[Congressional Record Volume 159, Number 93 (Wednesday, June 26, 2013)]
[House]
[Pages H4074-H4076]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
JOBS, SECURITY, AND THE WELL-BEING OF THE COUNTRY
The SPEAKER pro tempore (Mr. Pittenger). Under the Speaker's
announced policy of January 3, 2013, the Chair recognizes the gentleman
from Connecticut (Mr. Larson) for 30 minutes.
Mr. LARSON of Connecticut. Thank you, Mr. Speaker. I believe I will
be joined by my colleague from Ohio (Mr. Ryan), whom I will recognize
at the appropriate time.
We wanted to make this Special Order this evening about solution-
driven legislation and about the need on behalf of the United States
Congress to come together in a nonpartisan manner and get after the
concerns that this Nation cares so deeply about, most notably those as
they relate to jobs and security and the well-being of the country.
This evening, Mr. Speaker, what if I told you that we could deal with
all of the rising costs of health care, bring down the national debt
and that we could do so while providing better quality, coordinated
patient-centered care?
{time} 1650
There might be some skepticism. What if I further told you that we
could do it without raising taxes or cutting Medicare? In fact, what if
we did it by extending the benefits of Medicare?
What if I were to tell you, Mr. Speaker, that this idea germinated
with the Heritage Foundation, a conservative organization dedicated to
conservative ideas, and was piloted by a Republican Governor in a
Democratic State and served as the basis for what we now call the
Affordable Health Care Act?
The Affordable Health Care Act, in its final form, was something that
a number of colleagues on the Democratic side didn't necessarily
prefer. It was not their first choice. A number wanted to see a single-
payer system or Medicare for all, but that is not what transpired and
that is not what is the law of the land nor is what is upheld by the
Supreme Court.
We need, in this body, a paradigm shift that will allow us to come
together and embrace the ideas that we all agree upon in a way that we
can move this Nation forward. The budget leader in the Republican
conference is Paul Ryan, a distinguished, bright, and capable
gentleman. We agree that health care costs are what are driving our
national debt. There is no doubt about that. Statistics will reveal
that.
Further, when it comes to improving patient care, patient outcomes,
making sure that we provide for our elderly, making sure that we have a
continuum of care for people, that's something that's neither Democrat
nor Republican. That's something that is truly American and that we all
agree on.
Where we may disagree but where we can come together is in
recognition of how we get to the solution, solve this problem, instead
of these endless ``tastes great, less filling'' debates that go on in
the United States Congress. To do so, you have to be bolstered by
studies.
This slide will show that there are no less than 10 different studies
that have been authored by private sector individuals that all point to
one thing: that there's $750 billion to $800 billion annually that's
wasted in fraud, abuse, and inefficiencies.
This evening, we want to focus on the inefficiencies, noting of
course that fraud, abuse, and waste are very important, have been
documented several times on ``60 Minutes'' and other notable sources as
well, and certainly is something that will help us in terms of bringing
down the costs of health care, which, of course, solves our problems
with the national debt.
Health care costs in the United States of America have risen to 18
percent of our gross domestic product. This next slide will demonstrate
clearly that we are way above every other Western democracy, and this
is what the inefficiencies of a system have produced: a hodgepodge
system that is inefficient and driven upward in its cost because of the
lack of coordinated care and outcomes that suggest a new paradigm shift
and people coming together and embracing that which is in the public
health care system that works and does extraordinarily well, all that's
in the realm of science, technology, and innovation that we get from
the National Institutes of Health and for the Centers for Disease
Control that have been taxpayer funded and produced miraculous
opportunities and a better quality of life.
Then, thirdly, to embrace that with the private sector,
entrepreneurial efforts to drive inefficiencies out of a system. This
chart demonstrates how that can be done and that there is both the
profit in doing it for the private sector and the results of lowering
that cost for the public sector and an outcome for patients that is
centered around wellness, their well-being and their security in the
later years of their life. It's that combination that we believe can
work.
How do we know that that is so? We're fortunate to see, even in this
time of politics where there has been disagreement and too much
politics around the quality of health care, that our citizens rightly
deserve and the private sector in our hospitals with our doctors, with
our surgeons, with our medical devices, and with our entrepreneurship
are coming to embrace. The passage of the Affordable Health Care Act
is, in fact, a paradigm shift.
What do we need to shift to? How do we need to move that forward?
Mark Bertolini, the president of Aetna, based in Hartford, Connecticut,
said that the one thing we have to make sure of is that we're not
taking away benefits from people who are going to pay for the medical
devices--the hospitals, the doctors, the insurance, and the
pharmaceuticals that they all need. We need to enhance that system.
