[Congressional Record Volume 153, Number 84 (Tuesday, May 22, 2007)]
[Senate]
[Pages S6478-S6479]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WHITEHOUSE:
  S. 1451. A bill to encourage the development of coordinated quality 
reforms to improve health care delivery and reduce the cost of care in 
the health care system; to the Committee on Health, Education, Labor, 
and Pensions.
  Mr. WHITEHOUSE. Madam President, I rise today because I will be 
introducing my first bills as a Member of this esteemed body; 
legislation that I hope will provide a helpful step forward as we 
address one of the most significant challenges this Senate faces, 
reforming America's broken health care system.
  I have heard from countless Rhode Islanders who have struggled to pay 
for their health care and who live in fear of losing coverage on which 
they and their families depend. I have met nurses frustrated and 
heartbroken that they must spend so much time coping with the paperwork 
and so little time caring for patients. I have talked with families 
whose lives and health were shaken by terrifying medical errors, lost 
paperwork, missed diagnoses that should have been totally avoided.
  I believe our current health care system is too complex and costs so 
much, yet so often does not provide patients with the quality of care 
they should have. It does not have to be this way. I have seen 
firsthand that we can make the system work better for everyone, we can 
cut costs, save lives, and improve the quality of the health care we 
receive, a critical step toward ensuring that all Americans have health 
care they can afford.
  In Rhode Island, we have been working and experimenting for years to 
find solutions to many of these challenges. I have been privileged to 
be part of much of that work, most directly when I founded the Rhode 
Island Quality Institute to focus on quality reforms in health care.
  While we have a long way to go, so far we have been successful. It is 
that Rhode Island experience that I bring to you today. It is Rhode 
Island's good work that I hope will provide a good example.
  Right now our health care system is a mess, such a mess that we 
should hesitate to call it a health care system. It yields 
unsatisfactory results at vast expense. What I wish to talk about today 
is not how you finance the health care system--that is an important 
issue--but it is a different issue. I don't even want to talk about how 
you get all Americans covered by our health care system. That is 
another important issue, but that is not the subject today.
  The subject today is the issue of how the system itself runs, how it 
operates, put bluntly, how badly in America it runs. If we can reduce 
the cost of the underlying system by improving its performance, it will 
make solutions easier for financing our health care system and for 
finding a way to make sure every American gets health care coverage. 
Our health care system is a mess. The number of uninsured Americans is 
climbing and will soon reach 50 million. The annual cost of the system 
exceeds $2 trillion every year, and that number is expected soon to 
double. We spend more of our gross domestic product on health care than 
any other industrialized country in the world, 16 percent. That is 
double the European Union average.
  There is today more health care in Ford cars than there is steel. 
There is more health care in Starbucks coffee than there are coffee 
beans. Worse still, for all this money we spend, we get a mediocre 
product. We have the best doctors, the best nurses, the best procedures 
and equipment, the best medical education in the world. Yet the system 
produces mediocre results. As many as 100,000 Americans are killed 
every year by unnecessary and avoidable medical errors. That is just 
the fatalities. Think how many people have to stay longer in the 
hospital and run up costs.
  Life expectancy, obesity rates, and infant mortality rates are much 
worse than they should be in a country such as ours. We fail by most 
international measures. The system itself does not work. Hospitals are 
going broke. Doctors are furious, and paperwork chokes the system.
  Quarrels between the providers and the payers drive up costs, while 
potential savings in billions of dollars are left lying on the table. 
More American families are bankrupted by health care costs than any 
other cause. It is a system in crisis.
  I urge my colleagues to consider this point too. If we do not fix 
this system now, while we still can, if we don't get these savings now, 
then we are going to be forced to consider very tragic choices in the 
future: Cutting coverage for seniors now on Medicare, throwing children 
off S-CHIP or pushing more and more out-of-pocket costs onto families 
who need Medicaid in their struggle to get by.
  Those will be tragic choices, awful choices, ones I hope we never 
have to deliberate. But if we end up having to make these choices 
because today we failed to do our duty, then shame on us.
  I believe what is wrong with our system can be identified. The 
reasons for its failures can be identified. The causes of those 
failures can be corrected, and the failings can be cured.
