Statement On The Need For Health Care Reform Legislation

Very few people in America today would argue that our health care system is not in need of reform.  It is a travesty that in the richest, most powerful country in the world, there are more than forty-seven million people without health insurance.  That is an absolutely shocking number.  It represents roughly one in six people who are going without regular trips to the doctor, forgoing needed medications and resorting to emergency rooms for care because they have nowhere else to turn.  These are our friends, our neighbors, and millions of our children.

An estimated 47 million people – one in every three Americans under the age of 65 – were uninsured at some point in 2007 and 2008.  While my home state of Vermont has made significant strides in creating a plan for comprehensive coverage, there are still far too many Vermonters without health insurance.  While we beat the national average, roughly 10 percent, or 66,000 Vermonters remain uninsured.

Those Americans who are fortunate enough to have health coverage often cannot afford to access care.  Every day, Americans across this country are struggling to afford premiums for health insurance, which have nearly tripled since 2000.  In fact, new estimates show that the cost for health care for the average American family is more than $16,000 per year — an increase of over $1,100 from the previous year.  Health care reform has been put on hold for far too long and cannot be delayed any further.

It is encouraging that this Congress has already taken a few constructive steps toward insuring more Americans and making our health care system more effective.  One of the first bills that President Obama signed into law was the reauthorization and expansion of the Children’s Health Insurance Program.  This bill has extended and renewed health care coverage for over ten million children and provided 4 million more with new coverage.  As part of the American Recovery and Reinvestment Act, Congress extended health benefits for Americans who lost their jobs as part of the economic downturn and invested over a billion dollars to help states implement electronic health records to help make care more efficient with strong personal privacy protections, which I was proud to co-author with others.  While these bills have moved our country in the right direction, it would be a mistake to stop short of larger scale changes to our health system.  The need for comprehensive reform has never been more urgent.

Health care reform legislation must create a system where all Americans have the opportunity to access health insurance that is affordable and provides adequate coverage.  For far too long, an unregulated health insurance market has cherry-picked healthy Americans to provide coverage to, while offering unaffordable coverage to individuals with “pre-existing conditions.”  Many others who have insurance do not have adequate coverage and are insured only for certain conditions.  Others have high premiums or unaffordable deductibles so accessing care is unrealistic.          

Competition among private insurers has not driven down costs to consumers and the current private insurance market has a clear incentive to offer coverage only to the healthiest Americans.  Comprehensive health care reform can change this calculus and that is why I support the creation of a federally backed, public health insurance option.  For those who are satisfied with their current insurance there is no need to change.  A public option would only give consumers more choices to purchase an affordable and quality health insurance plan and will help drive down overall health care costs by introducing real competition into the health care market.  I was proud to join Senator Brown and over twenty other Senators to introduce a resolution stating our support of a public option as part of comprehensive health care reform legislation.  

I appreciated the recent news that leaders of the health care industry are working with the Obama Administration and have unveiled a plan to voluntarily trim roughly $200 billion in health care costs per year.  While this is a movement in the right direction, this should not distract from the fact that coverage must be affordable for Americans or the larger goal of reducing overall costs will not be realized.  A public option should recognize an individual’s ability to pay and offer subsidies for those who are still unable to afford care.  Leaving individuals without insurance drives up health care costs for us all, and we must work toward a goal of insuring all Americans.
Insuring more Americans is of no use unless we work toward incentivizing people to become nurses, doctors, and health care professionals.  My wife, Marcelle, is a nurse, and I understand the threat that nursing shortages pose to health care access and safety.  Additionally, with the costs of a medical education rising, many aspiring physicians are choosing to specialize instead of pursuing a career in primary care.  Especially in a rural state like Vermont, we are struggling to maintain primary and preventative care services throughout the state.  I have heard from far too many Vermonters who use the emergency room for everyday health care needs because there are not enough primary care physicians to handle the demand for services.  I support efforts to establish programs to help students repay their loans should they choose to practice in underserved fields or areas high in need of physicians and nurses across the country.

Strengthening our primary care workforce will also help Americans access preventative services to help maintain good health and reduce the incidence of debilitating chronic conditions.  Chronic diseases are often preventable or manageable with treatment, yet currently account for 75 percent of our health care spending.  Already we have seen a movement to target preventable diseases by focusing on ways to promote healthy lifestyles and choices.  As part of its Blueprint for Health, Vermont has begun a series of pilots across the state to enhance health care coordination and patient outcomes through patient centered medical homes.  Vermont is seeing good results and is finding that a coordinated approach to health care prevents repeated hospital visits and the emergence of chronic conditions.  Prevention must be seen as a cornerstone to both reducing costs and keeping Americans healthy.

Some argue that in our current economic climate it would be irresponsible to reform health care because we simply cannot afford it.  What we cannot afford is to stick with the status quo, which is crippling our economy and neglecting millions of Americans who want coverage but cannot afford it.  Health care costs currently consume 16 percent of the United States’ gross domestic product, which is expected to double in the next decade if nothing is done to slow the trend.

Strengthening our enforcement efforts to crack down on rampant fraud, waste, and abuse in the health care system is vital to lowering costs associated with health care.  The scale of health care fraud in America today is staggering.  According to conservative estimates, about 3 percent of the funds spent on health care are lost to fraud – that totals more than $60 billion dollars a year.  For the Medicare program alone, the General Accounting Office estimates that more than $10 billon dollars was lost to fraud just last year.  Unfortunately, this problem appears to be getting worse, not better.

The answer to this problem is to make our enforcement stronger and more effective.  We need to deter fraud with swift and certain prosecution, as well as prevent fraud by using real-time internal controls that stop fraud even before it occurs.  We need to make sure our enforcement efforts are fully coordinated, not only between the Justice Department and other agencies, but also between federal, state, and private health care fraud investigators.  Much has been done to improve enforcement since the late 1990s, but we can and must do more.

Health spending cannot be controlled without a comprehensive approach that focuses on all aspects of our health system.  We cannot afford to stop the growth in health spending without ensuring that Americans have access to primary care to prevent and treat chronic conditions before they begin.  We must target inefficiencies and fraud within the system and incentivize quality of care not necessarily quantity of care.

We have the opportunity to create a system that maintains patient choice, gives all Americans access to quality care and reduces overall health spending.  We cannot afford to neglect true reform to our health system any longer.

I look forward to working with the Finance and HELP Committees and all Senators to pass a comprehensive health care reform bill this year.

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David Carle: 202-224-3693