Economists like Clayton Christensen have talked at length about how
we need to be disruptive in economies, and in doing so, disruptive in
terms of our innovation. With the genomic projects at hand and the
potential for people to be living well beyond the age of 100 for my
children and for current generations, as we all know obviously living
longer, there's a need for us to embrace commonsense solutions and not
issues that either say we have to drive down the debt at the expense of
beneficiaries or that we have to raise taxes to help the beneficiaries.
How about we drive out the inefficiencies within the system, get
after
[[Page H4075]]
the fraud, abuse, and the waste, and work together as Democrats and
Republicans and achieve the goals that we were sent here to do by both
lowering the national debt and securing the future by making sure that
there is Medicare there for all of our recipients?
I think of so many people nearing the age of retirement who get
trapped in this gap. Once you turn 56, you start thinking, Is my
company going to keep me to age 65? What is going to happen to my
pension? But most importantly, what is the bridge I'm able to take to
get to Medicare and will it be there? There's got to be a resounding
``yes,'' and the important thing is that there's a path forward to
this.
Two things that are important to remember:
One, that the national debt is real and that we all agree that it has
to be addressed, and the primary driver is health care;
Secondly, Medicare is not an entitlement. It's the insurance that
people paid for. It's taken out of your paycheck. And if we drive the
inefficiencies out of the system, we actually can enhance the Medicare
system and make it solvent well into the future while paying down our
national debt.
{time} 1700
That should be the focus of the United States Congress. It will help
the economy, but most of all, it will help people in terms of the
quality of care that they need. This is what we hope to achieve in
Special Orders and prevailing upon our colleagues on both sides of the
aisle to come together and discuss solutions that will both reduce the
debt and preserve the Medicare system.
A person who understands this better than most, who has made
firsthand trips to hospitals and has written books, in fact, or at
least a book, as I seek to credit you beyond your authorship, Mr. Ryan,
but certainly someone who understands the importance of coordinating
care in such a manner that an enlightened new Republic that we are will
be able to participate in the wholeness and wellness that can come from
this paradigm shift afforded by the Affordable Care Act, and where
reasonable minds can come together to achieve these goals. I yield to
my colleague, the gentleman from Ohio (Mr. Ryan).
Mr. RYAN of Ohio. I thank the gentleman, and I would like to say a
deep thank you because I think this is one of the key issues that we
need to address as a country in order to have healthier citizens, have
a healthier economy, and drive down the national debt. As you said so
eloquently, the big driver for our national debt and deficits are the
Medicare and Medicaid programs, issues dealing with health. Look at
what is weighing down businesses right now. Small businesses
especially, huge increases in health care, year in and year out--10,
15, 20, 30 percent. We've all had people come to our office and say,
Hey, it went up 90 percent this year. How am I supposed to plan for
capital investments? I want to buy a new machine, and on and on and on
and on.
Where we start is, the current health care system is not working. We
spend $8,000 per capita in the United States versus $3,000 in
developing countries, and we have worse outcomes. We have worse
outcomes here. What we're talking about, what the CEO of Aetna is
talking about, is how do we take this system and recognize and begin to
appreciate in 2013 in America that if we put some money into
prevention, if we pay doctors and nutritionists and dieticians on the
front end, we're going to save a boatload of dollars on the back end.
Seventy-five percent of health care costs go to chronic diseases that
are mostly preventable.
So here we are bogged down by a system when the answer is patient-
centered care and having people participate in their own health care.
This is a challenge to every American to take responsibility for their
own health, their own well-being, and to create a system that
incentivizes everyone who is in the system to operate in this fashion
and help drive down health care costs in the long run. We all know this
intuitively, that if you take care of yourself, your diet matters, your
nutrition matters, your exercise matters, your checkups matter, and
through the Affordable Care Act, by having everybody covered, it begins
to change that business model of having the insurance company
incentivized to keep and help people get and stay healthy. I think it's
time for us to take the advice of the CEO of Aetna. This isn't John
Larson, this isn't me. We're looking at the statistics here in our
country, and we have to say, This is unacceptable. We have so many sick
people in our country, and we are doing nothing to prevent them from
getting sick in the first place.
Mr. LARSON of Connecticut. It isn't just the CEO of Aetna. As I was
pointing out earlier, a number of studies, whether they be done by
Reuters, whether they be done by Dr. Blumenthal and a number of groups
focused on this issue, they all arrive at the same conclusion: the
system is inefficient in its form, and how do you improve that system.
