[Congressional Record (Bound Edition), Volume 155 (2009), Part 15]
[Senate]
[Pages 20252-20254]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Ms. KLOBUCHAR. Madam President, health care reform is a very personal 
matter for me and a personal matter for so many people in my State. I 
first got interested in this issue, as I think many of us did, after 
something happened to me when my daughter was born. When she was born, 
she was very sick. She could not swallow. Back then, insurance 
companies had a rule that new moms and their babies were kicked out 
after 24 hours. After she had been in intensive care, I was kicked out 
of the hospital after 24 hours. As my husband wheeled me out in a 
wheelchair, I remember thinking: This wouldn't have happened to the 
wife of the head of the insurance company, but it happened to me.
  I went to the legislature, along with a lot of other mothers, and 
said we have to change this to at least guarantee new moms and their 
babies a 48-hour hospital stay. Minnesota was one of the first States 
in the country to adopt that rule, which later, under President Bill 
Clinton, became national policy.
  I remember going to the legislature and standing there at the 
conference committee, and some of the insurance companies were there 
trying to make sure the implementation of this 48-

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hour rule was delayed. I decided to take all the pregnant women I knew 
to the conference committee. We outnumbered the lobbyists two to one. 
So when the legislators said, When should this new bill take effect 
which guarantees new moms and babies 48 hours, all the pregnant moms 
said, ``Now.'' And that is what happened. That is my experience, and 
that is how I got involved in this issue.
  As I have traveled our State, I have heard from Minnesotans about the 
importance of doing something about health care. They want cost-
effective health care. We have one of the best health care systems in 
the country. The President has lauded Minnesota. We know it is good. We 
have something like 93 percent coverage, and it tends to be run a lot 
more efficiently.
  But still there are people in my State, as there are all over the 
country, who are saying: We can't have the status quo because we know 
our premiums are going up and up. Maybe we can afford it this year, but 
we are not going to be able to afford it next year; or, if I lose my 
job, I am not going to have health care tomorrow.
  That is what the people in my State are saying. I heard from Dawn in 
Staples, MN, who is struggling to afford the prescription drugs 
necessary to treat her multiple sclerosis, and John in Oakdale, MN, who 
has insurance for his wife and three sons but ends up paying thousands 
of dollars in deductibles and coinsurance if one of his boys gets sick.
  Meanwhile, a new study by the White House Council of Economic 
Advisers found that small businesses pay up to more than 18 percent--18 
percent more--to provide health insurance for their employees, often 
forcing these businesses to lay off employees or cut back on their 
coverage.
  I was up in Two Harbors, MN, about a month ago visiting a little 
backpack company that has done amazing things. They are actually making 
some of the backpacks now for our troops in Iraq and Afghanistan. They 
said that their health care premiums now are something like $20,000 for 
a family of four--small businesses paying that much, for one family, 
for health care insurance. It cannot go on.
  I was down in southern Minnesota in the southeastern corner of our 
State and met with one of the clinic heads there, someone who heads up 
one of the hospitals in Wisconsin and Minnesota. He said they had three 
emergency appendectomies in just a 2-week time period and they should 
not have happened at that point, they should have been caught earlier. 
When they talked with the three people who showed up for the emergency 
appendectomies, they said: Why are you here? Two said: We are in small 
businesses, and we thought if we came in too early--we thought we could 
just get over this because we were afraid what it would do to the 
premiums. The third person who had the emergency appendectomy said: I 
just don't have the money to pay for this.
  That is what we are hearing all over our State, in a State that tends 
to have one of the best health care systems in the country.
  The American people know inaction is not an option. If we do not act, 
costs will continue to skyrocket and 14,000 Americans will continue to 
lose health insurance every single day. That is the status quo. We must 
not waiver in our efforts to enact a uniquely American solution to our 
Nation's health care problems. We must keep what works and fix what is 
broken. We must also level the playing field between consumers and 
insurance companies, preserve choice, expand access, and provide 
safeguards so that people do not lose their coverage if they lose or 
change their jobs, have preexisting medical conditions, or simply grow 
older.
  As we prepare to take up landmark health reform legislation, many in 
Washington are looking to Minnesota as a national leader. In Minnesota, 
we have developed a health care system that rewards quality, not 
quantity. It promotes coordinated, integrated care, and it focuses on 
prevention and disease management and controls costs. That is why we 
tend to have healthier people in our State. That is why we tend to have 
