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Public Statements

Health Care And Education Reconciliation Act Of 2010

Floor Speech

Location: Washington, DC


Mr. CARPER. Mr. President, I would like to take a few minutes, before our Republican colleagues return to the floor, to talk about some provisions in the legislation the President signed today that are not very well understood but I think could be of real help in reining in the growth of health care costs. I have said all along--a number of my colleagues have heard me say this before--it is all well and good we want to extend coverage to people who don't have it. There are way too many people who do not have it. But if all we do is extend coverage without reining in the growth of costs, we will not do it for very long.

Among the provisions that I think are especially noteworthy--one, if a person turns 65 next month and they become eligible for Medicare, they are offered, under current law, at least before today's signing of the bill, the opportunity to get a once-in-a-lifetime deal, an annual physical. Under the law of the land until today, that was it. Under Medicare, if they live to be 105, they would not get another physical paid for by Medicare.

I have been getting annual physicals as a naval flight officer, and naval midshipman before that, for 27 years in all. I have had a lot of annual physicals. I think one of the reasons I am a fairly healthy guy is because of that and the feedback from annual physicals. We have a lot of people who never got an annual physical and one of the reasons why is it is not covered under your health insurance coverage. Under the legislation the President signed today, if a person turns 65 and becomes part of Medicare, they get an annual physical; in the next year, another one; in the year after that, if they live to 75 or 85 or 95 or, God bless them, 105, they will get a lot of annual physicals. I think that has the potential for addressing one of the real shortcomings in our health care system in this country. We don't do a very good job in primary care and part of primary care is, frankly, physicals from time to time. We are going to address that.

Another provision in the legislation that has not gotten a whole lot of attention--some but not a lot--is what can we do to incentivize people to take better care of themselves. It is all well and good that we want doctors to get more and nurses and hospitals, and so forth, and go after insurance companies, but what are we doing to incentivize people to take better care of themselves? If you look at a lot of countries where people have better health care than we do, one of the reasons is they take better care of themselves.

Something that has always fascinated me is, how do we figure out how to harness market forces for the delivery of health care? How do we harness market forces and incentives to drive good public policy behavior? We know it is not good for people to be overweight. How can we encourage them to lose weight? One of the things in the underlying bill is a provision that says, I think starting next year, we are going to have a provision requiring menu labeling. What do you mean by menu labeling? If you happen to be a restaurant company with 20 or more restaurants around--if you have a restaurant company and have restaurants in 20 or more sites around the country, you have to start, next year, putting on the menu board in the restaurant how many calories are in the items they serve. If they have a menu, you have to put it on the menu, how many calories they serve. It doesn't mean people will not go in and order 3 or 4,000 calories to consume, but people are going to start thinking about it. It will be a reminder.

Another provision in the legislation that I think is especially noteworthy is to build on something already in the current law but to make it, I think, stronger. We all know people who needed to lose weight and they go on a diet and join a gym or something. They stop. They start. They stop. They exercise for a while, go on a diet and then fall off the wagon and go back to their old habits. You know people stop smoking and they do it for a while and then they start stealing cigarettes from people and eventually they go back full time. What we are trying to do with our legislation is to say: Look, if companies have employees, they know they are overweight, they want to encourage them to lose weight, let them offer a premium discount.

In the legislation, the President said today employers can offer premium discounts of as much as 30 percent for their employees for whom they are providing health insurance. If they are overweight, if they are losing weight and keep it off, if they are smoking and stop smoking and continue to stop smoking, if they have high cholesterol or high blood pressure and they can control those and continue to control those, they can get premium discounts of as much as 30 percent. Everybody in this Chamber today, we all know people who have tried to lose weight, lose it for a while and then go back the other way. We know people who try to stop smoking, they do it for a while and then they go back. What our legislation does is say we want to put more money back in the pockets of people who do what is the right thing for them to do for their own personal health, and by doing that, they actually bring down the health care costs of their group, the place wherever they are working. I think those are ideas that make pretty good sense.

Let me ask the Presiding Officer how much time is left on our side.

The PRESIDING OFFICER. The Senator from Delaware has 50 seconds.

Mr. CARPER. Fifty seconds? The last thing I want to mention is our Presiding Officer is from Ohio. He has been to Cleveland many times. I spent some time in Ohio as well. One of my return visits to Ohio last year was to go back to the Cleveland Clinic to see how they are able to provide better health care for less money than a whole lot of other health care delivery systems. It is because they and the Mayo Clinic and Geisinger and others focus on the same kind of model, better focus on primary care, focus on prevention. All those patients have electronic health records. All the docs are salaried employees. They don't get more money if they do more tests or more MRIs or more this or that. It is a better model. What we do in our legislation signed by the President today is we incentivize a lot of other folks providing health care to use the same models.

With that, my time has expired.


Mr. CARPER. Would the Senator yield for 30 seconds? One of the things Senator Grassley and I have endeavored to do in working on this legislation in the Finance Committee is to try to figure out what works to rein in the growth of health care costs and improve outcomes.

Where we agree is on one of the best ideas that is in our bill--the idea of large purchasing pools that we modeled after the Federal Employees Health Benefits Plan. We know that we as Members and our staff have to be part of the exchange. The idea is to create large purchasing pools in all of our States and even regional purchasing pools as well.

Mr. GRASSLEY. Without a doubt.

Mr. CARPER. I am glad that provision has survived so far, and I hope it will go on. I wish we could implement it sooner.


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