Health Care Reform
I thank our chairman, the leader on this issue. Would the Senator yield? First, I say to Senator Dodd, I heard all this talk about socialized medicine. Socialized medicine. These are scare tactics. There are a lot of scare tactics going…
I thank our chairman, the leader on this issue. Would the Senator yield?
First, I say to Senator Dodd, I heard all this talk about socialized medicine. Socialized medicine. These are scare tactics. There are a lot of scare tactics going on.
I was in my State over the weekend, and people were talking about euthanasia in the bill. We hear all this crazy stuff going on out there, and I got to thinking about this. There is a lot of money on the table. We spend $2.3 trillion a year, if I am not mistaken. There is a lot of money, and a lot of people have a vested interest in not changing the system because they are making a lot of money. Obviously, what they are trying to do is scare people.
People elected us--and I think elected President Obama--to make some changes in the way we do things, but there are a lot of vested interests out there that don't want to change. There are a lot of scare tactics going on out there. They are unduly scaring people and obviously by people who don't want to change the system. They want the status quo.
The other thing I might say, as to all this talk about socialized medicine, historically, when President Harry Truman first proposed a kind of national health insurance program, that is the issue that was raised in 1951, I think it was. I could be off a year. Maybe 1950 or 1951 it was raised, when he was proposing this. The origins go back to an individual whose name I forget right now, but he was an advertising executive hired by the AMA at that time to stop Harry Truman's program. So he came up and he coined this whole phrase ``socialized medicine.'' It was picked up by then-Senator Robert Taft, and he kept harping on the Truman program was socialized medicine. Well, that was in 1949- 1950, I think it was, and here we are, all these many years later, and we hear the same arguments coming up again. It wasn't socialized medicine then and it is not socialized medicine now.
What we are trying to get is a system that is stable, that people can rely on, that they know is going to be there for them and that is affordable and gives them a quality health program--as my colleague, Senator Dodd, said--as we have. What we are trying to get for the American people is the same kind of system all Federal employees have. We are on the same system as your local postal employee in a small town in Connecticut or a small town in Iowa or somebody who works for the Farm Service Agency in the Federal Government. We are all on the same plan. We have a lot of choices, don't we? Every year, I think we get 20-some plans to pick from. We sort of have an exchange out there, where every year, if we don't like what we have, we can go to something else. Why shouldn't the rest of the American people have that kind of access?
I spoke with a small businessman in Iowa last week. He has 12 employees and spends 15 percent of his gross revenue on health care. He has 12 employees, and one of his employees had a kidney transplant. Another came down with cancer. In 2 years, his insurance premiums went up 100 percent. In 2 years. He has a $5,000 deductible, and he said he needs some work done. He wanted to go in for a colonoscopy because he turned 50, but a colonoscopy costs $3,000. Well, that is out of pocket because he has a $5,000 deductible.
I am trying to get to my point of prevention. Because we know if he has a colonoscopy and something happens, they can stop it. It is one of the most preventable forms of cancer, this colon cancer, but it is one of the most deadly if you don't get it in time. So I asked Art: Why don't you get a different plan? He said: I can't. We only have one in rural Iowa I can go to.
What we are trying to do is get more plans for people out there in small towns in Iowa, in Connecticut, and everywhere else so they do not have to be stuck with one plan; they can shop around and get other plans.
He asked me if he could get on the public option plan that we have in our bill. I said: Sure. Small businesses such as you? Absolutely. That means he can get in a pool with everybody else around the country and reduce his costs. I just remembered that, and I remembered him talking about trying to get a colonoscopy. This kind of gets to the nexus of what I wanted to talk about, briefly, which is the focus on keeping people healthy.
President Obama said very clearly, when he addressed a joint session of Congress earlier this year, that we have to make a major investment in prevention and wellness because that is the only way we are going to keep people healthy and reduce medical costs. Well, President Obama gets it. He understands we have to make a major new investment. That is what we have done in our bill--our Affordable Health Choices Act--which Senator Dodd so greatly led through our committee. We make a major investment in prevention and keeping people healthy.
