June 17, 1971
Page 20447
A MEDICAL BILL OF RIGHTS
Mr. EAGLETON. Mr. President, on June 4, Senator MUSKIE and I introduced amendments to the health manpower legislation now pending in the Senate Committee on Labor and Public Welfare. At that time, Senator MUSKIE referred to the tasks that lay before us in improving our health care systems above and beyond the need for national health insurance. He especially spoke about revamping our health manpower system and development of new types of health maintenance operations – HMO's.
On Thursday, May 27, Senator MUSKIE gave a commencement address at the Albert Einstein College of Medicine, in New York City. At that time he most eloquently described the health care crisis before this Nation, and in great detail, spoke of the "medical rights" that must be established for all Americans.
I ask unanimous consent that the full text of that statement be printed in the RECORD, so that all Senators may have the benefit of his views on this question.
There being no objection, the statement was ordered to be printed in the RECORD, as follows:
A MEDICAL BILL OF RIGHTS
When politicians speak at college commencements in 1971, careful students raise their guard.
You wonder what we really have to say – and whether you should even try to listen. The world in your time has left you with a sure sense of skepticism about public men and political life.
A graduate of Einstein has seen too much in recent years to accept very much of the rhetoric he hears.
For as long as you have been in college, America has been in Indochina. Your generation has stood up for peace – and your protest has persuaded most of my generation to oppose the war. But still the fighting rages on – and still our free system fails to bend our policy to the will of our people.
For as long as you have been in medical school, you have witnessed in some neighborhoods of the Bronx the starkest evidence of man's inhumanity to man. You long ago heard the pledge of new priorities – but daily you encounter mothers without food, workers without work, and children hooked on heroin. Politicians have always made promises to the South Bronx – but they have seldom made progress for the families who live there.
Finally, for as long as you can remember, the stain of racial prejudice has mocked our claim to national equality. We have talked civil rights and supported civil rights and even proclaimed civil rights. But how would white Americans now answer President Kennedy's probing question: "Which of us would willingly trade places with a black man?"
So I understand whatever skepticism you bring to this ceremony today. I know that my words cannot erase your doubts. Only the deeds of government in the years ahead can restore your confidence and renew our country. But I think we can do what we must – and I think that we will. I think that ultimately America will turn from the tasks of death abroad to the tasks of life at home.
I cannot prove my conviction. But I ask you to share it – in spite of the wrong you have seen – and because of the right you have experienced. Your education alone is vital evidence of an ability to build justice here in America.
In 1954, Dr. Samuel Belkin founded Einstein, not only because New York City needed another high quality medical school, but because the nation needed another non-discriminatory medical school. His faith and the faith of his fellow founders can be reduced to a single, simple truth.
They believed that something better than bias should determine the chance to learn how to heal. They believed that general quotas could not measure individual qualifications. And they translated their belief into a place that is first rate in its profession and first rate in its principles.
In 1971, Einstein is a quietly eloquent testament to the good that Americans can create. And Einstein's remarkable record gives us reason to hope that our institutions can respond to our conscience and our social crisis.
Between 1958 and 1971, your medical school graduated only 15 blacks and Puerto Ricans. In 1974 alone, it will graduate 20. The difference is that Einstein is no longer waiting for minority applications. It is actively seeking them – and it is succeeding in its search. Your institution has done what some say no institution can do – it has adapted the practices of the past to the present and the future needs of people.
But Einstein's response has not been limited to serving the cause of racial justice. This new college has also discarded the old prejudice of the medical profession against women.
Twenty-nine of them become doctors here today – twenty-nine more than almost any medical school would have wanted or accepted only a few years ago. Their hands and brains will have lives – because Einstein has broken with an ancient tradition that was wrong from the beginning.
And now Einstein is pointing the way to further reform. In response to the shortage of doctors, it is increasing its enrollment and reducing its course of study. The result of the three-year program will be more doctors of equal competence trained in less time. And the result of that will be more health care for more Americans.
Anyone privileged to graduate from Einstein cannot be completely skeptical about institutions and their potential to advance the cause of compassion and decency. You should be proud to come from a medical school which is serving, not only your special profession, but our entire society. Its example is a lesson to take with you as you leave here today – a lesson equal to any you have learned – a lesson as important as anatomy or physiology or biochemistry. For you, like your college, have a social as well as a professional service to perform.
