Health Care Reform

Floor Speech

HEALTH CARE REFORM -- (Senate - August 06, 2009)

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Mr. WHITEHOUSE. Let me thank Chairman Dodd for his leadership and for his remarks. He said he would give us a discussion of where we are, and he has done a wonderful job of showing how this bill will improve the lives of regular Americans in a very concrete way, including particularly Americans who have insurance.

To supplement his discussion of where we are, I wanted to give a quick discussion of where we have been because the trajectory of where we have been to where we are tells us something about where we are going. And everybody in this country, insured or uninsured, should have some real concern about where we are going in health care in this country if we do not act.

The year I was born was 1955, and this was the headline from the New York Times in 1955. It is hard to read the little part here; I will read it to you. It says:

The Problem of Cost. Millions of Americans cannot afford to pay the costs of medical care, and they are not protected by adequate health insurance.

That was 1955. This section says:

In human terms, this meant that the American had to scrap his budget, dig into savings or go into debt, to pay some $7.5 billion for doctors, hospitals, dentists, nurses, and the myriad physical accessories of medical care.

That was 1955, when the Nation's medical bill ran over $10 billion. They were horrified to say over $10 billion. It is now over $2.5 trillion.

So that is the year I was born. We were already bemoaning the state of America's health care system.

This is 1979. I had just gotten out of college. And the HEW Secretary said: Health cost called unjustified. HEW Secretary Patricia Roberts said: The quality of American health care does not justify its price tag of more than $200 billion a year. Still bemoaning the health care problems, still not getting anything done about it.

Now, 1988. This was the year my wife became pregnant with our first child. And here it is. Prospects: Soaring health care costs. Joseph Califano said--he was the former Secretary of Health and Welfare--``The average jump in premiums could hit 30 percent in 1989.'' But at the same time, we are getting less for it.

Chairman Dodd just talked about a 20-percent jump in his State recently. You think this was happening today? It is from 1988, 20 years ago. The more
things change in health care, the more they stay the same.

Here is 1992. Health care costs increasing at more than twice the rate of wages have made benefits so expensive it would be surprising if companies were not responding. ``Health care costs dampening hiring.'' And they dampen wages, as we have seen, and increasingly businesses are having to avoid health care because they cannot keep up with that cost. That from 1992.

So we took those stories and we put them together on this chart. This shows the increases in America's spending on health care in each of those years, starting back the year I was born, that first story, 1955, then 1979, then 1987, then 1992, then 2009. It increased from $12 billion, which seemed like a big number then, to $200 billion, to over half a trillion dollars, to $850 billion, nearly a trillion, and now $2.5 trillion.

Look how much it has bumped from 1992 to 2009. This, my friends and colleagues, is what is called a trajectory. It is going to keep going if we do not do anything about it.

The latest estimates for my home State of Rhode Island are that in 2016, which is not too far from now, in 2016, probably about this far up on the graph, $26,000 a year is what a family will have to pay for family coverage--more than $26,000 a year. That means if you are a comfortably earning hard-working individual pulling down a salary of $52,000, half of your income, pretax income, goes out the door for health care before you start anything else. That is not sustainable. That is why we talk about Thelma and Louise instead of Harry and Louise. That is why we need to change the direction of our health care system, not just for the uninsured but for everyone so that all Americans can have a secure health care future. No American will have a secure health care future if this trajectory is allowed to continue.

So if you are out there asking, How would a change in the direction of our health care system help me, think of Thelma and Louise headed off the cliff because that is what the American health care system is like right now. The cliff is coming, and we are all in the car together, and together we have to solve this problem. Because we have to solve it together, it is very disappointing that so many of our friends on the other side have refused to participate in this conversation and have reverted to labels and name calling: socialized medicine, government mandates--things that have nothing to do with our legislation but are designed to scare people and to provoke those who have not sat down and read the bill and do not know better. It is unfortunate.

What does it measure up against? Let me show you a couple of other things. We have had a lot of talk in recent days about the stimulus plan and how effective that has been--a $787 billion stimulus. There it is, that $0.88 trillion is the stimulus for all of the barking and moaning we have had about how much that cost this country. That is what it is. The $8.9 trillion is what George Bush ran up in debt for this country during his Presidency.

Three-quarters of the debt this country bears, George Bush ran up during his Presidency. It was an orgy of fair-weather borrowing. When we didn't need to go into debt to protect our economy, when things were humming along, that is what he did, $9 trillion. Here is our unfunded Medicare liability, $38 trillion. We don't have $38 trillion now. Unless we do something about this cost, we are truly going off the cliff in that car with Thelma and Louise, following that trajectory of cost I showed.

