Health Care Reform
Floor Speech
HEALTH CARE REFORM -- (Senate - December 14, 2009)
BREAK IN TRANSCRIPT
Ms. KLOBUCHAR. Mr. President, I thank the Senator from New Hampshire for mentioning the Mayo Clinic, along with several other great facilities in this country that have done things a little differently. They have done it by focusing on the patient, by saying what is best for the patient is best for all of us. When you do what is best for the patient, you get higher quality care. When you get higher quality care, you actually get lower costs.
I think of people when they go in to pay for a hotel room and they say: If I pay more, I will get a better view and a bigger room. That is usually true. Not in health care. If you look at trends across the country, the States, the metropolitan areas that have the least efficient health care tend to cost the most. That is what we need to change if we want true cost reform. It is good in States such as Minnesota, New Hampshire, and Wisconsin. Why? Because we tend to have higher quality care at lower costs. We are rewarded for that.
It is also good for the States that need to get their quality of care up, so that we don't see massive readmissions to hospitals. Who, when they go to a hospital and are sick, wants to go back in because they get sick in the hospital? Who wants to have something go wrong in the hospital so they have to go back? Who wants to go to an area where they have massive fraud, so all this money gets drained in the amount of $62 billion a year in Medicare fraud? That is what happens.
That is why, on delivery system reform, the courageous thing is to step back and say: How do we do this better? How do we do it so we are rewarding quality and not just quantity, so that we are putting the patients first?
That is what this bill is about. Why does this matter? I think anybody who has a checkbook understands what this means. At $2.4 trillion a year, health care spending represents close to 17 percent of the American economy, and it will exceed 20 percent by 2018 if the current trend continues. Hospitals and clinics in every part of the country are providing an estimated $56 billion in uncompensated care. That is taxpayer money going down the tubes--$2.4 trillion per year. That is where we are now. Everybody knows it is costing them and making it very difficult for big businesses to compete against businesses from other countries that have more efficient health care systems. It is making it impossible for small businesses to keep all of their employees on health care. Why? Well, their costs are 20 percent more than big businesses.
The small businesses have created 64 percent of the jobs in the last decades in this country. We have to allow them to continue to thrive, not with these health care costs that are a drag on these small businesses.
I always tell people to remember three numbers: 6, 12, and 24. Ten years ago, the average American family was paying about $6,000 in premiums. Now they are paying $12,000. That is average. We have a lot of small business owners all over our State paying $20,000 a year, $23,000 a year. If we do not do anything, if we do not do anything at all, 10 years from now it is going to cost between $24,000 and $36,000 average in this country for individual families to buy health care--$24,000 to $36,000 average per family. That is why we must act. We know inaction is not an option. If we do not act, costs will continue to skyrocket, and 14,000 Americans will continue to lose their health insurance every single day.
What does this bill do? First, it gives coverage to 31 million people who do not have coverage now. People are saying: Wow, where are they getting health care now? I will tell you where: the emergency room, such as in the hospital I used to represent when I was the county attorney for the biggest county in Minnesota. That was paid for by the taxpayers. When someone does not have insurance, when they don't have a doctor, they have diabetes, they are supposed to be doing their insulin and watching their diet and they wait and wait and they end up in the emergency room and they get their leg cut off and have big costs for all taxpayers, not to mention the disastrous quality of life for the person involved. That is going on in this country.
Last year, I was down in one of our smaller towns in southern Minnesota. I heard how one science hospital had three people come in with stomach problems, appendicitis attacks. Their appendixes burst. This was over a period of several months. They asked:
How come you didn't come in earlier? Two of them said: We work at a small business; we didn't want the premiums to go up. It would hurt everyone at the small business. Another said: I had such high premiums I would have to pay I didn't want to come in and have it checked out.
If you do not have that kind of safety net in place for people, you get more expenses on the far end. That is what this bill does. It changes the delivery system, insuring 31 million more people.
What else does it do? It helps to reduce the deficit. That is what I said from the beginning. I do not want to support a bill that adds to the deficit. Actually, this bill we are talking about--some changes are being made--reduces the deficit by billions and billions of dollars.
A third thing: What does this bill have? Insurance reforms. What does that mean? It means if you have a sick kid, you no longer are going to lose your insurance. You cannot be pushed off, put off in the deep end all by yourself if your kid gets sick. It means if you have a kid going to college, you can keep them on your insurance until they are 26 years old. That is what the bill does. It gives a safety net, consumer protections that people in this country have demanded.
Finally, with Medicare, it adds 9 years onto the life of Medicare. Right now, Medicare is scheduled to go into the red by 2017. No one wants to talk about it. We need to talk about it. What this bill does is keep it solvent for 9 more years.
