[Congressional Record (Bound Edition), Volume 157 (2011), Part 12]
[Senate]
[Pages 17653-17655]
[From the U.S. Government Publishing Office, www.gpo.gov]




                                MEDICARE

  Mr. WHITEHOUSE. Mr. President, I am not going to speak very long 
tonight, and I am not going to speak very formally either. But I did 
want to come back to the Senate floor and make a point again that I 
have made repeatedly here on the Senate floor before; that is, there is 
a path to reform of our health care system that will improve the 
quality of care for patients, will improve the experience of care for 
patients, will improve the outcomes of care for patients and for our 
Nation, and will lower costs for our country.
  The reason I come to raise that point again is that the Senate is now 
awash with rumors that the 12 Members of Congress--Senators and 
Congressmen--who have been tasked with trying to create a solution to 
our deficit problem are going to cut Medicare benefits by hundreds of 
millions of dollars. That is, as best I can tell, only a rumor. I 
certainly cannot vouch for it being true. Indeed, I hope it is not 
true.
  The time I wish to spend this evening is to remind my colleagues it 
is a very unfortunate and mistaken path to take to follow the road of 
benefit cuts at a time when the road to reform is so promising in terms 
of the win-win of better care at lower cost.
  It is not just me saying this. The President's Council of Economic 
Advisers has said the annual savings that could be accomplished with 
health care delivery system reform, without reducing anybody's quality 
of care or access to care--indeed, I would hypothesize actually 
improving quality of care--is $700 billion a year in the American 
health care system.
  The President's Council of Economic Advisers is not alone in that 
opinion. The Institute of Medicine has just said it is around $770 
billion a year. A few years back, the New England Healthcare Institute 
said it was $850 billion a year. And the Lewin Group, which is a fairly 
well respected health care consultancy here in Washington, as well as 
George Bush's Treasury Secretary, Secretary O'Neill, have both agreed 
annual savings could be $1 trillion a year--all by improving the 
quality of care and the coordination of care.
  I do not know if it is exactly going to be $700 billion or $1 
trillion, but my point is, there is a big savings target out there that 
everyone from President Obama's Council of Economic Advisers, to George 
Bush's Treasury Secretary, to a lot of very well thought of groups in 
between, including our National Institute of Medicine, all agree on. So 
I think that makes it a very important target to pursue in this 
discussion.
  It is not just me in believing, at this potential split in the road, 
we should work and fight very hard to make sure we are taking the right 
path and we do not go down the easy-to-score but unnecessary and 
unhelpful path of benefit cuts, which singles out seniors in Medicare 
and does nothing about the underlying costs of the system and makes it 
the wrong road to follow when we have a well illuminated path that can 
move us toward a better, more efficient delivery system that provides 
better quality health care, better outcomes, fewer hospital-acquired 
infections, better coordinated care, stronger electronic health 
records--all of the things that will support a truly modern health care 
system that can be the envy of the world.
  That is the choice we have. I think it would be a terrible mistake to 
go the benefit cuts route instead of the reform route, and it is not 
just me who says that. George Halvorson is the chief executive officer, 
the CEO, of Kaiser Permanente. Kaiser Permanente is one of the biggest 
health care systems in the country. It provides health care in many 
States, and George Halvorson is a very serious individual who knows his 
stuff in health care. He would not be the CEO of that big company if he 
did not.
  Here is what he said the other day:

       There are people right now who want to cut benefits and 
     ration care and have that be the avenue to cost reduction in 
     this country. And that's wrong. It's so wrong, it's almost 
     criminal. It's an inept way of thinking about health care.

  That is not me. That is the CEO of Kaiser Permanente.

       There are people right now who want to cut benefits and 
     ration care and have that be the avenue to cost reduction in 
     this country and that's wrong. It's so wrong, it's almost 
     criminal. It's an inept way of thinking about health care.

