[Congressional Record (Bound Edition), Volume 153 (2007), Part 14]
[Extensions of Remarks]
[Pages 19861-19862]
[From the U.S. Government Publishing Office, www.gpo.gov]




         MEDICAL WAITING TIMES A PROBLEM FOR AMERICAN CONSUMERS

                                 ______
                                 

                       HON. JANICE D. SCHAKOWSKY

                              of illinois

                    in the house of representatives

                        Wednesday, July 18, 2007

  Ms. SCHAKOWSKY. Madam Speaker, I rise today on behalf of my 
constituents who continue to receive inadequate health coverage in our 
broken health care system. With the recent release of Michael Moore's 
documentary, ``Sicko,'' attention is being brought to the many problems 
perpetuated by our health care system, especially those that result 
from a desire on the part of insurers to maximize their profits. The 
movie strikes a chord with my constituents who know that, in a Nation 
in which over 45 million citizens are uninsured, even those with health 
insurance are at risk for not getting the health care they need. 
Although those who support the status quo have been quick to criticize 
the movie, its popularity in my district underscores its resonance with 
my constituents who are dissatisfied with a system that has failed them 
over and over again and who are demanding comprehensive change.
  I am deeply troubled by recent comments from health insurance 
companies and their defenders arguing that wait times under universal 
health care systems are disproportionately longer than those in our 
private health system. Such comments gloss over the realities faced by 
my constituents, who continue to call and write my office frustrated 
that pre-existing conditions, pre-approval, and prohibitive costs have 
made long wait-times commonplace for them. Recent statistics from the 
Institution of Healthcare Improvement reveal that Americans nationwide 
are waiting an average of 70 days to see a provider. In many 
circumstances, people who are initially diagnosed with cancer are 
waiting over a month. Is this the best we can do for our citizens in 
the richest, most prosperous nation in the world?
  When we compare ourselves to nations with national health care, the 
statistics paint a much different picture than the critics would like 
us to believe. According to a recent article in Business Week (``The 
Doctor Will See You--In Three Months''--July 9, 2007), ``both data and 
anecdotes show that the American people are already waiting as long or 
longer than patients living with universal health-care systems.'' In 
addition, a Commonwealth Fund study that compared the U.S. health-care 
system to five industrialized countries with national health coverage 
showed that waiting times were worse in the U.S. than in all of the 
other countries but one. Only 47 percent of U.S. patients can get a 
same or next-day appointment for a basic medical problem, and 26 
percent of U.S. adults have gone to an emergency room in the past 2 
years because they couldn't get in to see their regular doctor when 
needed.
  As long as Congress ignores this issue, our constituents will 
continue to wait for medical care that should be provided to them 
expeditiously. It is disappointing that this problem has been left on 
the backbumer for so long, and I hope that this reinvigorated health-
care discussion will allow us as Members to seize the opportunity to do 
what is right for our constituents. I strongly urge Members to read the 
attached Business Week article and a recent column by Paul Krugman that 
describe the health-care waiting game that so many of our constituents 
face on a regular basis.

                   [From Business Week, July 9, 2007]

                The Doctor Will See You--In Three Months

                          (By Catherine Arnst)

       The health-care reform debate is in full roar with the 
     arrival of Michael Moore's documentary Sicko, which compares 
     the U.S. system unfavorably with single-payer systems around 
     the world. Critics of the film are quick to trot out a common 
     defense of the American way: For all its problems, they say, 
     U.S. patients at least don't have to endure the endless waits 
     for medical care endemic to government-run systems. The 
     lobbying group America's Health Insurance Plans spells it out 
     in a rebuttal to Sicko: ``The American people do not support 
     a government takeover of the entire health-care system 
     because they know that means long waits for rationed care.''
       In reality, both data and anecdotes show that the American 
     people are already waiting as long or longer than patients 
     living with universal health-care systems. Take Susan M., a 
     54-year-old human resources executive in New York City. She 
     faithfully makes an appointment for a mammogram every April, 
     knowing the wait will be at least six weeks. She went in for 
     her routine screening at the end of May, then had another 
     because the first wasn't clear. That second X-ray showed an 
     abnormality, and the doctor wanted to perform a needle 
     biopsy, an outpatient procedure. His first available date: 
     mid-August. ``I completely freaked out,'' Susan says. ``I 
     couldn't imagine spending the summer with this hanging over 
     my head.'' After many calls to five different facilities, she 
     found a clinic that agreed to read her existing mammograms on 
     June 25 and promised to schedule a follow-up MRI and biopsy 
     if needed within 10 days. A full month had passed since the 
     first suspicious X-rays. Ultimately, she was told the 
     abnormality was nothing to worry about, but she should have 
     another mammogram in six months. Taking no chances, she made 
     an appointment on the spot. ``The system is clearly broken,'' 
     she laments.

