Throughout my first term, I held hearings and town meetings throughout my district to hear what Idahoans had to say about health care reform. In all of these forums, my constituents told me that they wanted to see changes in our system that would improve access to health care in rural areas. They expressed concern that many proposals they has heard about or read would do little or nothing for access to care in Idaho. After listening to my constituents, I introduced H.R. 237, the Rural Health Care Access Improvement Act. This bill outlines a moderate agenda that I believe will promote solutions to many of the health care delivery problems in rural America. Doctors and other health care providers will be encouraged to practice in rural areas through a combination of financial incentives and administrative simplification. To increase the number of rural and frontier physician placements through the National Health Service Corps, the bill changes the current allocation formula. In addition, it provides grants for primary care nursing clinics in medically underserved areas, and telecommunications demonstration programs in rural areas. It revises some current federal anti-trust provisions to enhance the development of cost and resource-effective networks in rural areas, and provides for system-wide paperwork reduction. In addition, I introduced H.R. 3070, to support the development of electronic telemedical networks in rural areas. have a personal interest in seeing that we support and enhance the development of telemedicine in this country, because this field holds enormous potential for increasing access, for delivering service, and reducing costs, especially in rural areas. The widely distributed study by Arthur D. Little and Company suggests that significant savings could be achieved throughout our system by applying this technology to health care delivery. However, in order to speed the development, distribution and application of this technology, the Health Care Financing Administration will have to join the effort, and develop reimbursement procedures to support "telemedicine." Before I introduced H.R. 3070, I spent time thinking about underlying principles that can move us forward quickly and reliably. There is no need to wait for some super-high-tech development. We merely need to use some common sense. I In constructing a rural telemedicine infrastructure, we should use as many off-the-shelf components as possible. The constituent pieces of a telemedicine delivery system already exist, to a large extent. We need a policy structure that allows for the use of current technologies without committing large amounts of capital to the latest theoretical innovation that will be obsolete in the near future. We cannot wait for the perfect high tech development. We need to be trying and demonstrating. We need to be building modest networks that work and that have the latent ability to fit together. We need to put the little pieces together right, and then begin connecting them. Putting pieces together is what "rural" is all about. An information infrastructure to support telemedicine, but with the capacity and architecture to permit expansion, can provide the link between rural providers of all kinds. In Idaho, in health care, that provider may be a clinic, not a hospital; it may be a nurse practitioner or a physician's assistant, or even an emergency medical technician, rather than a doctor. In each case, an information infrastructure can make access a promise we can deliver; in the health care field over the near term, and eventually in areas and applications we cannot even imagine today. The networks would give patients, doctors, and health care facilities in rural areas and small towns instant access to other doctors, specialists, and state-of-the-art medical equipment located hundreds, or even thousands, of miles away. These linkages will allow patients to receive care in their community and will ease the burden on specialists already in underserved areas. These links will also support efforts in underserved rural communities to recruit and retain physicians by helping to increase education and training opportunities. Doctors could participate in lectures and conferences without leaving home. Electronic medical school libraries could provide access to books, journals, and graphics describing medical protocols. Digitized videos of surgical procedures could help educate medical staff and students. -- now - The fundamental purpose of the Rural Telemedicine Development Act would be to begin constructing linkages between health care providers of all levels, right down to the emergency medical technicians. It would be to begin constructing them in sufficient numbers with sufficient coherence that they evolve into compatible networks. We need networks to keep the health care professionals we have in place, with support, so that they can live "out there" and work "out there," and keep the edge that comes from knowing one is doing a good job delivering toprate health services. We need to ensure that they can stay involved in rural health care but not lose touch with the cutting edge of their profession. The Rural Telemedicine Development Act offers federal support for building telemedicine networks. It uses three grant programs to encourage their development in rural areas. The first provides seed money for rural hospitals and other facilities seeking to benefit from the cost savings and access to specialists that telemedicine can provide. The second would help strengthen the link between existing rural health networks, allowing interactive video consultation, shared educational services, and greater efficiency in administrative activities. The third would provide grants for networks of rural hospitals and other providers to link to existing fiber optic telecommunication systems. In conclusion, Mr. Chairman, I urge the committee to examine quickly the wide range of legislative options for health care reform, so that we retain what is best about our current system, and create the kind of flexibility for the future that maintains individual choice, improves access and controls costs for all concerned. Our goal should be the guarantee of private health insurance for every American that cannot be taken away. This is a tall order, but I am optimistic that history will record health care reform as the most important accomplishment of the 103rd Congress. Thank you. Mr. CARDIN. We will now hear from Hon. Bernard Sanders from the State of Vermont. STATEMENT OF HON. BERNARD SANDERS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF VERMONT Mr. SANDERS. Thank you, Mr. Chairman. We have already submitted written testimony, so I will summarize. There are some debates in this country as to whether or