September 13th, 2006
Progressive Vision Speech Series Launch Event
Remarks as written by Representative Sherrod Brown
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Thank you,
I read the promotional materials for this event, and it appears I am about to “unveil a new progressive vision on “Health Care for All.”
I’m looking forward to hearing it.
Actually, I don’t think progressives need a new vision on health care for all. We see things pretty clearly.
What we need is to increase the concentration of policymakers in Washington who write bills for people who don’t contribute to political campaigns, who don’t benefit from tax cuts, who may not even vote.
We need fewer policymakers who legislate for the rich and patronize the poor.
We need more policymakers who recognize that they were not hired to make sure the multinational prescription drug industry becomes more profitable, but to make sure Americans can afford the prescription drugs they need.
More policymakers who are bothered by the fact that the same taxpayers who subsidize health coverage for members of Congress may or may not have coverage of their own.
Our nation can ensure every American access to health coverage, but we can’t do it with a White House and Congress who intentionally overpay health insurers…
…who intentionally shelter the drug industry from competitive forces…
and who pass trillions worth of tax cuts for billionaires while the majority of Americans slip further and further behind.
We can’t do it with a White House and Congress who try to pass off tax shelters as a coverage strategy and bare bones coverage as “consumer-driven health care.” “Thank you for the $5,000 deductible, President Bush – I was hoping to pay premiums for insurance that pays out nothing.”
Democracy is a shared vision.
Its strength and its resilience are fueled by shared responsibility and mutual progress. It is weakened by cronyism, by indifference, and by deceit.
The gap between the rich and poor is growing, the number of Americans without health insurance is growing, the number of children in crumbling, overcrowded public schools is growing.
Progressives don’t need a new vision, we need increased representation in Washington.
“Health care for all” brings to mind Dave Barry’s analysis of the “Health Security Act” debate.
Some of you were kids when Bill Clinton took office and Hillary Clinton led a major effort to extend health care to all Americans, but it was a long and contentious battle.
I’m paraphrasing here, but he described the process this way: “Congress started out with a detailed national health care plan, and ended up with a non-binding resolution urging everybody to floss.”
Closing the gaps in our health care system is a considerable challenge.
Reform is complicated, mostly because our health care system itself is complicated.
In the absence of a universal insurance system, the United States has erected a patchwork of private and public financing mechanisms that sometimes overlap, sometimes leave serious gaps, and sometimes discriminate against the very people who need health care the most.
Reform is a political minefield, mostly because the healthcare industry is such a political force.
Multinational drug firms alone donate hundreds of millions of dollars to their favorite politicians, most of them Republican. The Medicare drug law is a recent reminder of the health care industry’s clout.
It prohibits Medicare from negotiating bulk discounts on prescription drugs and lavishes about $14 billion in bonus payments on health insurers. Mike DeWine voted for that bill and I did not.
According to recent AP report, Mike was richly rewarded for that vote when the drug industry bankrolled a series of Chamber of Commerce Ads trying to put a positive spin on his pro-industry record... but that’s a story for another day.
Health care reform is expensive at the start, even if there are efficiencies that save us money down the line.
Reform is complicated, politically thorny and expensive. That doesn’t mean we should tread water.
Health coverage is eroding and health care costs are spiraling upward. It’s a lethal combination and a vicious circle.
46.6 million Americans are uninsured. That’s about the population of Ukraine. That’s just short of the population of South Korea.
Our nation is the wealthiest in the world. We are also the only developed nation that abides a 16% uninsured rate.
For individuals and families, the lack of health insurance is a financial disaster waiting to happen.
Catastrophic health care expenses are the cause of 50% of all personal bankruptcies in this country.
The lack of insurance is a disincentive to receiving care at appropriate times in appropriate settings. It’s a closed door to the kind of preventive and screening services that can reduce the need for health care down the line.
For the health care system and third party payers, it’s uncompensated care and all the financial problems and inefficiencies that go with it.
It’s cost shifting; it’s feast or famine...an overabundance of top notch, but often duplicative, health care resources clustering around insured patients, while a dearth of safety net providers starve.
For the nation as a whole, it’s a drag on our potential. Insurance gaps compromise our public health goals, our productivity and prosperity, and the health and well being of millions of children and adults in this country.
I’ve met uninsured Ohioans who look a whole lot like you and me.
They had good insurance through work, then their company downsized.
