[Pages S4342-S4345]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

Healthcare

Mr. GRASSLEY. Mr. President, I am committed to lowering healthcare
costs, expanding access to high-quality care, and supporting research
and innovation. The healthcare system in the United States needs more
reform and accountability. However, we shouldn't ruin it by turning it
into a government-run healthcare system, whether you want to call it
government-run healthcare system, Medicare for All, or single payer, or
even socialized medicine.
A government-run healthcare system is a one-size-fits-all approach.
It results in longer wait times, delayed care, and do-it-yourself
healthcare because you cannot access a doctor.
In February, the Wall Street Journal highlighted the failure of the
United Kingdom's National Health Service, NHS for short.
They wrote:

Now, the state-funded service is falling apart. People who
suffer heart attacks or strokes wait more than 1\1/2\ hours
on average for an ambulance. Hospitals are so full that they
are turning patients away. A record 7.1 million people in
England--more than one in 10--are stuck on waiting lists for
nonemergency hospital treatment like hip replacements.

But I want to quote from the article of the Wall Street Journal,
another one:

Delays in treating people are causing the premature deaths
of 300 to 500 people a week. One in five British people were
waiting for a medical appointment or treatment by NHS in
December.

If you didn't find that article about the United Kingdom alarming, in
May, British Columbia announced that they are sending cancer patients
to Bellingham, WA, in the United States, for treatment.
A Canadian news outlet wrote this:

Health Minister Adrian Dix announced . . . that eligible
breast and prostate cancer patients will be sent to one of
two clinics in Bellingham for radiation treatment. . . . The
unprecedented move to send thousands of [British Columbia]
patients to the [United

[[Page S4343]]

States] over the next two years is an attempt to address the
backlog in [British Columbia] which has one of the longest
waits for radiation treatment in Canada.

Canada is taking this action because its cancer patients face
unacceptable waiting times. Currently, only 82.9 percent of the British
cancer patients who require radiation start treatment within 28 days.
That means that 17 percent of cancer patients are waiting at least a
month or longer to start cancer treatment.
Canada's single-payer healthcare problems aren't found in just one
province. In January, the Wall Street Journal reported that Ontario is
turning to private healthcare options to fix the growing problem with
its single-payer-funded healthcare system. Canada's most populous
province is allowing more patients to go to private treatment centers
for cataracts and joint replacement surgeries and for services such as
MRIs and CT scans.
The Wall Street Journal writes:

[T]he median wait time in Canada last year between referral
and treatment was between 27.4 weeks, the longest on record,
compared with 9.3 weeks in 1993. Ontario reported the
shortest wait times of 20.3 weeks, while the eastern province
of Prince Edward Island reported the longest at 64.7 weeks.

And, finally, back to Great Britain, a YouGov poll recently found
that Britons are ``pulling their teeth out with pliers'' because they
can't access the National Healthcare Service dentists. The poll found
10 percent of the respondents had attempted do-it-yourself dentistry.
I am committed to improving the healthcare system. I am working to
lower the cost of prescription drugs, maintain access to rural
healthcare, ensure our Nation's seniors can have high-quality,
affordable hearing aids, address high maternal mortality rates, and,
lastly, improve the healthcare delivery systems for kids with complex
medical needs. And that is just to name a few.
However, a government-run healthcare system is not the answer.
British and Canadian healthcare systems are plagued by longer and
longer wait times and delayed care. These government-run healthcare
systems are paying for patients to get care in the United States, not
resorting to DIY healthcare. This body needs to be reminded how
government-run healthcare systems are broken and do not work.
In closing, I ask unanimous consent that the articles I referred to
in my remarks be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

Senator Grassley Floor Remarks--More Examples of Socialized Health
Systems Failing Patients

[From the Wall Street Journal, Feb. 6, 2023]

The U.K.'s Government-Run Healthcare Service Is in Crisis

(By David Luhnow and Max Colchester)