We're at a fork in the road here, as Dr. Blumenthal from the
Commonwealth Fund points out. Health care policy, we either are going
to end up in a situation, as the poster points out, where we cut
payments, reduce benefits, and restrict eligibility for public
programs, or we re-engineer health care and improve the health care
costs, improve the outcomes for patients.
As Mark Bertolini from Aetna says, the answer lies not in cutting
people's benefits but in improving their care. This is the juncture
that we're at. It would seem to me that, especially in this body, that
we now have an opportunity. We all agree that the national debt is a
problem. We know that health care is the primary domestic driver of
that debt. We have an opportunity to change that. We have a structure,
the framework of which, as I said in my opening remarks, was provided
by the Heritage Foundation and was pioneered by Mitt Romney in
Massachusetts as Governor, and done successfully.
Let's expand on that opportunity, only make it better. Make it better
because we know the great virtue of public health and all it has meant
for the wellness of this country. We know the great strength of our
hospitals and doctors and our scientific community, our innovators, our
manufacturers, our medical devices, our pharmaceutical companies, we
know the great genomic project that is going to have remarkable
abilities that are going to enhance the quality of life like we have
never seen it before.
Instead of arguing the old wars and the last battles, we have to be
embracing the future in a way that makes the American citizenry secure
in the outcome of knowing that science, technology, and innovation,
their government and the best of the private sector, are all working on
their side. It's not a question of choosing one or the other; it's
embracing all three in a way that both lowers the costs, demonstrated
in study after study after study, and that will also enhance the
quality of health for our individuals. So many people in Ohio, I know,
have problems that have dealt with this.
Mr. RYAN of Ohio. And to figure out how to target the technology. We
were out at Walter Reed a few weeks ago, going through and seeing all
of the various techniques and approaches that are being used for our
veterans that are coming back, and they talk about having high-tech
health care, high-touch health care. A good portion of our health care
costs are driven up by the sickest 1 percent of the people, and the top
5 percent of the people in health care are driving a lot of the costs.
Mr. LARSON of Connecticut. Fifty percent of the costs.
Mr. RYAN of Ohio. From the top 5 percent. So 5 percent of the people
drive 50 percent of the health care costs. I think what a lot of these
folks are finding out, if you can surround that patient, the patients
in the center and figure out exactly what's going on and make sure that
that patient has preventive care and a consistent doctor and a
consistent nurse and somebody to consistently make sure that they are
taking their medication, these techniques, these medical homes, these
accountable care organizations, to surround the patient to make sure
that they get better, and then reward the doctor and the nurses and
everybody, the hospital, everybody who is involved for saying, we're
not going to pay you the same amount of money every time you see this
patient that still has the same problem that they had from the first
time they came in; you will be
[[Page H4076]]
paid to make them healthy. And that begins to shift the incentive and
squeeze some of that excess out of the system that the gentleman from
Connecticut talked about.
{time} 1710
Mr. LARSON of Connecticut. Well, you know, inefficiencies, as I said,
were going to be our focus. Let's talk about that just from a practical
standpoint.
You say the word ``inefficiency'' and what do people actually think?
Think about the last time you were in any doctor's office, or made
any trip to the emergency room, and the number of forms you had to fill
out, the number of forms where we have complicated a system that needs
to be streamlined.
One of the things that our colleagues and I should embrace is the
need for us to streamline regulation in the process so that it becomes
simple, cost-effective, electronically or digitally driven in a way
that both reduces costs and adds to a better quality of life for the
individual.
When Mr. Bertolini speaks, he talks about, as you point out,
developing coordinated care with our areas, our centers of expertise.
Whether it's the Mayo Clinic or, in Ohio, the Cleveland Clinic, or
whether it's Sloan Kettering, whether it's Jackson Labs in the State of
Connecticut, by working in conjunction and coordinating the best
outcomes, and then also doing this locally, from the bottom up, that
coordination, quite frankly, hasn't existed before. That's what's
driven our health care costs up so dramatically.
No other Western democracies in the world, some that have more aging
populations than we do, face a similar crisis. We have the opportunity
to attack this like no other nation in the world.
Just a word about the genomic project. Jackson Labs is located in my
district in Connecticut, and they're known for their Nobel Prize
winners because of what they have been able to do with mice.
Mice, as I know the gentleman from Ohio knows, because of their lack
of an immune system, allow them to be great vehicles to test with
respect to breakthroughs in disease and how we deal with disease.