  In the days to come, I will speak at greater length on three critical 
areas of reform, one by one, and advance proposals for each one that 
will help provide a cure.
  Today, I wish to highlight all three of the major failures, how they 
combine to worsen each other and keep our system broken, and how 
reforming those three areas can reinforce each other and repair our 
broken system.
  Left unattended, these three conditions will continue to degrade our 
system. Properly reformed, they will begin to improve it. This is 
because what we are dealing with, in a nutshell, is market failure. 
Market forces are bottled up, logjammed, conflicted, and misdirected to 
push the health care system in a bad direction.

  I trust market forces and I believe in market forces, but I see it as 
our job in Government to create the environment in which market forces 
operate in a healthy way to serve the public interest.
  That is our job. It always has been. Where that healthy environment 
for market forces does not exist--which is the case right now in our 
health care system--Government must act. The market failure in health 
care has three core components: One, the American health care system 
does not optimize investment in quality of care, even where--indeed, 
particularly where--that quality investment in improving care would 
also lower costs; two, the system does not have the information 
technology infrastructure to support the improvements we need; three, 
the way we pay for health care sends perverse price signals that steer 
us away from the public interest.
  These problems can each be fixed, but fixing each in isolation will 
not yield the change we need. Similar to three climbers roped together 
for an ascent, the three solutions need to track with each other, not 
necessarily in lockstep but staying close because each one reinforces 
the other.
  Let me tell a story about each one of those problems to illustrate 
the three points. Let's look at the area where improved quality of care 
would lower costs. That intersection, where improved quality of care 
and lower costs converge, should be our Holy Grail. A good example 
comes out of the Keystone Project in Michigan, home to Senators Levin 
and Stabenow.
  The Keystone Project went into a significant number of Michigan 
intensive care units to improve quality and reduce line infections, 
respiratory complications, and other conditions that are associated 
with intensive care units. In a 15-month span, between March 2004 and 
June 2005, the project saved 1,578 lives, 81,020 days patients would 
otherwise have been spent in the hospital, and it saved--in that 15 
months--over $165 million.
  The Rhode Island Quality Institute has taken this model statewide in 
Rhode Island, with every hospital participating. Infections in patients 
with catheters decreased 36 percent from the

[[Page S6479]]

first quarter of 2006 to the fourth quarter. Eleven out of twenty-three 
participating intensive care units had zero infections for 12 months. 
Savings from the initiative are on track to produce $4 million 
annually. That is pretty good money in Rhode Island.
  What is true in intensive care units in Michigan and Rhode Island is 
also true far more broadly in health care. There are many areas where 
significant savings can be achieved by making care better. There could 
be initiatives similar to Keystone throughout the health care sector. 
They do not necessarily have to be reforms of existing procedures and 
practices because Keystone was. Quality improvements, quality reform, 
could well involve improvements in prevention and detection of illness, 
stopping it before it even gets to the hospital. There are vast and 
unexplored horizons out there, rich with opportunity, and the Keystone 
story is one example of how improved quality of care can lower costs 
and save lives. This takes us to the second story, this one about the 
reimbursement problem. Why isn't this quality reform happening 
spontaneously all over the country if these big savings are there? 
Think of Michigan, $165 million in 15 months in one State. That is big 
money.
  Why isn't it being pursued? Why aren't we all doing this? Well, 
primarily because the economics of health care pays providers not to 
and punishes providers who try. When a group of hospitals in Utah began 
following the guidelines of the American Thoracic Society for treating 
community-acquired pneumonia, significant complications fell from 15.3 
percent to 11.6 percent, inpatient mortality fell from 7.2 to 5.3 
percent, and the resulting cost savings exceeded half a million dollars 
a year. But net operating income of participating facilities dropped by 
over $200,000 per year because treating the healthier patients was 
reimbursed at roughly $12,000 less per case.
  In Rhode Island, when we got into this intensive care unit reform, 
the Hospital Association estimated a $400,000 cost for $8 million in 
savings, a 20-to-1 return on investment. But all the savings went to 
the insurers and the payers, and the costs came out of the hospitals' 
pockets. Do you know a lot of businesses that invest money in order to 
reduce their revenue? I don't. How many businesses would spend $400,000 
in cash to lose $8 million in revenues every year? With reimbursement 
incentives such as the ones we have, it is no wonder that quality 
investments face an uphill struggle.
