[Congressional Record Volume 153, Number 53 (Tuesday, March 27, 2007)]
[Senate]
[Pages S3822-S3827]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE
Mr. COBURN. Mr. President, I understand that I am to be able to speak
as in morning business for up to 1 hour.
The ACTING PRESIDENT pro tempore. We are in morning business, and the
Senator is recognized for up to 1 hour.
Mr. COBURN. I thank the Chair.
Mr. President, if you go out in our country and you ask, besides the
war, what is on people's minds, the No. 1 topic you will hear about is
health care. And what are the questions that you hear? Why can't I
choose my own doctor? Why can't I pick my own health insurance plan?
Why do my premiums increase every year but my benefits don't increase?
Why do I have trouble understanding which benefits my health plan
offers? Why does my employer get a tax break from my health care but I
don't? Who can make the best health care decisions for my family, us in
Washington, the insurance bureaucrats, other people, my employer, or
how about me? How about me getting to make a decision about my health
care?
There is no question America's health care is broken. It is not that
we are getting bad care, it is that we pay a tremendous amount for what
we get in our care. The estimates are anywhere from $1 out of every $3
to $1 out of every $4 we spend on health care doesn't go to help
anybody get well in this country and doesn't go to help anybody prevent
having an illness. That is $2.2 trillion, and it will be over $2.3
trillion this year.
When you see what happens--and these are not my numbers, by the way;
these are Price Waterhouse numbers, a breakdown on health care
dollars--what you see are some pretty interesting statistics. You see
that when we go to spend $1 on health care, 35 percent of it goes to
hospitals, 21 percent of it goes to doctors, 15 percent goes to
prescription drugs, and 5 percent goes to equipment.
All the rest of that, the medical liability insurance--nobody
realizes that is 10 percent. Ten cents out of every dollar we spend
goes to medical liability. We are insuring against a problem in health
care--10 percent. It costs us 6 percent to process the claims. One-half
of all the claims filed against all the insurance companies in this
country are denied because the people haven't met their deductible, and
yet we keep sending the claims, keep spending the money.
One out of every three people who works in a hospital, one out of
every three people who works in a doctor's office doesn't do anything
to help anybody get well. Why is that?
It is because of the system we have set up. If you add this 10
percent for liability insurance, 6 percent for processing, 5 percent
for marketing, 23 percent for the insurance industry profit--and I
doubt seriously it is that low--what you come up with is 24 percent, as
a minimum, that doesn't have anything to do with helping anybody get
well.
Now, why is that? Why is it we have this system? It is because we
have somebody besides the patient choosing what they will get in terms
of health care. In Medicaid, it is your State. Oftentimes in Medicaid
it is your State paying a very low rate, so now you get to choose from
those who will accept the lowest rates. In Medicare, they tell you
exactly what the price is. We spend all our time around here trying to
change Medicare, because when we push on the balloon one way, something
else pops out.
So whether it is the Deficit Reduction Act or some of the other
things we have had, what we find is we cannot control this tiger
because we have a bureaucratic maze that nobody understands. When we
try to use price controls, when we try to limit expenditures, we end up
losing control.
So what happens? Who makes your health care decisions? Either CMS,
the Center for Medicare Services, in conjunction with your State,
either for Medicare or Medicaid, your employer, or an insurance
company.
[[Page S3823]]
Whatever happened to you making decisions about your health care,
about which doctor, about which insurance policy, about which hospital
you want to go to? And why is it that if you happen to be Medicaid, you
get to choose less than somebody who doesn't happen to be Medicaid? Why
is it we are treating in an unequal fashion those who are the poorest
among us?
Why shouldn't we have the right to pick what insurance benefits are
best for us? Why shouldn't we have the right to choose who is going to
be our caregiver, whether it is a doctor, a nurse practitioner, a
physician's assistant, a chiropractor, or an optometrist? Why shouldn't
we get to choose that, rather than an insurance company or an employer
deciding who we can or cannot see?
They also decide the price we are going to pay because we are trying
to control all these costs. They are also going to decide which
hospital we go to. But how is it that we have a system now where
everybody except the patient gets to decide what happens to them in
terms of their health care?
We can't afford the health care system we have today. For one thing,
16 percent of our GDP, the highest of any country in the world by 50
percent, is spent on health care. Although we have good health care, we
don't have better health care than those countries that are spending
less. We are spending 16.2 percent, or $2.3 trillion, per year on
health care, so we should be 50 percent better off. We should have a
50-percent better life expectancy, 50 percent less heart disease, and
50 percent less cancer. Of the money we spend on health care, fully
three-quarters of that is spent on five diseases.
