17, 2019)]
[Senate]
[Pages S4880-S4883]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. BARRASSO. Mr. President, I come to the floor today to once again 
give the facts about the Democrats' one-size-fits-all healthcare 
proposal, the legislation that many Democrats are referring to as 
Medicare for All.
  My focus today is what is going to happen to American patients if the 
government takes full control of our Nation's healthcare system. I 
speak as a doctor who practiced medicine for 24 years in Casper, WY. It 
is so interesting, as a doctor, to take a look at what is being 
proposed because I know the specifics of the impacts on the lives of 
patients, patients I have taken care of as part of my training and part 
of my practice in Wyoming, and as a doctor, I have personally studied 
what is happening to healthcare in other countries around the world.
  You have no doubt heard about the worsening crisis of care in 
England. There are doctor shortages, and, of course, there is rationing 
of care. British rationing has actually become the focus of a recent 
article in the magazine, The Economist. The article is entitled, ``The 
front line of England's NHS is being reinvented.'' It says, ``A 
shortage of family doctors leaves little choice but to try something 
new.''
  Mr. President, I ask unanimous consent to have this article printed 
in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

[[Page S4881]]

  


                          [From The Economist]

          The Front Line of England's NHS Is Being Reinvented


A shortage of family doctors leaves little choice but to try something 
                                  new

       The National Health Service is free, so it is also 
     rationed. Family doctors, known as general practitioners 
     (GPs), act as the first port of call for patients; friendly 
     gatekeepers to the rest of the service who refer people to 
     specialists only if needed. But in some parts of the country, 
     including St Austell on the Cornish coast, access to the 
     rationers is itself now rationed. ``You can't book an 
     appointment to see me here,'' explains Stewart Smith, a 39-
     year-old GP, one of a team in charge of an innovative new 
     medical centre. ``You go on a list and then we triage you.''
       It is an approach that will soon be familiar to more 
     patients. Simon Stevens, chief executive of NHS England, has 
     said that being a GP is arguably the most important job in 
     the country. There is, however, a severe shortage of them. 
     According to the Nuffield Trust, a think-tank, there are 58 
     GPs per 100,000 people, down from 66 in 2009--the first 
     sustained fall since the 1960s. Only half of patients say 
     they almost always see their preferred doctor, down from 65% 
     six years ago. The average consultation lasts just nine 
     minutes, among the quickest in the rich world.
       Although the NHS hopes to train and recruit new family 
     doctors, the gap won't be plugged any time soon. A new five-
     year contract to fund GP practices will eventually include 
     K891m ($1.1bn) a year for 20,000 extra clinical staff, such 
     as pharmacists and physiotherapists, with the first cash for 
     such roles arriving on July 1st. To access the money, 
     practices will have to form networks which, it is hoped, will 
     help them take advantage of economies of scale and do more to 
     prevent illnesses rather than merely treating them.
       When the four practices serving St Austell merged in 2015, 
     it was an opportunity to reconsider how they did things. The 
     GPs kept a diary, noting precisely what they got up to during 
     the day. It turned out that lots could be done by others: 
     administrators could take care of some communication with 
     hospitals, physios could see people with bad backs and 
     psychiatric nurses those with anxiety. So now they do. Only 
     patients with the most complicated or urgent problems make it 
     to a doctor. As a result, each GP is responsible for 3,800 
     locals, compared with an average of 2,000 in the rest of 
     Cornwall.
       Although few practices have made changes on the scale of St 
     Austell Healthcare, across England the number of clinical 
     staff other than GPs has grown by more than a third since 
     2015. The logic behind the introduction of these new roles is 
     compelling, says Ben Gershlick of the Health Foundation, 
     another think-tank. The NHS estimates that 30% of GPs' time 
     is spent on musculoskeletal problems, for instance, which 
     could often be handled by a physiotherapist. Another estimate 
     suggests 11% of their day is taken up by paperwork. Doctors 
     complain that they are overworked, and growing numbers retire 
     early. They are also expensive: the starting salary for a GP 
     is K57,655, whereas a physio costs around half as much.
       NHS leaders hope the new workers will help practices play a 
     more active role in their community, linking up with services 
     provided by local authorities and charities. Each network 
     will be responsible for a population of 30,000-50,000. The 
     plan is that they will use data analysis to intervene early 
     to prevent illness, and that practices will often share the 
     new staff with others in their network.
       Those that are further down the road sing the benefits of 
     the new approach. Caroline Taylor of the Beechwood Medical 
     Centre in Halifax says that new roles quickly show their 
     worth. Her practice took in a ``work wellness adviser'' 
     employed by the council. The adviser's goal was to help ten 
     people over the age of so with poor mental health back to 
     work in a year--a task which she completed in just six weeks. 
     In St Austell two pharmacists last year helped to cut more 
     than K140,000 from prescribing costs. Far fewer staff now 
     report that they are burnt out.
       Working in a team will nevertheless require a big shift in 
     mindset for many doctors, particularly those in surgeries 
     that have never before employed anyone else aside from the 
     odd nurse. One worry is that practices will end up doing what 
     they must to get the extra funding, but little more. There 
     are also more practical problems. Seven in ten GPs say their 
     practices are too cramped to provide new services, and it is 
     not clear where some of the extra staff will be hired from.
       Perhaps the biggest problem is that patients have grown 
     used to having a doctor on demand. Although those who no 
     longer have to queue for an appointment may be happy, others 
     might feel fobbed off if diverted to another clinician. A 
     study published last year by Charlotte Paddison of the 
     Nuffield Trust, and colleagues, in the British Medical 
     Journal found that patients had less trust in the care 
     provided by a nurse if they initially expected to see a 
     doctor. Patients who have a close relationship with their GP 
     tend to be more satisfied and enjoy better health outcomes 
     than others.
       But other evidence suggests that, for some conditions, 
     nurses provide care that is as good as or better than that 
     provided by GPs. The aim, says Nav Chana of the National 
     Association of Primary Care, which helped develop the new 
     approach, is therefore to use small teams of doctors and 
     other clinical staff to replicate the sort of relationship 
     with patients that used to be more common. Just parachuting 
     in ``a lot of people who look like doctors'' will not raise 
     standards, he warns.
       The shortage of GPs leaves the NHS with little choice but 
     to try something new. ``A lot of the world has either copied 
     or is trying to copy English primary care,'' in particular 
     its openness to all and the continuity of care that it 
     provides, says Dr. Chana. Keeping these strengths, while 
     changing how primary care works, is the task NHS officials 
     are now facing up to. Even if they succeed, it will take time 
     for the public to adjust. Having explained the benefits of 
     the new way of doing things, one GP pauses, before adding: 
     ``I should say, though, patients don't love it.''