For more than a decade, the British government has run its
National Health Service, the world's largest government-run
healthcare system, on a tight budget. The NHS prided itself
on being one of the leanest healthcare systems in the
developed world, spending less per head on average than its
large European neighbors--and far less than the U.S.
Now the state-funded service is falling apart. People who
suffer heart attacks or strokes wait more than 1\1/2\ hours
on average for an ambulance. Hospitals are so full they are
turning patients away. A record 7.1 million people in
England--more than one in 10 people--are stuck on waiting
lists for nonemergency hospital treatment like hip
replacements. The NHS on Monday faced the biggest strike in
its history, with thousands of paramedics and nurses walking
out over pay.
The NHS's woes are an extreme example of issues playing out
across the developed world. Healthcare systems, hit hard by
Covid, are under pressure as people live longer and have a
wider range of treatment options. Aging populations mean
costs will keep growing. The U.K.'s experience is a warning
of what happens when supply in healthcare provision can't
keep up with demand.
``The healthcare system in the U.K. is facing a crisis like
no other I have seen in my career,'' said Nigel Edwards, the
retiring chief executive of the Nuffield Trust, a healthcare
think tank, and former chief executive for the NHS. ``The
U.K. has mistaken cheapness for efficiency in its approach to
health, and it's coming home to roost.''
The NHS has lost thousands of hospital beds in the past
decade in its drive for efficiency. Covid delayed treatments
for patients, resulting in a vast waiting list. Hospitals in
England were already at 98% capacity in December when the
brutal flu season began to take hold. The mass of sick
patients gummed up the system to devastating effect.
Delays in treating people are causing the premature deaths
of 300 to 500 people a week, according to estimates from the
Royal College of Emergency Medicine, a professional
association in London. One in five British people were
waiting for a medical appointment or treatment by the NHS in
December, according to the U.K. Office for National
Statistics (ONS).
The NHS said those excess death figures are likely too high
but acknowledged delays are costing lives. In late January,
the U.K. government announced funding to provide more
ambulances, call handlers and 1,000 extra hospital beds to
relieve the strain on the health system.
Fixing the service will take time, said NHS chief executive
Amanda. Pritchard. The NHS said that over the next year it
aims to cut the average time a heart attack sufferer waits
for an ambulance to 30 minutes.
``No one should be waiting longer than necessary for
treatment,'' said Will Quince, a minister of state for
health, adding that the government is spending up to $17
billion over the next two years to address issues facing the
NHS and social care services.
Just before 5 p.m. on Nov. 18, the family of Martin Clark
called 999, the U.K. equivalent of 911, after the 68-year-old
father of five began having chest pains. After waiting half
an hour, the family said, they called again and pleaded for
an ambulance, saying Mr. Clark's condition was getting worse.
In another call 15 minutes later, they told the dispatcher
they were going to drive him to hospital themselves,
according to the family, even though the dispatcher
encouraged them to wait for the paramedics.
Twenty minutes after the family had left for the hospital,
the dispatcher left a voice mail to say the service still