Think about that: 75 cents out of every dollar that actually gets
into health care, which is only 60 to 70 percent of the money we
actually pay into health care, 75 cents of that goes for either heart
disease, stroke, chronic obstructive pulmonary disease, diabetes, or
cancer. Five diseases, most of which are readily preventable--not
partially preventable but readily preventable--through increased
prevention activities.
This Government this year will spend $20 billion on prevention in 12
different agencies, through 27 different programs, none of which are
coordinated to try to maximize the education of the American people to
what they need to know about their health care so they can make
decisions on prevention. Consequently, we are very ineffective with
prevention.
If you look down the road at what is coming in terms of Medicare and
Medicaid, what you see is an unfunded liability of over $60 trillion--
$60 trillion--we are adding. This isn't about health care now. That $60
trillion that is getting ready to hit our kids and grandkids in terms
of Medicaid and Medicare that we have promised for the future, that we
have no way to pay for now, one of the great ways of lessening that
number is to change what we do on prevention. Prevention is the key.
Grandma was right: An ounce of prevention is worth a pound of cure.
As a matter of fact, it is said in 2070 $1 out of every $2 that
Medicare spends, at our current rates, will be spent on diabetes--$1 of
$2. So when you look at this Medicare number, with the vast majority of
the baby boomers who are going to retire and then their generation is
going to retire, $1 of every $2 that will be spent by Medicare will be
spent on one disease only, which means we only have $1 to spend on all
the rest of health care for seniors, plus any attempts at prevention
and at early diagnosis or new and modern treatments. We can't continue
without a coherent plan on health care.
The other problem that is facing us as a nation is right now we can't
compete globally in many areas because of health care costs. When you
compare GM and Toyota, there is a four times greater differential for
what goes into a car made in this country by one of the Big Three
versus what goes into a car made outside of this country by their
competitors. So there is no way that we can, in fact, be competitive
globally until we handle health care. There is no way we can handle
Medicare and Medicaid until we change the health care system.
Myself and Richard Burr and several other Members of the Senate will
be introducing a bill tomorrow that addresses every problem our health
care system faces today, whether it is tort liability, and making sure
people get awarded what they need when a mistake is made during the
practice of medicine, or whether it is immunizations. The fact is, we
have very few States where we have achieved 90-percent immunization.
We are going to address every problem we face, the liability that
comes at us in the future through Medicaid and Medicare, the problems
we face on liability, the problems on access, the inequality that
somebody, because they happen to work at a very low-paying job, gets
stamped with something on their forehead that says, you are of less
value than somebody who happens to work someplace that has great
insurance and a higher paying job.
Our bill changes all of that, and instead of going to the Department
of Motor Vehicles to wait in line, we are talking about a health care
system where you, the consumer, are No. 1. The government isn't No. 1,
the doctor isn't No. 1, the hospital isn't No. 1, the drug company
isn't No. 1, but you, the patient, become No. 1. You get to choose what
insurance you want, you get to choose what kind of insurance you want,
and you get to choose how much you will pay for it. We create a new
insurance market where everybody gets to play by an even set of rules.
How do we do that? We do that by giving everybody the same advantage
in this country when it comes to health care, and that is a refundable
tax credit, $2,000 for every individual, or $5,000 for every family.
What that means is, if you are earning about $120,000 a year or less in
this country, you will gain in terms of your taxes off of this bill. If
you are making $120,000 or less, what is going to happen is you are
going to have the option of staying with your employer, if you like
what they have, and that tax credit will be available to your employer.
But if you decide you want something different, maybe it offers
something you don't get covered today or doesn't cover a whole lot of
things you think you need, you can take that tax credit and buy that
insurance and save the difference in the money for your future health
care. The Universal Health Care Choice and Access Act provides $2,000
for every one of the 45 million uninsured tomorrow, every one of them
as an individual.
Now, what does that buy? People say: That won't buy much. Well, if
you go to Kentucky and you happen to be 35 years of age, you can buy a
$2,000 yearly deductible policy for $897 and have $1,300 or $1,100 left
over between that and the deductible. If you try to buy that same
policy in the Chair's State, it is almost $6,000 for that identical
policy. Why? Because government has decided in New Jersey differently
than what government has decided in Kentucky. Therefore, the cost of
getting this minimal coverage, because of the mandates put on by
government--not what a patient wants but by what government says
patients should have--makes that unavailable in New Jersey.
