Editor’s Note: As Congress debates the massive government takeover of health care, Senator John Ensign (R-Nevada) gave this speech in the Senate. It’s filled with lots of useful information.

Mr. ENSIGN. Madam President, there is an urban myth that people like to talk about when they are discussing health care reform. It is like one of those rumors that runs rampant on the Internet. Nobody knows where it started, but you are sure it must be true.

The story is about Canadian health care: everyone there is covered, and they have a progressive health care system that we should somehow copy.

Well, it is time to bust this myth and tell the American people what a government-run health care system like Canada’s would mean for us in the United States.

Canada and Great Britain offer what is typically referred to as universal coverage. Universal coverage, however, does not mean unlimited access to care or readily available care. Let me tell you why.

Let’s talk about spending first. The U.S. spends about 16 percent of its gross domestic product on health care, while Canada spends about 10 percent. I know some Members of this body have been asking: If Canada can spend less money on health care, why can’t we?

Well, there is a right way to reduce spending with technology, healthier behaviors, common sense, medical liability reform, other things I have talked about; and there is a wrong way.

In Canada, the government spends 10 percent on health care by setting a global budget. When the demand for health care exceeds that amount, the Canadian Government does not increase funding. Instead, medical care is often delayed and/or denied. Some estimate that about 750,000 Canadians are currently on a waiting list for medical procedures or referrals to specialists.

Madam President, can you imagine waiting up to 6 months for a hip replacement or up to 6 months for cardiac bypass surgery? What if you had to wait up to 4 months to get an MRI.

People who live in countries that have government-forced health care systems often wait, and then wait some more, for medical care. This chart shows typical patient wait times in Canada. The blue bar shows median clinically reasonable wait times. The red bar shows actual wait times. So this, in the blue, is what a reasonable patient wait time should be and what is shown in red is what patients actually experience.

If you look at this chart and study the wait times, you can see that in every single one of these cases whether it is general surgery, gynecology, internal medicine, neurosurgery, or ophthalmology, the actual wait times are always much longer than what a clinically reasonable wait time should be in Canada.

For example, the median clinically reasonable wait time for neurosurgery is 5.8 weeks. But, as we see from this chart, the actual wait time is 31.7 weeks. That is for neurosurgery. That is shown on this part of the chart. Can you imagine having to wait that long for neurosurgery?

For orthopedic surgery, the clinically reasonable wait time is 11 weeks. The median actual wait time is 36.7 weeks. This is hard to fathom.

In Canada, the wait time depends on many factors. Getting in to see a doctor depends on the province in which you live, whether you are an urban or rural resident, the urgency of your medical condition, and your age.

I want to encourage all Americans not to take my word for it on these wait times. You can go to this Web site, http://ontariowaittimes.com, and it will actually tell you what the wait times are for various procedures.

As a matter of fact, my assistant who is on the Senate floor with me today broke her arm several months ago. Interestingly, she went to this Web site to find out how long her wait time would be for surgery in Ontario. By the time she would have got in to see a doctor in Canada to have the necessary procedure conducted, her arm would have already healed. It would have healed incorrectly, but it would have already healed.

That is unacceptable, but that is typical of what happens in countries where there is government rationing, and where the government sets a global budget.

Think about how frustrated you would be if you had to wait that length of time. Some Canadians get tired of this waiting. They leave the queue and catch planes, trains, and automobiles to the United States to get medical care when they need it most.

The Mayo Clinic, for example, sees about 2,000 Canadian patients each year. The Henry Ford Clinic in Michigan saw 191 hospital patients from Canada and had about 1,400 outpatient visits from Canada last year alone.

Those numbers have increased steadily over the past 3 years. In fact, revenue from Canadian patients has increased by $7.5 million at the Henry Ford Clinic in the last 3 years. Although these major medical clinics do not track why some Canadian patients come to the United States for medical care, I believe the significant wait times in Canada are one of the primary reasons they choose to cross the border.

I also believe that Canadian patients come to the United States to reap the benefit of America’s research and development and to access new breakthroughs in medical technologies.