It is not all going for health care that makes everybody better. It is going to a lot of other things. Here is one thing it is going to. Insurance industry profits. Have you noticed your wages going up a lot in the last couple years? For a decade, from 1999 to 2009, wage growth has been 29 percent. That is less than 3 percent a year and way less than 3 percent a year compounded. That is what wage growth has been like. If you don't feel like your wages have gone up much in the last decade, you are right. They haven't. For many Americans, wages flat-lined for a decade. How about your insurance premiums? Did they flat-line? No, sir. The insurance premiums went through the roof, increased 120 percent, more than doubled in one decade. That is the steep curve I showed you, 120 percent. How about insurance industry profits? Up 428 percent in the same period that wages were up 29 percent. So there is something we can do something about.

On insurance, so many Americans are uninsured, it is worth taking a look at this. We have all used and heard the figure about 46, 47 million Americans who are uninsured. That is the people who are uninsured at any given minute. As I stand here at this desk right now, out there in America there are about 47 million people who are uninsured. But some people gain insurance and some people lose insurance. Over the course of a year, the number of people who lose their insurance, whose families lose their insurance, is nearly 87 million. If you started on the east coast and moved your way west, and when you got to the Mississippi and you started into Minnesota, Iowa, Missouri, Arkansas, and Louisiana and you took the population of every single State west of that all the way to California, the population of all these States is about 87 million, to give you an idea of how many Americans lose their health insurance and have to go without it at a point during the year.

Then there are catastrophic levels of waste in our health care system. Our former Treasury Secretary, a Republican, knowledgeable about this, ran the Pittsburgh Regional Health Initiative for years. He said $1 trillion of annual waste is associated with process failures. He has calculated $1 trillion a year of waste in our health care system.

The Lewin Group is a group many people talk about here. They are described on the Senate floor as the gold standard in health care information. Sources of potential excess costs: Excess costs from incentives to overuse services, from poor care management and lifestyle factors, excess costs due to competition and regulatory problems, excess costs due to transactional inefficiencies; $151 billion here, $519 billion here, $135 billion here, $203 billion here. As we say in Washington, a billion here and a billion there, and pretty soon it starts to add up. This adds up to over $1 trillion in waste in congruence with what the former Treasury Secretary said.

It is not just newspapers that are saying it. It is also President Obama's own Council of Economic Advisers. Their report on July 9 said that:

Efficiency improvements in the U.S. health care system potentially could free up resources equal to 5 percent of U.S. GDP which is above $700 billion a year.

They also noted:

[It] should be possible to cut total health expenditures by about 30 percent without worsening outcomes ..... [which] would again suggest that savings on the order of 5 percent of GDP could be feasible.

Again, two calculations coming to the same point, savings of over $700 billion a year.

That is one of the things we are trying to do. In addition to family-by-family improvements, small business-by-small business improvements, individual-by-individual improvements that Chairman Dodd has wrought through this bill, we are also trying to turn around a health care system that has been out of control, that has not been reformed for my entire lifetime. So that now is our moment, and it is on a trajectory that will break this country if we don't do something about it. We simply cannot continue a cost curve such as this that is already at $2.5 trillion and is accelerating northward. We can't be competitive with our international competitors in trade if we do this. We can't sustain our families if we do this. We simply cannot keep this government fiscally solvent if we do it. We have to turn the car before it gets to the cliff. If we can't do that, then shame on us.

I think we need to be in this together. One of the ways we will do this is through a public plan. A public plan is important because there are a number of ways in which you change those cost curves. You don't have to take services away from people because of all that waste. What you have to do is deal with the waste. You build in electronic health records for every American so the efficiencies that other industries have enjoyed from the computer revolution finally hit health care which, according to the Economist, has the worst information infrastructure of any American industry except mining--the mining industry and then health care. Huge improvements and huge savings from that.

Quality improvements can save money. It has been demonstrated over and over again, as in Senator Stabenow and Senator Levin's home State of Michigan. They did quality improvements in intensive care units. In 15 months, they saved $150 million and 1,500 lives, and it wasn't even in all the intensive care units. It was just in one State. It was that one kind of quality improvement program, just in intensive care units. So huge gains to be made from quality improvements.

Prevention. Senator Harkin spoke the other day about what can be gained from preventing particularly conditions that arise from diabetes. Enormous savings, if we can focus on all that.

Transparency and improved administrative efficiency so doctors and insurers aren't fighting all the time. We can do all those things, but somebody has to lead. The question for us is, can we trust the private insurance companies to lead in all those areas. If you look back, you see they never have. We are way behind where we should be. They are not leading. It will take a competitive public option to pick up those issues and run with them and show what we can do.

