[Congressional Record Volume 169, Number 146 (Monday, September 11, 2023)]
[Senate]
[Pages S4342-S4345]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. GRASSLEY. Mr. President, I am committed to lowering healthcare 
costs, expanding access to high-quality care, and supporting research 
and innovation. The healthcare system in the United States needs more 
reform and accountability. However, we shouldn't ruin it by turning it 
into a government-run healthcare system, whether you want to call it 
government-run healthcare system, Medicare for All, or single payer, or 
even socialized medicine.
  A government-run healthcare system is a one-size-fits-all approach. 
It results in longer wait times, delayed care, and do-it-yourself 
healthcare because you cannot access a doctor.
  In February, the Wall Street Journal highlighted the failure of the 
United Kingdom's National Health Service, NHS for short.
  They wrote:

       Now, the state-funded service is falling apart. People who 
     suffer heart attacks or strokes wait more than 1\1/2\ hours 
     on average for an ambulance. Hospitals are so full that they 
     are turning patients away. A record 7.1 million people in 
     England--more than one in 10--are stuck on waiting lists for 
     nonemergency hospital treatment like hip replacements.

  But I want to quote from the article of the Wall Street Journal, 
another one:

       Delays in treating people are causing the premature deaths 
     of 300 to 500 people a week. One in five British people were 
     waiting for a medical appointment or treatment by NHS in 
     December.

  If you didn't find that article about the United Kingdom alarming, in 
May, British Columbia announced that they are sending cancer patients 
to Bellingham, WA, in the United States, for treatment.
  A Canadian news outlet wrote this:

       Health Minister Adrian Dix announced . . . that eligible 
     breast and prostate cancer patients will be sent to one of 
     two clinics in Bellingham for radiation treatment. . . . The 
     unprecedented move to send thousands of [British Columbia] 
     patients to the [United

[[Page S4343]]

     States] over the next two years is an attempt to address the 
     backlog in [British Columbia] which has one of the longest 
     waits for radiation treatment in Canada.

  Canada is taking this action because its cancer patients face 
unacceptable waiting times. Currently, only 82.9 percent of the British 
cancer patients who require radiation start treatment within 28 days. 
That means that 17 percent of cancer patients are waiting at least a 
month or longer to start cancer treatment.
  Canada's single-payer healthcare problems aren't found in just one 
province. In January, the Wall Street Journal reported that Ontario is 
turning to private healthcare options to fix the growing problem with 
its single-payer-funded healthcare system. Canada's most populous 
province is allowing more patients to go to private treatment centers 
for cataracts and joint replacement surgeries and for services such as 
MRIs and CT scans.
  The Wall Street Journal writes:

       [T]he median wait time in Canada last year between referral 
     and treatment was between 27.4 weeks, the longest on record, 
     compared with 9.3 weeks in 1993. Ontario reported the 
     shortest wait times of 20.3 weeks, while the eastern province 
     of Prince Edward Island reported the longest at 64.7 weeks.

  And, finally, back to Great Britain, a YouGov poll recently found 
that Britons are ``pulling their teeth out with pliers'' because they 
can't access the National Healthcare Service dentists. The poll found 
10 percent of the respondents had attempted do-it-yourself dentistry.
  I am committed to improving the healthcare system. I am working to 
lower the cost of prescription drugs, maintain access to rural 
healthcare, ensure our Nation's seniors can have high-quality, 
affordable hearing aids, address high maternal mortality rates, and, 
lastly, improve the healthcare delivery systems for kids with complex 
medical needs. And that is just to name a few.
  However, a government-run healthcare system is not the answer. 
British and Canadian healthcare systems are plagued by longer and 
longer wait times and delayed care. These government-run healthcare 
systems are paying for patients to get care in the United States, not 
resorting to DIY healthcare. This body needs to be reminded how 
government-run healthcare systems are broken and do not work.
  In closing, I ask unanimous consent that the articles I referred to 
in my remarks be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

  Senator Grassley Floor Remarks--More Examples of Socialized Health 
                        Systems Failing Patients

              [From the Wall Street Journal, Feb. 6, 2023]

       The U.K.'s Government-Run Healthcare Service Is in Crisis

                  (By David Luhnow and Max Colchester)

