[Congressional Record Volume 155, Number 49 (Monday, March 23, 2009)]
[Senate]
[Pages S3587-S3589]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Ms. KLOBUCHAR. Mr. President, today I am here to talk about health 
care reform. I would mention, first, that I was just with Debbie 
Wasserman Schultz, the Congresswoman who last year battled with breast 
cancer and today was there, healthy, to introduce a bill. I am proud to 
be the Senate sponsor, to focus on increasing awareness among younger 
women about the risks of breast cancer.

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  But we are here today to talk about something else and that is how to 
bring costs down in health care. As we look at how to expand health 
care, as we look at how to improve the quality of health care, there 
must be work done to contain the costs. I believe, based on what I have 
seen in my State, you can actually reduce costs and improve quality.
  A few weeks ago, President Obama convened a health care summit to 
bring together industry leaders, providers, and advocacy groups to 
discuss our opportunity to move forward with serious health care 
reform. That reform should begin with the Medicare system. Medicare is 
one of the most valued social welfare programs our country has produced 
in the last half century. Yet it is also a program in dire need of 
reform if it is to survive on sound financial footing and continue to 
provide the fine medical care our seniors have come to expect from it.
  Change is needed now. By 2011, the first baby boomers will enter the 
Medicare system and by 2016 the number of Medicare beneficiaries will 
increase by almost 5 percent.
  This past winter, I convened a health forum in Minnesota to discuss 
the various challenges affecting the Medicare system. The message is 
clear: without action, costs will continue to rise and waste will 
proliferate.
  Medicare is the single largest purchaser of health care and its 
policies directly affect nearly every health care provider. Medicare's 
payment system, coding, quality reporting, and recordkeeping are the 
industry standard. Spending for the Medicare Program is projected to 
increase 114 percent in the next 10 years. Twenty percent of Medicare 
beneficiaries suffer from one of five chronic diseases. Medicare spends 
66 percent of its annual budget to treat this group. Two-thirds of 
Medicare spending only helps one-fifth of Medicare beneficiaries. If we 
are going to sustain Medicare as a healthy, high-quality program 
Americans deserve, we must do something to address these challenges. In 
short, we need to reform Medicare so it addresses efficient, high-
quality care.
  As it happens, doctors and hospitals in many regions of the country, 
including my State of Minnesota, practice exactly this kind of high-
quality, low-cost medicine and they should be rewarded for it. But 
Medicare does not reward them. Instead, it punishes them. In fact, at 
the health summit last week, President Obama actually asked the 
gathered group, ``Why should we punish Minnesota because other States 
are less efficient?''
  The problem is, despite periodic efforts at reform, Medicare pays for 
quantity, not quality. More tests and more surgeries mean more money, 
even if the extra tests and operations do nothing to improve a 
patient's condition. States that have historically delivered excessive 
procedures are still rewarded for the wasteful practices of the past, 
while efficient States, such as Minnesota, are punished.
  If you look at this chart, you will see that the areas in dark blue 
are the ones that receive the lion's share of Medicare payments. The 
light blue area States, such as Minnesota, Montana, Iowa--I see Maine 
is looking good, as I see the Senator from Maine across the way--but a 
number of States, you can see, are in areas where Medicare spending is 
low but quality of care is high. It is as if there were a huge 
transfusion that basically takes taxpayer money from one region, one 
area of the country, and puts it in another.
  It is not to say people are not sick in other parts of the country--
they do deserve that help--but looking at the limited resources, we 
have to figure out what is working and how come areas of the country 
that tend to have the lowest health care costs also have the highest 
quality health care?
  It is not what you would think. You would think: Well, the highest 
cost must have the highest quality. That tends to happen sometimes, in 
clothing and other things. That is not what is going on in this country 
right now. Regions with more specialists and more hospital beds tend to 
provide more services and get more of the money.
  According to the Dartmouth Institute for Health Policy and Clinical 
Practice, high-cost regions in Medicare boast 32 percent more hospital 
beds, 31 percent more doctors, and 66 percent more medical specialists. 
In other words, supply is driving demand. The result is that Medicare 
pays much more in some parts of the country than it does in others for 
medical care that is no better.
  Medicare's own report shows that quality of care is higher in many of 
these low-cost States. In fact, Medicare spends more in places such as 
Florida and New Jersey than it spends in States such as Minnesota and 
Oregon. Let me give you one example:
