[Congressional Record Volume 155, Number 87 (Thursday, June 11, 2009)]
[Senate]
[Pages S6488-S6489]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. BENNET. Madam President, I rise today to discuss the urgent need 
for health care reform. The people of Colorado, and the American 
people, have waited for too long for Washington to act.
  We should begin with a basic principle: if you have coverage and you 
like it, you can keep it. We will not take that choice away from you.
  But even as we keep what works, we must confront the challenges of 
soaring health care costs and the lack of access to affordable, quality 
health care. The status quo is unacceptable. Every day, families in 
Colorado and across America face rising premiums. Their plans offer 
fewer benefits. They are denied coverage because of preexisting 
conditions.
  And until we fix the health care system, we will not be able to fix 
the fiscal mess in which we find ourselves.
  Since 1970, the share of health care as a part of the GDP has gone 
from 7 percent to 17 percent. The United States spends over $2 trillion 
in health care costs, including over $400 billion on Medicare. 
President Obama has said the biggest threat to our nation's balance 
sheet is the skyrocketing cost of health care. He is right.
  In Colorado, we have not waited on Washington. We have made real 
progress in showing how you can provide high quality health care at a 
lower cost. Last week, the New Yorker magazine published an article 
titled ``The Cost Conundrum'' that highlights the important work that 
has been done in Mesa County, CO. Over 30 years ago this community 
serving 120,000 people came together, doctors, nurses, and the 
nonprofit health insurance company. They agreed upon a system that paid 
doctors and nurses for seeing patients and producing better quality 
care. They realized that problems and costs go down when care is more 
patient-focused.
  In Mesa County, the city of Grand Junction implemented an integrated 
health care system that provides follow-up care with patients. This 
follow-up care has helped lower hospital readmissions rates in Grand 
Junction to just 3 percent. Compare that to the 20 percent rate 
nationwide, and it is clear that our rural community on the Western 
Slope of Colorado is onto something groundbreaking.
  High readmission rates are a large problem for our seniors. Nearly 
one in five Medicare patients who leave a hospital will be readmitted 
within the following month, and more than three-quarters of these 
readmissions are preventable. Rehospitalization costs Medicare over $17 
billion annually.
  It is painful for patients and families to be caught up in these 
cycles of treatment. All too often, care is fragmented; you go from the 
doctor, to the hospital, to a nursing home, back to the hospital and 
then back to the doctor again. Patients are given medication 
instructions as they are leaving the hospital, many times after coming 
off of strong medications. They do not know whom to call, and they are 
not sure what to ask their primary care doctor.
  The solution, both our Denver and Mesa County health communities have 
found, is to provide patients leaving the hospital with a ``coach.'' 
This coach is a trained health professional connecting home and the 
hospital. This coach teaches patients how to manage their health on 
their own.
  Our Denver health community created a model based on this idea called 
the Care Transitions Intervention. Their work is the basis for the 
Medicare Care Transitions Act of 2009, a bill I introduced to implement 
this model on the national level. This legislation recognizes that 
patient care should not begin in a doctor's office and end at the 
hospital doors. Investing in coaching and transitional care now can 
head off huge costs down the road. It has the advantage of being both 
preventive and responsive.
  Take 67-year-old Bill Schoens, from Littleton, CO, who recently 
suffered a heart attack. Before he was released from the hospital, 
registered nurse Becky Cline was assigned as his Transitions Coach. She 
made sure that he understood the medications that his doctors 
prescribed and everything else he needed to do to get healthy. Bill 
even pointed out, ``When you are in the emergency room, you are all 
drugged up and can barely remember what to do. Confusion starts to set 
in.''
  Becky went through each step Bill needed to follow when he left the 
hospital. Becky evaluated Bill's ability to follow doctor's orders in 
his environment and helped him maintain his own Personal Health Record. 
With her help, when Bill visited the doctor, he did not have to 
remember everything that happened since he left the hospital; it was 
all in the book.
  Bill said, ``When people are in front of their doctor, their blood 
pressure goes sky high and they forget what they need to ask.'' He said 
he found the help and guidance he received from his Transitions Coach 
``invaluable and life-saving.''
  We need patient-centered coordinated care, care that views nurses, 
doctors and family members not as isolated caregivers, but as partners 
on a team whose ultimate goal is to make sure patients get the guidance 
and care they need. Hospitals are not the problem, primary care 
physicians are not the problem, and nurses are not the problem. Our 
fragmented delivery system of care is the problem.
  This bill also makes sure that we are teaching patients to manage 
their own conditions at home.