This morning you receive a piece of paper and swear a solemn oath that will permit you to cure the sickness of people. But the diploma and the oath will require something more from each of you – a constant commitment to cure the sickness of a medical care system which too often keeps doctors and the people who need doctors far apart. The technical name for the system is "health care delivery." The human reality behind the name is painfully visible everywhere in this city.
In the South Bronx, a young couple dips into their meager savings, not to send a son to school, but to bury their youngest child. It is no consolation for them to learn that their neighbors share their sorrow – that the rate of infant mortality in the South Bronx is double the rate of communities to the north.
In Brownsville, a seven-year-old is brought to an emergency room with stomach cramps from eating lead paint. After treatment, he is returned home to more hunger – and to a further risk of lead poisoning – a risk that each year becomes a reality for at least 900 children throughout New York City.
On the lower east side, a Spanish speaking mother takes her injured daughter to the hospital. After waiting around for seven hours, she is told in words she barely comprehends to return tomorrow. She does not know enough English to understand the explanation that there are not enough doctors. All she is left with is a worried night alone with her child.
And on Staten Island, a widow discovers that all the insurance and investments of years have been drained by the $30,000 bill for her husband's cancer treatments. She is discovering a hard fact of life and death in America – that sickness is often a financial as well as a physical catastrophe.
Multiply all these tragedies a hundred fold – reduce them to categories and numbers – and you will end up with the sad statistics of a failing health care system.
Between 1966 and 1980, the number of workers who cannot work due to illness will climb from 18 million to 21 million.
Seventy-five thousand newborn babies die in the United States each year.
The number of general practitioners has declined 35% since 1957 – and foreign physicians now constitute more than 25% of our nation's doctors.
One hundred and fifty counties across the country have absolutely no health professionals of any kind. In most central cities, the situation is as bad – or just a little better. In the Kenwood section of Chicago, there are only two physicians for 46,000 people.
The cost of medical care has skyrocketed to over $60 billion annually. At the same time, the health insurance industry has used its actuarial studies to exclude segment after segment of our society from access to medical protection. The poor are abandoned to uneven and often inhuman public health services. And the middle class is caught squarely in the middle – too well-off to qualify for government help – too pressured to help themselves with comprehensive insurance.
In the end, millions of Americans go without adequate medical care. They cannot afford it. They are afraid it will break them. Or they cannot find a doctor. Some of them die. Others are left destitute. And most of them fall victim to needless pain and needless suffering. They are your parents or mine – your children or mine – our friends and our fellow citizens.
The disaster we call medical services makes most Americans forgotten Americans. It betrays each of them and all of us. Our system of medical care is in fact a system of medical neglect. It is in the deepest sense un-American.
Despite our power and our strength, despite our trillion dollar G.N.P., we have let young people die before their time and old people die when there was some precious time left. How will history judge us, a country which was first in the wealth of its resources, but far from first in the health of its people? And more importantly, how will we judge ourselves in those quiet, inner moments, when we remember that what finally counts is not how much we have, but what we are?
It is time for us to do more until we have done enough to sustain and enhance the health of our nation.
Countless medical students and some doctors have already answered the call to a new kind of service. In the early 1960s, student health organizations from Los Angeles to Boston pioneered concepts for comprehensive health care. In the summer of 1967, students like you joined together in New York City to found the student health project of the South Bronx. Their historic initiative was a sign of a new generation's determination to make medicine work for people.
But the young and the concerned in the medical profession cannot do the whole job alone. Your voices have been heard – and sometimes even heeded. But your own efforts will take too long. And the results will be too uncertain. The only certainty is that entrenched and established forces will oppose you every step of the way. We cannot wait or gamble on the outcome. Human life and human health hang in the balance.
Four decades after organized medicine almost adopted a report favoring uniform financing for medical services – four decades and a hundred million illnesses too late – we must enact a medical bill of rights for all Americans. The Constitution commits our country to protect political freedom. Now, by legislation, the Congress must commit America to protect the physical health which alone makes possible the exercise of liberty.
The first medical right of all Americans is care within their means. Admission to a hospital or a doctor's office should depend on the state of an individual's health, not the size of his wallet. And we cannot depend on reform on half-way measures and halfhearted compromise. A right to medical care which left the burden of cost on the poor and the near poor would mock its own purpose. The only sure security is federally funded universal health insurance. That is our best hope for the future – and a priority goal in 1971.