  Mr. BARRASSO. Mr. President, the story opens with a simple 
observation, and this is the first sentence: ``The national health 
service is free, so it is also rationed.''
  That is what we are seeing, and that is what people are living with 
every day in Britain. Under the guise of healthcare being free, they 
live in a world where healthcare is rationed.
  So how bad can that be? What would this mean with this one-size-fits-
all Medicare for All, which the Democrats are proposing?
  The Economist writes that in Britain today ``[o]nly patients with the 
most complicated or urgent problems make it to a doctor.'' Actually, 
today you need a doctor's referral to see a specialist in England. But 
now, in some parts of the country, a British bureaucrat must preapprove 
your visit to the family doctor, who will then make the referral to the 
specialist. I can't imagine people in our country tolerating that. So, 
ironically, ``access to the rationers is itself now rationed.'' 
According to the article, ``Only half of [British] patients say they 
almost always get to see their preferred doctor.'' So only half get to 
see the doctor they choose.

  Remember that old line--``If you like your healthcare, you can keep 
it. If you like your doctor, you can keep your doctor.'' In Britain, 
only half get to see their doctor--if they get to see them, if they get 
to go through the rationer, who is a bureaucrat.
  What happens after you wade through all of this, wade through the 
morass of the bureaucrat and the family doctor to get to the 
specialist? What does the article say about when you actually get to 
see a doctor? The average consultation time, it says, is only 9 
minutes. It is 9 minutes on average. As a doctor, I can state that 9 
minutes is one of the shortest consults I have ever heard of. I cannot 
imagine 9 minutes--after waiting all of this time to see the doctor, 9 
minutes and then you are done, and they are on to the next patient, who 
has also been waiting and waiting and waiting to see the doctor.
  What does this tell us about what would happen in the United States 
to patients trying to see doctors if we followed this one-size-fits-
all, government-run healthcare program that Senator Sanders and so many 
of the Democrats are supporting? If we adopt a government-run, one-
size-fits-all healthcare system, which is what they are proposing, I 
would tell Americans to expect to pay more to wait longer for worse 
care. That is what we would see. To borrow the line from The Economist, 
bureaucrats will, as they say, reinvent what healthcare means for you.
  You may have seen the stories about the thousands of elderly patients 
right now going blind in Britain--going blind. Why are they going 
blind? Well, because the British health service is rationing eye 
surgery. The president of the Royal College of Ophthalmologists has 
said that the rationing is part of the government's cost-cutting in 
England, and people are going blind as a result. Thousands of elderly 
patients are desperately in need of eye surgery, but the bureaucrats 
who must approve it are denying the treatment. The number of denials 
has doubled in the last 2 years.
  According to the Royal College of Surgeons, a quarter of a million 
British patients have been waiting more than 6 months for planned 
medical treatment. That is happening in England today. The waiting 
times are getting longer.
  Now let's look at Canada. According to the New York Times, Senator 
Bernie Sanders likes the Canadian healthcare system because he says it 
is ``free.'' Of course, Senator Sanders

