Repeal Big Oil Tax Subsidies Act-Resumed

Floor Speech

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Mr. WHITEHOUSE. Madam President, I rise today to talk about the changes the affordable care act is making to the way care is delivered in our health care system. This is a topic that has not received much public attention. Instead, the public debate has largely focused on contentious flashpoints such as the individual mandate or preposterous false claims about death panels or rationing or socialized medicine.

While these contentious debates have raged on, there has been a quiet, steady, and important effort made by the health care industry, by State and local leaders, and by the Obama administration to improve our model of health care delivery. Progress made on these efforts is steadily transforming the care that is delivered under our health care system, from care that is disorganized and fragmented and often riddled with error, to care that is coordinated, efficient, and the high quality Americans deserve. By improving the quality of care and our health outcomes, these delivery system reforms promise to significantly reduce health care costs. Care gets better, costs go down, a true win-win.

I came to the floor today to release a report on health care delivery system reform and on the administration's progress implementing these provisions of the affordable care act. I undertook this project with the support and assistance of Chairman Harkin and Senator Mikulski, both strong advocates and experienced legislators on the types of reforms that are highlighted in the report.

The report makes the case for the reforms our country urgently needs in order to tackle our health care cost problem. My report defines five priority areas of health care delivery system reform: payment reform, quality improvement, primary and preventive care, administrative costs, and health information infrastructure. It outlines the potential cost savings in each area.

It also highlights successes across the country from leading private health providers such as Geisinger Health Systems in Pennsylvania, Intermountain Healthcare in Utah, and the Marshfield Clinic in Wisconsin, to the State of Vermont's Blueprint for Health, to several examples in my home State of Rhode Island, which has shown great leadership. We have much to learn from these efforts, and the affordable care act gives us the tools to support this type of reform across the country.

The problem is our health care delivery system remains clumsy and wasteful. We spend more than 18 percent of America's gross domestic product on our health care system every year. To put that into context, the highest any other industrialized country spends is approximately 12 percent of gross domestic product on health care. Eighteen percent United States of America; least efficient other industrialized country in the world, 12 percent. Huge room for improvement. In a nutshell, we overspend and underachieve.

The President's Council of Economic Advisers estimated that over $700 billion a year can be saved without compromising health outcomes. The Institutes of Medicine put the savings from these kinds of reforms at $765 billion a year. The New England Health Care Institute projected $850 billion in savings annually, and the Lewin Group and former Bush Treasury Secretary Paul O'Neill have estimated the savings at $1 trillion a year. Whichever is accurate, this is clearly an enormous opportunity and it is right before us. We can achieve better results for American patients and families, and spend less to do it.

As I said, the solutions fall into five priority areas: payment reform, primary and preventive care, measuring and reporting quality, administrative simplification, and health information infrastructure. These solutions do not cut benefits; they do not increase premiums. Instead, they realign incentives to reduce or get rid of overpriced or unnecessary services, inefficiently delivered care, excessive administrative costs, and missed prevention opportunities.

In this report, we outline actual savings and care improvements that can be found in each priority area. For example, payment reform refers to the new payment reform models that pay doctors more for getting better results, as opposed to ordering more procedures.

In 2010, Blue Shield of California collaborated with Hill Physicians Medical Group and Catholic Healthcare West, California's largest hospital chain, on a pilot program for the California Public Employees Retirement System. The pilot program focused on improved coordination of care by sharing clinical and case management information across medical facilities and among physicians.

In its first year, the Blue Shield pilot program reported impressive results: Readmissions were reduced by 15 percent; hospital days were reduced by 15 percent; inpatient stays of 20 or more days were reduced by 50 percent, cut in half--all saving millions of dollars.

In primary and preventive care--as a country, we don't devote nearly enough resources to primary care and prevention. Only 6 percent to 8 percent of health care spending goes to primary care, to your regular doctor appointments. That is less than the percentage that goes in private insurance to insurance company overhead.

According to the Centers for Disease Control and Prevention, to give an example: When colorectal cancer is found early and treated, the 5-year survival rate is 90 percent. But screening rates for colorectal cancer are low. The National Health Interview Survey found that in 2005, only half the population aged 50 and older received recommended screening for colon cancer. The American Cancer Society has found that increased colorectal screening in the pre-Medicare population could save lives and reduce subsequent Medicare treatment costs by $15 billion over 11 years.

On measuring and reporting quality, we don't do this anywhere near well enough. Nearly 1 in every 20 hospitalized patients in the United States gets a hospital-acquired infection. This is very expensive and it is preventable. A hospital-acquired infection should be a never event. Yet it costs our health care system approximately $2.5 billion a year in harmful costs we could avoid.

Administrative simplification. The proportion of the U.S. health care dollar that is lost to administration has always been high relative to our peer countries. The cost of administration by insurance companies is not only high itself, but it creates a shadow cost imposed on providers who have to fight back against the insurance company claims denial apparatus, and that cost is probably even higher.

A study published in Health Affairs documented that physicians spent on average 142 hours annually interacting with health plans, totaling nearly 7 percent of total health care costs.

That is just the physician's time. That doesn't count all the nonphysician office staff dedicated to administration and chasing the insurance companies.

Last, health and information technology. Health information technology is the essential underlying framework for health care delivery system reform. It is the foundation on which other delivery system reforms can be built. In 2000, the Institute of Medicine estimated the number of deaths resulting from medical error as high as 98,000 American deaths annually. The most common cause of those preventable injuries and deaths in hospitals was medication errors, which can be reduced dramatically through the adoption of computerized physician order entry systems--health information technology.

