tv [untitled] CSPAN June 16, 2009 12:00am-12:30am EDT
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could insert government bureaucrats in between the patients in the position. what has happened is in the stimulus bill, congress appropriated $1.1 billion for something called comparative effectiveness research. this type of research has been used for years by physicians and hospitals, medical schools who do research, and they determined what kind of treatments are best. if you have two different address for the same condition, they will determine which one works the best by testing them both. the use the result of that research as recommended for the best way to treat a particular condition. it is not mandatory. what is good for most patients may not be good for all patients. it is not something that is forced upon people. it provides good information. .
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to have a federal entity or even a state entity or i should say a private entity, use that research in ways that would end up rationing care. to say that some care is too expensive for you to have and since the government is paying for it, the government isn't going to give it to you. what our bill would do is to make it clear that comparative effectiveness research cannot be make it clear that comparative effectiveness research cannot be used coverage of either to deny coverage of a service or treatment. we say the secretary of health and human services because of all of the entities that may do that are part of hhs. it would prevent the secretary of hhs to deny a service or
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treatment. you think that would be uncontroversial. i hope, at the end of the day, it is not controversial. nobody wants their health care rationed by somebody in washington d.c. comparative effectiveness research could not account for preferences by patients and their response to personalize the medicine. the breakdown of genes in the body to all of the different elements which make as unique as individuals. what the research focuses on is what exactly is it in your human gene composition, the human genome that might be different than someone else's? impersonalize treatment might work for you, but it might not work for someone else. they are finding that they can tailor specific drugs to treat specific genes in such a way
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that if they know you're human composition, they can find a way to treat your condition, say cancer, slightly differently than they would treat somebody else's cancer. whether it is in the dosage of the medicine or in the specific kind of medicine. the point being that not everybody is the same. we are all unique. at one of the things that medicine must recognize is our uniqueness as individuals and not get into the habit of saying that there is a size that fits all. if doctors would treat everybody with this particular medical advice, a drug, or treatment, we will pay for it, but we will not if they do anything else. that inserts the government between the patient and the physician. the bill also makes clear that nothing prohibits the fda commissioner from responding to drug and safety concerns under
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his authority. if a drug is not safe, the fda needs to say that the drug is not safe and we would not pay for it. this comparative effectiveness research should not be used by the government to delay or ration care. the reason for it is that we all want to be in charge of our own health care with our doctor. we want the choice. if a doctor says that we think you need this kind of treatment and we can get coverage for their from their insurance, we want to get that care. if we cannot, we want to provide in-find insurance that can provide that for us. what we do not want is for the federal government to say that it does not matter if you want to pay for it. it does not matter if you are covered, and you cannot get it because the federal government says so. if that is what could happen if we have a government run insurance.
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the president has said that he wants a public auction. there will be a government insurance company that will be a place where everybody could go for coverage if they do not have it. i think that there are better ways of getting everybody covered. there are some people that need help in getting coverage. the government can provide that help without changing the coverage that the rest of us have. everybody believes that we should help people get insurance that do not have it. by the same rough numbers, and they say that you do not need to affect my coverage in order to do that. i have insurance, i like it, i want to keep it. i do not want to have to pay for my insurance or have care rationed to ensure that somebody else gets care. we all want that patient/dr. relationship maintained. you might say, why would we be worried that this comparative effectiveness research might be
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used to ration care? is there anything in the legislation that suggests that this is going to happen? in the bill that came from the health committee and the of legislation that will be drafted in the finance committee, there are organizations that are going to do this research that could, in fact, ration care. in the health committee bill, a government entity is going to be created to conduct this research and nothing prohibits that entity from denying care based upon the -- based upon rationing. the same plan is being talked about in the finance committee. a private entity is organized. there is nothing that would prevent the private entity or the federal government from rationing care that his research by the private entity. the health committee creates what it calls the agency for
