Revolutionary War And War Of 1812 Battlefield Protection Act - Continued

Floor Speech

BREAK IN TRANSCRIPT

Mr. GRASSLEY. Mr. President, I think our colleagues know that the issue of health care reform is hopefully on a fast track in the sense of getting something done this year. This is a very big project to get underway. Senator Baucus and I have laid out an ambitious schedule for enacting a bipartisan health reform bill, and I think there are a lot of facets of it that we have to expect people who are not on the committees--Senator Kennedy's committee on the one hand and Senator Baucus's committee on the other hand--will have to take into consideration. I am asking, through a series of speeches I will give this spring, for people who perhaps don't think about the issue of health care reform because they do not serve on the committees to think of various things.

Today, I wish to address an issue we often read about in newspaper accounts--and the most recent one comes from a Wall Street Journal article I had a chance to read--that comes up as a reminder when people think about health care reform that we ought to take into consideration. I often refer to Canada, I suppose because a lot of Americans are familiar with the health care system in Canada, and we have a lot of our constituents who ask us why we don't put in place what they have in Canada. We refer to that system as single payer. We often run into people who say: Well, don't do what they are doing in Canada. I think a lot of our colleagues here would support single payer. So obviously, when these things are discussed in America at the grass roots level, I think we ought to be constantly reminded of this here as we debate health care reform, and a lot of our colleagues need to be thinking about this a long time before legislation comes to the floor.

We have a lot of work ahead of us if we want to see meaningful legislation that will accomplish our three main goals of health care reform: lower cost, expanded coverage, and better quality.

Let me say that again: Lower cost, expanded coverage, and better quality.

As we roll up our sleeves, it is helpful to look to our neighbor to the north, Canada, for some lessons about what works and what does not work. Some of the proposals that are being discussed--the public plan option, rationing of care, and a Federal health board--will make our current market-based health care system that we have in the United States more similar to the Canadian health care system. Some like that. Some do not like it. My purpose is to be raising questions that our colleagues ought to be considering.

The Canadian health care system might seem like a good idea to some of my colleagues, but this should make anyone who values access to care and the doctor-patient relationship very nervous. Canadian patients often wait months or even years for necessary care. It has become so bad that some patients are suing the Government in Canada to gain access to care. One Ontario man suffering from headaches and seizures was told he would have to wait 4 1/2 months for an MRI. Instead of standing in line, he did what a lot of Canadians do. He traveled across the border to Buffalo for an MRI. It was there he discovered he had a malignant brain tumor. When he returned to Canada, he was told again it would be months before he could have surgery, so once again he traveled to Buffalo, for surgery. Another Canadian man waited in pain for a year before he could see a doctor about his arthritic hip. Once he finally saw the right specialist he was told that he would need a state-of-the-art procedure to resurface his hip, but sadly the Canadian Government told the 57-year-old gentleman he was ``too old'' to get the procedure. He was also prohibited from paying for the surgery with his own money. Similar to so many other Canadian patients, he is taking his case to court.

These court cases gained traction in 2005, when the Canadian supreme court ruled that patients suffer physically and psychologically while waiting for treatment in Canada's Government-run system. The court also concluded that the Government's controls over basic health care services impose a risk of irreparable harm and even death.

As some people propose that the Government take a more active role in our Nation's health care system, I hope we can agree that access to a waiting list is not access to health care. We all agree we need to fix our health care system but, as we try to fix it, let's not make it worse. Let's learn from our neighbors to the north. Let's not force patients in America into a one-size-fits-all Government-run system.

COMPARATIVE EFFECTIVENESS RESEARCH

I would like to speak on another matter, about an important provision tucked away in the $1 trillion spending bill that passed last month. During the debate, Members spent a lot of time talking about big-ticket health care provisions--Medicaid, COBRA, Health IT. But one issue that did not receive enough attention was a term that a lot of our colleagues are not familiar with, but every colleague needs to become familiar with--this phrase ``comparative effectiveness research.'' I still haven't figured out how spending money on comparative effectiveness research is actually stimulative, but this is one of those things that probably should not have been in the stimulus bill--but it was there and is now law.

I am even willing to guess that a lot of Members do not even know what comparative effectiveness research actually is, but in the so-called stimulus bill, we increased our investment in this research from about $30 million to $1 billion. That is over a 3,000-percent increase for something a lot of Members don't know about and can't even define--and I am not sure I want anybody to ask me right now to define it in the purest sense. This makes me a little nervous.

Mr. President, $1 billion is a lot of money, but maybe it is money that even people in comparative research might not even know what they are spending the money for.

Some policy experts have expressed concerns that this drastic increase in funding will help establish the United States version of England's National Institute for Health and Clinical Excellence, also referred to as--I don't know whether the English pronounce it ``nice'' or ``niece,'' I am going to say NICE.