The reform areas my report discusses synchronize with one another, and there is a growing national movement of providers and payers and States that recognize their critical importance. Focusing on quality rather than quantity and focusing on efficiency rather than volume will better serve not only their patients but their bottom line.

The report I am releasing today looks at 45 provisions in the affordable care act that promote these delivery system reforms. From the discussion one would not know that virtually one-third of the affordable care act was about these delivery system reforms because they have been noncontroversial, but they are in there and they are important.

The report also assesses the administration's progress in implementing them. We found that the administration has already implemented 25 provisions fully and made significant progress on two others. The complexity and sheer number of reforms included in the law make this accomplishment in a relatively short period of time noteworthy.

In addition to the hurdles presented by our fragmented health care system, there has been resistance in Congress to the administration's implementation efforts that has also created barriers. For the 20 delivery system provisions that have not yet been implemented, lack of congressional funding is a significant factor in delaying their forward progress.

In these reform provisions, the affordable care act is supporting and building upon the efforts undertaken by the private sector by realigning incentives in the health care system to support private sector efforts. A broad array of pilot and demonstration programs has been launched, from which best practices will be deployed nationwide. The process to get to a more sustainable path will be one of, as CBO Director Elmendorf said, ``experimentation and learning. It will be a process of innovation.''

The affordable care act improves the conditions that allow that innovation to take place, and it has the mechanisms needed to propagate those reforms widely throughout the system as quickly as possible once they are proven effective.

American ingenuity can overcome our toughest challenges, not through command and control but through dynamic, flexible, and persistent experimentation, learning, and innovation. We are at a fork in the road on our health care future. One path we could travel is to protect the dysfunctional status quo and cut benefits to pay for the waste. That is the way a lot of my colleagues want to go.

The other way is to shift incentives so that we innovate toward better, safer health care--which costs less. We as Americans need to trust that the path of innovation and experimentation is the right one and not give up on these efforts.

Last year, George Halvorson, who is the CEO of Kaiser Permanente and knows a little something about health care, said it this way:

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 is wrong. It's so wrong it's almost criminal.

He continued:

It's an inept way of thinking about health care.

The affordable care act has the tools that enable providers to focus on quality rather than quantity, efficiency rather than volume, and patients rather than their bottom line, to avoid the inept way of thinking about health care.

As I close, let me say that throughout the process of writing this report I found one thing to be glaringly absent; that is, a cost savings goal set by the administration for us to reach toward on these delivery system reform provisions.

In 1961, President Kennedy declared that within 10 years the United States would put a man on the Moon and return him safely. This message was clear, it was direct, and it created accountability. As a result, a vast mobilization of private and public resources occurred to collaborate in innovative ways to achieve the President's purpose.

While the issue facing our country in health care is different, the urgency and the need to mobilize the public and private sectors toward improving quality and reducing cost is the same. So I challenge the administration to set a cost-savings target for delivery system reform. A cost-savings target will focus, guide, and spur the administration's efforts in a manner that vague intentions to bend the health care cost curve will never do. It also will provide a measurable goal by which we can evaluate our progress.

A clear and public goal will help make this vision of our health care system a reality. It will drive forward progress, and it will generate momentum to achieve that goal.

I urge the administration: Set a goal you are prepared to be accountable to meet.

When President Kennedy announced in September of 1962 that America would strive to put a man on the Moon, he said:

We choose to go to the moon in this decade ..... not because [it is] easy, but because [it is] hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one we are willing to accept, one we are unwilling to postpone, and one which we intend to win.

We need to face the challenge posed by the rising health care costs in our system. We need to recognize we cannot postpone finding a solution. We can win this challenge, we can drive our system toward a sustainable path of higher quality care and improved outcomes, and we can do so by setting clear goals and supporting the measures in the affordable care act that propel us in that direction.

I yield the floor.

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Mr. WHITEHOUSE. Setting aside the questions that this raises about the House's ability to govern, which I think are raised by this issue but focusing on this highway question, it is now the end of March. If we go 90 days, 30 days takes us through the end of April, 30 more days takes us through the end of May, and 30 more days takes us through the end of June. There is a seasonal component to getting this work done, is there not? What is the effect of our entire highway, road, and bridge industry having no certainty about what their funding is going to be until practically the Fourth of July with the construction season then underway?

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Mr. WHITEHOUSE. Mr. President, I see the Republican leader is on the floor, and I understand there may be a unanimous consent that is propounded, and I can offer some remarks in the context of an objection and a counterproposal, if the minority leader would like to proceed now.

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Mr. WHITEHOUSE. Mr. President, I ask unanimous consent to speak until I get a signal from the majority leader that he will seek recognition, at which point I will yield the floor.

I wished to follow in the footsteps of Senator Landrieu of Louisiana and reflect my own dismay and dissatisfaction with the situation we are in right now. The House extension on the highway bill, which we are going to be asked to proceed with, is going to cost--as far as the estimates I can see so far--around 100,000 jobs, and that is damage to our economy. That is a self-inflicted wound. More specifically, it is a House-inflicted wound, and I would very much like to see the Senate fight to force action on the Senate highway bill. It is a bipartisan bill with amendments and is fully paid for. This is a serious bill, as opposed to inflicting this kind of damage on our economy with a short-term extension.

Does the majority leader seek recognition?

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