  The final problem is our health care information technology, which is 
inexcusably underdeveloped and underdeployed. It has been described by 
the Economist magazine as the worst information technology system in 
any American industry except one, the mining industry. We are leaving 
massive savings in health care costs unclaimed as a result.
  Some pretty respectable groups have looked at health information 
technology to see what an adequate system would save in health care 
costs, and here is what they report: Rand Corporation, $81 billion per 
year conservatively. David Brailer, the former National Coordinator for 
Health Information Technology, $100 billion per year. The Center for 
Information Technology Leadership, $77 billion per year. That is a lot 
of savings to leave sitting on the table, savings desperately needed by 
American businesses and American families.
  Here is my third story, about a courageous and passionate doctor in 
Rhode Island trying to build an electronic health record for patients 
in our State. By the way of context, Rhode Island may be the lead State 
in the country at developing health information technology. We have 
Patrick Kennedy in the House, our Representative, who has been an 
absolute leader on this issue; Lifespan and other hospitals are leaders 
in electronic physician order entry; the Rhode Island Quality Institute 
is a leader in e-prescribing, electronic health records and health 
information exchange; Rhode Island Blue Cross is beginning to fund 
innovations; all the local Rhode Island health care folks are active in 
this. It is very impressive. I mean no criticism by telling this story, 
only to illustrate what an uphill struggle it is.
  The lead on developing electronic health records in Rhode Island is 
being taken by a very frustrated doctor, Dr. Mark Jacobs, who put his 
practice on hold, went out and looked at what was available, found an 
e-clinical works platform, had it modified to suit what he thought 
would be more useful for his needs, and is now raising capital and 
trying to recruit his colleagues to get around that system and get it 
up. It is his passion, and he is dedicating himself to it with energy 
and conviction.
  What Dr. Jacobs is doing is heroic, but if you went to any business 
school and if they asked you, what is the best way to seize that $81 
billion a year in savings that RAND Corporation has said is out there, 
and you had said: Well, we are going to wait until a doctor gets so 
frustrated he is willing to give up his practice and go out and try to 
learn about health care technology and do it on his own, you would be 
laughed out of that business school classroom. They wouldn't just say 
you flunked the course, they would suggest you should maybe look at 
another livelihood. But that is exactly the system we have right now.
  If a truckdriver were to go out with a pick and shovel building bits 
of the interstate highway for us, that would be pretty heroic and 
noble. But all the way back to Dwight Eisenhower, people in Government 
knew that would be a pretty nonsensical way to finance the Federal 
highway system.
  We have work to do in these three areas: fixing our information 
technology to increase efficiency and generate savings; improving 
health care quality and prevention in ways that lower costs; and 
repairing the reimbursement system so it does not discourage those 
reforms but encourages and rewards them.
  In the coming days, I will expand on each of these problems, and I 
will propose solutions in those three areas that will unleash market 
incentives in positive directions. As I conclude, my message is this: 
The health care system that underlies all our health care financing and 
coverage problems is itself broken. The underlying health care delivery 
system is itself broken. It is administrative and bureaucratic 
machinery, but it is still machinery. It needs to be repaired the way 
any broken machinery does. Fixing it, however, will reduce costs, 
improve care, and make a badly operating system run better and move us 
a critical step forward to making sure every American family has access 
to health care they can afford.
  I sincerely hope to work with all of my colleagues on solving this. 
Please think of it this way: If your car is not running right, there is 
no Republican or Democratic way to tune it up. There is just getting it 
working. If your plumbing is jammed and water is flooding out, there is 
not a Republican or Democratic way to fix that. It is either flowing 
properly or it isn't. If your electric system is sparking and short 
circuited, again, there is no Democratic or Republican way to solve 
that problem. It is working right or it is not. Our health care system 
is not working right, and it needs to be fixed. Because the health care 
system is a dynamic system, you can't tell it what to do. You have to 
take the trouble to identify what is wrong, identify why it is wrong, 
and correct the cause.
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