How do we fix that? We allow people to buy insurance anywhere they
want, just like they buy their auto insurance today; like they buy
their homeowner's insurance. They can buy it from any company anywhere
in America, as long as they have a registration with a State. We create
a primary and a secondary location for that. So if you want to buy
something that has a better price, that fits your needs, you have the
capability to do that and put the difference into a health savings
account, where you can use it for future health care needs, that you
can use to apply to any deductible, or if you get enough money in it,
you can bring it down to where, if you want to, you can have a zero
deductible--if you want--but most people will not want to do that. We
allow you to select a health plan that truly meets your family's needs,
not what some Government bureaucrat says or some Senator says you must
have. It is what you want. We allow individuals to choose what they
want in terms of their health care.
What will that do in terms of the market? That is going to create
innovation in the health care market all across this country. It is
going to cause competition like crazy for the dollars. Once we truly
have competition, which is something we do not have in health care
today, which we tremendously need, then we are going to see a big
change.
[[Page S3824]]
The other thing this does is it gives access for affordable health
care for a ton of people who do not have it today. They get to choose
their health care provider. The patient gets to choose who takes care
of them. Not the Government, not their employer, not the Senate, not
their State insurance commissioner, but they are going to get to choose
who is going to take care of them. It is the right to choose who is
going to care for you.
How do we do that for the States? We do not mandate anything for
anyone. We do not say anybody has to do anything. But we create a lot
of incentives. We tell the States that, if you want to, you can take
your Medicaid funds and your disproportionate share funds and anybody
who is Medicaid eligible, under the 133 percent of poverty level, you
can take their $2,000, plus the Medicaid money, plus the DSH money, and
you can help them buy an insurance policy in your State. If you want to
stay with Medicaid, you can stay with Medicaid. There is no mandate
from the Federal Government other than to get people into coverage.
You ask any government tomorrow if they would take $2,000 per
eligible person in their Medicaid program, would they take a deal with
them having the freedom to design what is best for their State? Every
Governor will tell you yes. Every Governor will tell you yes. Why?
Because now we are given the resources there to allow a Medicaid
patient to be just like everybody else--a Senator, their mayor or
somebody who works at the best factory in town. They have an option to
not be discriminated against because they show a Medicaid card. Now
they have an insurance card. People ask: What about the people who do
not want to have insurance? We allow the States the opportunity to have
a default mechanism. If the State of Tennessee--I see the Senator from
Tennessee here. If the State of Tennessee wants to decide we will
option, if we have people in our State who are going to be so
irresponsible that they will not even buy themselves coverage and they
have an opportunity to take tax money to do that, then we are going to
create a default mechanism whereby the State of Tennessee--if you are a
25-year-old motorcycle rider and you don't want to buy insurance, they
can take your tax credit and buy a high-deductible policy for you so
when you go to the ER, all the rest of us don't have to pay all your
costs. What is happening in our health care system is we keep
transferring the costs so we have a rationale for jumping up the price
because they are doing something for somebody else at a low price.
What the real facts are--and we never hear it--the real facts are,
when you look at the hospitals out there, all--the vast majority of
them--and this is a very key, important point--the vast majority are
nonprofit entities. That means they pay no income taxes, they pay no
payroll taxes. On order, the vast majority, and on average, offer 10
percent of their total billed care as indigent care.
But that is not a real number. The reason it is not a real number is
because they bill the highest prices they have for that indigent care.
If you look at the cost of that care, it would be far below that. I
know in the State of Oklahoma, the hospitals there last year billed
over $5 billion in revenue, made over $5 billion in profit, and out of
that they billed another $400-some-odd million in care that was
uncollectible to people who did not have insurance or couldn't pay.
That was not really their cost. That was their billed price.
Remember, we give this nonprofit status to all these entities, this
$500 million worth of profit in Oklahoma, for example, and they pay no
taxes on that. They pay no real estate taxes. In essence, they offer
about $100 million worth of charitable care.
What this bill does is it takes away all the cost shifting.
