[Congressional Record (Bound Edition), Volume 155 (2009), Part 13]
[Senate]
[Pages 16995-16996]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. SPECTER. Mr. President, moving on to a second subject, The New 
York Times today has an analysis of health care which bears directly 
upon the legislation which will soon be considered by the Congress on 
comprehensive health care. The article focuses on prostate cancer, for 
illustrative purposes, to raise the issue that the key factor of 
holding down costs is not being attended to under the current system 
because there are no determinations as to what is affected.
  The article points out that the obvious first step is figuring out 
what actually works. It cites a number of approaches for dealing with 
prostate cancer, varying from a few thousand dollars to $23,000, to 
$50,000 to $100,000. It notes that drug and device makers have no 
reason to finance such trials because insurers now pay for expensive 
treatments, even if they aren't effective. The article notes that the 
selection customarily made is the one which is the most effective.
  I have talked to Senator Baucus and Senator Dodd and have written to 
them concerning my suggestion in this field. I ask unanimous consent 
that the text of the New York Times article be printed in the Record, 
together with my letters to Senator Baucus, Senator Dodd, and Senator 
Kennedy.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                [From the New York Times, July 8, 2009]

             In Health Reform, a Cancer Offers an Acid Test

                          (By David Leonhardt)

       It's become popular to pick your own personal litmus test 
     for health care reform.
       For some liberals, reform will be a success only if it 
     includes a new government-run insurance plan to compete with 
     private insurers. For many conservatives, a bill must exclude 
     such a public plan. For others, the crucial issue is how much 
     money Congress spends covering the uninsured.
       My litmus test is different. It's the prostate cancer test.
       The prostate cancer test will determine whether President 
     Obama and Congress put together a bill that begins to fix the 
     fundamental problem with our medical system: the combination 
     of soaring costs and mediocre results. If they don't, the 
     medical system will remain deeply troubled, no matter what 
     other improvements they make.
       The legislative process is still in the early stages, and 
     Washington is likely to squeeze some costs out of the medical 
     system. But the signals coming from Capitol Hill are still 
     worrisome, because Congress has not seemed willing to change 
     the basic economics of health care.
       So let's talk about prostate cancer. Right now, men with 
     the most common form--slow-growing, early-stage prostate 
     cancer--can choose from at least five different courses of 
     treatment. The simplest is known as watchful waiting, which 
     means doing nothing unless later tests show the cancer is 
     worsening. More aggressive options include removing the 
     prostate gland or receiving one of several forms of 
     radiation. The latest treatment--proton radiation therapy--
     involves a proton accelerator that can be as big as a 
     football field.
       Some doctors swear by one treatment, others by another. But 
     no one really knows which is best. Rigorous research has been 
     scant. Above all, no serious study has found that the high-
     technology treatments do better at keeping men healthy and 
     alive. Most die of something else before prostate cancer 
     becomes a problem.
       ``No therapy has been shown superior to another,'' an 
     analysis by the RAND Corporation found. Dr. Michael Rawlins, 
     the chairman of a British medical research institute, told 
     me, ``We're not sure how good any of these treatments are.'' 
     When I asked Dr. Danielle Perlroth of Stanford University, 
     who has studied the data, what she would recommend to a 
     family member, she paused. Then she said, ``Watchful 
     waiting.''
       But if the treatments have roughly similar benefits, they 
     have very different prices. Watchful waiting costs just a few 
     thousand dollars, in follow-up doctor visits and tests. 
     Surgery to remove the prostate gland costs about $23,000. A 
     targeted form of radiation, known as I.M.R.T., runs $50,000. 
     Proton radiation therapy often exceeds $100,000.
       And in our current fee-for-service medical system--in which 
     doctors and hospitals are paid for how much care they 
     provide, rather than how well they care for their patients--
     you can probably guess which treatments are becoming more 
     popular: the ones that cost a lot of money.
       Use of I.M.R.T. rose tenfold from 2002 to 2006, according 
     to unpublished RAND data. A new proton treatment center will 
     open Wednesday in Oklahoma City, and others are being planned 
     in Chicago, South Florida and elsewhere. The country is 
     paying at least several billion more dollars for prostate 
     treatment than is medically justified--and the bill is rising 
     rapidly.
       You may never see this bill, but you're paying it. It has 
     raised your health insurance premiums and left your employer 
     with less money to give you a decent raise. The cost of 