So you are not misled, many patient groups consider NICE to be anything but nice. NICE was created by the British Government in 1999 to decide what treatments, prescription drugs, and medical devices the British Government is going to pay for. In other words, you are having bureaucrats and/or politicians interfere in decisions that in America we normally leave to the doctor and the patient. Put another way, NICE was created for the Government to ration care and ultimately save money.

If the Congress of the United States was passing something to ration care, I will bet a good number of people in this country would get up in arms. For example, a news story printed in August entitled ``UK's''--meaning United Kingdom's--``NICE says `No' to four new cancer drugs.'' It detailed how the NICE panel concluded that the four drugs would extend people's lives, but somehow you cannot use them because they are not cost-effective.

So, under England's single-payer Government system, patients were prohibited from getting those drugs, regardless of what the patient or their doctor might have thought. It was not until there was public outrage about that decision that made newspaper headlines around the world that NICE then reversed its decision about at least one of those drugs. The three other drugs are still considered too costly to give to patients.

Another article in the New York Times on December 8, 2008, was entitled ``British Balance Benefit vs. Cost of Latest Drugs.'' This article told the story of Bruce Hardy, a British citizen who was diagnosed with kidney cancer. Mr. Hardy was unable to get a particular drug that would have extended his life because NICE determined the drug was not ``cost-effective.'' That is because NICE has decided the British Government can only afford to pay about $22,000 for every 6 months of life.

Get this. The Government of England is putting a value on life of about $22,000 for every 6 months of life. This may be acceptable in a government-run single-payer health care system, but here in the United States only two people should be involved in deciding what treatment, drug or device to use, and those two people would be, on the one hand, the doctor; on the other hand, the patient.

We do not need the Federal Government standing between patients and their doctors. We do not need bureaucrats in Washington denying patients with terminal cancer access to the newest and most promising experimental drugs. We do not need the drug companies to have undue influence over our system either.

I think my work overseeing, as congressional responsibility dictates, the Food and Drug Administration, gives me some authority to speak in this area, that drug companies should not have undue influence. I have been a leading advocate for increasing oversight of drugs and device manufacturers. In fact, I have introduced legislation to make manufacturers report payments to patients so we can make sure we do not have conflicts of interest getting in the way of high-quality care. I have also supported drug importation and legislation to prohibit brand-name manufacturers from gaming the system to prevent lower cost generic drugs from getting to the market. So I am not down here today to defend the drug companies or device industry. They can do that on their own, and I think they do it very well. But I think it is legitimate to be concerned about patients. I don't want some faceless, unelected Government panel keeping patients in Iowa or anywhere from getting the lifesaving treatment they need.

At this time, I ask unanimous consent to have printed in the Record a letter I received from 60 patient groups, from the breast cancer advocates to muscular dystrophy, to name two, expressing concerns about using comparative effectiveness to ration care.

There being no objection, the material was ordered to be printed in the Record

BREAK IN TRANSCRIPT

Mr. GRASSLEY. I agree we need to lower the overall cost of our health care system. We need to improve quality. It is true we spend more money, about twice as much more than other developed nations in the world, and still rank poorly in many health care indicators. But having the Government ration care is not the answer. In fact, the Congressional Budget Office concluded that comparative effectiveness research would only save 1/10th of 1 percent of the total health care spending.

Let me remind you when I started out I was saying I want my colleagues to become familiar with comparative effectiveness research because this is something we are going to be dealing with in the legislation later on this year, and we just put $1 billion into this project as opposed to $30 million previously.

If Congress is going to spend this $1 billion on this research, let's not bill it as some magic bullet to control health care spending because the Congressional Budget Office--and I hope you know they are God around here, they are God around here because if they say something costs something, it costs something. If you want to overrule them, it takes 60 votes to overrule. So what they say counts. If we are going to spend that $1 billion, we have to make sure it is improving quality and informing patients and providers. If Congress is going to spend $1 billion on this, let's not establish the United States version of the United Kingdom's government-run National Institutes of Health and Clinical Excellence that I have been referring to by the acronym NICE. Let's not set up a system for Washington dictating to your doctor what treatment to prescribe. If we are going to do this, we have to do it right. Comparative effectiveness research should be about comparing clinical treatments and then letting your doctor decide the best way to treat it.

I am not up here saying there should not be any comparative effectiveness research. I am here to say it should not be a subterfuge for some bureaucrat or politician deciding who is going to live and who is going to die. It is information for doctors and patients. It should be done in the most open and transparent process possible.

Finally, the research should be used to get information to doctors and patients about the best treatment.

It should not be used for Washington to make policy or to decide what treatments the government will or will not cover. I hope we can agree the Federal Government should not be in the business of determining the value of a person's life, as I indicated to you this outfit in the United Kingdom decides that your life is worth $22,000 per 6 months.

Clinical comparative effectiveness can be a valuable tool in creating a more efficient health care system, but let's make sure we use this tool wisely.

I yield the floor.

BREAK IN TRANSCRIPT

Source