They have diabetes or arthritis or lupus or a heart murmur, and no insurer will cover them.
They can get coverage, if they pay the $10,000 premium. They may be willing, but they aren’t able.
People like you and me – they’re just uninsured.
When I took office in 1993, I pledged to forgo federal health benefits until every American had access to meaningful health coverage.
Since then, the number of uninsured has grown by about 7 million. Needless to say, I still don’t have federal health benefits.
Whether it’s a failure of leadership, will, or focus, it’s a failure. To reverse course, our nation needs a higher concentration of policymakers who won’t take “no” for answer, and we need to send the ones home who take the path of least resistance.
Mike DeWine takes the path of least resistance. Again and again and again and again.
He voted to send seniors into the private insurance market for their drug coverage, even if the rest of their benefits were provided by the federal Medicare program.
Privatizing a single insurance benefit – there’s no logic to it, but there are a lot of dollars in it for the insurance and drug industries.
The Bush Administration was all for it, the drug and insurance industries were all for it. Mike DeWine was all for it.
He voted against legislation to enable legal importation of prescription drugs from Canada. We pay the highest price in the world for prescription drugs. Importation would create competition to bring those prices down. He voted against it.
The Bush Administration opposed it. The drug industry opposed it. Mike DeWine opposed it.
Every taxpayer and every Medicare beneficiary is paying dearly for Mike DeWine’s questionable loyalties and predictable votes.
Our nation can do better. The gaps and inefficiencies in our health care system hurt individuals and they hurt businesses.
The cost of coverage is compromising the competitiveness of US businesses. Our economy can’t afford that.
According to Ford, its health care costs have grown 67 percent since 2000. Ford spends $1,100 per vehicle on health care -- more than it spends on steel.
Not only does our nation have to contend with spiraling health care costs and persistent coverage gaps, we have to contend with potentially catastrophic public health threats.
It’s resource and time-consuming to prepare for the worst; it’s irresponsible not to.
As it stands, our nation is ill-prepared for pandemics, bioterrorist attacks, even for the resurgence of such latent US health threats as TB, a deadly, antibiotic-resistant strain of which has recently emerged in South Africa.
In addition to costs, in addition to coverage, in addition to preparedness, health care reform means cleaning up our act.
Medical errors take up to 100,000 American lives each year. That’s a tragedy.
According to Dr. David Satcher, the distinguished Surgeon General who served in the Clinton Administration, 80,000 black Americans die every year because of disparities in health care. 80,000. That’s a crime.
And despite the fact that the U.S. spends more than any other on health care, we continue to lag behind other nations across a range of health indicators, including life expectancy and infant mortality.
The challenges are daunting, but they are not insurmountable.
The first step is not flashy, it’s simple common sense.
The first step is to hold on for dear life to the progress we’ve already made, and build on it.
Policymakers must stop trying to reduce health care costs by reducing health care coverage.
That ensures nothing but an increase in unmet needs. We have enough of those already.
The President’s 2007 budget would cut Medicaid, the nation’s insurer of last resort, by $14 billion over five years and $35 billion over 10.
In my home state – Ohio -- Medicaid covers 1 in 6 residents, 1 in 3 children, 1 in 3 births, and 70% of all nursing home care. It’s not a throw-away program – It anchors the public health.
Fortunately, Republicans in Congress don’t appear inclined to pass another round of Medicaid cuts this year. I attribute their reticence to the work of folks like you, who lobbied so hard against last year’s cuts.
Unfortunately, not cutting Medicaid is not enough. If we’re going to save Medicaid, we’ve got to invest in it.
Under the guise of “state flexibility,” the President and the Republican-led Congress have already set the wheels in motion for significant cuts in coverage and access for “optional” Medicaid enrollees.
There’s nothing optional about health care needs.
Cutting “optional” Medicaid enrollees and services isn’t just short-sighted, it’s ineffectual.
Medicaid cost growth is largely a function of increased health and long-term care spending for the aged, blind and disabled, populations left largely untouched by the new “flexibility.”
Our nation must confront the long-term care issue head-on.
There are strategies we can use to federalize the expense of long-term care for low income populations without breaking the bank.
We can couple public and private long-term care insurance vehicles with savings incentives, while doing a better job of case management, disability support, and application of best practices to the treatment of chronic conditions.
We are fast approaching a time when states will simply be unable to maintain the long-term care coverage they provide today. The federal government must step up to the plate.