My colleague is right. I started out saying we have a sick care system instead of health care. I started saying that in 1992; that we have a sick care system, not a health care system. If you get sick, you get care, one way or the other. But there is not much there to try to keep you healthy in the first place and to focus on prevention. Again, our bill has a very strong prevention provision in there.
Some ideas on what we have tried to do. The real health reform starts with prevention, it does. If we don't do prevention and wellness, you can jiggle the payment system all you want and you are not going to save a dime, unless we start focusing on keeping people healthy in the first place. Is there support for that out there? Sure. The American people get it. They understand this. They were asked: Should we invest more or not invest more in prevention and wellness? Well, you can see that 76 percent of the American people said we had to invest somewhat or strongly; invest more, 53 percent; invest somewhat, 76 percent; not invest any more, 10 to 16 percent.
The American people get it. They get it. You can talk to anyone you want about health care and ask them: Would you rather just have something that takes care of you when you get sick or would you rather have more focus on keeping you healthy? I will tell you the response will be: I want to stay healthy. People want to stay healthy. But in a lot of cases, they don't know how. There are not the support systems there to do that.
Again, on saving some money; a lot of times we hear that: Oh, this won't save money, and the CBO--Congressional Budget Office--doesn't score it. But we asked voters. The poll question was: Will prevention and wellness save us money? Seventy-seven percent said yes. Yes, it will save us money. Again, the American people get it, that we have to focus more on prevention and health.
We have some problems with CBO. That is the Congressional Budget Office, for those who don't understand the jargon around here. The Congressional Budget Office doesn't score us very well. Score means they do not give us much savings when we invest in prevention and wellness. Well, I have gone over that with the Congressional Budget Office, and the problem is they do not give a savings because they do not give savings on what they call secondary savings. Secondary savings is what prevention provides. It saves you money from going to the hospital or getting sick. But they do not give us a good score for that on savings. But do we have data on that? Do we know if it saves money? Sure, we do.
This is from the Trust for America's Health. They did a big survey of community-based interventions and for $10 per person, in 1 to 2 years, they save $2.8 billion; 5 years, $16.5 billion; 10 years, $18.5 billion. That is just $10 per person, and that is just community programs. So we address the whole gamut. We address the community-based programs and the clinical-based programs.
For example, what we do in our bill is we set up an investment fund to do a number of different things. Let me give one example. We are going to train health professionals in how to work with prediabetic individuals, people who have tested high, who look like they are prediabetic. We will train them to work with them to manage their condition, to get them on the proper diet, to manage them as they go along. What is so important about that? Well, what is important about
that is that right now, for example in Medicare, Medicare will pay $30,000 to amputate your foot if you have diabetes. They will not reimburse one cent for nutrition counseling before so you don't get diabetes. But they will pay for nutrition counseling after you get diabetes. That doesn't make any sense.
Right now, the cost of diabetes in our society is $174 billion a year. That is $174 billion a year on diabetes. Well, it doesn't take a genius to figure out that if we can get hold of people who test prediabetic and get them on a well-managed program so they do not come down with diabetes, we will save money. But the Congressional Budget Office doesn't score that as any savings.
So at the clinical level we will do that. We will reimburse, for example. There will be a reimbursement for cancer screenings, for smoking cessation, nutrition counseling, colorectal screening. There will be reimbursements for that, and you will not have to pay any deductibles or copays. So for my friend who is now facing $3,000 for a colorectal screening, this will not cost him anything. No copays, no deductibles, and the insurance company has to reimburse for that.
Again, if we catch these things early, it is just like mammogram screening. We know if we get breast cancer early, it is curable. Again, let me say something that is public. The mayor of Cedar Rapids is a woman. I was in Iowa this weekend, and it was announced she has breast cancer. She went in today for a small surgery, and she will be back to work tomorrow because they got it early.
I appreciate the Senator saying that, and that is why we have to have more focus on this prevention and getting people in for early screenings. If you get it early, you are cured. We know that. So we want to remove any of the obstacles people have going in and getting screening.