Many of my colleagues have heard the story of Shona Holmes. Shona, a Canadian citizen, was experiencing numerous conditions, including headaches, fatigue, and severe vision problems. Her primary care doctor in Canada ordered an MRI and the results suggested a brain tumor. Shona would have to wait 4 months to see a neurologist or 6 months to see an endocrinologist in Canada. She couldn’t wait that long. Since it would be illegal for her to see a doctor outside the government-run health care system in her own country, she traveled 2,000 miles to the Mayo Clinic to Scottsdale, AZ, and paid for the visit herself. Doctors at the Mayo Clinic diagnosed Shona with Rathke’s cleft cyst.

Shona returned to Canada with her diagnosis and attempted to have surgery under Canada’s government-run health care plan. The Canadian Government wasn’t able to do the necessary surgery within a 6-month time period. Since Shona’s vision was rapidly declining, waiting more than 6 weeks for surgery was completely unacceptable. So her husband got a second job, took out a second mortgage on their home, and borrowed money from family and friends for surgery at the Mayo Clinic. Incidentally, the Mayo Clinic recommended a second surgery to remove her adrenal gland. So Shona went back to Canada and got in line. It took 3 years for her to get her second surgery in Canada — 3 years.

In written testimony before the House Energy and Commerce Committee, Shona said:

If I had relied on my own government-run health care system in Canada, I would not be sitting before you today. At the very best I would be blind and at the very worst I would be dead.

Shona isn’t the only Canadian citizen who has come to the United States for access to timely medical care. A private company called Timely Medical Alternatives was created in 2003 to help Canadian citizens obtain medical care in the United States. Over the years, the company has sent more than 500 Canadians to the United States for timely medical care. Richard Baker, the founder of Timely Medical Alternatives said:

The Canada Health Act is responsible for more pain, more suffering, and more death than any other piece of domestic legislation in Canadian history.

I am concerned that the inclusion of a government-run health plan in the Democrats’ health reform bill will destroy the American health care system as we know it today.

Section 1323 of this bill establishes the community health insurance option. Don’t let the name fool you; it is a government-run plan. States can opt out of the government-run plan if they enact a law prohibiting the offering of the government-run plan in the exchange, but I honestly expect that few States will take this course of action. Regardless of the language indicating that people won’t be forced to participate in a public health insurance program and won’t be penalized for not participating, I still believe that some individuals will be forced into this government-run plan. I also believe this is just the first step toward a complete government-run plan.

Under the bill, the Secretary of Health and Human Services will be required to negotiate provider reimbursement rates. The government typically doesn’t negotiate with doctors and hospitals. The government would likely resort to price-setting based on Medicare or Medicaid or use existing government programs as leverage for negotiations, creating similar effects. Remember, Medicare and Medicaid currently reimburse at much lower rates than the private sector.

Madam President, I ask for an additional 3 minutes.

The PRESIDING OFFICER. Is there objection? Without objection, it is so ordered.

Mr. ENSIGN. Madam President, Democrats claim that they will not be putting private health insurance companies out of business, but it seems to me that they are doing everything possible to make it harder for these companies to stay in business. I also question whether Members of Congress will be required to participate in this government-run program. We should be required to do so. If we decide that a government-run plan is good enough for the American people, then I believe that Members of Congress should subject themselves to the same type of care. I know there will be an amendment to do just that.

I want to tell a story about how federal government officials don’t always think that they should be subject to the same type of care as their country’s citizens. Belinda Stronach, a former Canadian Member of Parliament, opposed the privatization of Canada’s health care system. Well, that was at least until she got sick. She was diagnosed with breast cancer in June 2007. Although she had led the charge against having a private system in Canada, she didn’t want to wait in line in Canada to obtain treatment — so what did she do? As a matter of fact, she traveled to the United States for care — on the advice of her doctor. She went to UCLA for surgery and she paid for that treatment out of her own pocket. I have a feeling that she came to the United States because she knew that if she waited for care in Canada, the chances of her having successful treatment would be a lot lower.

Madam President, the wait to see a doctor is not the only wait Canadian patients face. Canada and other countries with government-run health care systems are slow to adopt new medical technologies. And, access to the latest medical technologies is limited. As a result, patients often have to rely on old or outdated medical equipment for treatment.

Canadians have less access to MRIs, CT scanners, and lithotroptors than patients in other countries belonging to the Organisation of Economic Co-Operation and Development. Lack of access to cutting-edge medical technology has significant consequences. New medical technologies can often provide faster and more efficient identification and treatment of disease. They can offer the patient safer, less invasive and more comfortable treatments and care, as well as offering new treatment options where none previously existed. What is the secret to other countries’ keeping costs down? One is refusing to approve or cover new life saving drugs and medical devices.

