Bennet: We Need to Get Health Care Reform Done - And Done Right

Following numerous town hall meetings and conversations with Coloradans in every county in the state, Michael Bennet, U.S. Senator for Colorado, continued to push for strong health care reform late yesterday. Bennet brought the stories and concerns of Coloradans to Washington in a presentation that laid out the need for an aggressive health care reform bill with a public option, that puts an end to double digit cost increases; devotes less of a percentage of our GDP to health care than we do today, allowing us to compete more effectively in the global economy; and puts us back on the path of fiscal sustainability in Washington.

Bennet also stressed the need to hold insurance companies more accountable by ending denials of coverage based on pre-existing conditions, and make exorbitant out-of-pocket costs and arbitrary caps on coverage a thing of the past.

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Below is a transcript of the speech:

Thank you, Mr. President. On this day, the day after the President's speech to the Joint Session and on a day when so many of our colleagues have given so many moving tributes to Senator Kennedy, I wanted to come to the floor tonight to talk a little bit about health care. What I wanted to do is share a presentation that I've given in every corner of my state - all across Colorado and rural Colorado, urban Colorado.

I'm extremely proud that over the course of the entire recess, we had town hall meetings all across our state. And though there were lots of different feelings over whether reform that we're pursuing is a good idea or not, every one of the conversations that we had was a substantive conversation. It was a serious conversation about what our working families and small businesses are facing as a consequence of the status quo and also the fiscal problems we're facing as a country and how health care reform done right is an important part to fixing our financial health.

So tonight what I wanted to do was go through some of those slides with you, Mr. President. I'll try to be pretty brief because the hour is late. But I wanted to give you a context of the kinds of conversations we had in our state. The overarching feeling people had, I think, when we were done, is we do need to change the status quo. The status quo is intolerable for our working families and small businesses. But there's a deep concern that we have the capacity to make it even worse. I left every meeting saying I think that's too low a standard for the Congress. We need to do much better than that and get health care reform done. But we need to get it done right, and we need to take the time that's required to get it right.

The first slide I started with was just to explain to people the difference between our deficit and our debt. Our deficit, as this slide shows, is the annual gap between our revenues and our expenses. The debt, which we have far too much of in this country, is what adds up year after year after year if we continue to have our deficits.

The second slide shows that over the years we have actually continued a pretty good job of managing our deficit. Anything over 3% of GDP is a problem because it's not sustainable. Our borrowing costs will outstrip our ability to catch up to our deficits if we're above 3%.

This slide shows that over the years, except in wartime, except in World War II and more recently during the wars in Iraq and Afghanistan, we've gone far above the 3% of GDP. This slide just shows us how we've stacked up debt so quickly over the last decade or so. We had about $5 trillion of debt on the nation when the last president assumed the presidency, and we're now at $12 trillion. As you can see, there has been an enormous spike between 2000 and today.

This is just a slide to show how much debt this really is. Our entire economy, our entire GDP, is $14 trillion, and our debt is $12 trillion. You can see that these other countries all have a much smaller GDP than we do. That's good news. Unfortunately, some of these folks, particularly China, own an awful lot of our debt. We also took the time to say to people, how did this happen? How did we let this happen to the American people? And to our kids and grandkids? How is it possible that in a blink of an eye we went from having $5 trillion of debt in the country to having $12 trillion of national debt? What you can see is both parties bear responsibility for where we are. The tax cuts in the early 2000s are responsible for $1.4 trillion of the debt passed on to our kids and grandkids. $900 billion for the wars in Iraq, which we didn't pay for - didn't make the choices needed to pay for it. We put it on our kids and our grandkids. The Recovery Act funding - roughly $780 billion. Forty percent in tax cuts and the rest in spending. The bank bailout - half in the last administration and half in this administration - $600 billion. And Medicare Part D, the drug program for seniors, which again, may be a very legitimate program, and it may be a program that people like to have, but we didn't pay for it. We said to our kids and our grandkids, "you pay for it."

These are just the CBO numbers that show our steady state. If we don't do anything to change course, the mountain of debt will just continue to grow.

And then, finally, (and this is going to take us into the health care discussion that we had in Colorado over recess) if you look at the biggest drivers of our future deficits, what you see on this slide - here's the tax revenue line; you can see that's pretty flat over time, from 2008 to 2039. But the biggest drivers are interest on the debt that we're putting on the backs of our kids and our grandkids. And the spiraling costs, or, maybe a better word is skyrocketing costs, given the direction of this line, of Medicaid and Medicare. The president talked about this last night. The biggest driver - other than interest - are rising Medicare and Medicaid costs. Obviously, the biggest driver of Medicaid and Medicare costs are rising health care costs.

So in my judgment, no matter what one thinks of the health care reform discussion, if you are someone who takes seriously the idea we have to get a hold of our deficit, we have to get a hold of the national debt before it so constrains the choices of our kids and grandkids, that we do not provide them with the kinds of choices or the kinds of opportunity they should have. We have to do something about the trajectory of those Medicaid and Medicare lines, and that means health care reform.