I firmly believe that regardless of who is in office, this nation’s values will not permit us to ignore the welfare of children living in poverty, seniors in nursing homes, individuals with severe disabilities, and the other vulnerable populations served by Medicaid.
We’ve got to save Medicaid and other public health programs. So that’s the first step.
The second step is to get back to basics when it comes to health care financing. Health insurance is meant to spread risk and cover the costs of unpredictable health care needs.
Stable insurance systems spread risk across large groups. Anyone can get sick. Everyone is protected.
Good insurance policies cover medically necessary health care without bias. If you need primary health care, your insurance covers it. If you need mental health care, your insurance covers it. Anyone could need either type of care. Everyone can get it.
Broad pooling of risk and comprehensive insurance plans work for everyone.
That’s why it makes sense to enable small businesses to join large purchasing pools that abide by state insurance laws, that’s why it makes sense to enable early retirees to buy into Medicare, and that’s why it makes sense to preserve large and successful insurance programs like Medicaid.
About 20% of patients account for 80% of health care spending. Reinsurance mechanisms can be used to provide health insurance broadly and affordably, and the cost of reinsurance itself can be reduced by better managing the care provided to high cost patients.
By “managing” care, I don’t mean denying it. No one wants to go back to old-school HMO tactics.
When I say we need to “manage” health care, I mean we need to ensure that patients are receiving the right care on a timely basis by the right providers, and that those providers are communicating with one another. We need coordination and common sense.
There are other broad-scale strategies we can deploy to get a grip on health care inflation. I’ll get to those in a minute.
First I want to review some of the insurance “strategies” that my opponent, Mike DeWine, has supported…strategies like health savings accounts and “association health plans.”
Rather than making our health insurance system more inclusive, they degrade and fragment our insurance system, transforming it from a common fund into a country club.
He supports HSAs and Association Plans, which encourage the healthiest individuals and groups to break off from the rest of the insurance pool to get a better deal. Insurance becomes more expensive for those who are left, forcing more people into the ranks of the uninsured.
HSAs are coupled with high deductible coverage.
Hmmm. Health coverage with high deductibles and minimal benefits. Nothing could be better…if you’re an insurer.
But if you are a person who happens to need one of the excluded benefits or who forgoes needed health care because you haven’t met your deductible, your insurance policy is about as valuable as the paper its printed on.
My opponent also supported legislation to deregulate health insurers. I’m guessing he’s never dealt with one.
He voted for legislation that would allow insurers to bypass state insurance laws, collecting premiums for a product less like insurance and more like one of those joke gifts where you open one box and there’s a smaller one inside, and a smaller one inside that, and sometimes there’s nothing in the smallest one at all.
You buy insurance that, after you pay a $1000-$2000 deductible, covers 60% of whatever they consider to be reasonable and customary, which turns out to be about 20% of the doctor’s charge, and then it turns out your plan doesn’t cover that kind of doctor without a referral, etc. etc.
If the goal is to expand access to health coverage, stabilize health care costs, and improve health care outcomes, shoddy insurance and exclusive insurance clubs won’t get us there.
Good coverage, inclusive insurance pools. So the second step is to get back to basics and focus on pooling our resources as a hedge against unanticipated health care needs.
The third step is to squeeze as much suboptimal care and unnecessary spending out to the health care system as we can.
That means deploying health information technology – tools like electronic prescribing and paperless billing – to reduce medical errors and red tape. About 31% of health care costs derive from administration and billing. That’s a lot of money.
It means investing appropriately in our public health system, following through on promises to support local infrastructure, because it is the local public health and public safety systems throughout our country that will face the greatest challenges should our nation confront a public health emergency.
We are not prepared yet, and getting there must be a priority.
Optimizing our health care system means investing in cost effectiveness research and the development of best medical practices, to make sure we’re paying the right price for the right medical interventions.
It means promoting healthy lifestyles and making much greater use of case management, nurse pre-screening and other health care efficiency strategies.
It means getting people into decent coverage so that they aren’t forced to use expensive emergency rooms as their doctor's office.
And it means paying the right price for health care. We can’t afford monopolies, we can’t afford businesses that exploit their power over our health.
We must stop letting the multinational drug industry walk all over us.
The drug industry routinely charges American consumers 2, 3, or 5-times more than consumers in Canada, because Canada’s government takes a stand for its citizens and the U.S. government allows drug companies to charge Americans any price they want.