       For more than a decade, the British government has run its 
     National Health Service, the world's largest government-run 
     healthcare system, on a tight budget. The NHS prided itself 
     on being one of the leanest healthcare systems in the 
     developed world, spending less per head on average than its 
     large European neighbors--and far less than the U.S.
       Now the state-funded service is falling apart. People who 
     suffer heart attacks or strokes wait more than 1\1/2\ hours 
     on average for an ambulance. Hospitals are so full they are 
     turning patients away. A record 7.1 million people in 
     England--more than one in 10 people--are stuck on waiting 
     lists for nonemergency hospital treatment like hip 
     replacements. The NHS on Monday faced the biggest strike in 
     its history, with thousands of paramedics and nurses walking 
     out over pay.
       The NHS's woes are an extreme example of issues playing out 
     across the developed world. Healthcare systems, hit hard by 
     Covid, are under pressure as people live longer and have a 
     wider range of treatment options. Aging populations mean 
     costs will keep growing. The U.K.'s experience is a warning 
     of what happens when supply in healthcare provision can't 
     keep up with demand.
       ``The healthcare system in the U.K. is facing a crisis like 
     no other I have seen in my career,'' said Nigel Edwards, the 
     retiring chief executive of the Nuffield Trust, a healthcare 
     think tank, and former chief executive for the NHS. ``The 
     U.K. has mistaken cheapness for efficiency in its approach to 
     health, and it's coming home to roost.''
       The NHS has lost thousands of hospital beds in the past 
     decade in its drive for efficiency. Covid delayed treatments 
     for patients, resulting in a vast waiting list. Hospitals in 
     England were already at 98% capacity in December when the 
     brutal flu season began to take hold. The mass of sick 
     patients gummed up the system to devastating effect.
       Delays in treating people are causing the premature deaths 
     of 300 to 500 people a week, according to estimates from the 
     Royal College of Emergency Medicine, a professional 
     association in London. One in five British people were 
     waiting for a medical appointment or treatment by the NHS in 
     December, according to the U.K. Office for National 
     Statistics (ONS).
       The NHS said those excess death figures are likely too high 
     but acknowledged delays are costing lives. In late January, 
     the U.K. government announced funding to provide more 
     ambulances, call handlers and 1,000 extra hospital beds to 
     relieve the strain on the health system.
       Fixing the service will take time, said NHS chief executive 
     Amanda. Pritchard. The NHS said that over the next year it 
     aims to cut the average time a heart attack sufferer waits 
     for an ambulance to 30 minutes.
       ``No one should be waiting longer than necessary for 
     treatment,'' said Will Quince, a minister of state for 
     health, adding that the government is spending up to $17 
     billion over the next two years to address issues facing the 
     NHS and social care services.
       Just before 5 p.m. on Nov. 18, the family of Martin Clark 
     called 999, the U.K. equivalent of 911, after the 68-year-old 
     father of five began having chest pains. After waiting half 
     an hour, the family said, they called again and pleaded for 
     an ambulance, saying Mr. Clark's condition was getting worse. 
     In another call 15 minutes later, they told the dispatcher 
     they were going to drive him to hospital themselves, 
     according to the family, even though the dispatcher 
     encouraged them to wait for the paramedics.
       Twenty minutes after the family had left for the hospital, 
     the dispatcher left a voice mail to say the service still 