Again, the Congressional Budget Office says they cannot figure out the savings. I said: Why don't you go look at Pitney Bowes. It is a big company, 200-some thousand employees, scattered all over the United States--
I didn't know that. Pitney Bowes, and their CEO, Mike Critelli, went on a big program of wellness and prevention for all their employees. I think they called it Health Care University or something such as that. Here is what they found.
They found, through their wellness and prevention program, they reduced their number of hospitalizations for all their people by 38 percent--38 percent. Think of the savings. They reduced their disability payments and claims by 50 percent, just through their wellness and prevention programs.
Again, this will save us money. It will make people healthier. Not only that, I say to my friend, just the productivity level--people will work harder, they will work better when they are healthy and they are well.
One other thing I wish to mention. We have a fund in the prevention title of the bill that will increase over the years to a significant amount of money. People say: What are you going to use that money for?
Right now at the Centers for Disease Control and Prevention, for cardiovascular disease prevention and heart disease prevention, the current funding is $50 million for all States. That is barely enough to even print a pamphlet to get information out to people--$50 million for cardiovascular disease. Yet angioplasties alone and bypasses, we spend over $90 billion a year--just on those two items. But if they are caught early and if there are prevention programs out there, we can cut those down.
You mentioned diabetes. Right now diabetes costs us $174 billion a year--for diabetes. So the current funding is $62 million a year for diabetes prevention and control in the entire United States.
Arthritis, the current funding is $13 million. For nutrition, physical activity and obesity, right now $42 million is all we spend through the Centers for Disease Control and Prevention--$42 million a year.
You get my point. My point is, we are not focusing enough on prevention and wellness. That is what this bill does.
I thank our chairman, I thank Senator Dodd for his great leadership. That is what people have to understand. In our bill, we have defined what we want to do on prevention and wellness. Frankly, I think we had good support on both sides of the aisle for that. I think the American people support putting more emphasis on keeping people healthy.
Andrew Weil, Dr. Andrew Weil has come out with a new book, ``Why Our Health Matters.'' One of the things Andrew Weil pointed out to me a while ago--he said the natural state of the human body is to be healthy. It is in our DNA. Our body wants to be healthy. Yet everything we do lends itself to be unhealthy. We have to do things to make it easier to be healthy and harder to be unhealthy. Right now we do the opposite. It is easy to be unhealthy and hard to be healthy--especially after you find you have to make all these copays and deductibles. There is not much out there if you are prediabetic. Where do you go to get the kind of counseling and help you need so you don't get diabetes? I suppose if you have a lot of money you can probably do it, but for the average person, they have no idea where to go.
The last thing I might mention, I say to Senator Dodd, also in our appropriations we have, and we hope we get some more in other bills, but: workplace wellness programs, to buttress what Pitney Bowes and Safeway and others have done in that area.
For this bill, it is key to reducing costs and changing the structure of health care in America. I am grateful for my colleague's leadership in pulling this together and making sure in this bill we have a very strong investment in prevention and wellness.
I thank my colleague. I think that is a very good point.
Mr. President, I wish to thank my friend from Oregon, with whom I have had numerous conversations, going back over years, on the whole wellness ethic and how we can kind of get this big ship of health care moving in a different direction. Senator Wyden has been one of the great leaders in this area, and I have consulted with him often on this issue. I look forward to his work on the Finance Committee.
Of course, on workplace wellness, we have to make sure small businesses are able to help their employees in wellness programs. We know from other businesses and what they have done--some larger businesses but some smaller ones that have done good workplace wellness programs--it pays off immensely in savings but also in productivity. Of course, that is something the CBO does not look at--increased productivity. They do not look at that.
But I say to Senator Wyden, he is absolutely right. What we have done, what we anticipate will be coming now from the Finance Committee, and in putting these together, we will have a whole new--what is that fancy word called Paradigm--a new paradigm in health care in this country, where people will have a lot of choices. They will be able to shop. They will not be like my friend Art in Storm Lake, IA, who only has one place to go with a $5,000 deductible.
Now we will be able to take a lot of these small businesses and they will be able to go on these exchanges and they can be in a pool with a lot of other people all over the country. We know a principle of insurance--I say to Senator Wyden, he knows this very well--one of the basic principles of insurance is: The more people in the pool, the cheaper it is for everybody.
