[Congressional Record Volume 153, Number 195 (Wednesday, December 19, 2007)]
[Senate]
[Pages S15966-S15968]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. WYDEN. Mr. President, anytime I am home in Oregon or have a 
chance to travel around the country, when I hear citizens talk about 
Government, they zero in on one word above all else. That word is 
``change.'' Americans want change in our foreign policy. Americans want 
change in our energy policy. And above all, Americans want change in 
our health care policy at home.
  So this afternoon I am going to spend just a few minutes talking 
about some of the most urgently needed changes in American health care, 
and then how the Congress can go about setting those changes in place.
  Above all else, Americans want changes in health care costs so as to 
hold down these staggering expenses. This country is going to spend 
$2.3 trillion this year on health care. There are 300 million of us. If 
you divide 300 million into $2.3 trillion, you could go out and hire a 
physician for every seven families in the United States. That is how 
staggering the health care costs are in this country. You could 
literally go out and hire a physician for every seven families in the 
United States, pay that doctor $200,000 for the year, and say: Doctor, 
your job for the year will be to take care of seven families.
  In fact, I know the Presiding Officer has a great interest in health 
care as well. Whenever I bring this up at a townhall meeting, and 
physicians are in the room, they usually say: Where do I go, Ron, to 
get my seven families? Because they think it sounds pretty good to 
change the American health care system so they can do what they were 
trained to do, which is, to be advocates for people, to stand up for 
their patients, to make sure they get the best shake for American 
health care.
  Certainly, employers want changes to hold down the costs of health 
care. Today, if you are opening a business in Coos Bay, OR, or Stowe, 
VT, you are competing in the global marketplace. You essentially spot 
your foreign competition something like 20 points the day you open your 
doors in Vermont or Oregon or anywhere else. That is because your 
premiums go up 13, 14, 15 percent a year, and your foreign competition 
benefits from national health insurance. So that is what these crushing 
costs mean for the business community.

  If you are lucky enough to have health insurance in our country--and 
because the costs are going up so high--you are literally one rate hike 
away from going without coverage.
  One of the reasons the costs hit people with insurance so hard is 
that today in America, if you have coverage, you also pick up the bills 
for those who don't have coverage. I am sure the distinguished 
Presiding Officer of the Senate hears the same thing I do at home. 
Somebody who has coverage, for example, is in a hospital and looks at 
the expenses and the bill and it says something like Tylenol, $60. A 
citizen comes to one of us at a townhall meeting and says to us: What 
do you mean Tylenol costs $60? I could have gone to CVS or to some 
other pharmacy and I could have gotten Tylenol for $20. Why did it cost 
me that much? The reason it costs that much

[[Page S15967]]

for somebody who has insurance is there are a lot of people in the 
hospital who don't have coverage and they couldn't pay for their 
Tylenol, so the cost gets shifted over to the people who are insured.
  So first and foremost, when it comes to changes in health care, we 
need changes that rein in these staggering costs--costs that are going 
up far beyond what cost increases are elsewhere in the world.
  The second area that is so critical to change in American health care 
is lowering the administrative costs in American health care. We have 
higher administrative costs than any other country on Earth. Once 
again, you see it at home and in your State when physicians and others 
come to you. In my home State, in a typical doctor's office with a few 
physicians, there is one person who will spend the entire day on the 
phone essentially trying to pry out information from insurance 
companies as to what they will pay on one claim or another. These are 
clerks trying to get information about an insurance company matrix, 
trying to figure out what will be spent because this country still 
lacks a uniform billing system because there are so many differing 
systems of paperwork and charges. This country's staggering 
administrative costs are an area that desperately needs to be changed 
in American health care.
  Most other parts of the country have simplified their record-keeping 
and their administrative costs. They use electronic record systems. 
Today, for example, the typical doctor's office has less technology to 
hold down administrative costs than the corner grocery store. So second 
on my list of changes to American health care are steps that would be 
taken to slow and reverse the crushing increase in administrative 
costs, hassle for doctors, and needless time and heartache that go into 
administering American health care.
  The third area of change--something I know the Presiding Officer 
feels very strongly about--is moving health care to prevention and 
wellness rather than sick care. The fact of the matter is that in the 
United States we don't have health care at all. What we have is sick 
care. The Medicare Program shows this more clearly than anything else. 
Medicare Part A, for example, will pay huge checks for a senior 
citizen's hospital bills. The check goes from the insurance carrier to 
a hospital in Vermont or Oregon or anywhere else--no questions asked. 
Medicare Part B, on the other hand, the outpatient portion of Medicare, 
will pay virtually nothing for prevention--virtually nothing to keep 
people well, to keep them healthy, and to keep them from landing in the 
hospital and racking up all those huge hospital expenses under Part A. 
That is a bizarre way, in my view, to run the Medicare Program. In 
fact, the Medicare Program, which is so biased in favor of sick care 
rather than wellness and prevention, runs the biggest outpatient 
program in the country that offers no rewards for, for example, 
lowering your blood pressure, lowering your cholesterol, stopping 
smoking. The biggest outpatient program in the United States is Part B 
of Medicare. Available to more than 30 million older people in our 
country, it is the biggest outpatient program that offers no rewards 
for sensible prevention. We have to change this bias. We can look at 
the problem in this country of childhood obesity and the onset of type 
2 diabetes. If we don't focus on prevention, wellness, and keeping our 
citizens healthy, we will see these continued increases in the costs of 
chronic care later in life, when heart disease, stroke, diabetes set in 
and our country racks up still additional health care costs because 
there has been no focus on prevention.
  Finally, it seems to me there has to be a much sharper focus on 
improving quality in American health care. When people talk about 
changing health care, they usually focus first on costs and that is why 
I brought it up initially. But they also want to make sure they get 
better quality care. Right now, with citizens reading reports, for 
example, from the Institute of Medicine--about thousands and thousands 
of needless deaths, hospital deaths, other deaths--it is obvious that 
steps need to be taken to improve the quality of our health care. Some 
of them are steps that certainly sound fairly simple: Better infection 
control in our health care facilities, making sure sensible steps are 
taken after an individual has a heart attack. Clearly, there needs to 
be more focus on early diagnosis of illness, which I think is part of a 
continuum of better quality care that starts with prevention and zeroes 
in on early diagnosis. But those are some of the areas I think need to 
be changed.
  The reality is the reason for all these changes and the reason why 
the country wants them is the health care system hasn't much kept up 
with the times. For more than 150 million people, the employer-based 
system is pretty much what we had in the 1940s. I talked earlier, for 
example, about the crushing toll it takes on employers, where they spot 
their foreign competition 18, 20 points the day they open their doors. 
But let's think about what it means for individuals.
  Right now, I can tell my colleagues a lot of individuals are very 
concerned, as they see their employer hit with these crushing costs and 
that every year their package will be skinnied down. There will be more 
copayments and fewer services, and a lot of them are very worried about 
whether their employer will be able to offer coverage at all. A lot of 
individuals come to me at townhall meetings and say: Ron, I am 56, 57. 
I am not sure my employer is going to be able to hold onto our coverage 
at work, and what will I do if I lose coverage at work and I am not yet 
eligible for Medicare. This, of course, would mean they might be 
without coverage between 57, 58, and 65. You can't be without health 
care coverage, as the Presiding Officer knows so well, for 7 or 8 
years.