     didn't have an ambulance to send. Mr. Clark died shortly 
     after arriving at the hospital.
       About a week later, 5-year-old Yusuf Mahmud Nazir died from 
     what began as a throat infection. His family said they had 
     taken the boy, who was having trouble breathing, to the 
     emergency room at their local hospital in Rotherham, which 
     gave him some antibiotic pills after a six-hour wait and sent 
     him home. The family said it pleaded with the hospital a few 
     days later to let Yusuf be admitted and given further tests, 
     but were told the hospital was full.
       By the time the family got Yusuf by ambulance to another 
     hospital, he had severe pneumonia. He died days later from 
     organ failure and cardiac arrest.
       ``They killed Yusuf--it's as simple as that,'' said Yusufs 
     uncle, Zaheer Ahmed, who accompanied the boy's family at the 
     hospital. ``A 5-year-old boy has died of tonsillitis in a 
     rich, industrialized country. It shows the entire system has 
     serious issues.''
       The Rotherham hospital said in a public statement it had 
     met with the family, apologized and launched an independent 
     investigation into what happened. It declined to comment 
     further.
       Almost every day, media reports allege new horror stories: 
     An 83-year-old woman in Leicester with a suspected stroke 
     waited more than 18 hours in a makeshift tent outside a 
     hospital emergency room. A 90-year-old woman with suspected 
     sepsis waited three days. A man in Wales with diabetes lost 
     his toe after it turned blue and then black after he sat 
     waiting for treatment for three days.
       The NHS is Europe's biggest employer, with around 1.2 
     million staffers, and has a budget this year of about $188.6 
     billion, funded through taxes. It now has 2.9 doctors per 
     1,000 people, compared with a European average of 3.7. The 
     U.S. has slightly less, at about 2.6 doctors per 1,000, 
     according to the Organization for Economic Cooperation and 
     Development.
       Aging populations will add to the demand. The elderly 
     consume between three and five times the amount of healthcare 
     compared with younger people, according to an estimate by the 
     OECD. The number of people in the U.K. aged 85 and above is 
     expected to double to more than 3 million by 2041. The U.K.'s 
     current population is around 67 million.
       Until 2010, governments of all political stripes kept 
     funding for the NHS growing faster than both population 
     growth and inflation--with annual increases from 2% to nearly 
     6% per capita, adjusted for inflation. But from 2010 to 2020, 
     per capita, inflation-adjusted funding declined very 
     slightly.
       The Conservative government has sharply increased funds to 
     the NHS since 2020, but most of the money has gone toward the 
     pandemic, including for vaccines. Inflation is now eating 
     away at about half the additional yearly funding. Overall, 
     the inflation-adjusted increase in funding amounts to a 2.9 
     yearly increase, still below the historic average of 3.4%, 
     according to the Institute for Fiscal Studies think tank in 
     London.
       Healthcare expenditures, both public and private, amounted 
     to around 11.9% of the U.K.'s gross domestic product in 2021, 
     according to the ONS. That compares with 18.3% of GDP in the 
     U.S. that year, according to government data.
       For the first time since the Industrial Revolution, 
     Britain's ill health is acting as a brake on economic growth, 
     said Andy Haldane, a former chief economist at the Bank of 
     England. The growing number of sick people is exacerbating a 
     productivity crisis within the British economy, he said. The 
     number of long-term ill people in the U.K. has shot up by 
     half a million in the past two

