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Public Statements

The 30-Something Working Group: Health Care

Floor Speech

Location: Washington, DC


Mr. ALTMIRE. I thank the gentleman for yielding.

I cannot think of a bigger issue to be dealing with right now. We have so many issues that this Congress is dealing with. Certainly energy, education, this enormous mountain of debt which we have accumulated over the years, all of these issues are critically important, and all of them are issues that this Congress is going to deal with. The issue of health care is an issue that impacts our national debt. We cannot dig our way out of this hole. We cannot achieve structural surplus like we had in the 1990s. We can't ever even approach that until we deal with the skyrocketing cost of health care.

This is an issue that affects every American in this country very directly. It affects every family and it affects every small business in the country in ways that other issues that we deal with don't on a daily basis.

So what we are talking about here tonight and what this Congress is doing over the course of this summer as we put together this health care reform bill is the three legs of the stool, as the gentleman pointed out, making sure that we find a way for every American in this country to gain access to our system and get affordable health care, making sure that we bring down the costs for everyone. Because we talk about the 47 million Americans who don't have any health insurance right now. They get treated. They show up at the emergency room, and they get their health care. It's certainly not the most cost-effective way. It's probably not the most efficient way, and it's probably not the best way for them to get health care, but they'll end up in the system somewhere. And as the gentleman knows, those of us who have insurance pay for them. They get covered. They get their treatment. But the cost shift that takes place is the reason why an aspirin costs $10 when you go to the hospital.

It's very easy to demagogue this issue if you're in it for political reasons, to say, well, here's what they want to do: They want to take your money and give it to those people who don't have health insurance because 87 percent of Americans in this country have health care. We spend a lot of time talking about those who don't, but 87 percent of Americans have health care. Now, they are in many cases one illness or injury away from losing everything, certainly one job loss away, and tens of millions of Americans that have coverage live in fear of losing it for those very reasons. Tens of millions more are underinsured. They have some coverage; they don't have what they need. And in many cases, the insurance companies have people, millions, approximately 2 million people, that are employed in this country specifically to find a way, if you are insured, to make sure that they can deny your claim, to redline you, to find a preexisting condition exclusion, to find a reason why they shouldn't have to pay your claim. Now, that's

another of the issues. Lastly is quality. So you have cost, you have access, and you have quality.

We have in many ways the best health care system anywhere in the world, and the challenge that we have in putting this bill together is we want to preserve what works. We want to say to the 87 percent of Americans who have health care, if you like your plan, if you enjoy the health care plan that you have and you want to keep it, we're not going to touch it and you can keep it. But if you want another alternative, we're going to find you another alternative. And if you have too much out-of-pocket costs, you're not satisfied with the situation that you have, we're going to give you another alternative. But we want to preserve what works in the current system. We want those who have health care to be able to keep it. And we want to make sure that our medical innovation, our technology, our research, which far exceeds anything available anywhere else in the world, is preserved. We want to fix what doesn't work and we want to preserve what does work.

So we are going to increase quality. And we're going to talk about, tonight, ways we are going to do that, the approaches we are going to take. We are going to increase access, bringing everybody into the system, which helps us all. And we're going to do access, we're going to do cost, and we're going to do quality improvements in this bill, all the while preserving what works in the current system.

And the gentleman used an example of how we're already paying for health care, something I mentioned earlier. Those who are afraid to bring new people into the system because they fear that this is going to increase their own costs, well, what I talk about when I have town meetings about health care is, again, they're already paying for people who don't have health insurance in a variety of ways. When that individual shows up at the emergency room, the cost shift takes place because the person without insurance gets their treatment and somebody else pays for it. Those of us who have health insurance pay for it. That's why an aspirin costs $10.

I had knee surgery many years ago, and to make sure that they operated on the right knee, they put a black magic marker that said ``L'' on my left knee. When we got the bill, I saw that that black magic marker to put that ``L'' on cost $20. That's because of the cost shift that takes place. Now, that's one example. Every American who's had to deal with the health care system has a similar example. If everybody is covered and everybody is in the same risk pool, we're not going to have that type of cost shift that takes place. But that's only one example of how we are paying for it.

The gentleman talks about $1,500 of the price of every car made in this country is due to health care costs because American manufacturers have to pay for health care for their employees and other countries don't have that burden in the manufacturing sector.

So we're starting at a $1,500 disadvantage for that one product. Think about the supply chain. Think about the way goods and services end up in a consumer's hands. Think about the distribution from the person who manufactures it--from the company that manufactures it--to the people who distribute it, to the people who stock the shelves, to the people who operate the stores, to the people who run the cash registers. At every segment of that supply chain, there is a health care component to that. That company, that business is paying, in many cases, health care for their employees. That is what we're paying for.