didn't have an ambulance to send. Mr. Clark died shortly
after arriving at the hospital.
About a week later, 5-year-old Yusuf Mahmud Nazir died from
what began as a throat infection. His family said they had
taken the boy, who was having trouble breathing, to the
emergency room at their local hospital in Rotherham, which
gave him some antibiotic pills after a six-hour wait and sent
him home. The family said it pleaded with the hospital a few
days later to let Yusuf be admitted and given further tests,
but were told the hospital was full.
By the time the family got Yusuf by ambulance to another
hospital, he had severe pneumonia. He died days later from
organ failure and cardiac arrest.
``They killed Yusuf--it's as simple as that,'' said Yusufs
uncle, Zaheer Ahmed, who accompanied the boy's family at the
hospital. ``A 5-year-old boy has died of tonsillitis in a
rich, industrialized country. It shows the entire system has
serious issues.''
The Rotherham hospital said in a public statement it had
met with the family, apologized and launched an independent
investigation into what happened. It declined to comment
further.
Almost every day, media reports allege new horror stories:
An 83-year-old woman in Leicester with a suspected stroke
waited more than 18 hours in a makeshift tent outside a
hospital emergency room. A 90-year-old woman with suspected
sepsis waited three days. A man in Wales with diabetes lost
his toe after it turned blue and then black after he sat
waiting for treatment for three days.
The NHS is Europe's biggest employer, with around 1.2
million staffers, and has a budget this year of about $188.6
billion, funded through taxes. It now has 2.9 doctors per
1,000 people, compared with a European average of 3.7. The
U.S. has slightly less, at about 2.6 doctors per 1,000,
according to the Organization for Economic Cooperation and
Development.
Aging populations will add to the demand. The elderly
consume between three and five times the amount of healthcare
compared with younger people, according to an estimate by the
OECD. The number of people in the U.K. aged 85 and above is
expected to double to more than 3 million by 2041. The U.K.'s
current population is around 67 million.
Until 2010, governments of all political stripes kept
funding for the NHS growing faster than both population
growth and inflation--with annual increases from 2% to nearly
6% per capita, adjusted for inflation. But from 2010 to 2020,
per capita, inflation-adjusted funding declined very
slightly.
The Conservative government has sharply increased funds to
the NHS since 2020, but most of the money has gone toward the
pandemic, including for vaccines. Inflation is now eating
away at about half the additional yearly funding. Overall,
the inflation-adjusted increase in funding amounts to a 2.9
yearly increase, still below the historic average of 3.4%,
according to the Institute for Fiscal Studies think tank in
London.
Healthcare expenditures, both public and private, amounted
to around 11.9% of the U.K.'s gross domestic product in 2021,
according to the ONS. That compares with 18.3% of GDP in the
U.S. that year, according to government data.
For the first time since the Industrial Revolution,
Britain's ill health is acting as a brake on economic growth,
said Andy Haldane, a former chief economist at the Bank of
England. The growing number of sick people is exacerbating a
productivity crisis within the British economy, he said. The
number of long-term ill people in the U.K. has shot up by
half a million in the past two