I will close with this. One of the things we are hearing is you can't possibly have a public option. It is a line in the sand. The very distinguished ranking member of the HELP Committee has said it is intolerable to have a public option. It simply would not work. It can't happen. There are two ways we get health insurance in this country. One is through a private health insurance provider. The other is through workers' compensation, which the business community runs in order to protect itself against the injuries and illnesses and diseases and catastrophic harms that can happen to people at work and that they have to protect themselves against. All across America, there are State funds, public options that deliver health care insurance, State by State, over and over again. So when the ranking member goes home to his State of Wyoming, not only is a public option for delivering health insurance not anathema, it is what he goes home to.

He goes home to a single-payer public option for health care, one his business community appears perfectly satisfied with and he appears perfectly satisfied with.

Their Presidential candidate, John McCain, goes home to Arizona to a public plan with 56 percent market share. It competes in a lively workers' compensation health insurance market. The distinguished minority leader goes home to Kentucky, and in Kentucky his business community enjoys a public option for workers' compensation health insurance. So we should be able, in the spirit of coming together in the face of this national emergency, to put aside the old notion that a public option simply can't exist, can't happen. It happens in nearly half our States. It is supported by the business communities in those States. It delivers care efficiently, and none of the Republican Senators from those States have, to my knowledge, ever complained about it in that context.

I will conclude with that. I think we are at a turning point, and it is important, as we go, that we remember this is a long struggle we have been on. My entire lifetime, since 1955, it has gotten dramatically worse, and the rate at which it has been getting worse is increasing. It is worsening. We have to do something about it now--for everybody in this country, for businesses large and small, and for people and families, insured and uninsured, and we are pledged to do that.

I thank the very distinguished chairman and yield the floor.

Mr. DODD. Mr. President, I thank our colleague from Rhode Island. He has been very eloquent in talking about the historical framework of this debate, going back, even predating the 1950s, when we determined the need for a national health plan in this Nation, not only to deliver health care to people but also to deal with the economic problems associated with health care costs. I thought it might be worthwhile to invite my colleague to share some additional thoughts on this view. Today, as I am told, we are spending about 17 percent of the gross domestic product on health care costs. I am told, by those who are economists looking at this, that if we don't alter anything but merely sort of stumble along, that percentage of our gross domestic product will jump from 17 percent to 34 percent of the gross domestic product, which is a staggering amount when we consider how expensive that would be and the result, in practical terms, to the very premium costs the Senator from Rhode Island has identified.

I also talked the other day to a leading businessman in our country, the former chief executive officer of Pitney Bowes, a well-known, established company, headquartered in my home State of Connecticut but has facilities in many States across the country. It employs thousands of people. The former CEO is a man named Mike Critelli. He is no longer the CEO, but he was the CEO who was responsible for bringing a wellness plan to Pitney Bowes. I think my numbers are pretty accurate on this point. I think their premium reduction, as a result of putting a wellness plan in place there, reduced those costs by around 30 or 40 percent. They decided to alter the lifestyles of their employees by offering them incentives--the opportunity to reduce weight, quit smoking, improve diets, all these things.

Talking to Mike Critelli, he did it because, one, he thought it was the right thing to do. Certainly, improving the quality of the health of your employees is a decent thing to do. But Mike Critelli also pointed out to me that in addition to being the decent thing to do, it was a very sound practice for business. Very simply, he said: If I could increase the productivity of my workers, which is the critical element, if the United States is going to compete in the 21st century, if wage rates are not going to drop down to Third or Fourth World country levels, we are going to have higher wage rates. We are going to have higher costs to produce our products.

The one advantage we bring over third-rate and fourth-rate nations that don't pay as much for employment is the productivity of the American worker, which historically has exceeded that of almost any other worker anywhere in the world.

Mike Critelli's point is that having a good wellness plan in place increases the productivity of that worker, and that is our edge in a global economy. So we need to start thinking in these terms.

I hear people in the business community say we can't afford to do this. We can't afford not to do it. You can't have 34 percent of your gross domestic product be consumed with health care costs.

Our advantage is productivity. As Mike Critelli points out, if your workers are sick, if they are obese, if they have diabetes, if they have chronic illnesses at a young age, as many do today, then the ability of that worker to produce those products and services is going to be curtailed and we suffer.

So there needs to be some lights turned on for some in the business community about this debate. Some are having sort of a Pavlov's dog response to it. If you mention health care reform, they reach back decades to the age-old bromides and responses to this issue without thinking about what this means in the 21st century, freeing up the ability of workers to produce better products in a highly competitive marketplace.

