Medicare

Floor Speech

Mr. WHITEHOUSE. Mr. President, I am not going to speak very long tonight, and I am not going to speak very formally either. But I did want to come back to the Senate floor and make a point again that I have made repeatedly here on the Senate floor before; that is, there is a path to reform of our health care system that will improve the quality of care for patients, will improve the experience of care for patients, will improve the outcomes of care for patients and for our Nation, and will lower costs for our country.

The reason I come to raise that point again is that the Senate is now awash with rumors that the 12 Members of Congress--Senators and Congressmen--who have been tasked with trying to create a solution to our deficit problem are going to cut Medicare benefits by hundreds of millions of dollars. That is, as best I can tell, only a rumor. I certainly cannot vouch for it being true. Indeed, I hope it is not true.

The time I wish to spend this evening is to remind my colleagues it is a very unfortunate and mistaken path to take to follow the road of benefit cuts at a time when the road to reform is so promising in terms of the win-win of better care at lower cost.

It is not just me saying this. The President's Council of Economic Advisers has said the annual savings that could be accomplished with health care delivery system reform, without reducing anybody's quality of care or access to care--indeed, I would hypothesize actually improving quality of care--is $700 billion a year in the American health care system.

The President's Council of Economic Advisers is not alone in that opinion. The Institute of Medicine has just said it is around $770 billion a year. A few years back, the New England Healthcare Institute said it was $850 billion a year. And the Lewin Group, which is a fairly well respected health care consultancy here in Washington, as well as George Bush's Treasury Secretary, Secretary O'Neill, have both agreed annual savings could be $1 trillion a year--all by improving the quality of care and the coordination of care.

I do not know if it is exactly going to be $700 billion or $1 trillion, but my point is, there is a big savings target out there that everyone from President Obama's Council of Economic Advisers, to George Bush's Treasury Secretary, to a lot of very well thought of groups in between, including our National Institute of Medicine, all agree on. So I think that makes it a very important target to pursue in this discussion.

It is not just me in believing, at this potential split in the road, we should work and fight very hard to make sure we are taking the right path and we do not go down the easy-to-score but unnecessary and unhelpful path of benefit cuts, which singles out seniors in Medicare and does nothing about the underlying costs of the system and makes it the wrong road to follow when we have a well illuminated path that can move us toward a better, more efficient delivery system that provides better quality health care, better outcomes, fewer hospital-acquired infections, better coordinated care, stronger electronic health records--all of the things that will support a truly modern health care system that can be the envy of the world.

That is the choice we have. I think it would be a terrible mistake to go the benefit cuts route instead of the reform route, and it is not just me who says that. George Halvorson is the chief executive officer, the CEO, of Kaiser Permanente. Kaiser Permanente is one of the biggest health care systems in the country. It provides health care in many States, and George Halvorson is a very serious individual who knows his stuff in health care. He would not be the CEO of that big company if he did not.

Here is what he said the other day:

There are people right now who want to cut benefits and ration care and have that be the avenue to cost reduction in this country. And that's wrong. It's so wrong, it's almost criminal. It's an inept way of thinking about health care.

That is not me. That is the CEO of Kaiser Permanente.

There are people right now who want to cut benefits and ration care and have that be the avenue to cost reduction in this country and that's wrong. It's so wrong, it's almost criminal. It's an inept way of thinking about health care.

Yet that is the direction that it looks like we may be taking, the inept direction. I had a hearing in the HELP Committee--the Presiding Officer, Senator Bennet of Colorado, is a member of that HELP Committee--and we had some very interesting witnesses. Because the path toward savings through reform is not just a HELP Committee path, this is not something that some academic has constructed and maybe if you take that path things will work, this is a path that major corporations, major health systems, major hospitals in this country are already walking. They are already walking down that path.

Kaiser is one of them. Blue Shield of California is another. Intermountain out in the West is a third. Mayo, Geisinger, Gundersen Lutheran--there are a number along the East Coast. These are companies that have determined this is the right path, and they are walking that path.

Two folks were there from such companies. One was Dr. Gary Kaplan, who is at the Virginia Mason health system in Seattle, WA. Despite its name, Virginia Mason, it is actually in Seattle, WA, on the other coast. He pointed out that they went through a quality management transformation in their hospital with a cultural transformation, with a process transformation.

As a result, they have made significant improvements. Just in one back pain reform process they did with 2,000 patients, they calculated they have already saved $1.7 million on 2,000 back pain patients, and those patients are happier with the new regime, the less-expensive regime, than before because they are getting better quality care.

He testified they saved $11 million in planned capital investment, reduced inventory costs by $2 million through supply chain expense reductions, reduced staff walking distance by 60 miles per day, reduced labor expenses and overtime and temporary labor by half a million dollars in just 1 year, reduced professional liability insurance premiums by 56 percent, reduced their self-insured retention fund by 70 percent, reduced the time it takes to report lab tests by more than 85 percent, and improved their medication distribution, reducing errors, reducing the time when a patient first calls Virginia Mason's breast clinic with a concern to the time they receive a diagnosis from 21 days to 3 days, and many patients receive their results on the same day.

These are the kind of improvements that have put Virginia Mason at the front end and make them, according to the Leapfrog Group, one of the top hospitals in the country. They are walking the walk of improving the quality of their operations, improving the quality of care and saving money by doing so.

The other witness was Greg Poulsen from Intermountain. He described two examples. One was a sepsis program for people who are admitted to the hospital suffering from sepsis throughout their system. Sepsis is a dangerous condition. Sepsis, on average, has a 40-percent mortality rate. So 4 out of 10 people with sepsis die of it. They have reduced the 40-percent mortality rate from sepsis to 5 percent--from 4 in 10 dying to 1 in 20 dying. Did it cost a lot of money to do that? Was that a big investment they had to make? Did it cost the taxpayers a lot to save those lives? No. What they found is they saved $10 million with that improvement.