[[Page 19862]]

       It's not just broken for breast exams. If you find a 
     suspicious-looking mole and want to see a dermatologist, you 
     can expect an average wait of 38 days in the U.S., and up to 
     73 days if you live in Boston, according to researchers at 
     the University of California at San Francisco who studied the 
     matter. Got a knee injury? A 2004 survey by medical 
     recruitment firm Merritt, Hawkins & Associates found the 
     average time needed to see an orthopedic surgeon ranges from 
     8 days in Atlanta to 43 days in Los Angeles. Nationwide, the 
     average is 17 days. ``Waiting is definitely a problem in the 
     U.S., especially for basic care,'' says Karen Davis, 
     president of the nonprofit Commonwealth Fund, which studies 
     health-care policy.
       All this time spent ``queuing,'' as other nations call it, 
     stems from too much demand and too little supply. Only one-
     third of U.S. doctors are general practitioners, compared 
     with half in most European countries. On top of that, only 
     40% of U.S. doctors have arrangements for after-hours care, 
     vs. 75% in the rest of the industrialized world.
       Consequently, some 26% of U.S. adults in one survey went to 
     an emergency room in the past two years because they couldn't 
     get in to see their regular doctor, a significantly higher 
     rate than in other countries.
       There is no systemized collection of data on wait times in 
     the U.S. That makes it difficult to draw comparisons with 
     countries that have national health systems, where wait times 
     are not only tracked but made public. However, a 2005 survey 
     by the Commonwealth Fund of sick adults in six nations found 
     that only 47% of U.S. patients could get a same- or next-day 
     appointment for a medical problem, worse than every other 
     country except Canada.
       The Commonwealth survey did find that U.S. patients had the 
     second-shortest wait times if they wished to see a specialist 
     or have nonemergency surgery, such as a hip replacement or 
     cataract operation (Germany, which has national health care, 
     came in first on both measures). But Gerard F. Anderson, a 
     health policy expert at Johns Hopkins University, says 
     doctors in countries where there are lengthy queues for 
     elective surgeries put at-risk patients on the list long 
     before their need is critical. ``Their wait might be 
     uncomfortable, but it makes very little clinical 
     difference,'' he says.
       The Commonwealth study did find one area where the U.S. was 
     first by a wide margin: 51% of sick Americans surveyed did 
     not visit a doctor, get a needed test, or fill a prescription 
     within the past two years because of cost. No other country 
     came close.
       Few solutions have been proposed for lengthy waits in the 
     U.S., in part, say policy experts, because the problem is 
     rarely acknowledged. But the market is beginning to address 
     the issue with the rise of walk-in medical clinics. Hundreds 
     have sprung up in CVS, Wal-Mart, Pathmark, and other stores--
     so many that the American Medical Assn. just adopted a 
     resolution urging state and federal agencies to investigate 
     such clinics as a conflict of interest if housed in stores 
     with pharmacies. These retail clinics promise rapid care for 
     minor medical problems, usually getting patients in and out 
     in 30 minutes. The slogan for CVS's Minute Clinics says it 
     all: ``You're sick. We're quick.''