So, when you hear about people who don't have insurance and when you hear about the skyrocketing costs of health care, think about that part of it as well, not just what your copayment or your premium or your deductible is. Think about how every sector and every segment of our lives is impacted by that.


Mr. ALTMIRE. I thank the gentleman.

That is just one example, and we're going to deal with a lot of policy options over the next several months. To talk about just one related to what the gentleman is talking about, prevention and wellness is something that everyone can agree has to be an important component. We have to incentivize doctors and hospitals and our health care system more generally to keep people healthy and to keep people out of the system and not wait until the last minute when a situation develops like the one the gentleman talked about.

In western Pennsylvania, where I'm from, I'll just talk about one disease which is near epidemic proportion. That's diabetes. In some cases, it's preventable. In some cases, it's not. For every individual whom you can put on a program of wellness and can prevent diabetes from taking place or, at minimum, delay its onset, you're changing that person's life for the better. You're making a material difference in the life of that person and of his family. You're also, in a more global sense, saving money for the health care system. If you take that one person times the entire country and the entire group of people for whom you can delay the onset for not just diabetes but for any affliction which one may later get in life, you can prevent injuries if you keep people healthy. For the weekend warriors and so forth with joint injuries, with arthritis and its onset, these are very costly diseases to treat, and they can be debilitating in many cases, but they can be prevented or they can, at least, be made better in many cases.

So this is the type of thing that we want to incentivize in our health care system for which, right now, there is no incentive. Under our current reimbursement in health care, we reimburse based on the number of times one shows up to a doctor's office. Their incentive is also for you to be sick. They make more money the more often you go to see them. We want the reimbursement system to be based on keeping you healthy and on keeping you out of the system, reimbursing based on the quality of care provided, not on the volume of services provided. So this is one example of the policy option that we are considering.


Mr. ALTMIRE. We have talked about that, and I do think that the money that was in the stimulus plan and then money in the succeeding budgets, which we're also going to make a priority, is going to make a big difference. Health care is the only major industry in the country remaining that has not gone to an interconnected, interoperable computerized system. And I would ask my colleagues to think about the fact that--the gentleman's from Connecticut, and I'm from Pennsylvania--if we go to San Diego, and we put our bank card in the machine, we can pull up all of our financial records in a safe and secure way and never think about privacy or any type of intrusion. You just take for granted that that's going to work. But if you show up on that same trip at the emergency room in San Diego, well, they don't have any of your records. They don't have your history. They don't have your family medical history. They don't have your allergies. They don't have any of your imaging, your x rays and so forth. And they're going to ask you half a dozen times when you're there, what are you allergic to, and can you fill out these forms and, most importantly, how are you going to pay, what's your insurance? But if we were to go to a system, like every other industry in America has, where you have an electronic health record that goes with you everywhere you go and has your family history records, your personal medical history, your allergies, and yes, all your insurance information, then when you show up at the emergency room, they're not going to have to ask you half a dozen times. They're going to be able to get right down to the business of treating you for whatever the reason is you find yourself in that situation. We have to make sure that as we move forward as a country, we reward those who have already taken matters into their own hands. There are a lot of major health systems in this country from coast to coast that have spent hundreds of millions of dollars of their own money to make this a reality, to connect their own systems. The problem that we have in implementing this is, if you're a wealthy community and you have a system that's making a lot of money, a hospital system, you can afford to do that. But if you're a rural physician, a health care provider in central Pennsylvania or anywhere in this country 80 miles from the nearest hospital, you can't afford hundreds of thousands of dollars to upgrade your computerization to interconnect your records with the nearest hospital. It's just something you can't even consider, and that's where this money is going to go. We're going to move towards having an interconnected system in this country to resolve some of the issues that the gentleman has talked about. We're not going to allow it to get to the point--with the Department of Defense, for example, which has a wonderful health care information technology system, and the Department of Veterans Affairs, which also has a wonderful health care information technology system; but there's one problem. They literally cannot communicate with each other. What they do is, if you're one of the brave servicemen or -women who are serving our country as part of the Department of Defense, you're a part of their program, and they have all of your medical records; but when you leave the military and become a veteran and enter the VA system, under the current system, the Department of Defense sends a PDF file by e-mail to the VA, and somebody has to open up that file. They can't manipulate it in any way. They have to type by hand your entire career's medical history--if you've been there for 30 years, think about what we're talking about--into the new system for the VA.

Now Secretary Shinseki and Secretary Gates have announced that moving forward, they're going to merge the systems for the new people who enter the military. So moving forward with the newer generation of our military men and women and our veterans, we're not going to have this problem. But for the millions who have served up to this point, it's not interoperable. They cannot communicate with one another.


