I believe in access to quality, affordable health care for every American that preserves individual choice and protects the doctor-patient relationship. To promote these objectives, I support legislation that targets specific problems in our health-care system with specific, step-by-step solutions, including tort reform, the sale of health insurance across state lines, tax reforms, and new opportunities for small businesses to band together to provide their employees with affordable insurance coverage.
2009
As 2009 drew to a close, the House of Representatives and the Senate each passed versions of a health-care reform bill based largely on President Obama’s call for government-run care – even though polls showed nearly two in three Americans opposed the plan. (A CNN poll in December found that 61 percent opposed the legislation, and just 36 percent supported it. )
Both the House- and Senate-passed versions of the bill would impose $500 billion in new taxes and cut roughly $500 billion from Medicare to pay for a new health-care entitlement, raise health insurance premiums for just about everyone, and increase Washington’s control over health-care decisions.
I voted against the Senate bill, the single most dangerous consequence of which is the inevitable rationing that would result in the delay and denial of care. It passed on a party-line vote – 60 to 39 – on Christmas Eve.
2010
The Speaker of the House and the Senate Majority Leader immediately began working to merge the House- and Senate-passed versions of the legislation with the hope that a final bill could be passed by both chambers and be on the President’s desk before his State of the Union address. But, as the President subsequently put it, they “hit a little bit of a buzz saw along the way.”
The citizens of Massachusetts chose a new Senator in January who pledged to oppose the bill, denying its supporters the 60th vote they needed to be able to write the final bill behind closed doors, shut down further debate in the Senate, and pass the bill over the objections of the American people. Indeed, a Rasmussen poll in February confirmed the public’s continuing opposition, finding that 61 percent of U.S. voters said Congress should scrap the plan and start from scratch.
President Obama called a summit at the White House on February 25 in an effort to keep the bill alive. However, White House officials made it clear that the President did “not intend to restart the health care legislative process from scratch” and was “adamant about passing comprehensive reform similar to the bills passed by the House and Senate.” Imposing such preconditions on the summit meant the President had already decided to ignore public opposition and the many alternatives that my colleagues and I had put on the table. Indeed, the House Speaker and Senate Majority Leader were already laying the groundwork for a plan to use an arcane budget procedure, known as “reconciliation,” to try to jam the legislation through the Senate over the opposition.
As health-care reform continues to be debated in Congress and around the country, it’s worth considering what is good about our current system, and perhaps why, according to a USA Today/Gallup poll, eight in 10 Americans are satisfied or very satisfied with the quality of medical care that is currently available to them and their families.
The following are just some of the findings that were included in the report, “10 Surprising Facts about American Health Care,” which was published by the non-profit, non-partisan National Center for Policy Analysis last year. (To review the NCPA’s complete report, click here.)
- Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.
- Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statins are taking them, helping to reduce cholesterol and protect against heart disease. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them.
- Americans spend less time waiting for care than patients in Canada and the U.K. Canadian and British patients wait about twice as long – sometimes more than a year – to see a specialist, have elective surgery like hip replacements, or get radiation treatment for cancer.
- Americans have much better access to important new technologies, like medical imaging, than patients in Canada or the U.K. An overwhelming majority of leading American physicians identified computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade. The United States has 34 CT scanners per million Americans, compared to 12 in Canada and eight in Britain. The United States has nearly 27 MRI machines per million compared to about six per million in Canada and Britain.
- Americans are responsible for the vast majority of all health-care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed country. Since the mid-1970s, the Nobel Prize in medicine or physiology has gone to American residents more often than recipients from all other countries combined. In only five of the past 34 years did a scientist living in America not win or share in the prize.
Despite all of the good things about American health care, there are still specific problems that need to be addressed if we are to make it even better. The question is, how do we lower health-care costs and improve access to quality, affordable health care by building upon what works, rather than completely dismantling our health-care system?
Listed below are a series of proposals intended to solve specific problems without upending our entire health-care system or forcing individuals to give up their current coverage. These proposals would improve access to quality, affordable health care for every American, while preserving individual choice and protecting the sacred doctor-patient relationship.
Malpractice lawsuits serve a valuable purpose for those who have truly been wronged. The problem is, malpractice law is often abused by some trial lawyers who flood courts with baseless lawsuits. And the threat of these lawsuits is a big reason Americans’ health-care premiums have soared.
That is because many physicians must purchase expensive malpractice insurance – sometimes at a cost of more than $200,000 a year – just to keep their doors open. A Hudson Institute economist estimates that as much as 10 cents of every dollar paid for health care is associated with the cost of medical malpractice insurance.
Significant additional costs result from physicians practicing “defensive medicine,” ordering tests or other procedures that may not be needed, but will help protect them if they are sued. According to a 2008 study by the Massachusetts Medical Society, 83 percent of doctors reported ordering tests or procedures, or making referrals, solely as a way to protect themselves from lawsuits. Stanford economists suggest that the use of such defensive medicine increases Americans’ medical costs by $100 billion a year.