So we set up the bigger pools with our small businesses, my farmers and farm families to get into bigger pools, and not just these small pools that cost them so much money. But the idea behind it, of course, the one big paradigm, is to start focusing on wellness and health promotion, keeping people healthy. We have to put more incentives in there for people.
You talk to anyone. Go out and talk to anyone and ask them would they like to be healthier or would they like to be sick. That answer is easy. They want to be healthy. What kind of help do you get? When you go to your doctor, when you talk to your doctor and stuff, do they tell you how to be healthy? Well, I do not know. I do not think so. When is the last time you went to a doctor and walked out without getting a prescription? So the doctor gave you a prescription. Go get a drug. We have to change this. In our bill, we do.
Again, part of our prevention package is to focus on medical schools and how we get more people in general practices and family practices and residencies in prevention and wellness so they begin to understand how they can start working with people to keep them healthy.
So this is a way we are going to try to shift this so the person can say: Yes, I want to be healthy. And do you know what, I went to my health care practitioner--maybe a doctor, maybe a nurse
practitioner, maybe a physician's assistant, and it could be a host of different people; it could be a chiropractor--and, do you know what, they spent a lot of time with me, and they gave me a program to follow to stay healthy. And guess what. They check up on me and they find out: Are you following your program? Come in. You come in here in 6 months. I am giving you this program to show you how to stay healthy. And they call me up after a month. Someone in the office called me up, asking: Are you doing this? In 6 months, I have to come back in to make sure I am doing it.
No one has ever done that before. But in our bill, you see--in our bill--they will be able to get reimbursed for that. They will be able to get reimbursed for keeping someone healthy and not just taking care of you when you are sick.
I wish to thank my friend from Oregon. He has been a great leader in this area for so many years. I look forward to working with the Senator to get us over that finish line sometime this year.
I thank Senator Dodd again for all his great leadership. I say to the Presiding Officer, the Senator from Rhode Island--talking about the public option, to digress for 1 second away from prevention--here is one of the reasons we need a public option: From 2003 to 2007, the combined profits of the five largest health insurance companies went up 170 percent. Their profits went up 170 percent. The CEO compensation for the top seven health insurance companies right now: $14.2 million a year.
Well, that is why we need a public option out there, to kind of put some brakes on that, to give some competition out there so these health insurance companies know they have to be a little bit more stringent on maybe what they pay their CEOs, and maybe the profits will not be so high because they will have a public option out there that will act as a check both on their profits but also a check on the quality of care they provide. That is why the public option is so vital and necessary.
Well, again, I say thank you to Senator Dodd for having us here tonight, and I thank him again for his great leadership on this health care bill.
I say to my friend from Oregon, we are going to get it done. We are going to make this a wellness society, not a sick society.
I thank my friend from Oregon.
Mr. President, I can't thank Senator Dodd enough for getting the information out on what our bill does. A lot of people don't know that we have a very comprehensive bill. This one dealing with small businesses is so important.
Now, it is true we excepted businesses that employ fewer than 25, as we should. However, I just told the story about my friend in Iowa who employs 12 people, and they buy health insurance but they only have one plan, and this would give them more.
I believe that with the bill we have and setting up these exchanges and letting different insurance companies come on the exchange, and with a public option there are a lot of small businesses out there that would like to cover their employees; they just simply can't afford it or the deductible is so high that it is not even worth it. Now I believe they will be able to take, with our bill, after it is fully implemented--it takes about 3 years to phase in, if I am not mistaken-- there will be a lot of small businesses out there that employ 10 or 15 people that now will be able to get an insurance policy for their people that will be a heck of a lot more reasonable than what they can get now, and they will be able to shop for that.
So even though we have exempted them, I think a lot of small businesses want to cover their employees. They live in the same community; they go to the same church; they know one another, and they want to buy some health coverage for their employees. They can't now, but I believe under the bill we have through our committee, once we get it fully implemented, we will have that public option out there, we will have the exchange with all of the insurance programs out there, and they will be able to now shop around and find one that can fit their needs. So we will have a lot more support for small businesses that way.
I thank the Senator.