In 2007, the United States had 25.9 MRI machines per million people. Canada had 6.7 MRIs per million people and the United Kingdom had 8.2 per million people. In 2007, the United States had 34.3 CT machines per million people. The same year, Canada had 12.7 machines and the United Kingdom had 7.6 machines per million people.

It took France 5 years to approve the endoscopy pill camera and 10 years to approve implantable defibrillators. Japan is well known for refusing to pay for the latest technologies because of budgetary constraints and has yet to approve, for example, prosthetic titanium ribs and imaging masks for head surgery that have been approved in the United States for the past 6 years.

In my home State of Nevada, robotics surgery has become an exciting new frontier. Across Nevada, six hospitals are now equipped with the da Vinci Surgical System which allows patients access to cutting-edge minimally, invasive surgery. In all of Canada, the entire country, there are nine such machines. The United States has 968 machines. Wouldn’t you prefer a system that thrives on innovation in medical technology? Where you have access to the most cutting-edge technology that can better diagnose and treat you?

Even with this clear discrepancy in technology investment, Democrats have argued that the United States spends more money than any other country on health care and gets worse results. The implication is that we should look to other countries for guidance on how to run our own system better. But if we look, for example, at cancer survival rates, we see that the United States gets better results than other countries that have experimented with broader government control of health care.

International studies have found Americans have far better access to new cancer drugs than do patients in Europe and the United Kingdom. The United States also has higher rates of cost-effective prevention measures that can detect certain cancers early when they are cheaper, easier, and more effective to treat. As a result of this superior prevention and treatment, the United States has higher cancer survival rates.

Madam President, I would like to show another chart. This chart shows the European cancer survival rates for the major cancers in comparison to the United States. The United States data is in gold; the European Union data is in red. This chart shows 5-year survival rates. This part of the chart shows kidney cancer survival rates. We have significantly higher survival rates in the United States for colorectal cancer, breast cancer, cervical cancer, breast cancer, and skin cancer. You name it, across the board we have better survival rates because we don’t ration care, we don’t delay care, and we have access to better technology in the United States.

Madam President, I would like to be a little more specific when it comes to these facts and figures. A study published in The Lancet Oncology found that when comparing 5-year cancer survival rates, the United States had better outcomes than European countries. Among men, nearly two in three American cancer patients survived for at least 5 years, while fewer than half of Europeans did. Among women, 63 percent survived for 5 years in the United States, versus 56 percent in Europe. According to the study, survival rates for breast cancer were 11 percentage points higher in the United States than in Europe. Prostate cancer is even more alarming, with a 99 percent 5-year survival rate in the United States versus 78 percent in Europe. Colorectal cancer rates were 10 percentage points higher in our country than in Europe. And, survival rates for kidney cancer, cervical cancer, and melanoma were higher in the United States than in Europe.

Madam President, I think this body should take a look at what it would mean for quality of care and access to medical care in the United States if we were to adopt a government-run health care system. Many of us on this side of the aisle are opposed to government-run health care systems. We don’t want these type of survival rates that are common in the European Union. We don’t want people from Canada coming here and not having a place to go to obtain medical treatment. As a matter of fact, if the United States ends up going to a government-run healthcare system, where will Americans go for high-quality care when they need it most? All Americans should think about that as this bill is being considered on the floor of the Senate.

We should be very careful that reforms to our health system do not lead to reduced preventive care and poor access to lifesaving drugs. These reforms have led to lower rates of survival in places with greater government control over health systems.

These reforms have also proven unsustainable in other countries. The British National Health Service trust is issuing a report that says it will face the most severe and sustained financial shortfall in its history after 2011. In fact, the NHS trust is asking staff to work a day for free, take unpaid leave, and carry forward their vacations in order to save money. Germany’s new proposal to reform the health care system met with thousands of protesters because it faces a massive budget shortfall due to rising costs. What are they looking at doing? Introduce fees, raise taxes, and do away with private plans to bring people with those plans into the public system. Sound familiar? France, too, has a gaping hole in its health care budget. France is looking at cutting subsidies in order to stop the problem. Japan faces one of the most difficult problems because of its rapidly aging population. It too has budget problems and has to find a way to offset a 5-percent increase in next year’s health care budget despite all of its massive price controls on doctor, medical device, and drug prices. Is this the future of U.S. health care?