I believe effective health-care reform requires changes in malpractice laws, including caps on damage awards and attorneys’ fees, establishment of specialized health courts to handle malpractice cases, and implementation of stricter criteria for expert witnesses testifying in medical malpractice lawsuits.
Some states, including Arizona, have already implemented malpractice reform measures with positive results. For example, two statutes enacted in Arizona – one that reformed expert witness standards, and another that imposed a requirement to inform the defendant of expert witness testimony so that he or she has the opportunity to preview the substance of the testimony before trial – has led to a 30 percent reduction in the number of medical liability suits, as well as lower medical liability premiums. Arizona’s largest medical liability insurer, MICA, has reduced premiums and returned $90 million to its members in the form of policyholder dividends since 2006.
Texas approved a series of particularly good reforms in 2003, including limits on non-economic damages and a higher burden of proof for emergency room negligence. Medical malpractice premiums dropped 21.3 percent as a result, producing savings that were ultimately passed on to patients in their insurance premiums and out-of-pocket expenses.
Washington can learn from the states’ positive experiences with these reforms. With that in mind, I joined Senator John Cornyn as a sponsor of the Medical Liability Reform Act, which takes the best ideas for tort reform from both Arizona and Texas. For example, it includes Texas-style limits on non-economic damages (it does not limit the amount of actual economic damages an injured patient can receive). As a result, more than 10,000 doctors have returned to Texas, according to the Texas Medical Board. The bill adopts Arizona’s expert witness criteria, which requires an expert witness to be board-certified in the same specialty or area of practice as the defendant doctor. Arizona’s expert witness criteria have led to an estimated 30 percent reduction in suit filings since it was enacted in 2006.
The individual health insurance market is currently subject to a patchwork of the 50 states’ individual rules, regulations, and mandates. In fact, the Council for Affordable Health Insurance (CAHI) has identified 2,133 benefit and provider mandates across the country. Insurers in highly regulated states are required to cover a broad range of health-care benefits that increase costs to consumers, often leaving them without affordable coverage options. CAHI estimates that currently mandated benefits increase the cost of basic health coverage from a little less than 20 percent to as much as 50 percent. The increased costs limit access to affordable health insurance.
Just as life insurance can be sold across state lines, so too should health insurance. That would allow people to choose plans that best meets their health-care needs. People could pick a basic, low-cost policy offered in states without expensive benefit mandates, or choose a more comprehensive health insurance plan. In either event, the choice is theirs.
Employer-provided health insurance is generally tax free, but those who try to purchase insurance on their own will find that they can deduct only that portion of the cost that exceeds 7.5 percent of their adjusted gross incomes. Eliminating that bias and allowing people who buy their own insurance to fully deduct its costs would greatly expand access to health-insurance coverage.
With that in mind, I sponsored legislation to equalize the tax treatment and allow people who must buy their own coverage the same tax benefit as those who receive employer-sponsored coverage.
Health Savings Accounts (HSAs) are currently available to a limited number of people to provide a way to save tax-free for medical expenses. HSAs are portable, allowing individuals to continue their health-care coverage, even if they are between jobs.
I offered several amendments during the Senate’s health-care debate to improve HSAs in a number of ways. For example, one amendment would allow individuals to use money in their HSAs to pay premiums for high-deductible health plans. Another would raise contribution limits so that people are able to contribute the maximum amount that their plans will allow for out-of-pocket expenses.
Fewer than 40 percent of small businesses in Arizona are currently able to offer their employees health-insurance coverage. To change that, I support legislation that would enable small businesses to band together as a group and negotiate affordable coverage that they can offer their employees. According to the actuarial firm Oliver Wyman, such plans would be able to offer coverage at savings of as much as $1,000 per employee. Such an initiative would also help reduce federal and state Medicaid spending – since more people would be able to acquire private coverage – saving as much as $1.4 billion over 10 years.
Little disagreement exists about the need to reform the nation’s health-care system.
A routine trip to the doctor’s office can be surprisingly expensive, even for people who have health-care insurance. Many fear that if they lose their job or switch jobs, they’ll be left without coverage. Others, who are unemployed, may be wondering how they can afford to see a doctor at all.
Some have suggested that we upend the entire system – despite the fact that most people want to keep the care they have – and replace it with a “public option,” a federal government-run insurance company. Why? Ostensibly to compete with private companies and “keep them honest.” But, insurance companies are already highly regulated by the states, so a government competitor is neither necessary nor desirable. Experience shows that when government takes over health care, it results in a one-size-fits-all system that relies on complex rules, rationing of health care, and, of course, higher taxes.