[[Page S4344]]

     years, to a record 2.5 million, something economists say is 
     due in part to the NHS's inability to quickly treat sick 
     people.
       The NHS was created after World War II to offer free 
     healthcare to a war-hit population. Every hospital was 
     effectively nationalized and put under government direction. 
     It was a more sweeping overhaul than in any European country. 
     Some countries, such as Denmark, adopted a similar system, 
     while others have varying degrees of private care and 
     publicly funded insurance.
       The NHS has long been a point of pride for many Britons, 
     who have generally received quality care and can simply walk 
     out of hospital, without paying a bill. Yet seven in 10 now 
     describe the NHS service as bad, compared with 21% who 
     describe it as good, according to a YouGov poll.
       People can pay to access private healthcare in the U.K., 
     and according to the ONS, one in eight adults in Britain said 
     they paid for private healthcare in the past year because NHS 
     waiting lists were too long. Several private healthcare 
     providers have reported a jump in demand.
       Still, the overwhelming majority continue to support the 
     NHS's basic model of a government-run system. Just 3% said 
     they wanted the system totally privatized, according to the 
     YouGov poll.
       The government started constraining the NHS's budget in 
     2010, at the same time it launched an effort to make the 
     system more efficient, such as adding more internal 
     competition between different parts of the NHS for government 
     funds.
       These changes proved a distraction for management, former 
     and current officials say. As part of the drive for 
     efficiency, NHS managers were pressured to keep bed vacancies 
     low. Recruiting and training was given less priority, and 
     salaries for doctors and nurses steadily fell behind 
     inflation.
       When the pandemic hit in early 2020, the NHS's centralized 
     system helped it weather the crisis. The service delayed non-
     urgent treatments, and successfully rolled out a mass 
     vaccination program.
       The ripple effects are being felt now. By December, a total 
     of 401,537 people in England were waiting more than a year 
     for hospital treatment. The total was 1,613 just before the 
     pandemic.
       Struggles in the U.K.'s elderly care system, which has 
     major staff shortages and is funded separately from the NHS, 
     has also meant that many patients who would normally be 
     looked after at home or in a retirement home instead 
     languished in hospital wards.
       In December, an average of 13,439 beds a day in England out 
     of the roughly 100,000 available were taken up by elderly 
     patients medically fit for discharge--up almost a third from 
     the previous year, according to the NHS.
       The lack of space at hospitals this winter, when the flu 
     began to take hold, had a cascading effect. Ambulances began 
     to form lines outside of hospitals, waiting to discharge 
     patients because of a lack of free beds. That delayed the 
     time it took for ambulances to attend to other people in 
     need.
       By this winter, half of all patients in an emergency ward 
     waited four hours or more to be seen by a doctor, and a 
     further four hours on average to get a bed, according to NHS 
     data.
       A study of more than 5 million patients published in early 
     2022 by the U.K.'s top medical journal, the BMJ, found that 
     for every 82 people forced to wait beyond four hours for 
     emergency care, one additional person died who otherwise 
     would not have. The longer the wait, the worse the outcomes.
       ``Every day, I wake up thinking, how much harm is going to 
     occur to patients that we are responsible for,'' said Simon 
     Walsh, head of emergency-room services at a London hospital. 
     ``It's not if harm is going to occur, it's how much.''
       The stress of the pandemic and funding squeeze is 
     exacerbating a staffing crisis in the U.K. As of September 
     last year, there were 133,000 staff vacancies in the NHS, 
     compared with 83,000 before the pandemic, according to 
     government data.
       The average fully qualified family doctor in England is now 
     responsible for 2,300 patients on average, compared with 
     2,100 in 2018, according to government statistics. Average 
     pay has fallen by more than a third since 2008, adjusted for 
     inflation, according to the British Medical Association, a 
     union for doctors. The number of doctors who are retiring 
     early has tripled in the past 13 years.
       While the overall numbers of nurses have remained stable, 
     turnover has grown. From mid-2021 to mid-2022, more than 
     34,000 nurses left their role in the NHS, an increase of 25% 
     from the previous year, according to the King's Fund, a 
     healthcare think tank.
       Demands for increases in spending are coming up against 
     economic pressures. The Bank of England projects the U.K.'s 
     economy will shrink this year, potentially lowering tax 
     revenues. And as changes in demographics and medical 
     technology continue to weigh on the NHS, everhigher funding 
     risks crowding out state spending in other areas, such as 
     education and infrastructure.
       Money alone may not solve the problem, some in the industry 
     warn. In Wales, the regional government has for most years 
     since 2000 spent more money per capita than any region in the 
     U.K. Yet nearly every indicator from waiting times to health 
     outcomes are still worse. One explanation: Wales is both 
     poorer and has the oldest population in the U.K.
       Focus is turning to whether the system needs to be 
     revamped. In Scotland, which runs its own NHS, officials have 
     discussed ideas including further rationing of care or having 
     wealthier residents pay for care in order to fund free care 
     for the rest--an option that officials say was discarded.
       One former U.K. health secretary recently said patients 
     should pay to see a doctor. The idea was quickly dismissed by 
     the government.
       Just over a year ago, Akshay Patel, an IT professional in 
     northern England, made five calls to 999 when his mother, 
     Bina Patel, developed breathing problems. Initially the call 
     handler told him an ambulance would be there soon, Mr. Patel 
     said. His mother's health quickly worsened and she became too 
     sick to be loaded into a car. He watched his distressed 56-
     year-old mother gradually go pale and die. The paramedics 
     arrived after an hour and were unable to resuscitate her. The 
     local hospital was a 2-minute drive away.
       ``We always believe that the NHS exists for us when we're 
     in need,'' said Mr. Patel. ``But personally if I had to call 
     an ambulance. I wouldn't. I don't trust them. I can't.''
                                  ____