This shows there's no way to cut yourself out of the problem with discretionary spending cuts. This slide just shows if we don't do anything differently now, we're all going to be talking about tax cuts in the future that none of us would ever reasonably support.

So my view is that we do face a very significant fiscal challenge in this country, and that health care reform is not sufficient to solve that problem. But it is an important step and, in fact, the problem cannot be solved without addressing health care.

And as this slide says, we need to help solve, we need to urgently address health care reform to help solve our nation's crisis and also provide greater access to quality, affordable health coverage. There are a lot of questions in my state about whether or not we're up to making the tough choices that need to be made to be able to create a piece of legislation that can produce meaningful reform and can do it in a way that really changes the cost curve for Medicaid and Medicare. I don't frankly think we have a choice. I don't think we have a choice because our working families and small businesses cannot endure another decade like the last one. These numbers apply to my state, but they're very similar in states all across the United States.

In Colorado, if you look over the last ten years, our median family income is actually down in our state by about $800. And, by the way, that's before we entered the worst recession since the Great Depression. So that number is probably even worse today. It most certainly is worse and this, by the way, is an important issue for our working families, our families in our state because it implies something about how well our economy is working or not working for middle class families. It's very worrisome to see that our income is down $800, and the national number, I believe, over the same period is down $300. But, at the same time that our families' revenues were flat, the health care cost premiums in Colorado went up by 97% - almost double.

Mr. President, I can tell you this, I've now visited every one of the 64 counties in Colorado. I have had a conversation in every place. And I can find people that disagree on everything. But, Mr. President, I can also tell you that there is not a single person in a single one of those counties who has said to me that ‘my health care insurance is 97% better today than at the beginning of the decade' or ‘Thank you, Michael Bennet for making sure my costs went up 97%.' No one is saying that.

In fact, the reverse is true. The quality of coverage is going down. In my state also, over the same period of time, the cost of higher education has gone up 50%. So we are saying to our working families: you are going to have to make do with less; your income is going to be lower at the end of the decade in real dollars than it was at the beginning of the decade. At the same time, you are going to have to assume dramatically increased health care premium costs and a dramatically increased cost for sending your child to one of our institutions of higher education. It's no wonder that given the circumstances, household revenues are flat. These things are not nice to haves. They're essential to have for the stability of our working families and our small businesses. As our revenues have been flat, these costs have skyrocketed absolutely out of control. And it's no wonder why in my state and in states all across the United States that the last decade saw a time when families were saving not what they usually save, which is 7% of their net income, but zero. And going into debt with credit cards and home equity loans in order to try to bridge this extraordinary gap between their revenues and their costs.

This is a second slide I showed on this subject in my state and this just makes the point that today in the United States we're spending roughly 18% of our Gross Domestic Product on health care and that's going to 20% in the blink of an eye if we don't do something different. And what I believe, and what I said out there, is that we can't hope to compete in this global economy if we're spending a fifth of our economy on health care and every other industrialized country in the world is spending less than half that. Or at least if we can find a way to spend less than that on health care, we should, so that we can compete.

Mr. President, it's no different than if you had two small businesses - and you are a small business owner - two small businesses across the street from each other that did the exact same thing and one was spending a fifth of their revenue on their light bill and the small business across the street was spending less than half that. You don't need an MBA to know which of those two companies is going to being able invest in its business plan and grow for the future. So if we are going to compete in the way that I know this country can compete, we've get to do better than spending more than twice what all of our competition is spending on health care.

This is another slide that shows just how tough this has become for our middle class families in Colorado. What you see here is that - this is between 2000 and 2007. Again, this is before we entered the worst recession since the great depression. The numbers would be worse, today but this shows the rate of increase of insurance premiums. That's the red line. And the rate of increase of wages. That's the blue line. And I was asked when I was in the meetings, are there any small business people here. They would say "Yes." and I would say is this related? Are the two curves related to each other? And they said, Michael, of course they're related to each other, of course. Because we're doing everything we can to try to continue to offer health insurance to our employees but one of the effects that is having is that we cannot pay people the salary increases they're entitled to so there is a direct relationship between the costs of insurance and the wage compression that's happening in our state and, by the way, I would hazard a guess that one of the reasons why a median family income is down is that small businesses are struggling, mightily, to keep insuring their workforce.

This slide shows if we don't change anything, if we hang on to the status quo, by 2016 a lot of our families are going to be spending 40 cents of every one of their household dollars on health insurance. The current system is bankrupting a lot of our families. Sixty-two percent of all bankruptcies are health care-related. But the amazing thing to me on this slide is that of those health care-related bankruptcies, nearly 80% of them were folks that had coverage. These are people that have coverage, they paid into the system to create security, to create stability, and when they needed that protection, it wasn't there. And as a result their families went bankrupt. By the way, this could happen to anybody. As the President said last night, you could be anybody. Nobody can predict when they're going to get sick or when a child of theirs is going to get sick. And that's an important point, too, Mr. President. All these slides, everything up here, are not about the folks in our country that are or are not insured, this is about 300 million Americans. Everything we have talked about should be of concern to everybody in our country.