 How the U.S. Stacks Up: Able To Get Appointment Same or Next Day for 
                            Medical Problem


                                                                Percent
New Zealand..........................................................81
Germany..............................................................63
Britain..............................................................61
Australia............................................................56
U.S...................................................................7
Canada...............................................................36
Data: Commonwealth Fund
                                  ____


                [From the New York Times, July 16, 2007]

                            The Waiting Game

                           (By Paul Krugman)

       Being without health insurance is no big deal. Just ask 
     President Bush. ``I mean, people have access to health care 
     in America,'' he said last week. ``After all, you just go to 
     an emergency room.''
       This is what you might call callousness with consequences. 
     The White House has announced that Mr. Bush will veto a 
     bipartisan plan that would extend health insurance, and with 
     it such essentials as regular checkups and preventive medical 
     care, to an estimated 4.1 million currently uninsured 
     children. After all, it's not as if those kids really need 
     insurance--they can just go to emergency rooms, right?
       O.K., it's not news that Mr. Bush has no empathy for people 
     less fortunate than himself. But his willful ignorance here 
     is part of a larger picture: by and large, opponents of 
     universal health care paint a glowing portrait of the 
     American system that bears as little resemblance to reality 
     as the scare stories they tell about health care in France, 
     Britain, and Canada.
       The claim that the uninsured can get all the care they need 
     in emergency rooms is just the beginning. Beyond that is the 
     myth that Americans who are lucky enough to have insurance 
     never face long waits for medical care.
       Actually, the persistence of that myth puzzles me. I can 
     understand how people like Mr. Bush or Fred Thompson, who 
     declared recently that ``the poorest Americans are getting 
     far better service'' than Canadians or the British, can wave 
     away the desperation of uninsured Americans, who are often 
     poor and voiceless. But how can they get away with pretending 
     that insured Americans always get prompt care, when most of 
     us can testify otherwise?
       A recent article in Business Week put it bluntly: ``In 
     reality, both data and anecdotes show that the American 
     people are already waiting as long or longer than patients 
     living with universal health-care systems.''
       A cross-national survey conducted by the Commonwealth Fund 
     found that America ranks near the bottom among advanced 
     countries in terms of how hard it is to get medical attention 
     on short notice (although Canada was slightly worse), and 
     that America is the worst place in the advanced world if you 
     need care after hours or on a weekend.
       We look better when it comes to seeing a specialist or 
     receiving elective surgery. But Germany outperforms us even 
     on those measures--and I suspect that France, which wasn't 
     included in the study, matches Germany's performance.
       Besides, not all medical delays are created equal. In 
     Canada and Britain, delays are caused by doctors trying to 
     devote limited medical resources to the most urgent cases. In 
     the United States, they're often caused by insurance 
     companies trying to save money.
       This can lead to ordeals like the one recently described by 
     Mark Kleiman, a professor at U.C.L.A., who nearly died of 
     cancer because his insurer kept delaying approval for a 
     necessary biopsy. ``It was only later,'' writes Mr. Kleiman 
     on his blog, ``that I discovered why the insurance company 
     was stalling; I had an option, which I didn't know I had, to 
     avoid all the approvals by going to `Tier II,' which would 
     have meant higher copayments.''
       He adds, ``I don't know how many people my insurance 
     company waited to death that year, but I'm certain the number 
     wasn't zero.''
       To be fair, Mr. Kleiman is only surmising that his 
     insurance company risked his life in an attempt to get him to 
     pay more of his treatment costs. But there's no question that 
     some Americans who seemingly have good insurance nonetheless 
     die because insurers are trying to hold down their ``medical 
     losses''--the industry term for actually having to pay for 
     care.
       On the other hand, it's true that Americans get hip 
     replacements faster than Canadians. But there's a funny thing 
     about that example, which is used constantly as an argument 
     for the superiority of private health insurance over a 
     government-run system: the large majority of hip replacements 
     in the United States are paid for by, um, Medicare.
       That's right: the hip-replacement gap is actually a 
     comparison of two government health insurance systems. 
     American Medicare has shorter waits than Canadian Medicare 
     (yes, that's what they call their system) because it has more 
     lavish funding--end of story. The alleged virtues of private 
     insurance have nothing to do with it.
       The bottom line is that the opponents of universal health 
     care appear to have run out of honest arguments. All they 
     have left are fantasies: horror fiction about health care in 
     other countries, and fairy tales about health care here in 
     America.

                          ____________________