Let me mention one other thing I do not think we have talked about. Forty-four years ago from last week, Lyndon Johnson signed Medicare into law. Last week was Medicare's birthday. Medicare was signed into law 44 years ago, in 1965. Obviously, that was a great benefit to people over the age of 65, and what a difference it made. It took that population, which was the poorest sector of our population, the elderly, and put them on a standard of living that allowed them to lead decent lives after productive years of working.

So with prescription drugs, doctors visits, and the like, put aside the problems today with Medicare we know exist and we have to deal with, it did something else I do not think we have paid enough attention to. It was a source of relief and stability to a family. Because all of a sudden those parents--which a younger generation had to put aside resources to provide for that crisis that was inevitably going to happen to those aging parents--became less of a burden because Medicare existed. The cost of prescription drugs, the visits to the doctor, the hospitalizations--all of a sudden, magically, 44 years ago from last week, a good part of that burden was lifted off the shoulders of the children of Medicare recipients.

And it unleashed a level of investment that allowed our economy to prosper and grow. For other reasons too, but not the least of which, all of a sudden, there was that security in a family. They were not going to face financial ruin because, all of a sudden, their parents had a crisis they were going to have to pay for out of their pockets.

I do not know if there are any economic models that examined that, but I do not think we attribute enough of Medicare's success to the contribution it made to the overall economy of our Nation 44 years ago because of that stability and certainty and security in a family, where your parents--that aging population--at least had a safety net that would protect them against that financial ruin that can befall a family.

I think we are missing a point in this debate in that what people are really worried about is that lack of certainty, that lack of stability. People are socking away money today because: If I lose my job, if I end up with a preexisting condition, if we move, I could lose my health care coverage, and all of a sudden my kids, my wife, myself are put in the danger of economic ruin. That uncertainty, that lack of stability, that lack of security has a negative impact on the consumer choices people make. I might like to buy that second car. We may need it but--do you know what--756,000 people are going to lose their health insurance in the next 5 weeks. I might be one of them. And if something happens, how do I pay for that problem? So--do you know what--we are going to delay that purchase or this other thing we might have done because I don't have the stability, the certainty, and the security there is a safety net there. Lord forbid a crisis hits my family.

So while there is the comparison between Medicare's recent birthday 44 years ago and what we are trying to achieve--we are thinking about it in a very small context: How much does that doctor visit cost? How much is that prescription drug? There are benefits to this that exceed the parameters of what we are trying to achieve because of the investments we are making that I think have a larger impact on the overall economy of our Nation.

So I wanted to say to my colleague from Rhode Island, by talking about these rising costs--and no end in sight, by the way--unless we find some way to put the brakes on all of this and begin to reduce the problems--how do you do that? If all of a sudden you have a child who is getting good dental care at an early age, that child is less likely to have a problem as they get older. If we can convince children and families to eat better because we make the incentives to do so--3,500 children today started smoking in the United States, and 3,500 start smoking every single day. And every single year, 400,000 people die because of tobacco-related illnesses--400,000 die--not to mention the number of people who have lifelong illnesses and die prematurely.

Of the 3,500 who start smoking today, 1,000 become addicted. You do not have to have a Ph.D. in medicine to know that if you are a user of tobacco products, you are consuming a product with 50 carcinogens in each cigarette.

Here we know if we can begin to change that lifestyle, which we have done, by the way--and, again, I thank my colleagues because, for the first time in 50 years since the Surgeon General pointed out that tobacco could kill you, only a few weeks ago we did what we have never been able to do before: Tobacco marketing, sales, and production are now under the control of the Food and Drug Administration. By the way, the Food and Drug Administration regulates mascara, lipstick, and pet food. But we could not get the Food and Drug Administration to regulate tobacco products. Now that has changed as a result of the actions of this Congress.

But that is an example of what I am talking about. If we can stop a child from smoking, then that child grows up with a far greater likelihood they are going to reach retirement age in far better shape, which means far less usage of that Medicare dollar and that hospital or that doctor's visit. So you may not see the benefits of some of this immediately but over the longer term we will. And that is bending that curve. We are all talking about bending that curve of cost. We can do that making these kinds of investments.

I am told only 2 percent of hospitals in this country have complete electronic medical records--2 percent. Yet we know that we lose about 100,000 people a year from medical errors in the United States. It is the fourth leading killer of Americans. Electronic medical records reduce those numbers significantly because you have clarity in the records, you have portability of those records as people move around, you have the opportunity to determine what other conditions a patient may have, and you avoid the kinds of errors that produce the tragedy of a lost life. That savings alone in lives and dollars, we are told by some, could be as much as $500 billion. Electronic medical records--that one issue--could produce those kinds of savings and results.