  So the individual who has coverage at work is worried about the 
trends, and in a lot of instances, that worker feels job-locked. They 
would like, for example, to look at another position, say another 
position that paid more, but they can't do that because they fear if 
they gave up their current position, they would go into the marketplace 
and they would be uninsurable. They might have an illness. They might 
have had a previous health problem. They know what goes on in much of 
the marketplace--that there is a lot of insurance company cherry-
picking and that the insurance companies screen out people who have 
these health problems and try to send them over to Government programs. 
So a lot of our citizens feel job-locked and unable to move. It is why 
I think one of the most important changes that is needed in American 
health care is to modernize the employer-employee system. Because what 
we have today in 2007 isn't all that different from what we have had 
since 1947. My view is that will be one of the most important changes 
the country needs to look at in American health care.
  Finally, let me touch on the other side of the prevention coin in 
American health care. If we don't make changes and improve our system 
of health care prevention, what is surely going to happen is we will 
face increased costs for chronic health needs in America. Already, the 
evidence shows something like 6 percent of the Medicare population 
consumes 60 percent of the overall Medicare bill. These are the people 
who have problems with heart and stroke and diabetes--and the costs of 
chronic care go up and up and up. A modern health care system, one we 
ought to be looking at going to in the future, would put a better focus 
on chronic care management. So when you have an individual, for 
example, with several of these conditions, there is an effort among 
physicians and others to coordinate care. One of the best ways to do 
that is to have something which has come to be known as a health care 
home, where, in effect, an individual--a patient--can designate one 
person to coordinate their care when they have these multiple kinds of 
problems. But talk about the need for change: The Government does 
virtually nothing to promote the chronic care management which I have 
described and have had a chance to talk about with the Senator from 
Vermont.
  So we are going to have a chance to go home now for a few weeks and 
go to the townhall meetings and the Chamber of Commerce lunches and the 
service clubs. We are going to hear citizens talk about their hunger 
for change in a lot of areas: foreign policy, energy policy, education 
policy--a variety of areas. I think what they are going to

[[Page S15968]]

talk about when it comes to addressing their concerns here at home is 
the need for change in health care policy in America. They are going to 
talk about what is going to be done to contain the costs, what is going 
to be done to reduce some of the mindless paperwork, how we can put 
more focus on prevention and wellness, make better use of health care 
technology, and offer sensible policies that reward the coordination of 
managing cases for individuals with chronic conditions. These are the 
key areas they talk about. It all comes down to a health care system 
that doesn't work very well for them, No. 1. The issue becomes how can 
it be that a country such as ours--the richest country on Earth, with 
all these wonderful doctors and hospitals--cannot figure out how to 
meet the health care needs of our people.
  I believe we know what needs to be done. I have tried to outline a 
number of these key areas. As the Senator from Vermont knows, I have 
offered legislation with Senator Bennett of Utah--we have 13 cosponsors 
on a bipartisan bill--that addresses these kinds of concerns. But now, 
when we are home and we have a chance to listen to folks, I think we 
will have a chance also to talk about real priorities for our country, 
the changes that are needed. We need to especially talk about the 
changes that are needed in American health care so this country can end 
the disgrace that we are the only Western industrialized Nation that 
hasn't been able to figure out how to get basic, essential health care 
for all our citizens. We are up to it. It is now a question of 
political will and our willingness to embrace change.
  I have appreciated the chance this afternoon to outline some of the 
most important changes that are needed.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma is recognized.

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