I can tell you, my mom, who is 82, wants to stay on Medicare until she is way into her nineties. People in their fifties who want to get on Medicare at 65 want to make sure it is there for them, that it is solvent.
What this bill does with the reforms that are in it, with the promotion of high quality, closing that doughnut hole, which is difficult for seniors, it helps our seniors. This is an idea, someone said today--I was listening to other Members--whose time has come. This bill is not going to be perfect for everyone. I think about the people I heard from, such as the woman who wrote to me from northern Minnesota. She wrote this heartfelt letter about how she had gotten a call from her daughter whose husband worked at a small business. She said that husband, her son-in-law, had just found out they were not going to have insurance anymore at his small business. The woman who wrote, the mom, said she couldn't even understand her daughter. The daughter was sobbing, sobbing: What is wrong? What is wrong? What happened? I lost my insurance.
Do you know why this mattered so much for her family? Her daughter has cystic fibrosis. Her daughter needs this insurance every moment of her life. When that small business yanked that insurance coverage because they probably had to--I am sure they didn't want to, but they just couldn't afford it anymore--that daughter has to go on the open market now which, if you have a preexisting condition, is not an easy thing to do. She may not get insurance. That is what we are talking about when we talk about this bill.
At the end of the letter, the mom said: I need you to be my daughter's voice. She is not going to be able to go to Washington, DC, and lobby for this like all the companies that have come over here and lobbied for this thing and that thing. She needs us to be her voice, and that is what this is about.
The good thing here is that, as we look at some of the things in the bill, I didn't get everything I wanted to reduce costs, I can tell you that right now. But there are some great provisions in this bill.
Look at this. According to researchers at Dartmouth Medical School, nearly $700 billion per year is wasted on unnecessary or ineffective health care. That is 30 percent of total health care spending.
To rein in costs, we introduced a value index. I introduced a bill--Senator Cantwell, Senator Gregg are coauthors of this bill. Senator Cantwell got it on the Finance Committee bill and it is still in the merged bill today. What that does is it says, when you look at the Medicare fees, evaluate them on a lot of things but make sure you evaluate them on value. This indexing will help reduce unnecessary procedures because those who produce more volume will need to also improve care or the increased volume will negatively impact their fees.
Doctors will have a financial incentive to maximize quality and value of their services instead of quantity. My doctors in the State of Minnesota support this. They have supported this bill. They have endorsed this bill. They understand that if we want to get that high-quality care like we see in Minnesota in places such as the Mayo Clinic, the Cleveland Clinic, Intermountain, Kaiser--all over the country--you have to have those kinds of incentives in place.
This bill also focuses on bundling and integrated care. I was thinking, as I watched the Vikings game this weekend--I do not know if you noticed, but the Vikings won again; Brett Favre is quarterback--we are talking about a primary care provider who works with a team. We do not have 15 wide receivers running into each other. We have one person in charge--a quarterback in football, a primary care doctor in medicine--working with a team, with a wide receiver, with a tight end, with all the team they have working together, whether it is a cardiologist, whether it is a urologist, whether it is any kind of a doctor they want to work with as a team, depending on what the illness is. That is what integrated care is. You work as a team, share medical records. Patients do not get lost in the shuffle. They do not get sent to one specialist and another specialist without anyone watching over their care. That is what integrated care is about, a quarterback with a team.
The other thing about this bill is, we start to focus much more, as I mentioned, on reducing readmissions, on rewarding places such as Health Partners or St. Mary's in Duluth, places that work to have this integrated care, places that make sure we have less readmissions in the hospitals.
Finally--and I am pleased we got this in the freshman package that is coming out--there is a much bigger focus on fraud in the system. Mr. President, $60 billion a year is going down the tubes, going to fraudsters, to con men, siphoning off the system by storefronts that are not doctors' clinics that claim they should get some of the reimbursements that should be going to our seniors. That is $60 billion in Medicare fraud alone every single year.
There are increased penalties with tools to make sure we are better enforcing the law. We can reclaim some of that money and give it to the American taxpayers, give it to our seniors.
Those are a few things. I will be talking more about this, this week, when we focus on and talk about cost control in this bill.
Thank you for allowing me to share some of my thoughts on cost. Again, remember 6, 12, 24. Ten years ago, the average American family was paying $6,000 for their premiums. Now what are they spending? They are spending $12,000. What are they going to spend 10 years from now if we don't do anything? They will spend $24,000 to $36,000 a year. We know this is not going to be easy to bend this cost curve. We know there are going to be bumps in the road. We know it is not going to automatically turn itself around. To do nothing, to put our heads in the sand at this moment in history is just plain wrong. The American people deserve to have better health care. They deserve to have that high-quality, low-cost care, and this bill is the beginning.
I yield the floor.
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