Health Care Reform

Floor Speech

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Mr. ALTMIRE. I thank the gentlewoman for yielding. It's been a pleasure working with the gentlewoman as part of the New Democratic Coalition. We are the co-Chairs of that group.

The gentlewoman hit it right on the head, that we do have the best health care system anywhere in the world if you can afford to get it. If you have access, and there are millions of Americans that have insurance and they like it and they have access to the system, our medical innovation, as the gentlewoman said, our research, our technology far exceeds anything available anywhere else in the world. Our quality at the high end exceeds anything available anywhere else. It's why people come from all over the world to the United States to get their transplants, to get their heart taken care of, to get their high-end, high-tech care because we do it better than anybody else, and there is no question about that.

The problem is the costs are skyrocketing with our health care system. Every family, every business, every individual in this country is impacted by the cost of health care and not just with what you're paying directly for your health care costs--what your copayment, your premium or your deductible is. The cost of everything that you buy in this country is higher because of health care costs. We use the example of an American-made car. $1,500 of the price of every car made in this country goes to health care costs--to the health care costs of the workers who are involved in putting that car together.

It's more than that. It's every level of the supply chain, every segment. If you think about the company that manufactures the good, the people who ship the good, the people who receive it and stock the shelves, and the people who sell it, at every level, there is a component of cost that is increased because of health care costs of the companies involved in that. This is at every level of the supply chain.

If you think about every segment of our lives, health care is a part of that. What we are trying to grapple with here in this Congress over the next few months is how to preserve what works in our current system, because we don't want to throw the baby out with the bath water. We don't want to lose the good things about our health care system, but we do want to address the things that don't work. So we think about the fact that we spend $2.5 trillion a year on health care in this country, far more than in any other country in the world.

Yet, with some things, we don't get mediocre results; we get bottom-of-the-pack results when compared with other countries--in life expectancy and in infant mortality. We're not in the middle of the pack. We're at the bottom of the pack. We can do better. We're not getting our moneys worth, especially when you consider the 50 million Americans who don't have any health insurance at all. Now, when they show up at the emergency rooms, they get covered; they get treated, but the bill gets passed to the millions of Americans who do have health care coverage. The reason you pay $10 for an aspirin at a hospital is due to the cost shift that takes place, making up for the difference of the people who can't afford their health care. There are tens of millions more who live in fear of losing their coverage. They are one accident, illness or job loss away from losing everything, and that, in the United States of America, is unacceptable.

So we have very high quality at the high end, but we have very high costs, way more than any other country. We have millions of Americans who have coverage and who appreciate their coverage and who like it, but we have tens of millions more who don't have coverage or who are underinsured.

So the challenge we have as a Congress is how to fix what doesn't work--what's broken--and how to preserve what does work. We've put forward a plan, and we're in the very beginning stages. There is a lot of negotiation that's going to go into this, both in the House and in the other body, to talk about how we can achieve that goal--but make no mistake. As the gentlewoman knows, we are not going to fail. We are going to pass a health care bill this year because the American people have demanded that we do that.

As I said, it affects everybody in this country. The cost increases that are double and triple the rate of inflation every single year are simply unsustainable. We are never going to get ourselves out of the budget crisis that we have over the long term, our annual budget deficit and our structural debt that we have, unless, as the President says, we bend that cost curve on health care. We have to bring costs more into line with the rate of general inflation.

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There is a lot to talk about just with this one concept, with this one component of health care. Part of the issue that he'll, I'm sure, get into is that of computerized medical records, of having an electronic health record that you carry with you everywhere so you avoid this situation that the gentlewoman described where you have, as a consumer, 50 different medications when you show up at a provider's somewhere that's out of your hometown.

If I go to San Diego and put my ATM card in the machine, I can pull up all of my financial records safely and securely. I never think about privacy. If on that same trip I end up in the emergency room, they don't have my medical history. They don't have my family's medical history. They don't have my allergies, my prescription drug regimen. They don't have any imaging that I might have had taken--x rays and so forth.

There is no reason that health care has to be the only industry in the country that hasn't gone to an interconnected/interoperable health information technology system, which is part of where the gentlewoman is going.

The other part--and this is a great point--is we have to begin to have our reimbursement system structured in a way that we incentivize the quality of care rather than the volume of care. We should not just talk about how often the patient goes to see a doctor and then reimburse based solely on that. We should be reimbursed based on: What is the appropriate setting for the patient? Where would the patient rather be? Where is the patient going to get the highest quality care?

We don't do that right now in our health care system. If you have a chronic disease, there are some cases--and certainly it would be on an individual basis and in conversation with your physician--where it shouldn't be determined based on reimbursement, based on money, as to what setting in which you're going to get that care. It should be: What is the best outcome likely based on the setting that you get? If home- and community-based care is the best setting, we shouldn't provide a financial disincentive to get it there. If that's the most appropriate, cost-effective setting and, most importantly, that's where the patient wants to be and that's where his family wants the patient to be, then, by all means, we should incentivize that setting. We're not doing that today.

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Mr. ALTMIRE. I wanted to comment, following up on the gentlewoman's comment on quality of care and medical errors.

According to the Institute of Medicine, there are 100,000 people every year who lose their lives due to a preventable medical error. Needless to say, with each one of those individuals, there is a tragic component to their personal stories--to their families or certainly to their own losses of life. There is also a burden to the health care system of medical errors because there are hundreds of thousands more who, because of preventable medical errors, are injured. Their treatment costs more, and each one of those individuals, more importantly, has suffered a severe medical setback. Their families are impacted by that. Their lives may never be the same.

In the aggregate, when we talk about cost reduction, something as simple as preventing infection, as the gentlewoman talked about, or as simple as preventing medical errors through the use of information technology, these are things that are going to save billions of dollars for our health care system in the aggregate. More importantly, they're going to increase quality for every individual who enters our health care system and will prevent these medical errors.

So the gentlewoman is correct that, when you look at even that one segment of health care reform, you're talking about billions of dollars. You're talking about the quality component--impacting lives in a way that is exponential throughout the health care system, not just involving one person.

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