What are the other things we do? We incentivize high-risk pools. What
about the person who gets a chronic illness and they say all of a
sudden their insurance company drops them. We have incentivized so the
insurance company is not going to do that. In every State we give a
bonus if they set up a high-risk pool and then the high-risk pool is
funded out of everybody who is insured in that State. So if you have an
insurer insuring someone with complications from diabetes and they say
we will drop this person because it is too costly, they go to the high-
risk pool. Guess what. That insurance company is going to pay for them
anyway. There is no benefit for them to drop them. There is all the
benefit then for that insurance company to get busy and involved in
managing the chronic disease, where we know we can eliminate
complications, we can improve the quality of life, and we can also
increase life expectancy by managing the chronic disease.
Here is what we do for Medicaid patients. They get a $2,000 check
from the Federal Government plus from their State. They can go into
whatever plan they want. If their State says we want to stay with
Medicaid and take that in enhanced Medicaid, the State gets to do that.
There is not a mandate in anything. What it says is: If you think a
State Medicaid Program is better for your State, without choice, then
you can do it. But all the rest of the States are going to say I think
I would rather have our Medicaid patients have a true insurance, a real
card where they have the same access, the same equality of access as
anybody else.
All of a sudden you have everybody in the marketplace compete. They
can stay in a State-run system. They get to save what they don't spend
on their health care for future health care needs.
One of our problems is savings in this country. It is important. How
do we fix our health care system? We know that, if we look at the
liability costs that showed 10 percent of the health insurance dollar
going for liability insurance, that is an underestimate. The American
Hospital Association found, recently reestablished by another
organization, I can't remember who, that repeated the study--what we
know is each year, today, besides that 10 percent, providers order
another 8 percent of the cost of health care for tests that patients do
not need.
Why do they do that? They do that because they perceive they need to
have everything on the books to defend themselves that they can have,
so they fire a shotgun at it. We will get this test, this test, this
test--knowing they don't need it but they operate under the ``what if''
scenario, this adversary system that we have.
Finally, we address liability. We give another percentage bonus to
the States that will set up what is called a ``health court'' system.
It is a real simple system. If you have a complaint against a provider,
a hospital or a doctor, you can go to the health court. You don't have
to go to the health court. But you can go to the health court and you
can be seen in front of three lawyers, three doctors, and a judge who
have their own expert witnesses. This judge is schooled in medical
malpractice. They can make a decision for you right then.
If you accept the decision, then you give up your right to go to
court. If you don't accept the decision, you can't ever come back to
that court on that particular issue, but everything you do in court is
admissible. We do not take away anybody's right to go to court. But
what we do accomplish is making sure people get made whole quicker and
cheaper--40 percent now doesn't go to the trial lawyer for you to get
made whole.
There is no question we make mistakes in medicine every year. But why
should we drag it out for 3 to 5 years, No. 1. Why should we pay 40
percent of whatever the ultimate award is to somebody who helped us
accomplish that, where we can set up a system that will arbitrate that
in front of a nonbiased group of peers, lawyers and doctors who say:
Here is the right thing, here is the medical case, the legal case,
let's make a decision and send it on.
What it does is it saves tons of money directly, but what will it do?
As soon as you create confidence on the part of providers that they do
not have to order this other 8 percent of tests, you are going to see
that dropping about half. So we can gain 4 percent in this cost of
health care by setting up health courts, by changing the dynamic under
which we make sure people are made whole when something happens to them
in the medical malpractice area.
Not every State has to do this. But if your State decides to do this,
you get a 1-percent bonus on your Medicaid money--out of a large pool.
[[Page S3825]]
We have lots of ways in which we do not say we want the States to do
this and now we are going to tell you how to do it. We are saying here
are some ways we think you can also do it. Go figure out the best way
for you, and by the way, if you do some of the things that we think
will save some money, here is some extra money for you.
Ultimately, if we do not fix health care--everybody in this Chamber
knows we are going to go the way of Western Europe and that is the
following: We are going to decide that we are going to have a single-
payer system run by the Government. As P.J. O'Rourke says: ``If you
think medicine is expensive now, wait until it is free.''
We are going to control costs. We are going to do it the same way we
are trying to control costs with CMS. What happens? What happens is we
are going to start rationing care.
Let's take some real statistics. In England, diagnosis? Cancer. In
England, if you get a diagnosis of cancer right now, the average
starting time for your chemotherapy is 10 months after your diagnosis.