On average, Canadian consumers paid 45% less than American consumers for the same medicine.
I joined John McCain and others to secure passage of legislation that cracks down on anticompetitive practices by multinational drug firms, closing loopholes the drug industry used to block generic drugs from the market.
I also led the effort in the House to pass legislation to spur price competition in the US by enabling the importation of safe and effective medicines from Canada . That legislation stalled in the Senate.
I have led several bus trips to Canada with retirees from my district. I remember one of those trips in particular.
A constituent from Wellington, Ohio had been forced to put her house up for sale to pay for her prescriptions . She said to me: “I’m 75 years old and I miss my home.” Another constituent told me that she and her husband would be saving over $800.00 by buying a three-month supply of their prescriptions at a Canadian pharmacy.
These are the exact same medicines, manufactured in the exact same plants, as the medicines sold in the US.
The difference is that the Canadian government negotiates for reasonable drug prices. Our government does nothing.
My opponent has voted against importing medicines from Canada. And my opponent has received nearly $427,000 from the drug industry over the course of his career, $158,000 during this election cycle alone.
Speaking of drug industry influence, the Medicare drug coverage bill that was signed into law in 2003 prohibits the federal government from negotiating for bulk discounts on prescription drugs. The VA can do it, but Medicare can’t.
My opponent voted for the drug bill and the ban on price negotiations.
I am a cosponsor of bipartisan legislation in the House to end that ban. Needless to say, Mike DeWine is not a cosponsor of the Senate version.
A key factor in the increasing demand for prescription drugs is direct-to-consumer advertising (DTCA) for drugs. Increased sales of the 50 most heavily advertised drugs account for nearly half of the annual increase in drug costs.
And new drugs are advertised before their safe and effective use is well established in the medical community.
I am the lead sponsor of legislation that would place a 2-year moratorium on direct-to-consumer advertising of new prescription drugs.
Bottom-line, we need to treat the implications, both the public health and economic implications, of exploding prescription drug use far more seriously.
And last, but certainly not least, we need to confront health disparities.
We are the wealthiest nation in the world, and the strongest. Our strength lies in our diversity. We are multi-racial. We are multi-cultural. And as I mentioned earlier, we are a nation that allows 80,000 Americans to die each year because they can’t get decent health care.
There is no excuse for it.
11% of white Americans are uninsured. It’s about double that for African Americans and triple that for Latino Americans.
Minorities have higher rates of cancer, higher rates of heart disease, higher rates of diabetes, higher rates of HIV/AIDS.
Minorities have shorter life expectancies and higher infant mortality rates. Minorities are more likely to die prematurely and less likely to receive cancer screening. Minorities, adults and children alike, are less likely to receive routine vaccinations.
Doctors are four times more likely to correctly identify a heart attack and hospitalize a patient if that patient is white.
According to recent research, doctors are getting better at treating cancer pain...unless you are an African American or Hispanic patient.
You get the picture. Racial and ethnic health care disparities aren’t inevitable, but eliminating them is going to take determination and dollars.
As I mentioned, we need to invest in programs like Medicaid, which is the only source of health care for 25% of African Americans, nearly 50% of African American children, and 39% of Latino children. Altogether, 53 million low income Americans rely on Medicaid.
We need to invest in research focused on minority populations. Health care doesn’t do much good if it’s the wrong care.
If we want to build a health care system that works for every American, we’ve got to stop making noise and start making progress.
I’m a cosponsor of legislation aimed at reducing health disparities.
It puts all the pieces together: access equality; targeted research; a more diverse health care workforce; better data and more attention to the effects of the environment on health disparities – it’s a comprehensive bill that can move this nation toward health -- and health care -- equality. It’s something we need to get done.
Coverage gaps, cost increases that weigh on consumers, businesses and taxpayers, systemic failures that victimize individual patients and entire ethnic and racial groups – reforming our health care system is an imperative and a steep uphill climb.
It’s not going to happen unless you push policymakers to do it. You need to push this issue and you need to vote this issue.
The members of moveon.org have power. You penetrated a political system that was veering off course- more responsive to Wall Street and K Street than to Main Street – and you made your voice heard. Policymakers listened and they will continue to listen.
There’s a quote I like – I’m not sure who said it first, but it’s applicable here: “Don’t tell me what you believe, show me what you do and I’ll tell you what you believe.”
Thank you for what you believe.