     prostate cancer care is one small reason that some companies 
     have stopped offering health insurance. It is also one reason 
     that medical costs are on a pace to make the federal 
     government insolvent.
       These costs are the single most important thing to keep in 
     mind during the health care debate. Making sure that everyone 
     has insurance, important as that is, will not solve the cost 
     problem. Neither will a new public insurance plan. We already 
     have a big public plan, Medicare, and it has not altered the 
     economics of prostate care.
       The first step to passing the prostate cancer test is 
     laying the groundwork to figure out what actually works. 
     Incredibly, the only recent randomized trial comparing 
     treatments is a 2005 study from Sweden. (It suggested that 
     removing the prostate might benefit men under 65, which is 
     consistent with the sensible notion that younger men are 
     better candidates for some aggressive treatments.)
       ``There is no reason in the world we have to be this 
     uncertain about the relative risks and benefits,'' says Dr. 
     Sean Tunis, a former chief medical officer of Medicare.
       Drug and device makers have no reason to finance such 
     trials, because insurers now pay for expensive treatments 
     even if they aren't more effective. So the job has to fall to 
     the government--which, after all, is the country's largest 
     health insurer.
       Obama administration officials understand this, and the 
     stimulus bill included money for such research. But stimulus 
     is temporary. The current House version of the health bill 
     does not provide enough long-term financing.
       The next step involves giving more solid information to 
     patients. A fascinating series of pilot programs, including 
     for prostate cancer, has shown that when patients have 
     clinical information about treatments, they often choose a 
     less invasive one. Some come to see that the risks and side 
     effects of more invasive care are not worth the small--or 
     nonexistent--benefits. ``We want the thing that makes us 
     better,'' says Dr. Peter B. Bach, a pulmonary specialist at 
     Memorial Sloan-Kettering Cancer Center, ``not the thing that 
     is niftier.''
       The current Senate bill would encourage doctors to give 
     patients more information. But that won't be nearly enough to 
     begin solving the cost problem.
       To do that, health care reform will have to start to change 
     the incentives in the medical system. We'll have to start 
     paying for quality, not volume.
       On this score, health care economists tell me that they are 
     troubled by Congress's early work. They are hoping that the 
     Senate Finance Committee will soon release a bill that does 
     better. But as Ron Wyden, an Oregon Democrat on the 
     committee, says, ``There has not been adequate attention to 
     changing the incentives that drive behavior.'' One big reason 
     is that the health care industry is lobbying hard for the 
     status quo.
       Plenty of good alternatives exist. Hospitals can be 
     financially punished for making costly errors. Consumers can 
     be given more choice of insurers, creating an incentive for 
     them to sign up for a plan that doesn't cover wasteful care. 
     Doctors can be paid a set fee for some conditions, adequate 
     to cover the least expensive most effective treatment. (This 
     is similar to what happens in other countries, where doctors 
     are on salary rather than paid piecemeal--and medical care is 
     much less expensive.)
       Even if Congress did all this, we would still face tough 
     decisions. Imagine if further prostate research showed that a 
     $50,000 dose of targeted radiation did not extend life but 
     did bring fewer side effects, like diarrhea, than other forms 
     of radiation. Should Medicare spend billions to pay for 
     targeted radiation? Or should it help prostate patients 
     manage their diarrhea and then spend the billions on other 
     kinds of care?
       The answer isn't obvious. But this much is: The current 
     health care system is hard-wired to be bloated and 
     inefficient. Doesn't that seem like a problem that a once-in-
     a-generation effort to reform health care should address?
                                  ____



                                                  U.S. Senate,

                                    Washington, DC, June 17, 2009.
     Hon. Max Baucus,
     Chairman, Senate Finance Committee, Washington, DC.
       Dear Max: I write to call to your personal attention 
     provisions on bio-medical research which, in my judgment, are 
     critical--arguably indispensable--for inclusion in 
     comprehensive health care reform legislation.
       I urge that authorization for the National Institutes of 
     Health be set at a new baseline of $40 billion, reflecting 
     the current $30 billion level plus the $10 billion from the 
     stimulus package. The Administration's current request of 
     $443 million is totally insufficient since at least $1 
     billion is necessary to keep up with inflation and additional 
     funding is necessary to maintain an appropriate level for 
     more innovative research grants.