             [From the Wall Street Journal, Jan. 21, 2023]

       Canada Pursues Private Options To Ease Healthcare Backlogs

                            (By Vipal Monga)

       Toronto.--Ontario is the latest Canadian province that is 
     turning to private healthcare options in a bid to fix growing 
     problems with the publicly funded healthcare system.
       Canada's most-populous province this past week outlined a 
     plan to allow more patients to go to private treatment 
     centers for cataract and joint-replacement surgeries as well 
     as for services such as MRIs or CT scans. The province will 
     invest more than 18 million Canadian dollars, equivalent to 
     $13.4 million, in the private facilities to increase their 
     capacity.
       Ontario Premier Doug Ford said the moves would reduce the 
     backlog of 206,000 surgeries in the province and free up 
     public hospitals to concentrate on more-complicated 
     procedures. Patients wouldn't pay out of pocket, and the 
     treatments would be covered by the provincial insurance plan, 
     said Mr. Ford.
       British Columbia, Alberta, Saskatchewan and Quebec have all 
     in recent years increased the role of private clinics in 
     their provinces.
       Health authorities across Canada have been grappling with 
     long wait times in emergency rooms, backlogs for surgeries 
     and shortages of doctors and nurses.
       According to the Fraser Institute, a public-policy think 
     tank, the median wait time in Canada last year between 
     referral and treatment was 27.4 weeks, the longest on record, 
     compared with 9.3 weeks in 1993. Ontario reported the 
     shortest wait time of 20.3 weeks, while the eastern province 
     of Prince Edward Island reported the longest at 64.7 weeks.
       Former government officials have been calling for a rethink 
     of the way the Canadian system has been structured.
       Bill Morneau, former finance minister under Prime Minister 
     Justin Trudeau, said in a memoir published this past week 
     that Canada needed to change a system that costs the country 
     an amount equal to roughly 13% of gross domestic product.
       Peter Nicholson, who advised then-Prime Minister Paul 
     Martin in the early 2000s, said in a policy paper earlier 
     this month that Canada should look to countries such as 
     Australia, Germany and Norway, which have used private 
     healthcare to improve their systems.
       Canada's healthcare system is run separately by each 
     province.
       In Ontario, healthcare unions have said Mr. Ford's plan 
     would enrich the private providers at the expense of the 
     public hospitals and create a system in which wealthy 
     residents get better services and treatment. Mr. Ford's 
     government has said that residents wouldn't have to pay for 
     procedures covered by the provincial insurance plan, but the 
     private clinics would be able to sell patients more-expensive 
     products not covered by the insurance.
       Sharleen Stewart, president of SEIU Healthcare, which 
     represents 60,000 Canadian healthcare workers, said the plan 
     risks starving public hospitals of resources and siphoning 
     doctors and nurses into private clinics, which could worsen 
     outcomes for more-complex surgeries and deepen an already-
     acute healthcare labor shortage. ``It will be a two-tiered 
     system,'' she said.
       Job vacancies in healthcare and social services rose to a 
     record high of about 150,100 in the third quarter of last 
     year as demand for nurses surged, according to Statistics 
     Canada. The Canadian healthcare system could be short 44,000 
     doctors by 2028, according to government projections.
       Mr. Ford said his plan is meant to deal with the lingering 
     impact of the Covid-19 pandemic, which caused delays for 
     patients who needed treatment for nonpriority conditions or 
     wanted to have tests done. Hospital wait times have surged 
     since 2020. Patients in Ontario spent an average of 22.9 
     hours in an emergency department before being admitted to a 
     hospital in October, the longest average wait time on record, 
     according to provincial data.
       There are roughly 900 private clinics in Ontario, most of 
     which only do diagnostic testing; 10 private clinics are 
     licensed to perform surgeries. More would open under the 
     government's plan.
       During his announcement, Mr. Ford dismissed the concerns 
     about how treatments