This slide shows what the current system means for a small business who have struggled mightily to keep insuring the workforce. The slide on the left says that our small businesses pay 18% more to cover their employees than large businesses do. Somebody said to me while on the road, ‘Well, Michael, don't you know the reason for that is that they're small and their pool is smaller and it is harder to spread the insurance risk across a small group of people?' And of course that's true but from a business perspective it's absolutely ridiculous. Because no small business owner I know would invest 18% more for something unless they were making their business 18% more productive. Of course, the reverse is true here because they're buying the same thing that the large company is except they're not even buying the same thing. It's not as though they're getting 18% better coverage for their employees than the larger employers. The deductibles are higher. The lack of predictability is greater. It's a huge problem for small businesses.

It's no surprise that in my state, between 2002 and 2007, you can see the drop of the percentage of folks that are insured at work. Most of the folks, like they are in your state, are employed by small businesses, Mr. President. You can see the effect these cost increases are having. They're just not able to keep up with those increases. The proof is in the pudding. Here we see that over 50% of small businesses in 2000 were insuring their workforce. Now we're at about 40%. And that number is dropping.

In my view, no matter where you are on questions like a public option, which I support and have supported, or not a public option, the thing that should bind us all together is driving costs down in our system. I won't bother tonight to go through all of these, but I will say that in my judgment, a lot of this is pretty common sense reform that we all ought to be able to support. Changing our incentive structure so that we reimburse people based on quantity of care, not the quality of care. Coordinating patient care - we've got an incredible example of this in Colorado at Rocky Mountain Health Plans in Grand Junction on our Western Slope in Mesa County. Also at the University of Colorado at Denver. Also at Denver Health, the public hospital in Denver.

But there are examples all over this country, like the Mayo Clinic, a place that anyone of us would be proud to send our kids or send our parents for care that's delivering higher quality care for a lower price. That's something we should all be able to support. More focus of money on preventative care. Increase competition so that our families and small businesses have a broader pool to choose from. 53% of people in my state, the state of Colorado, are insured by just two insurers.

This is an important point that we haven't talked about enough. This is the investment in health care IT. When I traveled through those 64 counties, there was not a county that I went to where there wasn't a convenience store. And apart from the loose beef jerkey that sits on the counter, everything in that store had a barcode on it. That's 1970s technology that people have used to manage the inventory of their local convenience store, the business owner has used to manage their inventory. Only 3% of hospitals in this country use that sort of technology. One out of twenty five doctors in this country uses that technology.

I'm the parent of three little girls. They're 10, 8, and 5. I can't tell you the number of times I've had to take them to the doctor or take them to an emergency room and have to explain again the whole story of why we were there and what the last doctor told us or what the last doctor or nurse told us. That's not the fault of the doctors or nurses, but it is the fault of having a system of insurance and a medical system that has not invested in technology. Mr. President, you know that I've spent roughly half my career in the private sector. And when I look at the complete lack of investment in technology when it comes to health care and when it comes to electronic medical records, I find it breathtaking - staggering that we could have that kind of inefficiency. So this is an important investment as well. And then bundling payments to encourage medical professionals to work together for the benefit of patients.

The final slide I wanted to share, Mr. President, is just a reminder that there is a lot of insurance reform that is a part of the proposals floating around the congress. This is the whole issue of having people no longer denied insurance because they have a pre-existing condition or losing their insurance because they face a lifetime cap of some kind that many people don't even know they have in their policy. Or because their child gets sick and no one predicted that and they get thrown off their policy. Or because they lose their job. I think all of us can agree that that's a good idea.

So, Mr. President, as we leave again this week and we go home again this weekend, as I get to go back to Colorado and continue to have the conversations with people in my state, what I'm going to be focused on is the areas of agreement that working families, small businesses, Democrats, Republicans, Independents can all agree upon. I think that if we can focus our energy there, focus our attention there, what I think we're going to find is the areas of disagreement are actually smaller than we imagined them to be.

And finally, in my view, we have waited far too long to do these common sense reforms. I know there is a lot of concern about rushing into something, and I don't think we should rush. But I think we need to get this done, and we need to get it done right. The American people need us to because they can't endure another ten years of graphs that look like the ones that I just showed you. I don't want to have to go back to Colorado and explain why only 25% of people are covered at work. I don't want to have to go back and explain why there has been another 97% increase in their premiums. I don't want to have to go back and explain that when people buy insurance, there is no predictability to that insurance.

I have great hope, great optimism, that in working together, we're going to get the kind of health care reform done in a smart way, in a wise way, in a measured way, in a way that is going to require implementation over a period of time. But there is no doubt in my mind that we're going to be able to get this done.