SUBCOMMITTEE ON DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, And Related AGENCIES J. MICHAEL HALL, JAMES J. SOURWINE, Carol C. MITCHELL, AMY J. SCHULTZ, and TERRY MUILENBURG Minority Professional Staff BETTILOU TAYLOR and CRAIG A. HIGGINS Administrative Support NANCY C. ANDERSON and SANDRA J. KRUHM (II) 400 National Heart, Lung, and Blood Institute National Institute of Dental Research National Institute of Allergy and Infectious Diseases National Institute of Diabetes and Digestive and Kidney Diseases National Institute of Child Health and Human Development. National Institute of Environmental Health Sciences... John E. Fogarty International Center for Advanced Study in the National Institute of Neurologica, and Communicative Disorders and National Eye Institute. DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1991 WEDNESDAY, FEBRUARY 7, 1990 U.S. SENATE, SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, Washington, DC. The subcommittee met at 10 a.m., in room SD-192, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding. Present: Senators Harkin, Burdick, Bumpers, Specter, and Coch ran. DEPARTMENT OF HEALTH AND HUMAN SERVICES STATEMENT OF HON. LOUIS W. SULLIVAN, SECRETARY BUDGET REQUEST Senator HARKIN. Good morning. The Subcommittee on Labor, Health and Human Services, Education and related agencies will come to order. I want to welcome Secretary Sullivan here this morning to review with us the fiscal year 1991 budget for his Department. The fiscal year 1991 total request for the portion of the Department which is under the jurisdiction of this subcommittee is $135,623,000,000 of which $19,546,000,000 is for discretionary programs, $116,077,000,000 is for mandatory programs for which this subcommittee has very little control. This is a total increase of $11.2 billion or 9 percent, although the discretionary programs are only increased by 3 percent. In addition, in fiscal year 1991 the Department will spend an estimated $329 billion from the permanent trust funds, so this will bring the total annual spending in fiscal year 1991 to a total of about $464 billion representing 38 percent of the entire Federal spending. This morning's hearing will be followed by three additional hearings to examine in greater detail the requests of various agencies in the Department of Health and Human Services. This morning will give us an opportunity to review with the Secretary some major matters of broad policy significance. I was pleased, Mr. Secretary, to see the Department's budget give increased emphasis and focus to health programs which affect minority populations. The minority health legislation passed by the Congress last year is all but fully funded in the Secretary's budget. I want to compliment you on the leadership that you have shown in that regard. I do, however, continue to have concerns with the lack of full attention focused on matters of rural health care. I was particularly concerned to see the Department discontinue funding for the Rural Health Transition Grant Program which is very meaningful because a lot of these small hospitals out there, Dr. Sullivan, must change their old methods of operations if they are going to be viable entities in those communities. Those transition grants would have helped them go from a fulltime acute care facility to a facility that may encompass a lot of other types of support activities regarding health and human services in the local community. Those transition grants were very important to those hospitals, and I am greatly disappointed that they are going unfunded. With regard to the AIDS epidemic, the Department has once again chose not to request funding for AZT and has requested no funding for the AIDS home health care and the subacute care programs which we funded in 1990. Small amounts, but at least a beginning. With the recent FDA findings which have approved the use of AZT for those infected with HIV virus but who have not yet developed AIDS, and the FDA approval of the use of AZT for children with AIDS, we expect the demand for AZT to be greatly expanded. And if there is no funding in this program and we are up against budget crunches, then that puts us in quite a bind. Also, the administration does not seem to have a policy or program in place to deal with the need for AZT and other AIDS drugs for that indigent population which cannot afford them. An overarching concern is the concern we all share in bringing down the escalating costs of health care in America. I brought a couple of charts, Dr. Sullivan, to draw your attention to a couple of items. The first chart on my left with the bar graph shows two things. On the left-hand side it ranks the per capita health care expenditures by country. The right-hand column ranks the percent by which the U.S. exceeds that country in per capita health care expenditures. So, as you can see, the United States is No. 1 in per capita expenditures at $2,051-and again, we are going back 2 years on this, so this is the most recent data that we have. Canada, our neighbor to the north, is next highest at $1,483 yet, we exceed the expenditures of Canada by 38 percent, one-third higher. But in Canada everyone is covered, everyone. And last year Canada only had 37 malpractice suits. How many did we have in America? Tens of thousands, probably. When I look at these charts I think the Canadians are not all that much different than we are, and then you look down at some of the other countries which we exceed and it is just incredible. When you compare the chart on the left with the chart on the right, the chart on the right shows the growth in health care expenditures from 1965 to 1988. We use 1965 as a base year, assign it |