  Yet that is the direction that it looks like we may be taking, the 
inept direction. I had a hearing in the HELP Committee--the Presiding 
Officer, Senator Bennet of Colorado, is a member of that HELP 
Committee--and we had some very interesting witnesses. Because the path 
toward savings through reform is not just a HELP Committee path, this 
is not something that some academic has constructed and maybe if you 
take that path things will work, this is a path that major 
corporations, major health systems, major hospitals in this country are 
already walking. They are already walking down that path.
  Kaiser is one of them. Blue Shield of California is another. 
Intermountain out in the West is a third. Mayo, Geisinger, Gundersen 
Lutheran--there are a number along the East Coast. These are companies 
that have determined this is the right path, and they are walking that 
path.
  Two folks were there from such companies. One was Dr. Gary Kaplan, 
who is at the Virginia Mason health system in Seattle, WA. Despite its 
name, Virginia Mason, it is actually in Seattle, WA, on the other 
coast. He pointed out

[[Page 17654]]

that they went through a quality management transformation in their 
hospital with a cultural transformation, with a process transformation.
  As a result, they have made significant improvements. Just in one 
back pain reform process they did with 2,000 patients, they calculated 
they have already saved $1.7 million on 2,000 back pain patients, and 
those patients are happier with the new regime, the less-expensive 
regime, than before because they are getting better quality care.
  He testified they saved $11 million in planned capital investment, 
reduced inventory costs by $2 million through supply chain expense 
reductions, reduced staff walking distance by 60 miles per day, reduced 
labor expenses and overtime and temporary labor by half a million 
dollars in just 1 year, reduced professional liability insurance 
premiums by 56 percent, reduced their self-insured retention fund by 70 
percent, reduced the time it takes to report lab tests by more than 85 
percent, and improved their medication distribution, reducing errors, 
reducing the time when a patient first calls Virginia Mason's breast 
clinic with a concern to the time they receive a diagnosis from 21 days 
to 3 days, and many patients receive their results on the same day.
  These are the kind of improvements that have put Virginia Mason at 
the front end and make them, according to the Leapfrog Group, one of 
the top hospitals in the country. They are walking the walk of 
improving the quality of their operations, improving the quality of 
care and saving money by doing so.
  The other witness was Greg Poulsen from Intermountain. He described 
two examples. One was a sepsis program for people who are admitted to 
the hospital suffering from sepsis throughout their system. Sepsis is a 
dangerous condition. Sepsis, on average, has a 40-percent mortality 
rate. So 4 out of 10 people with sepsis die of it. They have reduced 
the 40-percent mortality rate from sepsis to 5 percent--from 4 in 10 
dying to 1 in 20 dying. Did it cost a lot of money to do that? Was that 
a big investment they had to make? Did it cost the taxpayers a lot to 
save those lives? No. What they found is they saved $10 million with 
that improvement.
  Similarly, they have a diabetes program that has been described by 
the former CEO of the Mayo Clinic as the diabetes program he would go 
to if he were sick with diabetes that has ``the best outcomes and 
lowest costs in the country.''
  They saved $5 million a year on diabetes treatment by going to better 
health care providing. There is a problem, as he pointed out. That $10 
million they saved is actually a revenue loss. Because when they saved 
money by not having unnecessary care, by not having complications, by 
having things be more efficient and streamlined, what they did was they 
reduced their billing to the insurance companies, and it is actually 
the insurance companies, it is the payers who saved the $10 million.
  What the providers spend is a revenue loss. So we have our system 
upside down in that respect, and that is one of the ways we need to 
reform our system. A third witness who was there was a Rhode Islander. 
His name is Chris Koller. We have a unique office in Rhode Island, an 
office of health insurance commissioner. He is the only health 
commissioner in the country. Also, I tease him that he is the tallest 
insurance commissioner because he is unusually tall, but that is easy 
because he is the only one.
  But he has done a very good job of bringing our hospitals and 
insurance companies together to try to focus on the ways we can deliver 
care better. One way is through prevention and primary care. It turned 
out that in Rhode Island, the amount of every health care dollar that 
was spent on primary care was 5.9 percent. So every $1 spent on health 
care in Rhode Island, less than 6 cents, went to primary care, went to 
your regular family doctor and the basic health care providers. Less 
than 6 cents out of every $1.
  The insurance companies have more overhead than that, administering 
the system. The costs of administration of the health care system is 
more than the primary care providers get out of the system. That is 
another sign that the system is upside down. He is encouraging them, 
and they have agreed, to step up the spending on primary care by 1 