Anybody here who wants that kind of medicine will vote against this
bill. That is exactly what we get. We get rationing. What it means is
people with great potential will not get the treatment in time to
capture that great potential. What it means is great suffering. What it
means is loss of innovation. What it means is a lack of available, fair
access. It is everything in England in their health care system takes
away all freedom.
It is also interesting to know this past year in Canada there was a
lawsuit filed, which was won. What this individual said is the Canadian
law says I can't go to anybody except a Canadian doctor who is owned
and run by the Government. They challenged that. The Canadian supreme
court ruled on the side of the patient: You ought to have the right and
freedom to go wherever you want, to whomever you want if you are
willing to pay the bill.
Paying the bill is the insurance part of this. If you want to be able
to have that access, then you are going to want to be able to buy a
policy that allows you to have it. If you don't want that access, you
can buy a policy that says here is a straight HMO, here are the only
four doctors you can go to, and here is the hospital you are going to
get to go to.
We are talking about freedom in health care. How do we get to the
bottom line, away from 16 percent of our GDP, down to 10 percent of our
GDP? More importantly, how do we create a system that gives us better
quality, at lower cost, with better value. That is what we are talking
about.
I yield to the Senator from North Carolina.
Mr. BURR. Mr. President, I commend my colleague from Oklahoma, a dear
friend and somebody who has been passionate about health care for
years. He and I came to Washington together in 1995. We served on the
Energy and Commerce Committee, and we recognized then that changes
needed to be made. Every year we have seen the same response in
Washington. We have seen the end of a calendar year come, the need to
find savings in health care. Administrations, Republican and
Democratic, turn to Medicare and Medicaid and say we are going to
extract $60 billion, $70 billion out of savings in these health care
systems. We have laughed as they called it ``waste, fraud, and abuse''
because there is waste, fraud and abuse in it. We just didn't get any
money out of it because we have been reluctant to fix the health care
system in this country.
What are we doing? What is this plan? This plan is universal health
care. Let me say it again. This plan is universal health care. This is
providing affordable, accessible health care, provided by the private
sector, for every American in this country.
This is change in the design of health care that has been
historically, up to this point, employer negotiated, the majority
employer paid for, and an employee has very little input into the
makeup of the policies that cover them.
It doesn't reflect their age, it doesn't reflect their health
conditions, it does not reflect their income.
What we are talking about is shifting it away from employers over
time. We are talking about creating real incentives for individuals. We
are talking about making sure 47 million uninsured Americans today and
tomorrow have tax credits that can be used for real insurance coverage.
What does that provide for them? For the first time, it creates a
relationship between a patient and a health care professional.
We have talked in this institution, we have talked in this town, and
we have talked in this country about the need to project wellness and
prevention in health care. Well, this does it. This, for once,
accomplishes that because we as individuals can negotiate our plans,
not through the group plan but as 250 million-plus Americans. We can
negotiate what makes sense for us from the standpoint of the scope of
coverage that reflects what we are willing to pay as it relates to
premium--and, by the way, provides States the capability to do the same
thing with their Medicaid beneficiaries, their Medicaid patients, if,
in fact, they want to begin to change the way their care is delivered,
by creating the same relationship between a health care professional
and them, because they now have the same insurance we do.
Medicaid beneficiaries have this big ``M'' on their foreheads. They
do not want to be on Medicaid, but they are there because it is the
last resort. What we want to do is integrate them into what all of the
rest of us have; that is, individual insurance.
Dr. Coburn hit on a real key; that is, an attempt to bring everyone's
health care costs down. It is not to pick out a group and to say, We
are going to reduce yours, and pick out a group over here and say, We
are going to reduce yours. This is an attempt--it is the first real
attempt--to bring every-body's health care costs down.
What we learned when we created Part D Medicare, the drug benefit for
35 million-plus seniors in this country, was that when we created real
competition between insurers and we brought transparency to price, two
very real things happened: In the first year, premiums dropped 28
percent over what we had projected, and drug pricing dropped 33
percent.
We have a model we have already tried that seniors across this
country say: Do not mess with this plan. That, in fact, exemplifies
what we are trying to do. We are trying to create real competition
between insurance for our insurance business; we are not letting one
employer negotiate the plan and then dump it on the employees. But the
question is, Can we have the same results as Part D by seeing the cost
of health care reduced for all Americans? Well, you start that process
when you eliminate cost-shifting. You accelerate that process when you
inject what this bill does; that is, transparency in the price of
health care that is delivered to you.