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health care, research, and quality in the department of health and human services. in neither case is the federal government prohibited from using this comparative effectiveness research. in addition to that, and the health committee bill establishes what is called a medical advisory council. the medical advisory council is specifically given very broad authority to make work -- recommendations on health benefits cover. what is covered by the federal government. insurance companies frequently employed -- apply those same kinds of rules. you do not want the government making decisions about how much health care or what health care you would have. another point that i have tried to make to folks that if they think that the federal government is not considering this, think about what some
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people have said in the federal government about allocating treatment based upon cost. no less than the director of the national institutes of health. he announced that the nih could use the stimulus money, the money in the stimulus bill that pays for the comparative effectiveness research to ration care, and just as is done in other countries. the nih released a list of research topics. it called for the rigorous cost- effective analysis. cost effectiveness research will provide accurate and effective information to guide future policies that would allocate the rationalist -- the allocation of resources. that is a euphemism for
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rationing health care. the president himself has talked about this, not in those specific terms, but in a recent interview he said, what i think the government can do effectively is be an honest broker and assessing treatment options. if it the government is going to be a broker in treatment options, that is a euphemism of deciding what it will and will not pay for. what you can get and what you cannot. a former u.s. senator and at one point candidate for hhs secretary talked about this. he and knowledge that doctors and patients might resent any encroachment on their ability to use the treatments. he called for the same kind of body in his book that would allocate treatments based upon this kind of cost research. there are many other steps have spoken about it as well.
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this the sun go down so well in countries that have tried it like great britain and canada. i will quote one other individual that has talked about this. a professor at the harvard business school said that the comparative effectiveness stimulus -- a fact of this research and the stimulus bill could morph into an instrument of health care rationing by the federal government. there are comparisons to what is being done in great britain, other european countries, and canada at a time when those countries are turning away from the federal monopoly or the national monopoly because of the fact that it has resulted in a rationing of care that the citizens of those countries do not like at all. the former head of the american medical association, which has endorsed our legislation said
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this in the chicago tribune today. he is talking about the british agency. it is the national institutes -- i will get it in just a moment. the agency that makes these decisions in the united kingdom determine that we are all worth it 2000 -- $22,750 for six months of life or $125 a day. $125 is the cost of a nice day with my wife, not the value of pilot -- nice with my wife, not the value of life. the value that they're going to place on the life for the purpose of comparing the cost to see whether the cost of the
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treatment outweighs the value of the life. and think about that. let me quote from the nuys webb said. national institute for collette -- clinical health and excellent. here is what it says. with the rapid advances of modern mersenne -- medicine, most people except that no publicly funded health care system can possibly pay for every new medical treatment which becomes available. if that is right. if the federal government has a monopoly, it probably does not have enough money to pay for every treatment available. the enormous costs involved means that choices have to be made. that is why they ration care and great britain. the quantitative a just and life helps us measure these factors of that we can compare different treatments for the same condition. it gives us an idea of how much
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-- how many extra years of life that a person may gain because of the treatment. each drug is considered on a case by case basis. if the treatment costs more than 30,000 pounds per quality adjusted life year, then it will not be considered cost-effective and they do not give it to you. we have many, many examples of people in great britain that are denied care because the government has decided that the cost of the treatment is more than your quality object -- suggested life here. this is adjusted for age. the older you get, even though the treatment may cost less, if you are less likely to get it because of your age. think about that. if something costs $20,000 in united states and you are 65 years of age and they decide they cannot afford to pay for it, is that what the united
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states of america is all about? should the government have the right to say that based upon the research that we have done, you cannot have that treatment? if you say that that cannot happen in the united states, i say that it can. it is happening in great britain and canada. what is the harm in adopting our legislation? that is the question that i would ask with anyone who says that it is not necessary. what harm does it do to say that this research cannot be used by the federal government to deny or delayed treatment? i hope that my colleagues will appreciate that healthcare is the most important thing to all of us for our families. whatever else we may think needs to be done to reform health care, where we can agree on is that it should not result in rationing of health care for americans. our legislation is one step in that process. it does not preclude rationing of health care in other ways.
