[Congressional Record (Bound Edition), Volume 150 (2004), Part 7]
[Senate]
[Pages 9212-9214]
[From the U.S. Government Publishing Office, www.gpo.gov]




                     HEALTH CARE AND THE UNINSURED

  Mr.VOINOVICH. Mr. President, I rise to speak today about the dilemma 
this Nation is facing regarding access to quality, affordable health 
care. Next to the economy, it is the greatest domestic challenge facing 
our Nation. In fact, the rising cost of health care is a major part of 
what is hurting our competitiveness in the global marketplace.
  Throughout my career in public service, health care has been one of 
my top legislative priorities. Unfortunately, despite increased 
spending on public and private health care programs, millions of 
Americans are without health care coverage. Although, my State of Ohio 
has one of the lowest percentages of uninsured.
  The statistics are overwhelming. For the fourth year in a row, health 
care spending grew faster than the rest of the U.S. economy in 2003. 
The average cost of family coverage was $9,018, with employees covering 
27 percent, or $2,412, of the cost. During that same period of time, 
the average family's contribution to their health insurance increased 
16 percent.
  Total spending on health care is now approximately $1.6 trillion or 
$5,440 for every man, woman and child in the United States, which 
translates into almost 15 percent of our GDP--the largest share ever.
  If we look at this in an international context, the statistics become 
even more glaring. Per capita health care spending in the United States 
continues to exceed other nations. In its May 2004 issue, ``Health 
Affairs'' reports that the Swiss spent only 68 percent as much as the 
United States per capita on health care in 2001. Even more troubling, 
Canada spent as little as 57 percent as much as the U.S. Both nations 
have a lower number of uninsured citizens than the United States.
  Despite all the spending some 44 million Americans--15 percent of the 
population--had no health insurance at some point last year. This 
number has increased steadily. In 2000, that number was 39.8 million. 
In 2002 it was 43.6 million. In 2 years, the country added almost four 
million uninsured individuals.
  Just this week, the Cincinnati Enquirer told the story of Yolanda 
Webb, who left her Hamilton County, OH, job to begin her own cosmetic 
business. However, after opening her own shop, she realized that due to 
a chronic condition she was diagnosed with 20 years ago, a health 
insurance policy would cost her $800 a month. Unfortunately, this is an 
expense she can not afford and as a result, Ms. Webb is one of the 
200,000 people in just the greater Cincinnati area that lives without 
health insurance coverage.
  In addition, with increased costs, employers are facing difficult 
options. A poll of over 3,200 employers conducted

[[Page 9213]]

by the Kaiser Family Foundation indicates that 56 percent of large 
firms increased employees' share of health costs in 2001. I have 
consistently heard from employers throughout Ohio that they want to 
continue to offer health insurance for their employees, but it hurts 
their ability to be competitive in the global market.
  In light of these startling statistics, I was eager to join my 
colleagues on the Senate Republican Health Care Task Force to provide 
some solutions for dealing with these trends.
  I have been in this situation before. As Governor of Ohio, I had to 
work creatively to expand coverage and deal with increasing health care 
costs for a growing number of uninsured Ohioans. I am happy to report 
that we were able to make some progress toward reducing the number of 
uninsured during my time as the head of the State by negotiating with 
the state unions to move to managed care; by controlling Medicaid costs 
to the point where from 1995 to 1998, due to good stewardship and 
management, Ohio ended up under-spending on Medicaid without harming 
families; and implementing the S-CHIP program to provide coverage for 
uninsured children. In fact, I recently learned from the Cuyahoga 
Commissioners that in our county, 98 percent of eligible children are 
currently enrolled in this program.
  Learning from this experience, I was especially encouraged by Senator 
Frist and Senator Gregg's commitment to solving the national health 
care crisis and applaud their decision to form the Senate task force to 
explore the issue. I am convinced that my colleagues and I have been 
able to identify some very viable and immediate solutions for reversing 
the trend of the growing uninsured and for dealing with the rapid 
increase in the cost of quality health care coverage.
  We can make this a reality by addressing the underlying factors that 
are contributing to dramatic increase in health care costs and the 
subsequent reduction in access to quality care. I have worked hard in 
the past on this issue, and am pleased that the package the task force 
released this week addresses the biggest factors driving health care 
costs.
  The first is medical lawsuit reform. I have been concerned about this 
issue for quite some time--in fact, since my days as Governor of Ohio. 
I wish we had the outpouring of support for medical liability reform 
six years ago that I see now. In 1996, I essentially had to pull teeth 
in the Ohio Legislature to pass my tort reform bill.
  I signed it into law in October 1996. Three years later, the Ohio 
Supreme Court ruled it unconstitutional, and if that law had withstood 
the Supreme Court's scrutiny, Ohioans wouldn't be facing the medical 
access problems they are facing today: doctors leaving their practice, 
patients unable to receive the care they need and costs of health 
insurance going through the roof.
  Continuing down this path, during my time in the Senate, I worked 
with the American Tort Reform Association to produce a study that 
captured the impact of this crisis on Ohio's economy. In Ohio, the 
litigation crisis costs every Ohioan $636 per year, and every Ohio 
family of four $2,544 per year. These are alarming numbers! In these 
economic times, families can not afford to pay $2,500 for the lawsuit 
abuse of a few individuals.
  The Medical Liability Monitor ranked Ohio among the top five States 
for premium increases in 2002. OHIC Insurance Co., among the largest 
medical liability insurers in the State, reports that average premiums 
for Ohio doctors have doubled over the last 3 years.
  In a very real sense, I have heard from young physicians in Ohio who 
tell me they are considering relocating to a place where the ability to 
practice medicine is better and the liability situation is more stable. 
A friend of mine shared with me a letter from an OB-GYN in Dublin, OH, 
who had decided to retire from his practice. He wrote the following to 
his patients:

       On June 17, 2003, I received my professional liability 
     insurance rate quote for the upcoming year, and it is 64% 
     higher than last year's rate. I have seen my premiums almost 
     triple during the past two years, despite never having had a 
     single penny paid out on my behalf in twenty seven years as a 
     physician. Even worse, during this time the insurance company 
     has reduced the amount of coverage that I can purchase from 
     $5 million to only $1 million, while jury verdicts have 
     skyrocketed, often exceeding $3-4 million. If I were to 
     purchase this policy, I would be putting all of my family's 
     personal assets at risk every time that I delivered a baby or 
     performed surgery. I refuse to do that.
       I have therefore decided to retire from private practice on 
     July 31, 2003, the final day of my current liability 
     insurance policy. This is not a decision that I take lightly, 
     but unfortunately it has become necessary. For many of you, I 
     have been part of your life for years. I have delivered your 
     babies, and helped you through some of life's most difficult 
     challenges. It has truly been an honor.''

  And for those of my colleagues who think medical liability reform is 
a State issue, I would ask them to read a letter, which I submitted for 
the record on February 24, 2004, and see how the medical liability 
crisis transcends State lines--particularly my friends from the 
neighboring state of West Virginia. Our Ohio physicians, who practice 
along the border, are feeling the effects of their proximity to West 
Virginia and its favorable plaintiff's verdicts. They are feeling these 
effects in their increasing insurance premiums. And unfortunately, 
Ohio's physicians are not alone.
  And it is not only doctors crossing State borders to find better 
insurance rates--it is patients as well. Citizens living along the 
thousands of miles of State borders very often obtain their medical 
care across that line. Federal action is appropriate and critically 
necessary. Even more so because this crisis affects Federal health care 
programs, including Medicare and Medicaid.
  Overall, the cost of this crisis to the economy is quite staggering. 
There is evidence that physicians are now practicing medicine 
``defensively'' in order to protect themselves from lawsuits. In fact, 
a March 3, 2003 report by the Department of Health and Human Services 
calculated the practice of defensive medicine costs the United States a 
total of between $70-126 billion a year and estimates that the cost for 
the Federal Government alone is between $35 and $56 billion.
  As a cosponsor of the HEALTH Act, the Patients First Act, The Healthy 
Mothers and Babies Access to Care Act, and the Pregnancy and Trauma 
Care Access Protection Act, I will continue to work with my colleagues 
to find a way strike a delicate balance between the rights of aggrieved 
parties to bring lawsuits and receive rapid and fair compensation and 
the rights of society to be protected against frivolous lawsuits and 
outrageous rewards for noneconomic damages that are disproportionate to 
compensating the injured and made at the expense of society as a whole.
  We can no longer allow unchecked, excessive litigation to continue to 
drive up the cost of health care and limit access for so many 
Americans.
  Beyond medical lawsuit reform, the task force has identified another 
way to limit the rapid increase in health care costs, that is to reduce 
regulations and paperwork requirements that burden out nation's health 
care providers.
  Whether due to Federal privacy regulations or insurance requirements, 
this is an important issue to providers in Ohio. Last November, I 
visited a small hospital in the southern part of my State, Marietta 
Memorial Hospital, to discuss health care reform. At this meeting, I 
spent some time discussing the administrative process the hospital was 
required to follow in order to treat the patients that come through 
their doors each day.
  The hospital provided me with a binder full of paperwork that was 
completed, in this case, for a total hip replacement procedure on an 
elderly patient. As you can see, Mr. President, this 72 page binder is 
full of more than 50 forms that either the hospital or the patient and 
their family were required to complete, some time multiple times, in 
order to for the patient to receive treatment.
  This is a big enough challenge for large hospital groups, but for 
small providers like Marietta Memorial with