Imagine the day that you can go online and you can actually see what
your doctor's visit is going to cost, what the lab workup is going to
cost, what a visit to the emergency room at your local hospital is
going to cost. In markets in North Carolina today, some choose not to
go to the hospital for the nonemergency care, even though that may be
their primary provider; they choose to go to the community health
center because the community health center actually delivers the same
if not a better level of care. But one thing is for certain: They know
exactly what it is going to cost them. And these are individuals who
are insured.
For the first time, all Americans have an opportunity at prevention
and wellness. What does that mean? It means we can make decisions about
our health care that have an impact on the cost of our health care to
us and consequently have a ripple effect across the marketplace, that
as more and more Americans make healthy decisions, the cost of health
care overall comes down.
It means we have freed up those valuable health care dollars to make
sure they are there for the individuals who are going to be susceptible
to disease--chronic or terminal illness.
It means the relationship we have now established between patient and
health care professionals means we have recognized we can accumulate
the data we need so that Medicare reimbursements are no longer a shot
in the dark where we pull a number down that may not be reflective of
the cost of delivering the service, may not be reflective of the value
of the service.
[[Page S3826]]
The reality is that when we create that relationship, we are able to
accomplish the accumulation of data that tells us what things really
should cost.
In health care, those healthy decisions allow individuals to make
decisions about disease management. The most costly part of the U.S.
health care system is the chronic diseases that exist and our inability
to manage those diseases. The most expensive is diabetes.
Today, we have electronic capabilities for diabetics and for coronary
heart patients where, at different periods during the day, their vital
signs can be transmitted over a telephone line to their doctor. The
doctor can instantly know whether, if it is a diabetic, they are
managing their insulin. If it is a coronary heart patient, they can
determine whether the fluid buildup means they need to adjust their
medication. What does that give us the ability to do? It means we can
take a patient who up to that point got too much fluid on the heart,
made an emergency room visit, and in all likelihood was admitted for 3
days as they get the medicine back in balance. Now, a doctor, 24 hours
a day, as these reports come in, can change their diuretic, can work
with a diabetic on checking their blood sugar and what their insulin
intake is, can detect whether they took the right medication. We can
extrapolate that across every disease because technology now lets us do
it in a real way. If we are not able to do this, then we are not able
to recognize the value of new technology.
So much technology today that would benefit us in the Medicare
marketplace is not reimbursable by Medicare. It is a decision they make
because it is not tested in the marketplace; therefore, it has no value
because they do not know how to reimburse for it. Well, the reality is,
when you have a health care system that responds to the benefits to
individuals, all of a sudden you have the market that creates a value
for the technologies and for the innovations.
So I am delighted to be here. There is so much to this bill. This
bill is the most comprehensive transformation of the health care system
in my lifetime.
One might say it is difficult to do so big a bite at one time. I made
that mistake. The reality is that when you look at the timeline we are
up against every year we do not adopt this type of transformation of
our health care system, more Americans become uninsured, more
individuals with preexisting conditions no longer can afford health
care, and the cost of everybody's health care in America goes up
because we have not eliminated cost-shifting.
With disease management we could do today if, in fact, people had
incentives in their system to take the time to monitor their health, to
take their medication, to counsel with health care professionals about
changes they could make, the more money we can save not only for each
one of us but for the total system.
I am convinced that if you could only pick one thing out of this plan
that you highlighted for the American people, it would be this: For the
first time, we are presenting a very real way to insure 47 million
Americans, the people who are most at risk in this country. If all of
us were the beneficiaries in some way of reduced prices, more access,
the ability to have transparency in pricing, the accumulation of data,
electronic medical records that enable us to find savings, if that is
the byproduct of us finding a way to use savings in the system to
insure 47 million Americans, I believe that is the right thing to do.
The President came out in the State of the Union and he presented a
very similar plan. Our plan expands on what the President said. Our
plan goes to the heart of the health care system and says: If we are
going to change it, then we have to go through total transformation.
This is that total transformation that at the end of the day empowers
every individual in this country to have custom health care coverage
for themselves, for everyone in their family, for their health
conditions, for their income and, more importantly, for their security.
So I commend the Senator for his work. I now look forward to working
with him as we go through what I think will be a very intellectual
debate about the future of health care in this country. As some look at
Europe and look at other countries and say, Maybe we ought to do that
in the future, I believe if we adopt this method we are going to have
every country in the world looking at this model and saying, How do we
do this? How fast can we do that?