not we are in a health care crisis or whether we need patchwork to deal with some of the more obvious problems. The people that I talk to in the State of Vermont suggest to me that our entire system is out of whack, and we need fundamental reform. The only way that we are going to address the issue of comprehensive health care, universal health care and doing it in a cost-effective way is through a Canadian-style, single-payer national health care system, administered at the State level, in my opinion-only a single-payer system which eliminates the private insurance companies, whose only function in life is not to provide health care but to make as much money as they can for themselves-only a single-payer can save substantial sums of money through elimination of the private companies, through simplification of the system. The single-payer system is, by definition, the simplest, least complicated system for doctors, hospitals and patients. Several national studies have suggested that there are enormous savings and that, in fact, the single-payer approach is the most cost-effective approach to universal health care. Only the singlepayer approach, in my judgment, can stand up to the pharmaceutical industry, which is ripping off the American people. It is a national disgrace that we pay twice the price for prescription drugs that they do in Europe and 30 percent more than they do in Canada. Only a single-payer system can effectively control the cost of medical procedures and doctors' fees. It is very interesting-we border on Canada; Canada coronary bypasses, appendectomies are 50 percent of the cost that they are in the United States. Somebody has to stand up to the specialists and to the surgeons of America, some of whom are making enormous amounts of money. We cannot control health care costs until we begin to stand up to them. When we talk about universal health care, the word "universality" means nothing unless we are talking about deductions and copayments. We have universal access to our local Cadillac dealer. The problem is many of us can't afford the $40,000 it costs to purchase the automobile. So unless we are talking about eliminating deductibles and copayments, we are not truly talking about universal access. One of the concerns that I have is understanding the power of the insurance companies and the AMA and the pharmaceutical companies and the people who are making billions off the current health care system. I am not confident nor are the American people that Congress is going to fully deal with those institutions and organizations and do the right thing and pass single-payer. The major aspect about the President's plan that I feel most comfortable with is not managed competition or managed care, which I happen not to believe in, and which I think for a small State like Vermont is irrelevant. We don't have competing hospitals. We have one major hospital in the State of Vermont. It is absurd to divide our State up into five HMOs. We have 560,000 people. But the major aspect of the President's plan which I like is that it at least gives the States the option to go forward with a single-payer plan. must confess I find it somewhat humorous or not so humorous that some people in Congress, especially conservatives, who day after day tell us how much they dislike the big, bad Federal Government and how they want the States to be a laboratory for change, that there is now a concerted effort on the part of the insurance companies and some Members of Congress to take away the option and the freedom of those States that want to go forward with single-payer to do so. I hope you will pay attention to that because if you don't have an option for States to go forward with a single-payer plan, I think the President's health care approach for rural America is not terribly significant. In my State of Vermont, the single-payer movement is very, very strong. A recent poll done by our largest paper indicated that while there are many plans out there, single-payer has more support within our legislature than any other; physicians and small business support it. What we are proposing is, we have concluded based on a task force that I appointed that we can save $270 million in a small State with a $1.8 billion health care budget by going the route of single-payer. Second of all, what we are doing now is seeing that many physicians, senior citizens coming forward, trade unions, low-income people coming forward in support of the single-payer concept. My hope, Mr. Chairman, is that as the debate unfolds, that this committee be very, very strong in making sure that States are allowed to go forward with single-payer, because I believe that ultimately this country will be single-payer, and the way it will move in that direction is through the success shown State by State. Thank you, Mr. Chairman. Mr. CARDIN. Thank you, Bernie. February 1, 1994 TESTIMONY OF REP. BERNARD SANDERS ON NATIONAL HEALTH CARE Mr. Chairman and Members of the Committee: I appreciate the opportunity to testify today on the vital subject of national health care. Like many of my colleagues, I have been very impressed by the President's initiative on this issues. For the first time in decades, a President of the United States has said clearly that all Americans should be guaranteed the health care they need, and that health care is a basic human right of all our citizens. The President has correctly diagnosed the ills of our current wasteful system, which costs far more per capita than any other in the world, overwhelms doctors and patients in paperwork, and yet still leaves 40 million of our people without health insurance. The President and the First Lady deserve a great deal of credit for bringing the crisis in our national health system to the fore, and for starting a national debate about the fundamental reforms that are necessary. As you may know, I do not agree with the specific solution that the President has proposed, or with the concept of "managed competition" on which it is based. I believe that, particularly in a small state like my own state of Vermont, the only way to provide universal, comprehensive, cost-effective health care coverage is through a Canadian-style single-payer system, administered by the states. Only a single-payer system can save substantial amounts of money by eliminating the bureaucracy inherent in both the present system and the managed competition system. Only a single-payer system can stand up to the pharmaceutical industry and get skyrocketing drug prices under control. Only a single-payer system can effectively control the costs of medical procedures and doctor's fees. Only a single-payer system will allow Americans to go to any doctor or hospital they choose, without out-of-pocket expenses. |