Health Care

It is no secret that spending on health care is out of control.  In 2007, the latest year that figures were available, total health expenditures reached $2.2 trillion, which translates to $7,421 for every man, woman and child; millions of Americans are without health insurance and San Diego doctors are finding it increasingly difficult to care for our city’s most vulnerable residents.  Without real reform, health care spending is going to suffocate our economy. 

Studies have shown that the visit rates to emergency rooms for patients with no insurance are twice that of those with private insurance.  While I support ensuring all Americans can access health insurance and believe it must be the first priority of any health care reform legislation, I cannot support a bureaucratic system dictated and controlled by the Federal Government.  Congress, just like the medical profession, must adhere to the Hippocratic Oath of "Above all, do no harm.”

It is important to remember that American health care is in many ways the envy of the world.  From our first class medical facilities to our world renowned life science enterprise, we are the leader in innovative care and solutions.  These innovations are allowing Americans suffering from major illnesses to live longer, healthier lives.  For instance, in a single decade, from 1993-2003 U.S. heart disease deaths dropped by 22 percent.  However, for all these benefits there is work to be done but not at the expense of destroying the entire health care system. 

To date, many people take to the airwaves and the town halls to expound what they are against.  I believe that this issue is too important to spend all our time arguing what we don’t want to do.  I want to first tell you what I support.

I support meaningful health care reform that puts patients and doctors in charge of health care, not bureaucrats in Washington.  My idea for sensible reform that will cover all Americans includes:

• Allowing states to be the health care laboratories for major reform.
• Investing in science and technology to ensure that America continues to be the land of innovation.
• Permitting individuals to buy health insurance across state lines.
• Using the consumer choice model that is based on health care that Members of Congress receive.
• Creating a health savings account system that allows individuals to put money aside for health care expenses and keep their coverage even in the event of job loss.
• Reform the tax treatment of health care to cover the millions of uninsured.
• Restricting the ability of lawsuits that threaten the solvency of our health system and replacing litigation with mediation.

One of the defining characteristics of our great nation is its diversity.  From the hallowed grounds of Arlington National Cemetery, to the majestic forests of California, we are blessed with a rich and varied nation of states.  I believe that we should allow individual states the ability to test new and exciting health care practices before expanding to the entire U.S.  What is good for Massachusetts might not be what is right for California.  However, mistakes and breakthroughs made at the state level are easier and less damaging to implement and fix than a national system that has the potential to destroy our nation.  As a former local elected official I fully understand the power and ingenuity that individual localities can have in solving a problem—especially one as big as health care.

America and San Diego in particular, is the hub of scientific research and innovation.  The state of California is by far the leader when it comes to federal funding for the National Institutes of Health (NIH).  There are approximately 36,000 employees in the life sciences community in San Diego County at more than 500 companies.  As Co-Chair of the Congressional Biomedical Research Caucus, I have fought hard to ensure San Diego receives the resources it needs to be a world leader in biotechnology and life sciences.  For example I have:

• Voted for FY 2010 Labor HHS appropriations bill that included millions of funding for NIH. 
• Voted to expand the number of stem cell lines available for research.  Following these efforts I organized a San Diego life sciences tour of UCSD and the Burnham Institute for Medical Research for National Institutes of Neurological Disorders and Stroke and Stem Cell Taskforce Director Dr. Story Landis.
• Worked with Representative Susan Davis (D-CA) to spearhead letter to Appropriations Committee calling for more funding for NIH in the stimulus bill.  One of four co-sponsors on letter calling for increased funding for NIH in FY 2010.  This letter was signed by 127 Members of Congress.
• Organized and drafted San Diego delegation letter to NIH supporting Scripps Health Center for Translational Science Award (CTSA) grant.  This letter was a key factor in Scripps receiving a $20 million dollar grant.
• Secured $2.4 million in the continuing resolution for the Burnham Institute for Medical Research to conduct infectious disease research at a Infectious and Inflammatory Disease Center.  This funding will go directly to researchers working to solve the mystery of the swine flu and other deadly infectious diseases.
• Spearheaded a bipartisan Science Committee letter with Congressman Jerry McNerney (D-CA) urging an extension of the R&D tax credit.  This letter was signed by every member of the House Committee on Science and Technology.

In today’s era of E-bay and Amazon.com individuals have many choices in which to purchases goods.  That is unless of course you want to shop around for health insurance.  Under current law, individuals must purchase health care from the states in which they reside.  Why shouldn’t families be allowed to shop throughout the United States for the best health care that fits them?  In an effort to fix this problem, I have co-sponsored the Health Care Choice Act.  This legislation, sponsored by Congressman John Shadegg (R-AZ), harnesses the power of the marketplace to allow Americans to compare insurance policies from across the country and pick one that best meets their needs.  It would provide every American with more and better health insurance choices. The legislation would also reduce the number of Americans who have been unable to find affordable coverage.

As Members of Congress, we have some of the finest health care in the world.  The rest of America should enjoy such as plan.  I support a system modeled after the Federal Employees Health Benefit Plan (FEHBP).  This plan is an employment based system that functions like a shopping mall for health plans.  This makes it easy for families to shop each year for plans and to have portable coverage.  Beyond providing prescription drugs and catastrophic protection for the most serious health occurrences, the FEHBP plan rapidly upgrades their benefit offerings.  It is not surprising that individuals with FEHBP plans rate their plans at a scale of 8 or higher on a scale of 1-10.  It is my hope that this year we model health care reform after this system.