Mr. COBURN. People may be saying: Well, how do you know this will
work? There is a great little company named MedEncentive. They have
been running pilot programs all across the country. Let me explain what
they do. They get doctors to agree to follow a certain set of protocols
called best practices, and they sign up communities, municipalities,
and their employees, and then they do a couple of things. They take
them under coverage, and they reward the employee--i.e, the patient--if
they will use those doctors.
What is unique about this system? One is, after the patient has
finished their office visit with the doctor, they have a patient-doctor
interactive form they fill out that says: The doctor wants me to take
this medicine. I understand this. Here is the reason he wants me to
take this. So they have to fill out the form to say they really
understood.
The other thing is, on the professional side, the practitioner side,
they agree to follow the best-practice model in how they treat these
patients. That was actually developed by Vanderbilt, where they
followed a best-practice guideline which helps them decide what to
order, what not to order, what to do, what not to do in terms of what
is best for that patient. They can get off if they choose to, if they
think in their medical judgment that they need to.
What has been the result? The three published results that I know of,
in all three communities, in the first year of operating this where
there was this competitive model, best-practice quality outline,
patient followup, because the insurance company is involved in making
sure the patient does that--what happened to their health care costs?
One down 18 percent, one declined 22 percent, and one declined 12
percent. Now, that is just in three. Each one of them had 300 or 400
patients and took all comers, chronic disease or not.
How did their costs go down? The costs went down for a lot of
reasons. One is they were practicing not defensive medicine, they were
practicing real medicine. They were not throwing tests at a patient
because they were worried but because they had the background of the
excellence of Vanderbilt University as a practice guideline at their
defense.
So what we know is that in the various test models where true
marketing, true competition, true transparency as far as price, true
concern for the patients' well-being, not just at the office visit but
thereafter, wellness and prevention were modified, what happens is
costs go down.
That is just in three cities in Oklahoma. It has been done all across
this country. But what we do know is that if we attack it in a
nonbureaucratic way, but we allow competitive forces--which would you
rather have, an insurance company that is invested to try to make your
health better or one that just wants to make a dollar on you and turn
on you?
So going back, let me just kind of summarize. The system we have
today limits our ability to do what we as Americans do well; that is,
discern value for what we have purchased--discern whether we get value
for it, discern how to do it, and we discern that on an individual
basis.
Our health care is not designed on an individual basis. In many
places, we get one-size-fits-all; what the Government says you will
have or what the State says you must have, you must buy this. I believe
a lot of our problems have come because we have tried to micromanage it
from Washington and from the statehouse. What we are talking about is
giving freedom of choice, not just to patients and providers but to
insurance industries.
Imagine the tremendous possibilities that will come into a market
that says: This is a new day. I get to market all sorts of different
things that might match up with different people. All of a sudden, now
I will have to compete not only with people in my State but all across
the country for the best plan that gives me the best value that meets
my needs. Why would we not want that? We have that in every other
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thing. Why would we not want to capture the best aspect of the American
consumer, which is discernment?
Not long ago I was sitting with some friends and put forth the fact
that I believe Americans are smart enough to know what they want in
health care. The idea got pooh-poohed. I thought, how insulting. We can
figure out what computer to buy and how much memory we want and how big
a hard drive we want and whether we want a photo section on it or a
print lab. We can figure out all of those things--as a matter of fact,
our 10-year-old kids can figure that out--but we can't figure out how
to buy health care. We are going to say to the American people: You are
not sophisticated enough, you are not smart enough to know what is good
for you or to know what you need. So, therefore, the Government is
going to tell you what you need. That is what we have today, whether it
is the Government or your employer or somewhere else.
This bill changes all that. This is a bill that will create
transparency so you as a consumer can know what something is going to
cost. It is going to create a situation where you can perceive whether
you have value. It is going to create an incentive to save for health
care for the future and an incentive for wellness, not just by what the
insurance company will come to sell you but by the $20 billion that we
are now spending, of which less than $2 or $3 billion makes any
difference at all in somebody's health care. We are going to focus that
on true prevention. We are going to direct that the HHS relook at every
one of these programs and develop a model to where we educate the
American people about the risk.
Let me give a personal story. I am a colon cancer survivor. What we
do know is with good prevention and good screening, one out of every
two people who are going to get colon cancer we can keep from getting
it. Why wouldn't we do that? Why wouldn't we prevent half the colon
cancer in this country? We don't have a good reason. One of the reasons
is because we have an ineffective prevention program.
