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Sheldon W.
Democrat RI

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  • Affordable Care Act

    by Senator Sheldon Whitehouse

    Posted on 2013-12-18

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    WHITEHOUSE. Mr. President, I wish to engage for perhaps the next 20 or so minutes with Senator Cantwell, who is arriving shortly. I will begin with some remarks and ask unanimous consent for us to engage in a colloquy.



    The PRESIDING OFFICER. Without objection, it is so ordered.

    Mr. WHITEHOUSE. I am here today to talk about the health care problem in the country, because I think the fixation of this body on the health care Web site has taken our eye off the fact we have a very significant and fundamental health care problem.

    This graph represents how much we spend on health care as a country. It begins back here in 1960. I was 5 years old in 1960. So this is a lifetime: 50-some years, $27.4 billion. That is what we spent on health care. Now here we are. This is up to 2011, and $2.7 trillion is what we spend on health care. It is 100 times as much in 50 years. Granted, there are more Americans but not 100 times as many.

    This has been an explosive cost growth curve. When we were trying to pass the health care bill, that is what we were looking at for costs. It is a big competitive problem for our country.

    This is a really interesting graph. I wish every time anybody talked about health care they would take 1 minute and look at this graph. I will explain briefly what it is.

    This column is the up access and measures life expectancy in years, country by country, 65 to 85, where countries fall in terms of their average life expectancy for their population, for their citizens. This along the bottom is the cost, the health spending per capita per person in that country. So if you measure it all out, what you see is a great raft of countries all through here: Japan, Great Britain, Netherlands, Switzerland, Norway, Italy, Greece. There is a whole large group of countries right here, and all of them have a life expectancy 80 or older and they all spend between $6,000 and $2,000 per person on their country's health care. Essentially the entire modernized, civilized world is in that zone, from here to here.

    Guess where the United States of America is. Boom. Here. We are below them all in life expectancy. We are trailing the pack of modern industrialized nations in our life expectancy. We are competing with Chile and the Czech Republic. But Japan, Greece, Great Britain, France, Germany, Luxembourg, all manage with their health care systems to achieve longer lifespans for their people. And we are doing it at a cost of about $8,500 per person per year.

    To give a comparison, here are Switzerland and Norway. They are the other two most expensive countries in the world per capita on health care spending, and they are at about $5,700 per year. If we could bring our per capita health care spending in this country down to the most expensive countries in the world, if we could compete head to head with the most expensive countries in the world, we would save more than $1 trillion a year.

    This is an interesting graph because it shows basically all the modern industrialized nations here, and it shows us here as a way outlier. It is a big deal for us to be an outlier here, because it means we blow about $1 trillion a year in wasteful and unnecessary health care which could be building infrastructure, solving problems, reducing the deficit, and could be doing other work. Instead, we spend it on a health care system which doesn't produce good health care results--at least not measured by life expectancy, which is a pretty good proxy.

    There is a huge $1 trillion a year cost to our society in being that bad of an outlier. The cost is also measured in lost lives and lost years of life, because we are averaging 77 years and these countries are averaging 82 years of life.

    We have a real problem on our hands, and obsessing about a Web site is a complete distraction from getting after this problem--5 years off every human's life in this country and $1 trillion a year. That is worth paying attention to.

    The health care changes we brought are actually making a difference. Here are some interesting graphs. Each one is a projection done by the nonpartisan Congressional Budget Office of what health care costs are going to look like in the future, and what you see is a progression. They did this graph in August of 2010. This was where they projected health care spending would go when they projected in August of 2010 for this period, from 2014 onward to the next decade. A year later they went back and they projected again, and they projected actually costs would be lower. Then they came back in August of 2012 and they did another projection, and their projection showed that these anticipated costs went down again, every year, lower and lower.

    Here is the big one. In May of this year, the Congressional Budget Office went back and redid its projections for Medicare and Medicaid spending from 2014 to 2023. Look how far below what they had projected 1 year ago, 2 years ago, and 3 years ago the current projection. That is a saving of about $1.2 trillion in that decade.

    That is a long way from $1 trillion a year we could be saving if we just got back to where we were on this graph, if we got back from here to where Switzerland and Norway, the most expensive countries in the world, are. That is $1 trillion over 1 year. This is $1.2 trillion over 10 years, but it is still a big change and it is still moving in the right direction. So we shouldn't be too quick to condemn ObamaCare when [[Page S8966]] that kind of savings is already being projected.

    The last slide I will show before I go to Senator Cantwell, who has been good enough to join us, is this one. Why might it be that those costs went down so far in May of 2013? Why might it be that graph of projected costs keeps going down? It is because of changes in what is going on in the health care system.

    This is one good example. This shows the hospital readmission rate from January of 2007 until August of 2013. This is how often somebody was discharged from the hospital, went home, and then within 30 days had to come back and be readmitted.

    That could potentially be for a completely new reason, but usually it is because the discharge planning wasn't done well enough and there was a bad handoff between the hospital and the primary care physician or the nursing home. What we found is you could make that transition much better for patients. When you do, guess what. They don't get sent back to the hospital. When they don't get sent back to the hospital, you save money.

    That is just one way the kind of huge $1.2 trillion over 10-year savings CBO has already projected could be taking place, but this is clearly a part of it. It is improving the quality of care so people aren't going back into the hospital, aren't going to the emergency room, and you avoid that cost at all by having handled the patient better, by having given them better treatment and better care.

    It is pretty astounding. In 2007, right through here until the end of 2011, it was a pretty steady readmission rate. Then when we changed the signal to the hospitals and cut their payment for readmissions, boom, down it fell. That represents a very significant savings in the system. And in the personal lives of those people and their families not having to go back to the hospital, that is a pretty big plus too.

    It was Senator Cantwell's idea that we should come down today and talk a little bit about the delivery system reform side of the health care discussion. I got started a little bit before she could get here, but my wonderful colleague now has arrived, so let me yield the floor to her. I will put this graph back because I want to leave this here for whenever the camera swings my way. I want people to see this graph. It is inexcusable that all of these competitive industrialized nations of ours should be able to deliver universal high-quality health care for what would be a $1 trillion a year savings if we could simply match them, and they produce a longer life expectancy for their people and we are stuck competing for life expectancy with Chile and the Czech Republic. Come on. We can do a lot better than that, and that should be the ball we have our eye on rather than obsessing about the ObamaCare Web site.

    I yield the floor.

    The PRESIDING OFFICER. The Senator from Washington.

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