Health Care

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Mr. WHITEHOUSE. Mr. President, 50 years ago on this day, President John F. Kennedy addressed a joint session of Congress, and he presented to our Nation a bold challenge. He said:

I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the earth.

It was and remains a memorable challenge. To meet it would require long-term commitment and unprecedented resources. It had great risk, and it had no simple solution. But President Kennedy put his faith in the talent and dedication and discipline of America. He believed his challenge could mobilize our country to meet this challenge and succeed. And he was right.

President Kennedy's goal to put a man on the Moon and return him safely in 10 years was clear, was direct, and was accountable. The result was a vast mobilization of public and private resources that collaborated in innovative ways to achieve that singular purpose. And we did.

I come to the floor today to call for a similar challenge to reform our health care delivery system. While the goal now is different, the urgency and the need to mobilize both public and private sectors toward a common and vital purpose is the same. Our massive budget deficit poses a real threat to our economic and national security. The Chairman of the Joint Chiefs of Staff identified it the other day as the single greatest threat to our national security, our Nation's debt.

There is also common ground that the skyrocketing costs in our health care system are at the heart of our Nation's fiscal problem. I do not agree much with Congressman Paul Ryan, but we do agree on that point. He has said if we are to be honest about our debt and deficit, at its heart is a health care problem. So now is the time for our country to set out a clear challenge, as President Kennedy did, that will address our health care cost problem.

That challenge must stand on two facts: One fact is that our health care cost problem is a system-wide problem. Republican proposals to end Medicare as we know it fundamentally misdiagnose the problem. Most everybody in America knows it does not matter who our insurer is, whether we are insured by Medicare or Medicaid, the VA or TRICARE, United or Blue Cross, in the last decade, costs across all insurers have gone through the roof. Indeed, just today in the news, Secretary Gates is reported to have said--about his Defense Department budget--everybody knows we are being eaten alive by health care. We have a system-wide health care cost problem, not a Medicare problem.

Health care expenditures are nearly 18 percent of our gross domestic product. The next least efficient country in the world spends only 12 percent of its GDP on health care. We would have to go far down the list of our competitor nations before we find a country that has as poor health outcomes as America has, even though we spend vastly more for our care. We have a system-wide health care cost problem and a system-wide health care quality problem.

The second fact is, the health care cost problem and the health care quality problem are related. We have at our disposal an array of health care reforms that will reduce the cost of health care while improving the quality of health care. These types of reforms--new models of care coordination, quality improvements in hospitals, paying for quality not quantity to our physicians, and reducing overhead costs in the system--all have one liability; that is, they do not lend themselves easily to estimates of cost savings. Because of this, there is less attention than there should be to the great potential of these reforms. Bowles and Simpson, Domenici and Rivlin have all conceded this in our Budget Committee hearings.

The promise of these reforms is immense. The President's own Council of Economic Advisers has stated that 5 percent of GDP can be taken out of our health care system without hurting the quality of care. That is about $700 billion a year. The New England Health Care Institute said it is $850 billion a year. The Lewin Group has estimated the potential savings at $1 trillion a year, a figure echoed by former Bush Treasury Secretary O'Neill. The savings are there, and they are considerable.

The question is, How do we get at them? Well, let's first look at the affordable care act that we passed. The affordable care act's delivery system reforms provide many of the tools that we need to drive down costs and improve the quality of care.

As we were working on that bill, I had a regular meeting in my office of experts from around the country, from the business community, from the labor community, from the NGO community, who really were dialed in to the delivery system reform problem in this country.

We met regularly, we met early in the morning, and every time we asked the same question: What more can we put in this bill to make sure it has the tools to get these reforms

done? By the time that bill passed, we were in agreement that everything we could want was in that bill.

It provides a tool box with five major strategies we need to deploy. The first is quality improvement, which will save the cost of medical errors, of misdiagnosis, of disjointed and uncoordinated care.

The clearest and simplest example is reducing hospital-acquired infections which affect nearly 1 in every 20 hospitalized patients in the United States. They cost us about $2.5 billion in unnecessary health costs every year.

The tens of thousands of deaths that are associated with these hospital-acquired infections are tragic. It is made all the more so by the fact that they are essentially preventable. Simple reforms, such as following a checklist of basic instructions--washing hands with soap, cleaning a patient's skin with antiseptic, placing sterile drapes over the patient--result in huge reductions in rates of infection and in costs.

So, first, quality improvement. The second strategy is prevention. The most inexpensive way to deal with disease is to prevent it in the first place. More than 90 percent of cervical cancer, for instance, is curable if the disease is detected early through Pap smears.

The third strategy is payment reform. We must pay doctors for better outcomes, not for how many tests and procedures they order. Rhode Island has a promising ``medical home'' primary care payment strategy already underway.

The fourth strategy is simplifying administrative processes to reduce overhead costs. The insurance industry in this country has developed a massive bureaucracy dedicated to delaying and denying payments to doctors and to hospitals.

So to fight back, the doctors and the hospitals have had to hire their own billing departments and expensive consultants. All of that, the entire war over payments between insurers and hospitals and doctors, adds zero health care value. It only drives up costs.

Finally, the fifth strategy is a robust, secure health information infrastructure. Health information technology was, years ago, estimated by the Rand Corporation to save $81 billion a year. Savings may very well be higher as the system builds itself out. Not only is a robust health information infrastructure a good end in itself, but those four other delivery system strategies are empowered and advanced and expanded by robust health information infrastructure.

These five delivery system reform strategies hold the promise to deliver the enormous savings we need to extract from our health care system, and to do so in the most humane way, by improving the quality of care. The debate we need to have on our health care cost problem must focus on delivery system reform, on how we can implement these delivery system reforms from the recent health care reform bill as quickly and as effectively as possible.

This is what brings me back to President Kennedy's speech on space exploration. President Kennedy did not say: I am going to see to it that America bends the curve of space exploration. Had he said that, the speech would have been consigned to oblivion, and we would likely not have put a man on the Moon on time. Instead, he made a memorable challenge with a clear objective: Put a man on the Moon, bring him back safely, within a decade. Everybody could know whether that had been done. It was a clear and accountable purpose, and it galvanized the entire Federal bureaucracy toward that common purpose.

We can and must do the same with health care delivery system reform. We can and must have a clear challenge to strive toward.

It is not enough to talk about bending some health care cost curve. Our country has the talent and discipline to accomplish extraordinary things. We can significantly bring down costs in our health care system. I notice that the junior Senator from Minnesota has just taken the chair in the Chamber. Minnesota knows well what can be accomplished through these kinds of delivery system reforms because companies such as Mayo, Gundersen Lutheran in Wisconsin, Intermountain in Utah, and Kaiser in California are all doing this kind of work effectively already. We can significantly bring down costs in our health care system. We don't have to be last or the least efficient country in the world in providing health care to our people. We can do this while improving the quality and the experience of health care for Americans.

I will conclude by saying that tackling these issues won't be easy. But to go back to President Kennedy's speech, he said:

We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard. .....

I urge my colleagues and the administration--we cannot afford to fail. Let's raise the stakes. Set a hard challenge. The future of our Nation's fiscal health certainly depends on it.

I yield the floor.

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