One of the most frightening experiences anyone can have is losing their job.  During this recession, more than 2 million Californians are without work.  In addition to the challenge of just putting food on their tables, individuals face the possibility that one minor health incident could bankrupt them for the rest of their lives.  Families should have the opportunity to carry their health care with them both during employment and between jobs.  Establishing portable health savings account plans will relieve the stress associated with job loss and lack of coverage.

Congress should include options for individuals to buy into tax free health savings account plans which will allow them to have coverage should they become unemployed.  Individuals can contribute upfront tax free money which can be used for catastrophic coverage as well as basic health services for them and their family.  If an individual should lose their job, they can still keep their health coverage into which they paid.  During these tough economic times, these plans will provide peace of mind for all San Diegans.

Health savings accounts and health plans modeled after the federal employee health system are sufficient if you already are employed but will not do anything for the millions of Americans who are uninsured or underinsured.  This population must be covered if we are to truly change health care in our country.  The existing tax treatment of health insurance is an inefficient system for individuals to obtain health care coverage.  Today, individuals receive a tremendous tax break for participating in coverage only when offered through their employer.  This linkage between employment and coverage has created a scenario that fuels the problems facing the uninsured.  I support a plan which provides a health tax credit which is both refundable and advanceable.  This would make health coverage more affordable and accessible to those in need.  A tax credit such as this would provide individuals and families a direct subsidy to help them purchase health care coverage.  For instance, under a tax credit approach, individuals would no longer be bound to their employer for their health insurance.  This means that regardless if their employer offers coverage or not, and regardless if they have a job or not, individuals would be able to maintain continuous health care coverage.

One aspect that has not been addressed in the current health care debate is the cost of litigation to our health care system.  For year’s doctor’s fear of medical lawsuits have required them to over test and over use the health care system.  When a lawsuit is instigated the results can force medical practitioners to lose their insurance coverage because of rising premiums.  This in turn has resulted in higher costs to our health care system as doctors run a battery of unnecessary tests and examinations for fear of not providing enough services in the case of a lawsuit.  According to a recent Towers Perrin study, the U.S. tort liability system cost each U.S. citizen $721 in 2001 ($205 billion total). More than 40 percent of doctors reported avoiding prescribing appropriate medication because they knew the drug might be involved in litigation.  Personal injury lawyers walk away with 30-50 percent of any jury award to the plaintiff, plus an additional percentage of the award to cover expenses.  One example of a questionable lawsuit is Baycol since its widely used cholesterol-lowering drug Baycol was withdrawn from the market, Bayer is facing more than 8,000 lawsuits. The New York Times notes that at least 6,000 of those lawsuits, however, are being filed by people who did not suffer any side effects whatsoever.  I would like to see punitive and non punitive damages capped as well as health courts set up to examine the damage these exorbitant lawsuits can have on the health system. 

As health care reform moves through Congress, please be assured I plan to work diligently with all my colleagues to ensure that any final bill helps Americans gain access to health care without destroying our economy.

HEALTH CARE LEGISLATION

• H.R.461: 10,000 Trained by 2010 Act. Requires the National Science Foundation (NSF) to award competitive grants for basic research on innovative approaches to improve health care information systems, as well as for scientific and engineering activities to improve education in the health care information fields. Establishes multidisciplinary Centers for Informatics Research for conducting cutting-edge, research to generate innovative approaches in health care information.
• H.R.686:  Creates a more efficient Medicaid distribution system by amending title XIX (Medicaid) of the Social Security Act (SSA). This legislation gives permission to local public agencies to act as Medicaid enrollment brokers
• H.R.1149: Child Protection Reauthorization Act of 2009. This bill works to protect our Nation’s children from sexual abuse. It provides federal assistance to states for enforcing sex offender registration requirements and pilot programs for monitoring sex offenders.
• H.R.1189: Colorectal Cancer Prevention, Early Detection, and Treatment Act of 2009. Establishes a program at the Centers for Disease Control and Prevention to provide screenings and treatment for colorectal cancer. Targets screening services toward individuals between 50 - 64 years of age (the pre-Medicare population), or those under 50 years old but with high risk of such cancer. Gives priority to low-income, uninsured and underinsured individuals who would not otherwise have coverage for colorectal cancer screening.
• H.R.1386: Pay for all your Undocumented Procedures (PAY UP!) Act of 2009. This bill provides for the federal reimbursement of emergency health services furnished to undocumented aliens. The rising number of illegal immigrants, especially in our border states is taking a toll on local hospitals and physicians. Two-thirds of funds are distributed among the fifty states, with the last third going to the six states with the highest number of illegal aliens.
• H.R.2536: Emergency Nursing Supply Relief Act. This bill provides relief for the shortage of nurses in the United States by issuing more competitive visas for qualified candidates. It also increases the number of faculty and students at nursing schools, by hiring new faculty, purchasing educational equipment, enhancing clinical laboratories, and recruiting students.