These are not health care systems that we should want to copy. Contrary to the opinion of some, the United States provides among the best care in the world for patients. The World Health Organization identifies the United States as 37th in the world, but these ratings are faulty. The United Nations World Health Organization uses subjective criteria such as “fairness” to rate many countries. “Fairness” means that any out-of-pocket expense by a patient is regressive and therefore penalizes poor people more. So, in the view of the United Nations, the United States is 54th in terms of their view of fairness. Consequently, according to the WHO ratings, countries like Colombia, Cuba, Micronesia, Mozambique, Saudi Arabia, Samoa, and Uruguay are “fairer” and therefore better than the United States. Something is wrong with that rating.

In contrast, the United States is No. 1 in responsiveness to patient care according to WHO. So, if you are sick and want the best care, even the United Nations agrees that the United States is the place to be treated.

Michael Moore’s movie “SICKO” advertised how great Cuban health care is, but he apparently did not see the system used by the 11 million ordinary Cubans where patients “have to bring their own food, soap, sheets” with them to the hospital.

Some of my colleagues ask, if the United States is No. 1 in responsiveness according to WHO, then why is there lower life expectancy compared to other developed countries? Simple. Because the numbers are wrong. Life expectancy in the United States has been rising as it has been in most of the developed world. All of the life expectancy statistics include accidental and even intentional deaths that clearly have no relation to the merit of our health care system.

For example, if you remove car accidents and homicides, both of which are higher in the United States for reasons unrelated to the effectiveness of health care, then the actual U.S. life expectancy is higher. Some economists rank the United States near the top of world rankings when that point is factored in. Moreover, the history of exceptionally heavy smoking in the United States and the recent increase in obesity means that diseases and shortened life expectancies related to these factors have little to do with the effectiveness of our health care system. That is why my approach to health care reform includes creating incentives for people to make healthier choices. We need to get to the root of health problems, not chase phantom foreign statistics.

Another example is high infant mortality. The United States has a higher level than other countries in part because of the higher number of low weight babies from teenage pregnancies. That social problem is not related to how effective our health care system is. In fact, a low birth weight baby in the United States has a better chance of survival than in Canada, but we have three times the quantity of low weight babies as Canada does.

The bottom line is that the United States has the best doctors, nurses, medical and nursing schools, medical research, medicine, hospitals, medical devices, innovative companies, and health care in the world. It is like that because we demand it.

Every night on the news for the past month or so, there are stories about the lines for the H1N1 vaccine. The vaccine supply has been slowly trickling out, and Americans are not accustomed to waiting for their care. They are frustrated about these lines and the priority groups that have denied some of them the vaccine. Welcome to government-run health care.

What Canada and Great Britain and other countries do with their health care systems is their business. They have determined that they want the government at the center of their health care system. The government decides what treatments patients can have, how long they have to wait, and how much is invested in technology. Here in the United States, that is the last kind of system we need. Instead, we need to move to a patient-centered system. We want to continue to empower patients to make decisions about their own treatment, to be consumers in the process, and to have access to the care they need.

The United States is home to some of the greatest medical advancements in the world. Turning away from that system at a time of great medical promise is not the direction we should be heading.

For generations, American researchers, scientists, physicians, and patients have worked together to push the envelope on the best tools for diagnosis and treatment. We have invested in finding cures and vaccines for illnesses. We could be on the cusp of cures for cancer, Alzheimer’s disease, Parkinson’s disease. The list goes on and on. But what happens when we become a one-size-fits-all, government-centered, bureaucracy-run health care system? We become like Canada and Great Britain, where wait times are unacceptable, where care is rationed, where technology and innovation are not a priority, where the doctor-patient relationship is devalued, and where patients have lost their say in their own care. So, it is not surprising that when people in other countries want the best, they come here.

Madam President, let’s not put Americans in a position where they may have to wait weeks and even months for medical care. Let’s not put Americans in a position where they can’t access the latest medical technology or the best prescription drugs. And, let’s not have government bureaucrats stand in the way of medical care. This is about patients. This is about creating a patient-centered healthcare system. The bill before us is not the answer.

The PRESIDING OFFICER. The Senator’s time has expired.

Mr. ENSIGN. I thank the other side for their indulgence and I yield the floor