What seems to worry people most about a government-run system is the prospect of long waits for tests and treatment – not to mention the actual denial of care – as occurs in countries, like Canada and Britain, which have socialized medicine. It’s telling that when the Premier of Canada’s Newfoundland Province needed heart surgery in February, his doctor advised him to come to the United States for care!
Concern about the rationing of care that will inevitably result under a government-run system is bad enough, but here are some other things to consider:
First, there’s the matter of cost. How much will it cost to cover the people who are currently uninsured? Who will pay? The Senate-passed legislation backed by President Obama would cost $2.3 trillion over 10 years when fully implemented.
Second, the Senate-passed bill would boost premiums paid by people buying their own health insurance by as much as 13 percent, according to an analysis by the non-partisan Congressional Budget Office. Employees of small and large businesses would continue to see unsustainable premium increases of five to six percent a year, despite the bill’s provisions. A study by the actuarial firm Oliver Wyman using actual claims data reveals an even worse impact. In Arizona, premiums would increase by a whopping 72 percent for individuals and families. Premiums for small businesses would increase 20 percent.
The American Academy of Actuaries warned that the Senate bill “could result in dramatic premium changes,” due to proposed new insurance rules based on age. The Senate bill would create a new “individual mandate,” forcing most Americans to purchase health insurance. It would then increase premiums for younger, healthier individuals and families in order to subsidize the premiums of people roughly 55 years of age and older. For this reason, the Academy concludes that “the premiums for younger and healthier individuals will likely be high compared to the penalty [individual mandate], especially in the early years, but even after they are fully phased in, they are likely to lead many to forgo coverage.”
Third, there’s a concern about the impact of a government-run insurance program on our nation’s seniors. The Obama administration has proposed nearly $500 billion in Medicare cuts to pay for a new entitlement, despite acknowledging Medicare’s already precarious financial situation.
Over 800,000 Arizonans rely on Medicare for their health-care coverage. They rightly want Congress to strengthen Medicare, make it more efficient, and, most importantly, make it solvent. They want it to serve its intended purpose – to meet the health-care needs of our nation’s seniors – not serve as a piggybank for other spending schemes.
With that in mind, I supported two amendments offered by Senator McCain during Senate consideration of the health-care reform bill. The first amendment would strike the nearly $500 billion in Medicare cuts. As Senator McCain explained, “These cuts would harm seniors who have paid into the program and expect it to be there to help them with their health care.” The second amendment was designed to preserve Medicare Advantage, which is utilized by 329,000 Arizonans. The Senate bill would otherwise slash Medicare Advantage benefits by 64 percent, according to the Congressional Budget Office. Unfortunately, both of Senator McCain’s amendments were defeated.
Senator Judd Gregg then offered an amendment that would have guaranteed that any Medicare savings are used to save the program, instead of paying for new government entitlement programs. I also supported Senator Gregg’s amendment, but it, too, was defeated.
Any reform bill that Congress considers must protect the sacred doctor-patient relationship and ensure access to the highest quality medical care.
Unfortunately, President Obama’s so-called economic stimulus bill and the health-care reform bills passed by the House and Senate would take us in the opposite direction, laying the foundation for a system in which the government, not physicians and patients, would set the rules and make health-care decisions.
The stalking horse for this dangerous shift in policy is what is known as “comparative effectiveness research.” In the hands of doctors, medical researchers, and other health professionals, comparing the effectiveness of various treatments can help patients and their doctors make informed health-care decisions. However, in the hands of government, so-called comparative effectiveness research can become a tool to delay or deny care (and since private insurers tend to follow the federal government’s lead, this research has significant implications for all patients).
Consider that the National Institute for Health and Clinical Effectiveness in Britain uses “cost-effectiveness research” to make health-care decisions. By basing treatment decisions on cost rather than need, Britain prescribes fewer cancer drugs than any of the other big five European nations; its patients therefore have the lowest survival rate, according to a report in the National Review. The U.K.’s system provides only half of the care for end-stage renal disease patients that we do in the United States. Obviously, such rationing of care is not something we should replicate in the United States.
Such a system empowers government bureaucrats – not you, your family, or your doctor – to decide whether you get the care you need, based on an arbitrary cost-benefit analysis and the amount the government is willing to spend. In effect, the government puts a price tag on what an extra year of your life is worth and then decides whether treatment is worth the cost. Government bureaucrats decide whether alleviating pain or saving a limb is worth the money.
President Obama’s economic stimulus bill, which was signed into law in February 2009, included $1.1 billion for comparative effectiveness research. It included no safeguards to protect patients or firewalls to prevent the government from using such research to ration care. The President’s FY2010 budget similarly included no limitations to prevent the use of the research to ration care; when I offered an amendment to include such limits, it was defeated, largely on party lines. I then introduced free-standing legislation, S. 1259, to establish a firewall to prevent the government from using comparative effectiveness research to deny coverage for any health-care service or treatment.
