[Congressional Record (Bound Edition), Volume 153 (2007), Part 10]
[Senate]
[Pages 13790-13791]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. WHITEHOUSE. Mr. President, I return to the floor to continue my 
series of remarks on health care reform.
  As I have said, I recognize the difficulty of figuring out a better 
way to finance our health care system, a better way than part employer 
insured, part Government insured, and part uninsured. I am committed to 
working to achieve universal coverage for all Americans, but we have to 
recognize also that the underlying health care system itself is broken. 
It is broken in the way it delivers and pays for care, it creates 
massive costs and poor health outcomes, and those massive costs and 
poor health outcomes make the financing and access problems actually 
harder to solve. So I wish to focus now on system reform to give us a 
better operating health care system.
  We have to start by recognizing that America's health care 
information technology is decades behind where it could be. The 
Economist magazine has described it as the worst in any American 
industry except one--the mining industry. As a result, we are losing 
billions and billions of dollars to waste, to inefficiency, and to poor 
quality care. Ultimately, and tragically, lives are lost to preventable 
medical errors because health care providers do not have adequate 
decision support for their decisions on treatment, medication, and 
other care.
  Let us stop on the financial question for a moment. Some pretty 
respectable groups have looked at health information technology to see 
what they think it would save in health care costs, and here is what 
they report: RAND Corporation, $81 billion, conservatively, every year; 
David Brailer, former National Coordinator for Health Information 
Technology, $100 billion every year; and the Center for Information 
Technology Leadership, $77 billion every year. If you average the 
three, you get $86 billion a year. For RAND, the number I quoted was a 
conservative number. Their high-end estimate was a savings of $346 
billion a year. So there is a huge amount of money at stake.
  The question is: Are we making the investments we need to capture 
these savings? Well, say you are a CEO, and one of your division heads 
comes to you with a proposed investment to reduce production costs in 
your facility by $81 billion a year. How much would you authorize her 
to spend to achieve those savings? I suspect it would be quite a lot of 
money. Well, here is what we authorized ONCHIT to spend this year--the 
Office of National Coordinator of Health Information Technology. This 
Congress authorized $118 million. That is about 14 hours' worth of the 
$81 billion in annual savings conservatively estimated by RAND. Would 
it not be worth spending more to capture those savings?
  You say, well, maybe the private sector will spend it for us. But 
look at the way our complex health care sector is divided into doctors, 
hospitals, insurers, employers, nurses, patients, and more. Which group 
do you expect to make the decisions about a national health information 
technology system? And they are not homogenous groups. Whom within them 
do you expect to make decisions about a national health information 
technology system?
  Go back to imagining that you are a CEO. You want to install an IT 
system in your corporation. Your corporation has five major operating 
divisions. Would you pursue your corporate IT solution by waiting for 
each division to try to build the entire corporate IT system, without 
even talking to each other? Of course not. It would be a ridiculous 
strategy. None of your divisions would want to go first. Each division 
would like to wait and be a free rider on the investment of another 
division. Each one would face what I call the ``Betamax risk,'' that 
they will invest in a technology that proves not to be the winning 
technology, and each would have to figure out how to pay for the 
system, the whole system, out of only its own share of the gains. The 
result is the capital would not flow efficiently.
  This pretty well describes where we are in America on health 
information technology. So here, in Washington, we have a job to do. 
First, we have to set some ground rules. In the old days, when our 
Nation was building railroads, the Government had a simple job to do: 
It had to set the requirements for how far apart the rails were going 
to be. That way a boxcar loading in San Francisco could get to 
Providence, RI, and know it could travel the whole way on even rails. 
The development of the rail system would never have happened without 
those ground rules.
  In health information technology, there are ground rules we need to 
decide on, too, to get this moving--rules for interoperability among 
systems, rules for confidentiality and security of data, rules for the 
content of an electronic health record. All of that is the job of 
Government to organize.
  The second job is to get adequate capital into the market. Software 
costs money. Hardware costs money. Entering data costs money. Most 
important, the disruption to the work flow of hospitals and doctors 
costs time and money, and it takes time and attention away from 
patients. So developing adequate health information technology is not 
going to be easy or cheap. But for savings of $81 billion a year, maybe 
$346 billion a year, it is worth a big effort.
  So how do we get that capital flowing? Well, one could argue the way 
to solve this is to treat the health information highway similar to the 
Federal highway system--a common good that we pay for with tax dollars 
because it is so valuable to the economy to get goods cheaply and 
reliably from point A to point B. So maybe we should pay for this 
through taxes, similar to the national highway system. But a highway is 
pretty simple technology. Because the health information network is so 
much more complex, and because I think we need a lot more market forces 
at work and a lot more initiative and profit motive than the Federal 
highway funding model provides, I looked around for another model, a 
model that provides the central decisionmaking that is required to get 
the boxcars rolling, a model that provides access to capital, and a 
model that captures the vibrancy of the private sector.
  I found one. We have actually been here before, or pretty close 
anyway. There was, some time ago, a new technology. Similar to health 
information technology, it would transform an industry; similar to 
health information technology, it would lower costs and expand service; 
similar to health information technology, it was a win-win situation 
for business and for consumers.
  But the technology was, like health information technology, stuck in 
a political and economic traffic jam.
  Our President at the time came up with the solution. The technology 
was communications satellites. The President was John F. Kennedy. The 
solution was COMSAT.
  The COMSAT legislation broke the logjam. The COMSAT legislation 
created a publicly chartered corporation with a private board that 
raised the capital, launched the satellites, was profitable and 
successful for decades, and eventually merged into Lockheed-Martin--a 
true public-private success story.
  My proposal, in a nutshell, is to create a not-for-profit, modern 
COMSAT for health information technology. Because of the complexity of 
the health care information puzzle, legislation is too blunt an 
instrument to drive the details. But an organization like this can be 
flexible enough to meet market demands and can maintain the expertise 
to develop the details as the plan develops. American leaders could be 
recruited from the private sector to lead this board--CEOs from the IT 
sector, America's top retailers, manufacturers, and service providers; 
the champions of health information technology in the medical 
community; enlightened consumers and labor representatives.

[[Page 13791]]

  I ask my colleagues to think of the caliber of just a few of 
America's leaders who have spoken to them about this issue, or spoken 
out publicly: Andy Stern at SEIU, Jim Donald at Starbucks, John 
Chambers at Cisco, or Lee Scott at Wal-Mart.
  In conclusion, enormous cost savings, new technological horizons, 
empowerment of patients, better quality of care, more convenience and 
efficiency, and lives saved by improved information, error reduction, 
and decision support--what a rich area this opens up for American 
technological companies, for American health care providers, for 
American patients, and for American manufacturers now drowning under 
health care costs, if only we can break the logjam blocking this future 
now.
  I hope my colleagues will consider seriously my legislation, 
proposing a nonprofit, privately led corporation that will help open 
the doors to that future.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from New Jersey is 
recognized.
  Mr. LAUTENBERG. Mr. President, I ask unanimous consent for 10 minutes 
to speak in morning business.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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