Remarks by U. S. Senator Tom Harkin (D-IA) to the American College of Preventative Medicine

REMARKS BY U.S. SENATOR TOM HARKIN (D-IA) TO THE AMERICAN COLLEGE OF PREVENTATIVE MEDICINE

Thank you, Dr. Harmon [ACPM president], for that kind introduction.

You know, the newspapers are full of stories about skyrocketing health care costs . . . rising rates of obesity . . . out-of-control Medicare and Medicaid costs, and on and on. But is it any wonder we are in this mess? Let's face it, in America today we don't have a health care system, we have a sick care system. We wait until people become obese, develop chronic diseases, or become disabled - and then we spend untold hundreds of billions annually to try to make them better.

And that's why I have looked forward so much to meeting with you this morning: Because you people "get it." You understand that, in America, we need to fundamentally redirect our focus toward wellness, disease prevention, exercise, good nutrition, and staying out of the hospital in the first place.

But, so often here in Washington, when I advocate this position, I run into a brick wall. In federal health care programs, virtually all the priorities and incentives - and most of the interest groups -- are slanted toward treating people after they get sick.

Case in point: The Administration recently proposed spending more than $3 billion a year implanting cardiac defibrillators into Medicare patients. Yes, this is amazing technology. It's a good thing to make this procedure available. But imagine if I proposed spending $3 billion a year on walking and bike paths, smoking cessation programs, diet and nutrition counseling, and other things to prevent heart disease! Most of my colleagues in Congress would say, "Harkin, that's just pie in the sky."

Well, it's not pie in the sky. It's down-to-earth common sense. America's health care system is in crisis precisely because we systematically neglect wellness and prevention. I mean, just look at the newspaper:

* The Washington Post recently reported that the Bush administration is considering getting rid of the tax deduction for employer-provided health insurance. The administration's reasoning is that if more people are paying their own health-insurance costs, they'll choose low-option plans, and they'll forego discretionary medical services - you know, things like annual physicals and cancer screenings.

* Another story not long ago noted that Ontario this year surpassed Michigan as the largest producer of automobiles in North America. Why did this happen? A big reason is that Canada is attractive to automakers because of its nationalized health care system. By contrast General Motors in the U.S. spends roughly $1,500 per vehicle on health care costs.

* And one more recent story: The Hardee's fast-food chain recently unveiled its new Monster Thickburger. This death-defying sandwich consists of two one-third-pound slabs of beef, four strips of bacon, three slices of cheese, and mayonnaise on a buttered sesame-seed bun. What the menu at Hardee's does not tell you is that the Monster Thickburger clocks in at 1,400 calories and 107 grams of fat.

Now, these are just three unrelated stories. But they speak volumes about the mess we are in: Health care costs are out of control - hurting the competitiveness of American businesses, and driving up the number of people without insurance. Medicare and Medicaid costs are eating the federal budget alive. Restaurants are super-sizing their meals. Americans are super-sizing their bodies.

We can't go on like this. We are choking our economy. We are exploding the federal budget. And we are, literally, killing ourselves.

Consider the obesity epidemic. Some 65 percent of our population is now overweight or obese. Obesity now contributes to the death of more than 360,000 Americans a year. The incidence of childhood obesity is now at epidemic levels. Alarm bells are going off all over the place. But our government has done virtually nothing.

In fact, we are going backwards. Just look at the budget that President Bush proposed last week. As usual, it proposes hundreds of billions of spending on sick care - treating people after they get sick.

Meanwhile, the President proposes a 10 percent cut in funding for the Centers for Disease Control and Prevention, CDC - the one agency whose entire mission is wellness and prevention.

He proposes to zero-out funding for the preventive health block grant. This is a major source of funding for health promotion activities in the United States. And the White House wants to get rid of it.

The President also proposed that we eliminate funding for the VERB program This program, which is run by CDC, encourages young people ages 9-13 to be physically active every day. But the President wants to end it.

And one more thing: Medicare currently spends about $7 billion to reimburse teaching hospitals for programs that prepare doctors in various fields of specialization. One of the few specialties that do not receive funding is - you guessed it -- preventive medicine. I want to work with you to get rid of this restriction, so we can get more preventive doctors in the field!