  In Miami, FL, Medicare spent roughly $15,000 per patient per year in 
the year 2005. In Minneapolis, a Medicare patient received about $7,000 
worth of care that year. To put it another way, Medicare will spend 
$50,000 more on a 65-year-old patient in Miami over the course of his 
or her lifetime than on a comparable patient in Minneapolis. Now, 
$50,000, that is a lot of money.
  At $2.4 trillion per year, health care spending represents close to 
17 percent of the American economy, and it will exceed 20 percent by 
2018 if the current trends continue. If you look at this 
internationally, you can see the United States spends far more than any 
other nation, without getting better care. We can and we must do 
better. A number of models are out there to provide direction for the 
future. The Mayo Clinic, based in my home State of Minnesota, is 
renowned for the effective care it provides at a reasonable cost. Now, 
think about this. There was a Dartmouth study that came out. It showed 
this: If the rest of the hospitals in the country used the same kind of 
high quality, with very high quality efficiency ratings from families, 
and high efficiency care as the Mayo Clinic now does, in the last 4 
years of a patient's life, the country--the taxpayers of this country--
would save $50 billion over 5 years. That is $50 billion over 5 years 
by simply following the protocol of having a more organized, efficient 
delivery system with one primary doctor, with experts who work 
together, without duplicate tests.
  That is $50 billion every 4 years by following a set protocol with 
some of the highest quality ratings in the country. The Congressional 
Budget Office has also studied the problem and found the potential for 
huge savings. This chart reflects that Medicare spending would fall by 
29 percent if spending in medium- and high-spending regions were the 
same as that in low-spending regions. That is the CBO.
  So how do we change the Medicare system in a way that will reduce 
these disparities and reward our doctors for doing what is right? Real 
reform will start when the system starts paying for quality. Here are 
the three priorities I plan to start working on immediately. First, we 
need to enhance Medicare incentives that reward quality care. For many 
illnesses and conditions, the medical profession has widely accepted 
practice guidelines that result in better health care outcomes, such as 
when to give aspirin to heart patients, and how often to perform cancer 
screening, but they are not always followed. A recent RAND Corporation 
study found that adults received recommended care only 55 percent of 
the time. Medicare needs to reward doctors and hospitals for doing the 
right thing and achieving improvement in care. These quality guidelines 
can be the basis for Medicare payments to providers.
  Second, we need to rethink the Medicare payment system. Right now, 
Medicare pays for tests, visits, and other procedures one by one, 
giving providers an incentive to order more and more services. We need 
to have better coordination of care, and less incentive to bill 
Medicare purely by volume. Increasing the bundling of services in 
Medicare's payment system has the potential to deliver savings and 
start rewarding value and not volume.
  Third, we need to address the shortage of the number of primary care 
physicians who are currently practicing across our country. Today, 
effective primary care is severely undervalued in our health care 
system. Yet, research suggests that improving access to primary care 
and reducing reliance on speciality care can improve the efficiency and 
the quality of health care delivery. To accommodate the needs of an 
aging population, we need to promote primary care and transition away 
from our specialty-intensive health care workforce.
  The health care system we have now needs major improvement. That 
means

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transforming the system to pay doctors for the quality of care they 
provide and to turn the current disconnected, reactive health care 
system into one that is integrated and concentrates on delivering the 
best care for patients.
  Again, I want to stress this, when we talk about saving costs, when 
we look at these studies, those States that are most efficient, those 
areas that are more efficient, have high quality care.
  I leave you with this figure: The Mayo Clinic, in the last 4 years of 
a patient's life, if those protocols were followed across the country, 
we would save $50 billion every 5 years in taxpayer money. That is an 
independent study, $50 billion.
  I know we can do better. At the same time as we reduce the cost, we 
can improve the quality of care that our Nation's seniors deserve. 
Working together, we can give them the system they deserve.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Hagan.) The Senator from Maine is 
recognized.
  Ms. COLLINS. Madam President, I ask unanimous consent that I be 
permitted to proceed for 15 minutes as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The remarks of Ms. COLLINS pertaining to the introduction of S. 664 
are printed in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')
  The PRESIDING OFFICER. The Senator from South Dakota.

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