Well, when we add the genomic project to that, and the advances that
we can make in cancer, heart disease, diabetes, all of the areas that
plague us, we now have, at our disposal, but instead of a multitude of
tests, and random testing, we can now get down to an individual's DNA
and make that change.
That is enormous cost savings. That is the full embrace of science
and technology and innovation. That should be the discussion on the
floor here, the greatest breakthroughs and what we're going to do, and
how it's American ingenuity, it's American innovation, it's American
doctors and surgeons and medical manufacturers and medical devices and
chemistry, through pharmaceuticals and all the science that we've
brought to bear.
We put a man on the Moon in less than 10 years. Can we solve this
problem?
Of course we can. And it's on the cusp of being solved.
Let's embrace what the private sector is doing. Let's embrace our
scientific and university communities and our labs in a way that we're
coordinating with them, coordinating in a way that we drive out the
inefficiencies, because our end goal here is the consumer, it's the
patient, it's the citizen of this country who's paid tax dollars for
this, who's bought into an insurance system, who believes that his
country, or she believes that her country, is there for them in their
time of need as we make these critical transitions.
The American people want to see us here in this body working
together. Let's work around the issues that drive us, the national
debt, securing Medicare for the future, and understand that we have the
tools, many of which we owe to the public health system, and the
innovation, the labs, the Centers for Disease Control, the National
Institutes of Health, and all that's been done in our universities, as
well as the entrepreneurial expertise and the creation and innovation
that comes from our great system.
Let's enjoin that in a way that we solve problems, solution-oriented
legislation that gets over the ideological divide and recognizes that
we need common outcomes on behalf of the American people.
Mr. RYAN of Ohio. And, I think, take what is working in areas
systemically, but also techniques. Up at Walter Reed, for example,
they're using things like acupuncture. They're using things that can
help with stress reduction. They're using mindfulness-based stress
reduction because we now know, in 2013, given all of the brain science,
all of the research that the neuroscientists have done all over the
country and the world, Dr. Richard Davidson, at the University of
Wisconsin, and Dr. Amishi Jha, at the University of Miami, all of the
greatest institutions in the United States and the scientists that run
these labs, that study the body, study the mind, they know that the
future of health care is self-care.
How do we help people reduce their stress?
How do we help some of these soldiers that come back that are on 6,
8, 10, 12 drugs?
We spend $300 billion a year on pharmaceuticals. That's more than
many of the other countries in the world combined. And we're not saying
that you shouldn't have prescription drugs, because you're going to
need them in this system that appreciates and tries to utilize all of
the tools in the toolbox to keep people healthy.
But how do we create a system where a doctor can have more than 5
minutes with a patient?
And it's on to the next one and on to the next one and on to the next
one. That's not a system. That is not protecting the integrity of the
doctor/patient relationship. And that, in and of itself, can be a
healing relationship, being able to sit down with the doctor and find
out what's wrong.
How much stress and anxiety do people have when they just don't know
what's wrong?
Mr. LARSON of Connecticut. The gentleman makes excellent points; and
it's a point that underscores that, within this system, as the
gentleman points out, we are going to need that high quality of care.
But our care coordination problems have been driven by flawed
designs. The coordination of care in the new era, with all the science,
technology and innovation that we can bring to bear on this problem,
and the flawed design of our payment systems, are what we need to
correct.
The beneficiaries will not only be our veterans who return home and
are in need of our care, but our general population in dealing with
this. The exchange is going to present a great opportunity, an
opportunity to have a paradigm shift, an opportunity for us to come
together and solve major problems.
And you know what? As the gentleman from Ohio knows, if we solve the
national debt problem, then we don't have an issue with sequester, we
don't have an issue with debt ceilings, and we can get about the
infrastructure system that we desperately need in this country to
further enhance jobs.
But within the innovation, technology, and manufacture of drugs and
of medical devices, and the technology that grows out of health care,
we have a whole economy that's ready to burst and boom as well.
That's what we've got to be about. That's what I believe the American
people want to see us solving. And I'm glad that we've taken the time
this evening to do that.
Mr. RYAN of Ohio. And if you think about what the small business
person who's suffered the brunt of these huge health care increases
over the last decade or two, 120-some percent increase, I think, in the
last 10 years for a small business person, their health care, over that
period of time has gone up.
So if you start reducing that cost, the money that business person
will have to reinvest can be a stimulant for the economy.
Mr. LARSON of Connecticut. I thank the gentleman. I see that our time
has expired. I thank the Speaker, and we thank everyone for the
opportunity to lay out this case of coordinated care and cooperation,
reducing our national debt, and securing Medicare for our citizens.
I yield back the balance of my time.
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