[[Page S4344]]

years, to a record 2.5 million, something economists say is
due in part to the NHS's inability to quickly treat sick
people.
The NHS was created after World War II to offer free
healthcare to a war-hit population. Every hospital was
effectively nationalized and put under government direction.
It was a more sweeping overhaul than in any European country.
Some countries, such as Denmark, adopted a similar system,
while others have varying degrees of private care and
publicly funded insurance.
The NHS has long been a point of pride for many Britons,
who have generally received quality care and can simply walk
out of hospital, without paying a bill. Yet seven in 10 now
describe the NHS service as bad, compared with 21% who
describe it as good, according to a YouGov poll.
People can pay to access private healthcare in the U.K.,
and according to the ONS, one in eight adults in Britain said
they paid for private healthcare in the past year because NHS
waiting lists were too long. Several private healthcare
providers have reported a jump in demand.
Still, the overwhelming majority continue to support the
NHS's basic model of a government-run system. Just 3% said
they wanted the system totally privatized, according to the
YouGov poll.
The government started constraining the NHS's budget in
2010, at the same time it launched an effort to make the
system more efficient, such as adding more internal
competition between different parts of the NHS for government
funds.
These changes proved a distraction for management, former
and current officials say. As part of the drive for
efficiency, NHS managers were pressured to keep bed vacancies
low. Recruiting and training was given less priority, and
salaries for doctors and nurses steadily fell behind
inflation.
When the pandemic hit in early 2020, the NHS's centralized
system helped it weather the crisis. The service delayed non-
urgent treatments, and successfully rolled out a mass
vaccination program.
The ripple effects are being felt now. By December, a total
of 401,537 people in England were waiting more than a year
for hospital treatment. The total was 1,613 just before the
pandemic.
Struggles in the U.K.'s elderly care system, which has
major staff shortages and is funded separately from the NHS,
has also meant that many patients who would normally be
looked after at home or in a retirement home instead
languished in hospital wards.
In December, an average of 13,439 beds a day in England out
of the roughly 100,000 available were taken up by elderly
patients medically fit for discharge--up almost a third from
the previous year, according to the NHS.
The lack of space at hospitals this winter, when the flu
began to take hold, had a cascading effect. Ambulances began
to form lines outside of hospitals, waiting to discharge
patients because of a lack of free beds. That delayed the
time it took for ambulances to attend to other people in
need.
By this winter, half of all patients in an emergency ward
waited four hours or more to be seen by a doctor, and a
further four hours on average to get a bed, according to NHS
data.
A study of more than 5 million patients published in early
2022 by the U.K.'s top medical journal, the BMJ, found that
for every 82 people forced to wait beyond four hours for
emergency care, one additional person died who otherwise
would not have. The longer the wait, the worse the outcomes.
``Every day, I wake up thinking, how much harm is going to
occur to patients that we are responsible for,'' said Simon
Walsh, head of emergency-room services at a London hospital.
``It's not if harm is going to occur, it's how much.''
The stress of the pandemic and funding squeeze is
exacerbating a staffing crisis in the U.K. As of September
last year, there were 133,000 staff vacancies in the NHS,
compared with 83,000 before the pandemic, according to
government data.
The average fully qualified family doctor in England is now
responsible for 2,300 patients on average, compared with
2,100 in 2018, according to government statistics. Average
pay has fallen by more than a third since 2008, adjusted for
inflation, according to the British Medical Association, a
union for doctors. The number of doctors who are retiring
early has tripled in the past 13 years.
While the overall numbers of nurses have remained stable,
turnover has grown. From mid-2021 to mid-2022, more than
34,000 nurses left their role in the NHS, an increase of 25%
from the previous year, according to the King's Fund, a
healthcare think tank.
Demands for increases in spending are coming up against
economic pressures. The Bank of England projects the U.K.'s
economy will shrink this year, potentially lowering tax
revenues. And as changes in demographics and medical
technology continue to weigh on the NHS, everhigher funding
risks crowding out state spending in other areas, such as
education and infrastructure.
Money alone may not solve the problem, some in the industry
warn. In Wales, the regional government has for most years
since 2000 spent more money per capita than any region in the
U.K. Yet nearly every indicator from waiting times to health
outcomes are still worse. One explanation: Wales is both
poorer and has the oldest population in the U.K.
Focus is turning to whether the system needs to be
revamped. In Scotland, which runs its own NHS, officials have
discussed ideas including further rationing of care or having
wealthier residents pay for care in order to fund free care
for the rest--an option that officials say was discarded.
One former U.K. health secretary recently said patients
should pay to see a doctor. The idea was quickly dismissed by
the government.
Just over a year ago, Akshay Patel, an IT professional in
northern England, made five calls to 999 when his mother,
Bina Patel, developed breathing problems. Initially the call
handler told him an ambulance would be there soon, Mr. Patel
said. His mother's health quickly worsened and she became too
sick to be loaded into a car. He watched his distressed 56-
year-old mother gradually go pale and die. The paramedics
arrived after an hour and were unable to resuscitate her. The
local hospital was a 2-minute drive away.
``We always believe that the NHS exists for us when we're
in need,'' said Mr. Patel. ``But personally if I had to call
an ambulance. I wouldn't. I don't trust them. I can't.''
____

[From the Wall Street Journal, Jan. 21, 2023]

Canada Pursues Private Options To Ease Healthcare Backlogs

(By Vipal Monga)

