[Congressional Record (Bound Edition), Volume 159 (2013), Part 3]
[Senate]
[Pages 4153-4154]
[From the U.S. Government Publishing Office, www.gpo.gov]




                    AFFORDABLE CARE ACT ANNIVERSARY

  Mr. WHITEHOUSE. Mr. President, this Saturday marks the third 
anniversary of the passage of the Affordable Care Act. At age 3, the 
law is protecting consumers against abusive insurance practices, 
helping seniors by lowering prescription drug costs, and building the 
infrastructure to expand health insurance coverage to millions of 
Americans. For the first time, patients' interests and needs are being 
put ahead of those of the insurance and drug companies.
  The Obama administration has worked tirelessly to implement the law, 
in the face of constant opposition. My Republican colleagues in 
Congress have voted to repeal or defund the Affordable Care Act well 
over 30 times. It is a chilling, if useless, political refrain from the 
tea party.
  On this third anniversary, it is important not only to reflect on how 
far we have come but to continue pressing forward on the Affordable 
Care Act's many improvements to our health care system, particularly 
the delivery system reforms.
  The Council of Economic Advisers' 2013 ``Economic Report of the 
President'' identified a number of sources of waste in our health care 
system, including the fragmentation of the delivery system; duplicate 
care and overtreatment; the failure of providers to adopt best 
practices; and payment fraud. The council notes:

       Taken together, [these factors] have been estimated to 
     account for between 13 and 26 percent of national health 
     expenditures in 2011. The magnitude of this waste offers an 
     equally large opportunity for spending reductions and 
     improvement in quality of care an opportunity that underpins 
     many of the provisions of the Affordable Care Act.

  Thankfully, we have the tools necessary to seize the opportunity 
described by the Council of Economic Advisers to drive down costs and 
improve the quality of patient care. The Affordable Care Act included 
45 provisions dedicated to improving the way we deliver health care in 
5 priority areas: payment reform, primary and preventive care, 
measuring and reporting quality, administrative simplification, and 
health information technology.
  The effort to extract from the wasteful swamp of our health care 
bureaucracy a lean, humane, patient-centered system is vital. National 
health spending hit $2.7 trillion in 2011 or about 18 percent of GDP. 
The next least efficient developed country--the Netherlands--spent 12 
percent of its GDP on health care in 2010. Germany and France spent 
11.6 percent of their GDP on health care. If we were as efficient as 
the Netherlands, if we merely moved from last place to second-to-last 
place in health care efficiency, we would save over $800 billion per 
year.
  For all of our excess spending, one might expect that Americans live 
longer, healthier lives. But that is not the case. The Institute of 
Medicine recently compared the United States to 17 peer countries. We 
were worst for prevalence of diabetes among adults, worst for obesity 
across all age groups, and worst in infant mortality. We suffer higher 
death rates and worse outcomes for conditions such as heart disease and 
chronic lung disease.
  According to the Week, avoidable infections passed on due to poor 
hospital hygiene kill as many people in the United States--about 
103,000 a year--as AIDS, breast cancer, and auto accidents combined. 
These deaths are tragic because they are largely preventable. As we 
have shown in Rhode Island, when hospital staff follow a checklist of 
basic instructions washing their hands with soap, cleaning a patient's 
skin with antiseptic, placing sterile drapes over the patient, etc.--
rates of infection plummet, and the costs of treating those infections 
disappear. The costs of treating the 100,000 who die, as well as the 
hundreds of thousands who suffer nonlethal infections, disappear.
  Delivery system reform has real promise in improving the management 
and prevention of chronic disease. These diseases accounted for 7 out 
of 10 deaths in the United States in 2011 and at least 75 percent of 
our health care spending.
  I am not alone in saying that a correct diagnosis of the problem will 
lead us to delivery system reform. Gail Wilensky, the former 
Administrator of the Center for Medicare and Medicaid Services under 
President George H.W. Bush, said in 2011, ``If we don't redesign what 
we are doing, we can't just cut unit reimbursement and think we are 
somehow getting a better system.''
  In the private sector, George Halvorson, chairman and CEO of Kaiser 
Permanente said, ``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.''
  Saving money by reforming how we deliver health care isn't just 
possible, it is happening. At a 2011 hearing I chaired of the Senate 
Health, Education, Labor, and Pensions Committee, Greg Poulsen of 
Intermountain Healthcare said:

       Intermountain and other organizations have shown that 
     improving quality is compatible with lowering costs and, 
     indeed, high-quality care is generally less expensive than 
     substandard care.

  So when Republicans say we must cut Medicare and Medicaid benefits to 
fix our deficit, that assertion is flat-out wrong.
  Attacking Medicare and Medicaid is consistent with a particular 
political ideology, but it is not consistent with the facts. It ignores 
the fact that we operate a wildly inefficient health care system and 
that our health care spending problem is systemwide, not unique to 
Federal health programs. It is not just Medicare and Medicaid; former 
Secretary of Defense Robert Gates said of the Defense budget, ``We're 
being eaten alive by health care.''
  The President's Council of Economic Advisers estimates that we could 
save approximately $700 billion every year in our health care system 
without compromising health outcomes. The Institute of Medicine 
recently put this number at $750 billion. Other groups are even more 
optimistic: The New England Healthcare Institute has reported that $850 
billion could be saved annually. The Lewin Group and former Bush 
Treasury Secretary Paul O'Neill have estimated annual savings of a 
staggering $1 trillion. Most recently, the Commonwealth Fund laid out a 
set of policies that would accelerate health care delivery system 
reform and slow health spending by $2 trillion over the next 10 years.
  These savings will have a dramatic impact on the Federal budget. The 
Federal Government spends 40 percent of America's health care 
expenditures. If the estimate by the Council of Economic Advisers is 
correct, we could reduce the Federal deficit by up to $280 billion per 
year. If we achieve only one-quarter of the Council of Economic 
Advisers' estimate, the Federal savings would be $70 billion annually. 
Over a

[[Page 4154]]

10-year budget period, that amounts to $700 billion in Federal health 
care savings all without taking away any benefits, all while likely 
improving quality of care.
  In a report I issued last year for the Senate Health, Education, 
Labor, and Pensions Committee, I found that the administration has made 
considerable progress on implementing the 45 delivery system reform 
provisions in the law. But more can and must be done. Specifically, I 
again urge the administration to set a cost-savings target for health 
care delivery system reform. A cost-savings target will focus, guide, 
and spur the administration's efforts in a manner that vague intentions 
to ``bend the health care cost curve'' will not. As the Commonwealth 
Fund concluded, ``The establishment of targets can serve both as a 
metric to guide policy development and as an incentive for all involved 
parties to act to make them effective.''
  In 1961, President Kennedy declared that within 10 years the United 
States would put a man on the Moon and return him safely. The message--
and the mission outlined--was clear. The result was a vast mobilization 
of private and public resources to achieve that purpose.
  This administration has a similar opportunity--particularly now, at 
the height of the implementation of the Affordable Care Act. We need to 
put the full force of American innovation and ingenuity into achieving 
a serious cost-savings target for our Nation's health care system. But 
it is hard to do that if they won't set one.
  I urge the administration to set a cost-savings target, with a number 
and a date. And then let's get to work to give American families the 
health care system they deserve. Instead of waste and inefficiency, 
poor outcomes and missed opportunities, we would have a health care 
system that is the envy of the world.

                          ____________________