  Sixty-nine-year-old Frank Yanni of Denver, CO, had surgery for a 
staph infection of the spinal cord. After leaving the hospital, he 
noticed that the pain he was experiencing weeks after surgery was 
getting worse. Having been ``coached,'' he identified the problem and 
knew to insist on visiting his doctor immediately. A hospital test 
showed that Mr. Yanni required a second surgery. His coach said that, 
``Had he let that go for even another week, he could have ended up in 
the ICU, septic and horribly sick.''
  Our Colorado transition of care model, reflected in our legislation, 
gives health care systems the choice of whether to create this program. 
But it allows existing patient-centered transitional care programs like 
the one in Mesa County, CO, to continue on.
  We want communities and providers to think and work together to 
reduce readmission rates, reduce costs and provide better coordinated 
care to our patients. Other systems should look at Colorado and the 
systems in 24 States that have already begun to follow this model.
  As we begin to emerge from the economic downturn, we must call upon 
existing health care professionals from all walks of life--nurses, 
nurse practitioners, social workers, long-term care, and community 
health workers--to serve as transitional coaches.
  Colorado nurses like Becky Cline have found that focusing on 
transitional care has leveraged their skills,

[[Page S6489]]

empowering them to take a more active role with patients. They are able 
to work with both patients and family caregivers. For too long, family 
caregivers have been ``silent partners.'' Some 50 million Americans 
provide care for a chronically ill, disabled or aged loved one. This 
bill recognizes their importance, connecting them with a coach who can 
teach them how to properly coordinate at-home care.
  This bill is only a small part of the solution to the complex 
challenges of our fragmented health care system. The problems of rising 
costs and limited access affect people from all walks of life.
  Skip Guarini of Parker, CO, is a self-employed private consultant and 
retired U.S. Marine. After years of regular doctors' visits, Skip's 
dentist discovered a lump on his thyroid during a routine exam that had 
gone undetected by his physician despite 10 previous exams.
  Skip underwent a CT/MRI scan, ultrasound, and biopsy, all of which 
were inconclusive. A second series of tests 6 months later revealed 
that the lump had grown, and Skip underwent surgery. During the 
surgery, doctors found cancer. Skip was then sent to an endocrinologist 
who ordered more tests. All tests came back negative. A second full 
body scan revealed no sign of cancer anywhere in Skip's body.
  All these exams and screenings cost Skip $122,000.
  Since then, Skip has maintained perfect health, but he cannot obtain 
private insurance because of the thyroid surgery. He now relies on 
COBRA and is paying a monthly premium of $1,300. This coverage is set 
to expire in less than 1 year, at which point Skip will have no 
insurance.
  Hollis Berendt is a small business owner in Greeley, CO. She is 
covered through her husband's employer, which is ``a luxury many other 
small business owners don't have,'' she said.
  After graduating from Colorado State University in 2004, their 
daughter Abby found a job with a large company in New York City. She 
was told she could not get health care coverage until she had been 
working for the company 1 year. At 10 months of employment, she was 
diagnosed with an ovarian tumor that would require surgery. The 
expenses were too much for Abby, so her parents had to take out a 
second mortgage to pay her medical bills.
  Hollis shared that ``this experience brought to light, all too 
clearly, how close we all are to losing everything due to a health 
issue.''
  The current system is hurting our small business people and their 
employees. Take Bob Montoya of Pueblo, CO, who runs Cedar Ridge 
Landscape in Pueblo with his brother Ron. They are torn between 
providing health care coverage for employees and keeping the business 
afloat.
  Last year, the business paid out $36,000 for a health care plan to 
cover Bob and Ron's families and one other employee. The other 12 
employees and their families do not get coverage through their work. 
Bob said, ``As business owners, we want to do right by the people who 
work for us, but if all our employees opted into our health care plan 
and paid their 50 percent, we would be forced out of business.''
  He said it is an ``impossible situation'' for him and his employees.
  Like too many small business owners, Bob can not find good health 
care coverage at a cost he can afford.
  He said, ``The longer it takes to pass comprehensive health care 
reform, the more jobs will be lost as small businesses shut their doors 
due to rising costs.''
  These Coloradans speak for countless others across the nation. All 
they ask for is a health care system that works for them, a health care 
system that does not crush them with unreasonable costs, and a health 
care system that does not deny them coverage just because they have 
pre-existing conditions. I am hopeful.
  I am hopeful that we can keep what works in our system and fix what 
is broken. I am hopeful that this Congress, working with our President, 
will finally deliver on the promise of health care reform. The people 
of Colorado deserve it. The American people deserve it.
  I yield the floor, and I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Kaufman.) The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. NELSON of Florida. Mr. President, I ask unanimous consent that 
the order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. NELSON of Florida. Mr. President, I understand we are in morning 
business. I ask unanimous consent to speak for up to 20 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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