Toronto.--Ontario is the latest Canadian province that is
turning to private healthcare options in a bid to fix growing
problems with the publicly funded healthcare system.
Canada's most-populous province this past week outlined a
plan to allow more patients to go to private treatment
centers for cataract and joint-replacement surgeries as well
as for services such as MRIs or CT scans. The province will
invest more than 18 million Canadian dollars, equivalent to
$13.4 million, in the private facilities to increase their
capacity.
Ontario Premier Doug Ford said the moves would reduce the
backlog of 206,000 surgeries in the province and free up
public hospitals to concentrate on more-complicated
procedures. Patients wouldn't pay out of pocket, and the
treatments would be covered by the provincial insurance plan,
said Mr. Ford.
British Columbia, Alberta, Saskatchewan and Quebec have all
in recent years increased the role of private clinics in
their provinces.
Health authorities across Canada have been grappling with
long wait times in emergency rooms, backlogs for surgeries
and shortages of doctors and nurses.
According to the Fraser Institute, a public-policy think
tank, the median wait time in Canada last year between
referral and treatment was 27.4 weeks, the longest on record,
compared with 9.3 weeks in 1993. Ontario reported the
shortest wait time of 20.3 weeks, while the eastern province
of Prince Edward Island reported the longest at 64.7 weeks.
Former government officials have been calling for a rethink
of the way the Canadian system has been structured.
Bill Morneau, former finance minister under Prime Minister
Justin Trudeau, said in a memoir published this past week
that Canada needed to change a system that costs the country
an amount equal to roughly 13% of gross domestic product.
Peter Nicholson, who advised then-Prime Minister Paul
Martin in the early 2000s, said in a policy paper earlier
this month that Canada should look to countries such as
Australia, Germany and Norway, which have used private
healthcare to improve their systems.
Canada's healthcare system is run separately by each
province.
In Ontario, healthcare unions have said Mr. Ford's plan
would enrich the private providers at the expense of the
public hospitals and create a system in which wealthy
residents get better services and treatment. Mr. Ford's
government has said that residents wouldn't have to pay for
procedures covered by the provincial insurance plan, but the
private clinics would be able to sell patients more-expensive
products not covered by the insurance.
Sharleen Stewart, president of SEIU Healthcare, which
represents 60,000 Canadian healthcare workers, said the plan
risks starving public hospitals of resources and siphoning
doctors and nurses into private clinics, which could worsen
outcomes for more-complex surgeries and deepen an already-
acute healthcare labor shortage. ``It will be a two-tiered
system,'' she said.
Job vacancies in healthcare and social services rose to a
record high of about 150,100 in the third quarter of last
year as demand for nurses surged, according to Statistics
Canada. The Canadian healthcare system could be short 44,000
doctors by 2028, according to government projections.
Mr. Ford said his plan is meant to deal with the lingering
impact of the Covid-19 pandemic, which caused delays for
patients who needed treatment for nonpriority conditions or
wanted to have tests done. Hospital wait times have surged
since 2020. Patients in Ontario spent an average of 22.9
hours in an emergency department before being admitted to a
hospital in October, the longest average wait time on record,
according to provincial data.
There are roughly 900 private clinics in Ontario, most of
which only do diagnostic testing; 10 private clinics are
licensed to perform surgeries. More would open under the
government's plan.
During his announcement, Mr. Ford dismissed the concerns
about how treatments

[[Page S4345]]

are delivered. He said something must be done quickly to
reduce the backlog of surgeries in the province. ``A lot of
people out there, they want to have the endless debates about
who should provide care,'' Mr. Ford said. ``All our
government cares about is that you get the care you need
quickly and safely.''
Other supporters said that the plan could provide patients
with more options, give them greater access to timely care
and relieve stress on a system that has begun to buckle.
``We need to be more effective at deploying resources we
currently have,'' said Allan O'Dette, chief executive of the
Ontario Medical Association, a group that represents 43,000
doctors and medical students and that supports Ontario's
plan. ``Noncomplicated, low-acuity surgeries can easily be
done outside a hospital setting.''
____