[[Page S4345]]

     are delivered. He said something must be done quickly to 
     reduce the backlog of surgeries in the province. ``A lot of 
     people out there, they want to have the endless debates about 
     who should provide care,'' Mr. Ford said. ``All our 
     government cares about is that you get the care you need 
     quickly and safely.''
       Other supporters said that the plan could provide patients 
     with more options, give them greater access to timely care 
     and relieve stress on a system that has begun to buckle.
       ``We need to be more effective at deploying resources we 
     currently have,'' said Allan O'Dette, chief executive of the 
     Ontario Medical Association, a group that represents 43,000 
     doctors and medical students and that supports Ontario's 
     plan. ``Noncomplicated, low-acuity surgeries can easily be 
     done outside a hospital setting.''
                                  ____


                 [From the Vancouver Sun, May 16, 2023]

 Sending B.C. Cancer Patients to Bellingham for Treatment `a Sad State 
                        of Reality,' Critics Say

                           (By Katie DeRosa)

       Quote from the article: ``While the decision by the 
     province to send breast cancer and prostate cancer patients 
     to the U.S. for faster radiation treatment is being welcomed 
     by some, critics say it's an indictment of a flagging health 
     care system that has not kept up with demand. Health Minister 
     Adrian Dix announced Monday that eligible breast and prostate 
     cancer patients will be sent to one of two clinics in 
     Bellingham for radiation treatment, starting May 29. The 
     unprecedented move to send thousands of B.C. patients to the 
     U.S. over the next two years is an attempt to address the 
     backlog in B.C. which has one of the longest waits for 
     radiation treatment in Canada.''
       Quote from the article: ``Dix acknowledged cancer patients 
     face unacceptable waiting times which is why the province 
     opted to strike a deal with the clinics in Washington state. 
     Currently, 82.9 per cent of B.C. cancer patients who require 
     radiation start treatment within 28 days, Dix said. That's 
     well below the national average of 97 per cent, according to 
     figures compiled by the Canadian Institute for Health 
     Information. ``We want to be at 95 to 100 per cent within 28 
     days,'' he said. The percentage of British Columbians 
     receiving timely radiation has steadily declined, down from 
     93 per cent in 2019. Dix in February announced the government 
     will spend $440 million over the next 10 years to reduce the 
     waiting times for cancer treatment. Some of that money will 
     boost wages for radiation technologists and oncologists as 
     part of the recruitment drive, Dix said. The province is also 
     trying to acquire more linear accelerators, a specialized 
     piece of equipment which delivers external beam radiation 
     therapy to target and shrink cancer cells. Radiation therapy 
     is different from chemotherapy, which uses special drugs to 
     kill the cancer cells. More than 30,000 people in B.C. were 
     diagnosed with cancer in 2021 and B.C. Cancer projects that 
     number could rise to 45,000 by 2034. About half of cancer 
     patients need radiation treatment.''
       The article continues at: https://vancouversun.com/news/
local-news/critics-upset-that-b-c-has-to-send-cancer-
patients-to-bellingham-for-treatment?mc_cid=4baf8999cb&mc
_eid=3337eaf99e.
                                  ____


                     [From Sky News, July 14, 2023]

  Britons Are `Pulling Their Own Teeth Out With Pliers' Because They 
                       Can't Access NHS Dentists

       Quote from the article: A YouGov poll which spoke to more 
     than 2,000 people found more than 10% of people had attempted 
     ``DIY dentistry''--with more than half of those having 
     carried it out in the last year. People across the UK have 
     had to pull their own teeth out because they can't access or 
     afford an NHS dentist, a report suggests. Extractions have 
     been performed with pliers in some cases, while others have 
     been forced to make a five-hour round trip to see a 
     professional. The Health and Social Care Committee says 
     ``urgent and fundamental reform'' is needed--and there is 
     evidence of pain and distress that is ``totally unacceptable 
     in the 21st century''. Its report includes figures from a 
     YouGov poll performed in March 2023 that found 10% of 
     respondents had attempted ``DIY dentistry''--and of those, 
     20% did so because they couldn't find an NHS dentist.''
       The article continues at: https://news.sky.com/story/
britons-are-pulling-their-own-teeth-out-with-pliers-because-
they-cant-access-nhs-dentists-12920715#:g807-
     :text=People%20across %20the%20UK%20have,trip%20to%20see 
     %20a%20professional.

  Mr. GRASSLEY. I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.