I am a small government person; I admit that. But there is a
legitimate role for the Federal Government when it comes to teaching
America about our health needs, prevention, and wellness. We have
plenty of money to do it if we take the same money we have now and
redirect it in a way that educates the American people. Innovation
works. We know that. Competition works.
Take, for example, a year ago a 46-inch plasma TV cost $11,526. Today
you can buy the same thing for $2,300. Next year you will be able to
buy it for $1,400. The next year you will be able to buy it for $700.
Why? Competition. Competition breeds quality and value, only if you
have a market under which you can operate. We don't have that today in
health care. Innovation also works in health care.
Look at Lasik. Here is a procedure that is not paid for by the
Government. It is not paid for by any of the insurance industry. But if
you are nearsighted and you want to be able to look far away, you can
get that done. When it first started, it was $4,000 an eye. Now there
are places you can get it done--the same piece of equipment, the same
computer--for $500 an eye. Why won't that work? It will work in health
care. It will work. Innovation will come as a result of that.
What happens when we innovate. What we get is better quality at a
lower price and better value. I am hopeful that as the American people
look at this, they will be reminded of a couple things. This is
universal coverage. Everybody in America gets treated the same by the
Federal Government when it comes to health care. Everybody in America
is on equal footing as far as the Income Tax Code is concerned when you
go to buy your health care. No longer do we advantage the very rich
with $2,700 a year in tax benefit and the very poor with $100. We
totally neutralize that and say: Everybody ought to be treated the same
under the Tax Code for health care. It is universal coverage.
No. 2, it takes away discrimination. Because you are poor, because
you don't have the ability to have a job that has insurance coverage
today, and if, in fact, you are at 133 percent of poverty, why should
you be discriminated against because you are on the Medicaid Program?
This is no offense to any practicing professional out there because
there are great professionals who are taking care of Medicaid patients.
But if you look at the marketeering, the ones with the best doctors, as
a rule, because Medicaid pays so low, do they have time to take care of
Medicaid patients? No. What happens is, somehow they don't have time.
So what we have done is discriminated down with Medicaid patients.
Why shouldn't a Medicaid patient get the best doctor every time, just
like a Senator? Why shouldn't they have access to capability? Why
should they be discriminated against by having a Medicaid stamp on
their forehead? We are talking about universal access, equality of
care, and personal freedom and choice. You get to decide what is best
for you and your health care and your family.
By the way, when you get this money and you haven't spent it all, you
get to save it for next year and the year after and the year after. You
can buy what is best for you with that money.
This money also goes to retirees. If you retire at 60 and are not
eligible for Medicare, you still get your tax credit. We don't
discriminate against anybody. Everybody gets the tax credit.
The final thing I would say, it doesn't cost the American taxpayer
one additional dollar in income tax. There will be no increased cost
with this plan. Actually, we have tried to make it revenue neutral. My
worry is that it will save us money. We have tried to make it where it
does not. We have tried to make it the most generous thing we can to
get the most coverage for everybody out there. Again, prevention first,
free choice, freedom, and liberty. You get to decide who cares for you,
what insurance, what hospital, and every American gets that. It is the
Government not telling you what you must do but saying here is what you
can do if you want.
I yield to the Senator from North Carolina if he has any additional
comments.
Mr. BURR. I would only use that time to thank the Senator from
Oklahoma. This is a crucial debate that this country needs to have,
this institution needs to have. More importantly, we are at a point
where we have to stop talking about what we are going to do and
actually start doing something. The Senator from Oklahoma has stated it
very well. What we can do is bring a higher level of care to all
Americans--not just some Americans, to all Americans. Through that
effort, all Americans receive a financial benefit. Our system prospers
because we are able to take care of more, and we are able to provide an
unlimited opportunity in the future because we unleash innovation and
technology in health care.
I have wondered what it would be like if we had innovation at the
same level in health care as, say, in cell phones; that we would have a
new platform every 6 years, and that platform would provide an array of
opportunities to us that we are not forced to take, but they are
available to us if, in fact, we want them. Health care has been starved
of innovation, in large measure because it treats every American
differently. This is the first real opportunity for universal coverage,
universal access, where every American has an opportunity at the best
coverage available.
I thank the Senator from Oklahoma.
Mr. COBURN. I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER (Mr. BROWN). The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. REID. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
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