[From the Vancouver Sun, May 16, 2023]

Sending B.C. Cancer Patients to Bellingham for Treatment `a Sad State
of Reality,' Critics Say

(By Katie DeRosa)

Quote from the article: ``While the decision by the
province to send breast cancer and prostate cancer patients
to the U.S. for faster radiation treatment is being welcomed
by some, critics say it's an indictment of a flagging health
care system that has not kept up with demand. Health Minister
Adrian Dix announced Monday that eligible breast and prostate
cancer patients will be sent to one of two clinics in
Bellingham for radiation treatment, starting May 29. The
unprecedented move to send thousands of B.C. patients to the
U.S. over the next two years is an attempt to address the
backlog in B.C. which has one of the longest waits for
radiation treatment in Canada.''
Quote from the article: ``Dix acknowledged cancer patients
face unacceptable waiting times which is why the province
opted to strike a deal with the clinics in Washington state.
Currently, 82.9 per cent of B.C. cancer patients who require
radiation start treatment within 28 days, Dix said. That's
well below the national average of 97 per cent, according to
figures compiled by the Canadian Institute for Health
Information. ``We want to be at 95 to 100 per cent within 28
days,'' he said. The percentage of British Columbians
receiving timely radiation has steadily declined, down from
93 per cent in 2019. Dix in February announced the government
will spend $440 million over the next 10 years to reduce the
waiting times for cancer treatment. Some of that money will
boost wages for radiation technologists and oncologists as
part of the recruitment drive, Dix said. The province is also
trying to acquire more linear accelerators, a specialized
piece of equipment which delivers external beam radiation
therapy to target and shrink cancer cells. Radiation therapy
is different from chemotherapy, which uses special drugs to
kill the cancer cells. More than 30,000 people in B.C. were
diagnosed with cancer in 2021 and B.C. Cancer projects that
number could rise to 45,000 by 2034. About half of cancer
patients need radiation treatment.''
The article continues at: <a href='https://vancouversun.com/news/
local-news/critics-upset-that-b-c-has-to-send-cancer-
patients-to-bellingham-for-treatment?mc_cid=4baf8999cb&mc
_eid=3337eaf99e'>https://vancouversun.com/news/
local-news/critics-upset-that-b-c-has-to-send-cancer-
patients-to-bellingham-for-treatment?mc_cid=4baf8999cb&mc
_eid=3337eaf99e</a>.
____

[From Sky News, July 14, 2023]

Britons Are `Pulling Their Own Teeth Out With Pliers' Because They
Can't Access NHS Dentists

Quote from the article: A YouGov poll which spoke to more
than 2,000 people found more than 10% of people had attempted
``DIY dentistry''--with more than half of those having
carried it out in the last year. People across the UK have
had to pull their own teeth out because they can't access or
afford an NHS dentist, a report suggests. Extractions have
been performed with pliers in some cases, while others have
been forced to make a five-hour round trip to see a
professional. The Health and Social Care Committee says
``urgent and fundamental reform'' is needed--and there is
evidence of pain and distress that is ``totally unacceptable
in the 21st century''. Its report includes figures from a
YouGov poll performed in March 2023 that found 10% of
respondents had attempted ``DIY dentistry''--and of those,
20% did so because they couldn't find an NHS dentist.''
The article continues at: <a href='https://news.sky.com/story/
britons-are-pulling-their-own-teeth-out-with-pliers-because-
they-cant-access-nhs-dentists-12920715#'>https://news.sky.com/story/
britons-are-pulling-their-own-teeth-out-with-pliers-because-
they-cant-access-nhs-dentists-12920715#</a>:g807-
:text=People%20across %20the%20UK%20have,trip%20to%20see
%20a%20professional.

Mr. GRASSLEY. I yield the floor.
The PRESIDING OFFICER. The Senator from Connecticut.