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it says that you cannot use comparative effectiveness research in order to ration care. i hope that our colleagues would view this legislation as an important step that we can take. let me give you a couple of examples that i said i could provide. there is a fellow by the name of fernandez who was a kidney patient in britain. he was given two months to live with the cancer spread to his lungs. his doctor wanted to prescribe him a new drug for kidney cancer. the british government said no. he and thousands of other patients protested the government's decision. the government ultimately reversed its decision. fortunately, he was able to begin taking the drug. the british authorities knew that this was not the end. more life extending drugs would become available. patients would demand access to
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the drugs. the government would be faced with increasingly difficult decisions. faced with finite resources, the authorities decided that expensive drugs would only be approved under very specific conditions. they must extend life by at least three months and they must be used for ... that affect less than 7000 patients a year. is that what we want in the united states? before you can get a drug that would give you a better quality of life, the government is going to run through tests like this? if it does not meet the tests, you cannot get the drug? at this is the danger of a government-run system. we do not want that in america. i hope that we can all agreed that one of the things we can do to prevent this rationing is to have the say that we are going to do no harm. we're not going to allow this
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comparative effectiveness research to deny our care. i will ask unanimous consent to put in the record a lengthier statement and also the op-ed in the "chicago tribune" which i quoted from earlier. >> without objection. >> i just wanted to conclude by mentioning a couple of things. we have actually seen the danger in using this kind of research for rationing of care in another context. when we created the medicare part d, which provides drugs to seniors, we saw the danger of rationing of drugs. we specifically provided in the medicare modernization act,
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which provided for the benefit, an explicit provision that says that you cannot use cost- effective analysis to allocate the drugs. it is prohibited there. we should take the same policy and apply it to the rest of our health care. two seniors who are on medicare and to the rest of the population. the federal government will be able to dictate its care. we have not provided that same protection for any other carrier in the country. that is what air legislation that would do. mr. president, the final thing i would like to discuss is the notion that we could have a government-run insurance plan and that somehow that would be helpful for americans. stop and think for a moment. a government auction would be
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the federal government making decisions about care. well you may decide that it is a lot cheaper because the federal government can subsidize the insurance plan, the government will be deciding what kind of coverage you get. this is one of the areas we are concerned about in using this comparative effectiveness research. the so-called public auction in order to keep costs down could end up rationing care. that is ok if it is merely an option. even if it is cheaper, i do not want this. if a health-care consulting group says that unfortunately, because private employers are likely to dump their employees into the government run system, about two-thirds of the people that have insurance today, 119 million people, which end up with the government-run plant rather than the private insurance they have today.
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when the president says, if you like your insurance coverage, if you get to keep it, i hope he means that we would not do anything in our legislation to make that more difficult for you. if the predictions of consulting groups come true, what will happen is that employers, faced with a situation where it is much cheaper to insure their employees to this government-run program will take 119 million people, transfer them from private insurance to government insurance. at that point, you do not have any option. it is not like an option for you unless you want to change jobs to an employer who is willing to maintain the coverage. those are going to be few and far between. the same thing is true with the individual health-care market. the bottom line is that when people say that if you like your
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coverage, you will be able to keep it, that is not really true. under the bill written by the finance committee, that is not true either. even though you may like the insurance you have today and say that the federal government cannot tell me what care i get, it will not be too much longer before that will not be true. if you will have the government insurance and it will tell me what kind of care it can give you. when we talk about the fact that we are eager for adults reform, we're talking about people being able to keep their current coverage. it is portable when you leave one job and go to another job. to make sure that you cannot be denied care because you have a pre-existing condition. if you need financial help to find a way of providing the financial help, we believe that those are better solutions to making sure that everyone is insured and providing a public auction.