[[Page 16996]]

       When the appropriations for NIH, spearheaded by Senator 
     Harkin and myself, were increased by $3 to $3.5 billion each 
     year, there was a dramatic decrease in deaths attributable to 
     many maladies. Since reform legislation has as two principal 
     objectives, improving the quality of health care and reducing 
     costs, the best way to reach those objectives is through 
     increasing funding for bio-medical research at NIH.
       The second item which I urge for inclusion in comprehensive 
     health reform legislation is specified in S. 914, the Cures 
     Acceleration Network Act which I introduced on April 28, 
     2009. That bill would help our nation's medical research 
     community bridge what practitioners call the ``valley of 
     death'' between discoveries in basic science and new 
     effective treatments and cures for the diseases. This 
     translational medical research will accelerate medical 
     progress at the patient's bedside and maximize the return on 
     the substantial investments being made on bio-medical 
     research.
       I look forward to working with you on these proposals as 
     well as other facets of comprehensive health care reform.
       I am sending an identical letter to Senator Kennedy.
           Sincerely,
     Arlen Specter.
                                  ____



                                                  U.S. Senate,

                                     Washington, DC, July 8, 2009.
     Hon. Christopher J. Dodd,
     U.S. Senate,
     Washington, DC.
       Dear Chris: Before the 4th of July recess, I mentioned to 
     you on the Senate floor my strong interest in including a $40 
     billion annual base for NIH and my proposed Cures Accelerated 
     Network Act (S.914) in the comprehensive health care reform 
     legislation.
       I am enclosing a copy of a letter which I sent to Chairman 
     Kennedy on June 17, 2009 which spells out in some detail my 
     proposals.
       Thanks very much for your consideration of this request.
       My best.
           Sincerely,
     Arlen Specter.
                                  ____



                                                  U.S. Senate,

                                    Washington, DC, June 17, 2009.
     Hon. Edward M. Kennedy,
     Chairman, Committee on Health, Education, Labor and Pension, 
         Washington, DC.
       Dear Ted: I write to call to your personal attention 
     provisions on bio-medical research which, in my judgment, are 
     critical--arguably indispensable--for inclusion in 
     comprehensive health care reform legislation.
       I urge that authorization for the National Institutes of 
     Health be set at a new baseline of $40 billion, reflecting 
     the current $30 billion level plus the $10 billion from the 
     stimulus package. The Administration's current request of 
     $443 million is totally insufficient since at least $1 
     billion is necessary to keep up with inflation and additional 
     funding is necessary to maintain an appropriate level for 
     more innovative research grants.
       When the appropriations for NIH, spearheaded by Senator 
     Harkin and myself, were increased by $3 to $3.5 billion each 
     year, there was a dramatic decrease in deaths attributable to 
     many maladies. Since reform legislation has as two principal 
     objectives, improving the quality of health care and reducing 
     costs, the best way to reach those objectives is through 
     increasing funding for bio-medical research at NIH.
       The second item which I urge for inclusion in comprehensive 
     health reform legislation is specified in S.914, the Cures 
     Acceleration Network Act which I introduced on April 28, 
     2009. That bill would help our nation's medical research 
     community bridge what practitioners call the ``valley of 
     death'' between discoveries in basic science and new 
     effective treatments and cures for the diseases. This 
     translational medical research will accelerate medical 
     progress at the patient's bedside and maximize the return on 
     the substantial investments being made on bio-medical 
     research.
       I look forward to working with you on these proposals as 
     well as other facets of comprehensive health care reform.
       I am sending an identical letter to Senator Baucus.
           Sincerely,
                                                    Arlen Specter.

  Mr. SPECTER. Mr. President, it is my view that this is a critical and 
arguably indispensable item to be taken up in this comprehensive health 
care reform--and certainly weighs heavily on my mind--and that is to 
fund the National Institutes of Health at the $30 billion currently as 
the base, plus the $10 billion in the stimulus package, for a base of 
$40 billion. The results from medical research have been phenomenal, 
with decreases in fatality to stroke, breast cancer, and many other of 
the health maladies. Then, to combine that with legislation which I 
have introduced, S. 914, the Cures Acceleration Network, which 
addresses the issue taken up by The New York Times, and that is to make 
a determination of what actually works.
  There has been identified a so-called ``valley of death'' between the 
bench and clinical research and the bedside and application of the 
research. The pharmaceutical companies do not take up this issue 
because of the cost. This is something which ought to be taken up by 
the Federal Government as the dominant funder for the National 
Institutes of Health. So should the comprehensive health care include 
this issue to address, in a meaningful way, the very high costs of 
medical care? Certainly, if the tests make a determination that the 
less-expensive items are the ones which ought to be followed, that 
could meet the Federal standard and that could prevail.

                          ____________________