So when we have these debates and people talk about these things in such simplistic terms, without understanding the larger economic implications--and if we do not, the numbers our friend from Rhode Island have shown us, if history is any indicator of where we are going, those numbers will continue to skyrocket and skyrocket to the point that it will bankrupt and break this country financially.

What an indictment of a generation: Faced with a reality and the predictability of a situation, we are spending days around here with the inability to come together and make the tough, hard decisions the American people have elected us to do. That is the tragedy in some ways. I respect the fact we need a break and people are going home, but it is so troubling to me we are going to do this at a time and leave these issues hanging in the balance.

Mr. WHITEHOUSE. Mr. President, will the Senator yield for a moment?

Mr. DODD. Mr. President, I will be happy to yield to my colleague.

Mr. WHITEHOUSE. Mr. President, I want to respond to what the Senator was saying, that this trajectory is very likely to continue. Every signal and every prediction is it

is going to continue and we will hit that 35 percent, spending a third of our entire economy just on health care, and that really does break our country. It is a terrible indictment of our generation if we allow it to happen.

But we also have a great opportunity here, which the chairman has also pointed out. As you know, over and over again, as the distinguished Presiding Officer knows, over and over again, in legislation, we are asked to make hard choices between two things, and if you go one way, you cannot go the other. Economists would call it a zero sum game. You cannot have both. There is no win-win.

This is a situation where there is a win-win. As the distinguished chairman pointed out, we are spending 17 percent of our gross domestic product on health care in this country. It is the worst record, the highest expenditure, of any country in the world. Most other developed nations spend 8 or 9 percent. That is the average of the European Union of their gross domestic product on their health care.

For that exaggerated expenditure, what do we get? Lousy health outcomes. We are way behind our developed competitor nations in obesity. We have far higher rates of obesity in our country. We are way behind in child mortality. We have far greater rates of child mortality in the United States than there are in our developed nations with which we compete. There is far greater longevity in those countries than ours. Americans do not live as long as people in our competitor nations, the developed ones, and a lot of it has to do with our health care system.

So by bending that curve, by investing in prevention, by improving the quality by investing in electronic health records, by eliminating those medical errors, we accomplish two things at once. We improve the health statistics of our Nation, we have people who live long, we have less babies who die in childbirth, we have a thinner and less obese and less ill nation, and we lower the costs, and we do it together.

So it should be something we could agree on, on both sides of the aisle, but, unfortunately, these old canards about socialized medicine and how we
could not possibly have a public option--except for the fact we already have it in half our States, including our own; but we are not going to talk about that right now, we are just going to say we could never have it--that is the quality of the debate, when we have this huge win-win in front of us.

I hope everybody has a chance to sort of think about this over the break when we are gone and that we can come back with a new spirit of bipartisanship to really address this problem, seize that win-win, change the cost curve down, and solve this problem for the American people.

I will make one last point.

We have misled the public a little bit in our discussion, and we have done so because of the Congressional Budget Office and its professional capabilities. The Congressional Budget Office is very good at predicting what costs are going to be. So everybody has heard that our bill might be $600 billion, that the Finance bill might be $900 billion. They see the costs and they say: Well, how could you possibly be talking about savings when all we hear about are costs? All CBO can say about savings is that--and this is a quote--large reductions in health care costs are possible--large reductions. But they cannot quantify it. They cannot give us a number. And they have told us why they cannot give us that number.

They cannot give us that number because we can give the Obama administration, here in Congress, the tools to solve this problem. We already passed the electronic health records legislation. If, God willing, we pass the chairman's legislation from the HELP Committee, they will have the tools to improve the quality and turn the curve. They will have the tools to improve prevention and turn the curve. They will have the tools to reduce the unnecessary, wasteful administrative fighting between doctors and hospitals and insurance companies, that try not to pay them. That whole fight can disappear or at least shrink a lot, and that will help turn the curve.

But CBO cannot predict how effectively the Obama administration will do that. Like any CEO, the President of the United States and his staff are going to have to manage this problem, and that is where the savings will come. So people should not be misled that there are not real savings possible. Not only are they possible, they are mandatory. We have to turn this curve, and we have to do it dramatically. We can do it because we could drop our GDP expenditure of this by 50 percent and still have health care as good, if not better, than all of our competitor nations: France, New Zealand, Canada, England, Holland--all these countries--Japan. We can do it.

The promise is out there. We should not let the CBO scoring fool the public. That is my last point.

Mr. President, I yield the floor, and I will relieve the distinguished Presiding Officer so he can speak as the Senator from Colorado.

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