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it is a little bit like the government taking over general motors. it is one thing if the people running general motors make a mistake. it is usually not going to be a life or death situation. it is a whole new ball game if the government decides that you cannot get a particular it kind of drug or is surgery that a doctor says that you need. the government says that washington-run health care has significant dangers in it. more than if we would run the insurance companies or the car companies or the banks. if you have a medical advisory council as the health committee legislation provides for a national institute for health and clinical excellence, as in great britain, it is anything but nice to win your health care is tonight to you. -- anything but nice when your health care is the night to you. -- denie to you.
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the government says that you cannot have a certain device for treatment that you need because they use this research to say that in your case, you are not going to live much longer anyway. it is not cost-effective for us to buy it for you. that is not the american way. it is ironic that countries like canada and great britain are starting to provide private alternatives. they know that they cannot take care of all of their citizens. there is a revolt going on of people who not -- cannot get all of the care that they need. their safety valve is to have the private sector provide some of this coverage. why would we want to replicate their mistake in health care reform? there are easier, less costly, and less harmful ways to do that then the legislation that is being proposed that would allow research to ration your
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care. i hope my colleagues would take a look at the legislation. if it would like to co-sponsor it, we'd like to have support. when this issue arises or we could get this to the floor, i would like my colleagues to send it very strong message. comparative effectiveness research is great. it is not good if it is used to ration care to the american people. we have to put a stop to that right now in it -- and our legislation would do that. gentlewoman from north carolina rise? ms. foxx: permission to speak to the house for one minute, mr. speaker. the speaker pro tempore: proceed, without objection. ms. foxx: thank you, mr. ms. foxx: thank you, mr. speaker. the health-care debate has begun across the country. this will make the problem
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worse. when democrats talk about health care reform, what they really mean is a government takeover of health care. with few details available, some suggest that the plan for this government takeover will cost upwards of $1.20 trillion. all of this new federal spending will still not fixed the crux of our health-care dilemma. the american people deserve a plan that makes health care more affordable and accessible to all and allows those who like their current health care coverage to keep it. all democrats support raising taxes and rationing care, the republicans want to ensure that patients and doctors make health-care decisions, not a bunch of bureaucrats in washington. i yield back. >> for what purpose does the gentleman from south carolina rise? without objection.
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>> president obama and his democratic allies in congress have said that they want those who currently like their health care plan to keep it. then they publicly endorse a government-run health care insurance plan that would crowd out and eliminate the private insurance plans and that millions of americans currently enjoy. they cannot have it both ways. the proposals plan to increase access and affordability by letting the government determine what will and will not be paid for. as the only game in town, a government insurance plan would be the sole provider of the quality of health care available. conversely, republicans have long argued that health-care reform should focus on expanding access so more americans can afford a higher quality of care. we should be focused on a long and more individuals to afford the health care that they want. if congress chooses to have a
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new government-run insurance plan, it would undermine the doctor, a patient relationship that is the foundation of government health care. we will never forget september 11 and the global war on terrorism. >> if you are a democrat, you will emphasize the public park. if you're a republican, you will emphasize the government-run part of it. you believe that this is going to drive out private insurers and leave the government in charge of the health-care industry as the sole provider. that is what it is going to boil down to in terms of anything that will or will not get
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bipartisan support. >> you wrote about one element of the emerging plan that is kent conrad ' alternative to a system run by the government. how would that work? >> it remains to be seen exactly. the senate bridge -- there is supposed to be a bridge for the plan. instead of a public plan like a government run insurance co., is essentially what the public plan would be. he is offering to help create cooperatives that are similar to credit unions. they have some rules that make it a lot easier for customers to deal with and make it more price conscious. they do not have the same business pressures as private companies in terms of profit making. they are not government entities, and would be much more fair and how they competed with
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private insurance companies. that is what these medical cooperatives would be theoretically. some democrats were willing to take a look at that idea. they were trying to decide how the government would run the cooperatives themselves, which are causing republicans to say that is just like having a government-run private plan. even if you call it a cooperative. we are not interested. the -- >> president obama address the public insurance option to the american medical association. at what was his message there? >> he has no interest in socializing american health care industry. he does not want to move people who like their insurance and doctors and insurance company. they can go to the same doctors
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