Similarly, they have a diabetes program that has been described by the former CEO of the Mayo Clinic as the diabetes program he would go to if he were sick with diabetes that has ``the best outcomes and lowest costs in the country.''

They saved $5 million a year on diabetes treatment by going to better health care providing. There is a problem, as he pointed out. That $10 million they saved is actually a revenue loss. Because when they saved money by not having unnecessary care, by not having complications, by having things be more efficient and streamlined, what they did was they reduced their billing to the insurance companies, and it is actually the insurance companies, it is the payers who saved the $10 million.

What the providers spend is a revenue loss. So we have our system upside down in that respect, and that is one of the ways we need to reform our system. A third witness who

was there was a Rhode Islander. His name is Chris Koller. We have a unique office in Rhode Island, an office of health insurance commissioner. He is the only health commissioner in the country. Also, I tease him that he is the tallest insurance commissioner because he is unusually tall, but that is easy because he is the only one.

But he has done a very good job of bringing our hospitals and insurance companies together to try to focus on the ways we can deliver care better. One way is through prevention and primary care. It turned out that in Rhode Island, the amount of every health care dollar that was spent on primary care was 5.9 percent. So every $1 spent on health care in Rhode Island, less than 6 cents, went to primary care, went to your regular family doctor and the basic health care providers. Less than 6 cents out of every $1.

The insurance companies have more overhead than that, administering the system. The costs of administration of the health care system is more than the primary care providers get out of the system. That is another sign that the system is upside down. He is encouraging them, and they have agreed, to step up the spending on primary care by 1 percent a year for 5 years. We believe that is going to make a very substantial cost savings because there is so much that a primary care provider can handle without having to go to a specialist, without having to go to the emergency room, without the condition getting worse because they could not find you, by simply making primary care more accessible and more available.

So the additional expense for primary care should bring down system costs overall and having it designed more intelligently.

I will close with a few words from the witness, Dr. Kaplan, who said that through the work they have been doing on reform and efficiency, he said: ``We have demonstrated that the path to higher quality, safer care is the same path to lower costs.''

He actually said that if we could get more transparency to the system about who is doing a better job and who is not, what the outcomes are for different hospitals, that basically where we are right now in the delivery system reform provisions that were in the Accountable Care Act, he described them as one of the last chances of a market-based system.

This is somebody who is in this business all the time and is actually running a hospital that is actually producing results. This is a person who is steeped in the reality of health care, and contrary to what we hear in the cartoon version that infects Washington, where ObamaCare is socialized medicine and is a step away from market-based care, this practitioner says the potential of the Accountable Care Act, as I see it, is one of the last chances of a market-based system.

It could actually lead to a market, whether it was Medicare and Medicare Advantage as parts of Medicare or the commercial sector, that we would actually be able to understand what we are buying and what we are paying for.

That is the kind of commonsense transformation we need. You remember, Dr. Kaplan said: We have demonstrated the path to higher quality, safer care is the same path to lower costs.

Gary Paulsen, Intermountain, and other organizations have shown that improving quality is compatible with lowering costs. Indeed, high-quality care is generally less expensive than substandard care, and the primary challenge for us and the main reason more organizations do not adopt the high-value model discussed in the hearing that we held is the underlying fee-for-service payment system which predominates, of course, in the United States. We pay doctors for doing more, not for doing better. We pay doctors for doing more things to you rather than getting you well.

Because we do that, we have the results we have. When you look at that mess, you can say, OK, we are going to leave all that alone. We are not going to follow the path that Intermountain, that Gundersen, Lutheran, that Virginia Mason has proven, that Kaiser has argued for and proven, that so many systems around the country are doing, you can say, we are going to forget all that. We are going to leave it in place. We are going to leave it a mess, and we are just going to cut benefits away from seniors, from our elderly, from the people who need care the most, from the people who paid into the system, from the people who do not have a chance to recover, very often from people who are not in a position to direct their own care and make effective choices if they are the very elderly on Medicare or worse, the Medicare-Medicaid dual eligibles.

We are going to go after those people. We are going to cut their benefits, and we are not going to take the trouble to follow the path the professionals who are doing this are already showing is a path that leads to saving, is a path that leads to a better health care system, is a path that leads us out of the difficult position of being the only country in the world that spends 18 percent of our GDP on health care, of being the most inefficient country in the world in health care by a 50-percent margin. The next closest country in terms of inefficiency in health care is about 12 percent of GDP. We are at 18. Why is it necessary that America has to be the most inefficient health care provider in the world of all the countries we compete with by a factor of nearly 50 percent? That is half again worse than the most inefficient competitor we face. It makes no sense to be in that position.

There is enormous room for improvement. The path to that improvement is clear. It is already being walked by serious and responsible institutions that have set this as their corporate goal. That is where we should go. I will close again by repeating George Halvorson's exhortation. He is one of the great health care leaders in this country. He is a savvy corporate manager. He runs an enormous health care corporation. This is not an idle opinion of his.

There are people right now who want to cut benefits and ration care and have that be the avenue to cost reduction in this country and that's wrong. It's so wrong, it's almost criminal. It's an inept way of thinking about health care.

Those are CEO George Halvorson's words, not mine.

I hope that they ring through this body and we don't make the mistaken decision to go after Medicare benefits and instead take the positive path of reform and improvement.

I yield the floor and suggest the absence of a quorum.

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