[[Page S4882]]

knows it is anything but free. After all, the healthcare proposal that 
Senator Sanders is proposing has a $32 trillion price tag. The Senator 
admits the plan hikes taxes on middle-class families. He said it in the 
debate the other night. The truth is, even doubling our taxes couldn't 
cover this huge cost. Yet a majority of Democrats in the House of 
Representatives--a majority--have cosponsored what Senator Sanders is 
proposing. A majority of the Democratic Senators running for President 
today have cosponsored Senator Sanders' one-size-fits-all proposal. 
Apparently Senator Sanders approves of the Canadian long wait times 
because he says wait times are not a problem. Well, maybe he should 
check with the Canadians to see if wait times are a problem, because 
patients in Canada typically wait 3 months for treatments and for 
certain treatments, much, much longer. In some ways, the Canadian 
healthcare system has been called trick-or-treat medicine because if 
you haven't gotten your care by the end of October, by Halloween, you 
will have to wait until next year because they will have run out of the 
money allotted for that procedure or that healthcare in that country in 
that year.
  As a doctor practicing in Wyoming, I have actually operated on people 
from Canada who came to the United States for care. It is free up in 
Canada, but they couldn't afford to wait for the free care they were 
going to get in Canada, so they came to the United States to pay for 
the care here.
  Still, that is what the Democrats are proposing--a one-size-fits-all 
approach. So people will pay more through their taxes to wait longer 
for care that will be worse care. Even the Congressional Budget Office 
people who looked at this in terms of funding, looked at what it would 
cost to do a Senator Sanders' style approach, said it would be 
expensive, complicated, and the delays would be not just in treatment 
but also in technology.
  Many Democratic candidates for President have also endorsed--
amazingly so--free healthcare for illegal immigrants. You saw the 
question being asked on the debate stage. Every one of the Democrats 
running for President was standing there and was asked: Which one of 
you would have in your healthcare plan free health insurance, free 
healthcare, for people in this country illegally? And every hand on the 
stage went up.
  When you take a look at what the proposal actually is--this Medicare 
for All, this one-size-fits-all approach--it actually takes health 
insurance away from 100 million people who get it through work and 
gives it to illegal immigrants. So 180 million American citizens will 
lose their on-the-job insurance while illegal immigrants will get it 
for free. That is the Democrats' Medicare for All proposal.
  The Congressional Research Service recently reported that the Sanders 
bill ends Medicare as well as on-the-job health insurance, and what we 
will be doing is entering into one expensive, new, government-run 
system.
  Still, the Democratic Senators who are running for President and the 
118 Democratic Members of the House support the Sanders' legislation. 
They have cosponsored it, saying: Let the Washington, DC, bureaucrats 
call the shots--unelected, unaccountable bureaucrats calling the shots 
as they ration your care. They will micromanage your care, and they 
will delay your care, delay your treatment--treatment that you urgently 
need. That is the difference. People will lose the freedom to see their 
own doctor. We have seen what has happened in England. Patients will 
wait months for treatment. Keep in mind--care delayed is often care 
denied, and if they finally get to see a physician, the amount of time 
in consultation will be incredibly short. That is why what is being 
proposed by the Democrats in this one-size-fits-all approach--a British 
plan, a Canadian plan--is completely unacceptable to American citizens.
  You don't need Democrats' phony promises of free care; what you need 
is to have the freedom to get the care you want and need from a doctor 
whom you choose at lower cost. That is why Republicans are going to 
continue to work on real reforms that improve patient care, that 
increase transparency, that lower the cost of care, and that lower the 
cost of what people pay out of their own pockets, without adding these 
incredibly longer wait times and the loss of the ability to make 
choices on your own. Why should we pay more to wait longer for worse 
care, which is what we are seeing with a one-size-fits-all approach? 
Let's make sure patients can get the care they need from the doctor 
they choose at lower costs.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Romney). The Senator from Texas.
  Mr. CORNYN. Mr. President, I would ask unanimous consent that 
Senators Alexander and Menendez be allowed to speak for 5 minutes each 
before the vote scheduled at 2 p.m. today.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                   50th Anniversary of ``Apollo 11''