more people covered. That is why we tend to have more quality health 
care, because we focus on the system as a whole.
  Congressional Budget Office Director Doug Elmendorf recently 
testified before the Senate Budget Committee that to truly contain 
health care spending, Congress must change the way Medicare pays 
providers in an effort to encourage cost-effectiveness in health care.
  I couldn't agree more. Shifting to a value-based system is critical 
to controlling health care costs. Because you know what--and people 
would be shocked by this--when you look at States that have some of the 
highest quality, they tend to have some of the lowest costs, and States 
that have the highest costs tend to have the lowest quality care. That 
is messed up.
  Most health care is purchased on a fee-for-service basis, so more 
tests and more surgeries--if not done appropriately, with the patient 
in mind--can mean more money; quantity, not quality, pays. According to 
researchers at Dartmouth Medical School, nearly $700 billion per year 
is spent on unnecessary or ineffective health care. That is 30 percent 
of total health care spending.
  To rein in costs we need to have all health care providers aiming for 
high-quality, cost-effective results, as they do in Minnesota. That is 
why I have introduced legislation, along with Senator Martinez, that 
would create a value index as part of a formula used to determine 
Medicare's fee schedule. This indexing will help reduce unnecessary 
procedures because those who produce more volume will need to also 
improve care or the increased volume will negatively impact fees.
  To correct myself, that legislation was actually introduced with 
Senator Gregg, and Senator Martinez and I have introduced a bill to 
focus on Medicare fraud.
  Linking rewards to the outcomes for the entire payment area creates 
the incentive for physicians and hospitals to work together to improve 
quality and efficiency. In too many places patients must struggle 
against a fragmented delivery system where providers duplicate services 
and sometimes work at cross-purposes.
  We must also look at other areas where we can help reduce inefficient 
health care spending because, in the end, this is about focusing on 
quality care and getting that care to the patients who need it. It is 
focusing on the patients instead of all the insurance providers and all 
the other people who feed off the system. It is focusing on what works 
best for the patients. Recent studies show if all the hospitals in the 
country followed the protocol the Mayo Clinic uses in the last 4 years 
of a chronically ill patient's life--lives where the quality index is 
incredibly high--I think most people in this country and their families 
would love to have that kind of health care. If we used the model the 
Mayo Clinic uses, we would save $50 billion every 5 years in Medicare 
spending. That money can be used to bring more people into the system. 
That money can be used to make health care more affordable for the 
people of this country.
  That is what we are talking about when we talk about health care 
reform. The bill we have on Medicare costs and Medicare fraud--the bill 
I have with Senator Martinez--would require direct depositing of all 
payments to providers under Medicare and Medicaid so they are not 
ripping off the system or scamming the system; that it is going to the 
people who need it. The bill has been endorsed by the AARP, the 
National Association of District Attorneys, and the Credit Union 
National Association. Representative Patrick Murphy is carrying the 
legislation in the House.
  It is no small task, but we must reform America's health system. I 
strongly believe in reaching this goal to reform, making sure we don't 
have the status quo, where it is becoming harder and harder and harder 
for people in this country to afford health care. We need a system that 
depends on rewarding and controlling costs, that rewards quality and 
stopping fraud and making the system work for the people of this 
country.

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  For the sake of our fiscal health and for the sake of the millions of 
Americans struggling to afford the care they need, enacting effective 
health care reform in this country is essential. We know it is not easy 
and it will not happen overnight. It is 17 percent of this economy. But 
we also know that doing nothing and saying no to everything and calling 
things names, when we are effectively trying to find a solution, is the 
wrong way to go.
  I hope my colleagues in the Senate will start working on this bill 
constructively so we can get something done for the people of this 
country.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Illinois.
  Mr. DURBIN. Madam President, I see the Senator from Nevada is on the 
floor, and I would like to ask, before I seek recognition here--I would 
be happy to yield the floor to the Senator, with the understanding that 
I would follow him, if the Senator from Nevada would give me an 
indication of how long he might be speaking.
  Mr. ENSIGN. At the most, 10 minutes.
  Mr. DURBIN. Madam President, I ask unanimous consent, following the 
morning business statement of the Senator from Nevada, that I be 
recognized.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered. The Senator from Nevada.

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