Mr. ALTMIRE. There are many issues that are just like that, as the gentleman knows; and this gets to the complexity of the bill that we are going to be bringing to this floor and to the other body over the course of the next several weeks. If you look at what we expect, at minimum, the outcome to be on the insurance side, I think everyone would agree that a very likely outcome is going to be the insurance industry will not be able to redline you. They're not going to be able to use pre-existing conditions to exclude you from care. They're not going to be able to do the lifetime limits for people with chronic diseases. Basically, they're going to have to take all comers, and they're not going to be able to set your rates based on your individual health status. I think we would all agree that is a likely outcome to this debate.

Now the insurance industry makes a compelling case, and I think an actuary would tell you that the only way that works is if we find a way to make sure everybody is included in our health care system. You can't just have the sick people or the people who are about to become sick part of the risk pool. You have to have everybody. That's why it's so important that we expand access to the entire Nation, include these 47 million Americans who don't have health coverage, the tens of millions of more that are underinsured because the only way the risk pool works is if you have the young and the healthy, people who aren't going to use the services right now today to offset the risk for those who are. But as the gentleman indicates, there is still going to be opposition to this concept when we move forward and when we talk about ways to move people into the system that currently don't have access.

One of the ideas that we talk about, which the gentleman from Connecticut is very involved in, is the idea of having a choice for people to join a plan that would compete with the private insurance industry. We hear a lot of talk about how the private sector always does it better than government. They're more efficient. They're more cost effective. The government is too bloated. So I would say to those who make that case, well, then, what are you worried about? What are you worried about the competition from the government if the private sector always does it better than government? The difference in this case, if we do it right--and certainly there are ways you can structure it that wouldn't be the correct way--but if we establish a level playing field for the competition, you are going to have a situation where there's not going to be a profit motive, and there's not going to be any reason for someone to choose that plan who's involved in shareholding and so forth. You're not going to have that. You're not going to have people who are employed to try to deny claims. That might be a difference in the way these plans compete. But if we do it right, it would be a level playing field.


Mr. ALTMIRE. Think about the competitive advantage that businesses have in this country. Some are able to offer health insurance, some are not. Less than half of small businesses in this country are able to afford to offer health care to their employees.

What we want to create is a system where everyone in America will be covered and every business that chooses to do so will be able to afford to offer that benefit to their employees and to their potential employees to be able to recruit and retain the highest quality worker. That might be a benefit that small businesses would like to offer. We want to give them the opportunity to afford that benefit if they so choose.

But, again, we want to preserve what is working in our current system. We want those who have coverage and like it to not be touched in this. And that has to be a part of this. But for those that want to have another option, those who want to make a change, maybe the family status has changed over time, the plan that you are in doesn't work for you any more, we want to give them as many options as possible, and we want to give them the ability, as the gentleman indicates, to do some comparative shopping, to compare apples to apples, to look at what the costs are for the family situation across the different plans. Right now you are unable to do that.

If you are a Federal employee and you have the Federal Employees Health Benefits Program, it is a little bit easier. That is a plan where you are able to look at some of the paperwork and get on the computer and do comparison shopping. We want every American to have the same ability that Federal employees have today.

I would say to the gentleman, when we talk about this idea of the employers being required in some way to either offer health insurance to their employees or to pay into the system so that those employees will have the ability to make that choice, we don't want to do that in a way, and I want to be very clear about this, we don't want to do that in a way that is going to incentivize employers to say, well, you know what? I will just stop offering health care coverage and all of my employees can go into the plan. That is not what this is about.

We don't want to add one more financial burden to half of the small businesses in the country, the ones I am talking about that are already unable to afford health care. We don't want to add to their financial burden. We recognize that this is a very complicated issue and it is going to be very difficult to achieve these goals.


Mr. ALTMIRE. And the gentleman hits the nail right on the head, talking about bringing down the costs. That is where we started this discussion. We are going to pass a health care reform bill this year. I am confident in saying that. The public support is there, the support in this Congress is there. We need to certainly finalize the details, and that is going to take some work. But this issue is too important, it is too important to this country, it is too important to families, it is too important to businesses, and it is too important to every individual in this country for this not to become law this year. I am confident that will happen.

We have to bring down the costs of health care. That is why this is so important. We have to bring down the costs for our families, we have to bring down costs for our businesses, and we certainly have to bring down the costs for our government.

As I started our remarks tonight by saying what this

is about is the structural deficit over the long term that we have in our budget, and addressing the issues like energy and like education that have led to the skyrocketing deficit and debt that we have over the long term, and the only way you can begin to bring that under control is by bringing down the cost of health care for everyone in this country at every level, both in the private and the public sector. That is what this bill is going to do, that is what this discussion is about.


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