  Mr. CORNYN. Mr. President, 50 years ago, the world was transfixed by 
a grainy, black-and-white image of Neil Armstrong descending a ladder, 
preparing to take humankind's first steps on the Moon. I was one of 
more than half a billion people--the largest television audience in 
history--glued to the TV screen on that day. I was actually in high 
school, and, like so many Texans at the time, I was totally engrossed 
in what was going on.
  Staring at the television, it was hard to imagine that hundreds of 
thousands of miles away, two brave Americans were sitting on the 
surface of the Moon while their comrade remained in lunar orbit up 
above. I didn't quite understand what this development would mean for 
the future; I just remember thinking at that moment how proud I was to 
be an American. I looked up to these three men, and I still do, and I 
marvel at their courage, their intelligence, and their patriotism, as 
well as that of the tens of thousands of Americans involved in getting 
them to the Moon in the first place.
  We now know that this lunar trio had quite a sense of humor. Michael 
Collins was once asked in an interview what he was thinking about in 
the moments leading up to the liftoff on July 16, 1969, and he joked, 
``I was thinking of per diem, you know, how many dollars per mile we'd 
be paid for this voyage.'' Upon the astronauts' return, we learned that 
when Buzz Aldrin stepped off the ladder, he told Armstrong he was being 
careful not to lock the door behind him. And when talking about the 
fact that most of the photos from the surface of the Moon were of 
Aldrin, Neil Armstrong joked, ``I have always said that Buzz was the 
far more photogenic of the crew.''
  While the first lunar landing meant many different things to people 
around the world, there is one thing that was abundantly clear: That 
date--July 20, 1969--established the United States as the world leader 
in human space exploration. It also put my hometown, the place of my 
birth, Houston, on the map as a hub for spaceflight innovation in the 
United States.
  We all remember the very first words uttered by Neil Armstrong after 
landing. He said, ``Houston, Tranquility Base here. The Eagle has 
landed.'' Of course, he was talking to the greatest minds of the 
generation, who were working at Johnson Space Center in Houston, TX. 
The men and women at Mission Control Center exercised full control over 
Apollo 11, from the launch at Kennedy Space Center, to landing on the 
Moon, to the splashdown in the Pacific Ocean.
  For more than 50 years now, the Johnson Space Center in Houston has 
been at the heart of America's space program. The success marked the 
turning point in space exploration, and folks across Texas are eager to 
celebrate this momentous anniversary. You can do like I have and visit 
Johnson Space Center yourself and see NASA's Mission Control from 
Apollo. It was redesigned to look exactly the way it did in 1969, down 
to the retro coffee cups and glass ashtrays. You can watch the Houston 
Astros take on Oakland while wearing Apollo 11 caps. Across the State, 
you can see special movie screenings, space-themed menus, and ``ask an 
astronaut'' events to educate our next generation of space travelers.
  To commemorate this historic mission in Washington, I introduced a 
bipartisan, bicameral resolution with my colleagues Senator Brown, 
Congressman Babin, and Congresswoman Horn last month. I thank my 
colleagues who supported this effort and urge my fellow Senators to 
join me in passing it this week. This resolution honors Apollo 11's 
three crew members--Buzz

[[Page S4883]]

Aldrin, Neil Armstrong, and Michael Collins--whose bravery and skill 
made this feat possible. In addition, it commends the work of the 
brilliant men and women who supported this mission on Earth, including 
mathematicians like Katherine Johnson and the astronauts who lost their 
lives in previous spaceflight missions.
  To ensure that America remains the leader in human spaceflight, this 
resolution also supports the continued leadership of the United States. 
With this in mind, earlier this year, I introduced a bill called 
Advancing Human Spaceflight Act with Senator Peters from Michigan to 
provide greater certainty and stability for our space program.
  This legislation will extend the authorization for the International 
Space Station through 2030 and launch the United States into a new era 
of space exploration.
  Our future astronauts need spacesuits with advanced capabilities 
beyond what current technology can do, so this bill will also direct 
NASA to develop the next-generation spacesuit for future exploration to 
the Moon, to Mars, and beyond.
  In order to make this dream a reality, this legislation will allow 
NASA to partner with private space innovators to ensure we have the 
best and brightest working to achieve these goals.
  In addition, this bill will, for the first time, codify human space 
settlement as a national goal. I believe this legislation will help set 
the stage to launch the United States into a new era of space 
exploration, and there is no better time than this momentous 
anniversary to recommit ourselves to American leadership in space.
  In the year since that first ``small step,'' we have watched goal 
after goal being set and then met. From the Viking 1 landing on Mars to 
the Voyager Program exploring the outer planets, to the International 
Space Station making human space habitation a reality, I have no doubt 
that the success of the Apollo 11 mission made each of these victories 
possible and paved the way for the future.
  For the 50th anniversary of the lunar landing, today we honor the 
brave and brilliant astronauts, physicists, engineers, mathematicians, 
and scientists of all kinds who made our Nation the first to touch down 
on lunar soil. We are grateful for their courage, their sacrifices, and 
their immeasurable contributions to our Nation's space program.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.