You know, someone once defined insanity as doing the same old thing, over and over again, and expecting a different result. Well, our current health care approach is, by definition, insane. We continue to spend hundreds of billions on pills, surgery, treatments, and disability. We are cutting or eliminating programs designed to keep people fit and well - and out of the hospital. And we wonder why health care costs are skyrocketing.

The President is barnstorming the country, trying to persuade people that Social Security is going to go bankrupt. But let's put this in perspective. Over the next 75 years, the shortfall in Social Security is $3.7 trillion. Meanwhile, the shortfall in Medicare is estimated at $17 trillion. And the shortfall in the President's prescription drug program, alone, is $8.1 trillion.

And it's not only the federal budget that is being eaten alive by health care costs. It is also state budgets. It is family budgets. And it is corporate budgets.

Look at the numbers. Some 75 percent of health care costs in the United States are accounted for by chronic conditions and diseases - many of which are preventable. Last year, nationally, we spent more than $100 billion on obesity alone. Medicare and Medicaid picked up almost half of that tab.

This is unwise. It is uneconomic. And, as we now know, it is totally unsustainable. If we are going to control Medicare and Medicaid costs - and private-sector health care costs, as well -- we need a radical change of course. We need a fundamental paradigm shift toward preventing disease, promoting good nutrition, and encouraging fitness and wellness. This will be good for the physical health of the American people. And it will be good for the fiscal health of government, corporate, and family budgets.

Here, this morning, I'm preaching to the choir. And what's wrong with preaching to the choir? I like it. And the choir likes it. And when it comes to wellness and prevention, ACPM is not just any choir; you're like the Mormon Tabernacle Choir.

But in other quarters, there is fierce resistance to my message. The pushback, in a nutshell, goes like this: "We don't want a nanny government. Good health is a matter of individual responsibility."

Well, I believe strongly in personal responsibility. I believe that people should take charge of their own health. But I also believe in corporate responsibility, community responsibility, and government responsibility. And I make no bones about it: It is past time for the federal government to step up to the plate in a very robust way.

To that end, as many of you know, I have introduced the HeLP America Act, otherwise known as the Healthier Lifestyles and Prevention Act. This legislation takes a comprehensive approach to wellness and prevention. It provides tools and incentives to schools, employers, and communities. It aims to create better nutrition, physical activity and mental health opportunities for kids in schools. It gives the Federal Trade Commission authority to regulate unfair marketing to children. It provides incentives to build bike paths and safe sidewalks. It requires nutrition labeling on menus in chain restaurants. And it does much, much more.

As I said, the HeLP America Act is comprehensive. It is ambitious. And it is only at the beginning of a long legislative process. But I am confident that -- over time - we can build a bipartisan consensus to move the federal government in this direction.

We have already made progress. Several elements of the HeLP Act passed late last year. For example:

* We secured $440 million for research at the National Institutes of Health into the causes and cures of obesity.

* We got more than $50 million in grants to states to fund programs to address nutrition, physical activity, and obesity.

* We secured some $114 million for tobacco prevention and cessation activities at CDC.

* And we expanded the Fresh Fruit and Vegetable Program.

These are positive steps forward. But, to be honest, they are only baby steps. Meanwhile, powerful forces are mobilizing against me. For example, just last month, three giant food companies - General Mills, Kellogg, and Kraft Foods -- joined with the advertising industry to create a new lobbying group with one aim: to preserve their ability to advertise and market junk food to children with almost no restrictions.

So, my friends, I will not be coy about my reasons for speaking to you, this morning. Frankly, I need you. I appreciate you advocacy for preventive medicine back home in your communities, in academia, and with private businesses. But, today, I am appealing to ACPM as an organization . . . and to you as individuals . . . . to become even more outspoken in your advocacy here in Washington.

The College's members have tremendous expertise. As researchers and leaders in the health-promotion field, it is important for Senators and Representatives to hear your side of the story.

Frankly, I hope that the next time ACPM convenes here in Washington, you will include a legislative focus. What many associations do is this: They set aside an afternoon or morning for members to fan out on Capitol Hill and visit their members of Congress.

This would be a terrific opportunity for each of you to become advocates for wellness and prevention legislation. And if you want to speak up for my HeLP America Act, that will be just great!

So thank you my friends. Thank you for the important work that you do in preventive medicine - and for supporting my work in the Senate. Have a great conference. And next time you are in town, I look forward to seeing all of you up on Capitol Hill!

http://harkin.senate.gov/press/print-release.cfm?id=232291