percent a year for 5 years. We believe that is going to make a very 
substantial cost savings because there is so much that a primary care 
provider can handle without having to go to a specialist, without 
having to go to the emergency room, without the condition getting worse 
because they could not find you, by simply making primary care more 
accessible and more available.
  So the additional expense for primary care should bring down system 
costs overall and having it designed more intelligently.
  I will close with a few words from the witness, Dr. Kaplan, who said 
that through the work they have been doing on reform and efficiency, he 
said: ``We have demonstrated that the path to higher quality, safer 
care is the same path to lower costs.''
  He actually said that if we could get more transparency to the system 
about who is doing a better job and who is not, what the outcomes are 
for different hospitals, that basically where we are right now in the 
delivery system reform provisions that were in the Accountable Care 
Act, he described them as one of the last chances of a market-based 
system.
  This is somebody who is in this business all the time and is actually 
running a hospital that is actually producing results. This is a person 
who is steeped in the reality of health care, and contrary to what we 
hear in the cartoon version that infects Washington, where ObamaCare is 
socialized medicine and is a step away from market-based care, this 
practitioner says the potential of the Accountable Care Act, as I see 
it, is one of the last chances of a market-based system.
  It could actually lead to a market, whether it was Medicare and 
Medicare Advantage as parts of Medicare or the commercial sector, that 
we would actually be able to understand what we are buying and what we 
are paying for.
  That is the kind of commonsense transformation we need. You remember, 
Dr. Kaplan said: We have demonstrated the path to higher quality, safer 
care is the same path to lower costs.
  Gary Paulsen, Intermountain, and other organizations have shown that 
improving quality is compatible with lowering costs. Indeed, high-
quality care is generally less expensive than substandard care, and the 
primary challenge for us and the main reason more organizations do not 
adopt the high-value model discussed in the hearing that we held is the 
underlying fee-for-service payment system which predominates, of 
course, in the United States. We pay doctors for doing more, not for 
doing better. We pay doctors for doing more things to you rather than 
getting you well.
  Because we do that, we have the results we have. When you look at 
that mess, you can say, OK, we are going to leave all that alone. We 
are not going to follow the path that Intermountain, that Gundersen, 
Lutheran, that Virginia Mason has proven, that Kaiser has argued for 
and proven, that so many systems around the country are doing, you can 
say, we are going to forget all that. We are going to leave it in 
place. We are going to leave it a mess, and we are just going to cut 
benefits away from seniors, from our elderly, from the people who need 
care the most, from the people who paid into the system, from the 
people who do not have a chance to recover, very often from people who 
are not in a position to direct their own care and make effective 
choices if they are the very elderly on Medicare or worse, the 
Medicare-Medicaid dual eligibles.
  We are going to go after those people. We are going to cut their 
benefits, and we are not going to take the trouble to follow the path 
the professionals who are doing this are already showing is a path that 
leads to saving, is a path that leads to a better health care system, 
is a path that leads us out of the difficult position of being the only 
country in the world that spends 18 percent of our GDP on health care, 
of being the most inefficient country in the world in health care by a 
50-percent margin. The next closest country in

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terms of inefficiency in health care is about 12 percent of GDP. We are 
at 18. Why is it necessary that America has to be the most inefficient 
health care provider in the world of all the countries we compete with 
by a factor of nearly 50 percent? That is half again worse than the 
most inefficient competitor we face. It makes no sense to be in that 
position.
  There is enormous room for improvement. The path to that improvement 
is clear. It is already being walked by serious and responsible 
institutions that have set this as their corporate goal. That is where 
we should go. I will close again by repeating George Halvorson's 
exhortation. He is one of the great health care leaders in this 
country. He is a savvy corporate manager. He runs an enormous health 
care corporation. This is not an idle opinion of his.
  There are people right now who want to cut benefits and ration care 
and have that be the avenue to cost reduction in this country and 
that's wrong. It's so wrong, it's almost criminal. It's an inept way of 
thinking about health care.
  Those are CEO George Halvorson's words, not mine.
  I hope that they ring through this body and we don't make the 
mistaken decision to go after Medicare benefits and instead take the 
positive path of reform and improvement.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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