We must take the dollar sign out of medical care. We must destroy the financial barrier between deprived people and essential medical services. We must end the terrible choice so many Americans face between losing their health and losing their savings.
The second medical right of all Americans is care within their reach. Even if we guaranteed the payment of health costs, millions of our citizens could not find sufficient medical services. The system is not only inequitable – it is also undermanned and inefficient. It is on the verge of collapse. The Nation must now respond with Federal financial incentives that will insure real reform.
There are not enough doctors. But Federal incentives can persuade medical schools to follow Einstein's lead and expand their enrollment. New schools can be created and sustained by Federal loans and grants. And Federal funds must also be provided to help medical students who should have something better than money to worry about. A program of scholarship aid must include all who are in need – and it must encourage minority students who intend to return to the old neighborhoods.
Yet the number of doctors is not the whole answer. If we produce 50,000 additional physicians and plug them into the current structure, our efforts for reform will certainly fail. Some of the health manpower legislation now before the Congress would do just that – and the result would be too many more doctors serving too few people at too high a cost.
Here, too, Congress must set up financial incentives that can move medicine in a new direction. We must encourage a shift from a system dependent on the individual doctor to a system built around the concept of the health team, composed of primary care physicians and other medical professionals. Teams would allow us to allocate medical resources with maximum efficiency and to maximum effect. They would employ paraprofessionals to relieve nurses and doctors from routine, time-consuming tasks. They would gather together diverse skills – from internists to pediatricians – and patients would deal with the team, not just a single physician. Einstein has experimented with the health team concept. The Federal Government must make Einstein's experiment national policy.
And health teams must be sufficient in distribution as well as in number. Federal bonuses must make it worthwhile to practice in the inner city and in rural America. Medical care cannot reach people unless people can reach doctors. And people must have more than geographic reach. A health team should also be subject to the reach of local influence.
Location incentives for health services must be designed to create responsive, personal structures. It was never right – and it is no longer possible – to satisfy Americans with distant, impersonal medical care. The system must respect everyone's identity – and sacrifice no one's dignity. And we must always remember that it is easier for a patient to reach a health team that he knows – than a shining new medical center walled off from surrounding rural poverty or a nearby urban ghetto.
The third medical right of all Americans is care within their needs. The present health insurance system is heavily biased toward high-cost hospital treatment and against preventive health care. That is incredibly expensive – and incredibly insensitive to the real needs of people. It has filled hospitals with patients who should not be there and would be better off elsewhere. A new national health program must reverse the old priorities. It must guarantee a range of medical services, comprehensive in scope, preventive in emphasis, and restricted only by the scope of scientific knowledge.
America's concern over the quality of health care has reached a high water mark in 1971. You are graduating from medical school at a time when the whole medical profession may be profoundly altered. You should welcome change – and work for change. Only in the context of a medical bill of rights for every American, can each of you truly and in the most literal sense profess your profession – which is nothing more and nothing less than the protection of human life.
And that requires not just a medical bill of rights, but a social bill of rights. The real cure for lead poisoning is not hospital care, but decent housing. The most effective treatment for malnutrition is adequate food.
And the best guarantee of good health is a physically and emotionally healthy environment.
As health professionals, you must commit yourselves to total health care. And total care includes virtually everything that determines whether we are sick or well. You cannot confine yourselves to the technical skills you have learned here. You must also practice the fundamental human concern of a school like Einstein.
You must speak out for a fair and sensible medical care system.
You must stand up for social progress and for people – whether they are your patients or migrant workers two thousand miles away.
You can cure individuals – and you must help America build a compassionate society. It will take time. There will be setbacks and frustrations and defeats. But men and women who come from Einstein have good reason to believe that we can finally fashion a country that is great enough to be good. You have seen in your own lives what a difference one school can make. Now all of you have a chance to make a real difference in the lives of others.
The practice you choose and the practices you follow may not change our country overnight. But you can remind us by example of Aristotle's ancient truth: "Health of mind and body is so fundamental to the good life that if we believe men have any personal rights at all as human beings, they have an absolute moral right to the measure of good health that society is able to give them."
That is our challenge and our chance. Two thousand years after Aristotle wrote, we must secure a medical bill of rights for our own people. We can wait no longer – in health care or in society. In our individual lives and in our national life, whatever we can do, and whatever we dream we can do, we must begin now.