577 Sanders, Paul clash on health care at Senate hearing

May 11, 2011 Sanders, Paul clash on health care at Senate hearing By Nicole Gaudiano, Free Press Washington Writer WASHINGTON -- Put self-described democratic socialist Bernie Sanders and tea-party favorite Rand Paul in the same room, and a Senate subcommittee hearing can take some interesting turns. The clash of philosophies was on full display Wednesday after Sanders, a Vermont independent, noted that people in Vermont believe health care is a right. Paul, a Kentucky Republican, says it isn’t. “It means you could come to my house and conscript me,” said Paul, who’s also an ophthalmologist. “It means you believe in slavery. You’re basically saying you believe in slavery.” Wednesday’s hearing was Sanders’ first this year as chairman of the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging. Paul is the ranking Republican. “This is going to be an interesting year,” Sanders said. “I think it’s fair to say that Sen. Paul and I have slight philosophical differences.” Sanders turned to witness Dana Kraus, a family physician at the St. Johnsbury Family Health Center in Vermont, with what he called “a profound question.” “Do you, as an employee of a federally qualified health center, consider yourself as a slave?” Sanders asked, drawing laughter from the audience. Kraus responded, “I love my job. I chose to work there. I do not consider myself a slave. Thank you.” Sanders asked her if she ever worries police officers in St. Johnsbury will break down her door in the middle of the night and force her to treat a patient. Kraus said she doesn’t. Sanders called the hearing to investigate whether community health care centers can reduce costly emergency room visits for non-urgent health care services. Paul repeatedly suggested the health centers duplicate services provided by Planned Parenthood, which Republicans want to defund. He also complained that last year’s health care reform law will provide additional funding for community health centers, a reference to a a provision written by Sanders that will spend an additional $11 billion over five years operating, expanding and building the centers. Sanders agreed the centers duplicate services provided elsewhere. The question, he said, is whether access to primary health care makes people healthier and reduces costs. He also agreed the country has a deficit problem, but said “some of us” think the cause is tax breaks for the wealthy, and the cost of two wars and a Wall Street bailout. More people are seeking treatment at emergency rooms, often for problems that aren’t emergencies, and the number may keep rising because of a requirement in the new health care law that everyone get insurance, according to the Government Accountability Office. The average cost of a non-urgent visit to an emergency department is seven times greater than the cost of a health center visit, according to estimates GAO cited from the 2008 Medical Expenditures Panel Survey. Of about 117 million emergency room visits in 2007, about 8 percent were classified as non-urgent, according to GAO. Kraus’ health center is one of six health centers operated by Northern Counties Health Care that serve more than 18,000 patients in rural northern Vermont. The four centers in the St. Johnsbury area have helped lower the rate of emergency room visits in the past two years. Last year’s rate at the centers was 33 percent lower than the projected rate. A GAO study of nine health centers released Wednesday found they use three strategies to reduce emergency room visits: collaborating with hospitals to send non-emergency patients to a health center, coordinating care to prevent disease-related emergencies, and providing accessible services. The study, requested by Sanders and Tom Harkin, D-Iowa, chairman of the Senate Health, Education, Labor and Pensions Committee, highlighted Northern Counties Health Care model for medical homes, which uses a team led by a primary-care physician to coordinate all levels of care. Kraus said several of the model’s components are designed to reduce non-urgent ER visits. They involve assigning primary care providers to patients who don’t have one, helping patients access insurance options, following up with ER patients, improving access to primary-care providers and educating patients about appropriate ER use. Such steps have helped achieve “a significant decrease in ER visits and in hospitalizations,” Kraus said. “We also feel very strongly that by providing improved control of chronic conditions and increased adherence to preventative care, that in the future we will be seeing significant cost savings,” she said. Contact Nicole Gaudiano at ngaudiano@gannett.com.