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just 204 beds and 90 physicians, this paperwork and regulatory demand 
can be crippling.
  For this reason, I worked with the task force to include in our 
reform package ways to limit bureaucratic demands. We believe that this 
could save our Nation approximately $47 billion without risking patient 
safety, privacy or the quality of health care.
  In addition, the task force found that there were ways to increase 
hospital's and provider's use of technology to lower their costs and 
eliminate duplicative test and procedures. Fortunately, President Bush 
has taken a huge step forward in this area and has created a new 
position at the Department of Health and Human Services to coordinate 
the Nation's health information technology efforts. I am pleased that 
Secretary Thompson recognized the importance of and the immediate need 
to develop standards that help to create electronic medical records and 
other technology efforts.
  I have no doubt these standards when implemented will help improve 
quality and cost efficiency of care and will eventually help hospitals, 
especially smaller hospitals like Marietta Memorial, reduce duplicative 
costs and services to their patients and improve the quality of the 
care they can provide.
  These are only some of the ways we can act immediately to put an end 
to the increase in health care costs and reduce the number of Americans 
that find themselves without quality health care coverage.
  However, these are steps that will only provide interim relief.
  Like I said, health care reform has always been one of my top 
priorities and I have been studying this issue for some time. In the 
past 2 years, I have met with experts and other interested parties to 
get the full picture of the state of health care in the United States 
and learn about possible efforts for reform. I have discussed reform 
proposals with individuals as diverse as former Ohio Congressman Bill 
Gradison to John Sweeney, President of the AFL-CIO to Dr. Donald 
Palmisano, President of the American Medical Association, to Stuart 
Butler with the Heritage Foundation.
  And over the past year and a half, I have been traveling throughout 
my State of Ohio and have held 14 roundtables to specifically discuss 
health care reform with employers and employees, business and labor 
leaders, the uninsured and the underinsured.
  In fact, in Ohio I have even formed my own health care task force 
made up of representatives from physician and other provider groups, 
small and large employers, labor, policy experts, and others who have 
an interest in reforming our current health care environment. Together 
we have analyzed a variety of popular health care reform proposals to 
increase access to health insurance coverage. And what I have heard 
even from my most conservative friends--is that this health care system 
is broken.
  People are telling me we need to think about plowing new ground. I 
agree and believe we have to reevaluate the way we are spending the 
$1.6 trillion that is dedicated to health care in this county. We need 
to look at the big picture and determine how we can realign our system 
to more efficiently provide quality health care that maintains choices 
and responsibility for consumers.
  This, of course, will not happen overnight and, as a result, I am 
encouraged by and supportive of some of the interim and immediate 
solutions proposed by the Senate Task Force. My colleagues and I have 
taken a step in the right direction toward identifying immediate 
changes that will bring down the prices people are paying for their 
health care today, help those who have insurance retain it at 
reasonable rates, and expand access to affordable insurance for those 
who are currently uninsured and underinsured.
  Should I have the opportunity to serve my fellow Ohioans for an 
additional 6 years, reforming our Nation's health care system will be 
my highest priority.

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