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Health Care

Good health care is a very personal matter for me and my family. When my daughter was born she was very sick. But due to an insurance company rule, I was forced to leave the hospital just 24 hours after she was born. Along with other mothers, I went to the state legislature and got one of the first laws passed in the country guaranteeing new moms and their babies a 48-hour hospital stay. That experience was a crucial part of my decision to enter public service and fight for common sense health care solutions.

Americans rightfully expect to choose their own doctors and their own health plans. As we prepare to take up landmark health care reform legislation in Congress, we must protect these basic principles and change the way our system delivers quality care, by reducing costs, providing safeguards so that people don't lose their coverage if they lose or change jobs, and promoting wellness and prevention.

Minnesotans are facing higher health care costs than ever before -- costs that have far outpaced the growth in family incomes.

Many of our businesses, particularly small businesses, can no longer afford the costs of health insurance, even though they want to cover their employees. Employees are forced to pay a larger share of the premiums - or they get no health insurance at all. And more and more Minnesotans with health insurance struggle to pay escalating deductibles and co-pays.

We need to keep what works and fix what's broken. Ever escalating health spending now accounts for more than one-sixth of our economy. Unchecked, it will increasingly choke our family, local, state and federal budgets. We must make the system cost-effective, proactive and stable.

As Minnesota's U.S. Senator, I believe the following priorities should guide our health care discussions:

First, we must reform our system to reward high-quality, efficient care. As it happens, doctors and hospitals in many regions of the country, including Minnesota, practice exactly this kind of medicine. However, Medicare does not currently reward them for it. The problem is that, despite periodic efforts at reform, Medicare pays for quantity not quality. States that have historically delivered low quality, inefficient care are still rewarded for wasteful practices, while efficient states such as Minnesota are punished. For example, according to a study by the Dartmouth Institute for Health Policy and Clinical Practice, if spending for chronically ill patients everywhere in the country mirrored the efficient level of spending in the Mayo Clinic's home region of Rochester, MN, Medicare could save $50 billion in taxpayer money over five years. To rein in costs, we need to have all states aiming for high-quality, cost-effective results like those we have achieved in Minnesota. That's why I've introduced bi-partisan legislation that would create a "value index" as part of the formula used to determine Medicare's reimbursement system. My bill would give physicians an incentive to maximize the quality of their care to patients and help to reduce costs.

One of the driving forces behind Minnesota's well-earned reputation for high quality health care is a team approach of coordinated, accountable care, including prevention, and measures to remove perverse financial incentives from patient care decision-making. The beauty of integrated care systems is that a patient's overall care is managed by a primary care physician in coordination with specialists, nurses and other care providers, as needed. To better reward and encourage this collaboration, we need to have better coordination of care and less incentive to bill Medicare purely by volume. Increasing the "bundling" of services in Medicare's payment system has the potential to deliver savings and start encouraging quality, integrated care. The lesson of the high-quality, efficient states like Minnesota is that someone has to be responsible for the care of the patient from start to finish. Bundling will help ensure that practice is rewarded.

Second, America has a serious problem with health care inflation, runaway costs and wasteful spending. Ever-rising drug prices are among the leading causes. The "non-interference" clause in Medicare Part D expressly prohibits Medicare from negotiating directly with drug companies to obtain lower drug prices for seniors and lower costs for taxpayers. To reduce prescription costs, health care reform legislation should allow the government to negotiate the drug prices for Medicare Part D. I also support the re-importation of drugs from Canada to help slow sky-rocketing increases in pharmaceutical pricing.

I also believe we can reduce drug prices if we intensify scrutiny of the anti-competitive practices of drug companies. Last year, after hearing concerns from Minnesotans that a life-saving medication for premature infants had suddenly and dramatically increased in price, I requested the Federal Trade Commission investigate this case. As a result, Ovation Pharmaceutical -- the company with sole rights to the drug -- was charged with price-gouging and anti-competitive practices in violation of federal antitrust law. Greater competition in health care will go a long way to reducing costs.

Another way to incentivize more affordable health care in general is to better regulate insurance and create meaningful competition for health care services. I have long advocated for an option like the Federal Employee Health Benefits Program to give everyone access to the same health care benefits as members of Congress, and that is one of the competitive options under consideration, along with many others. I am especially focused on making sure that any reforms make it easier for small businesses and the self-employed to afford health care.

Third, I want to ensure that health care reform takes into account the needs of rural Americans. People in rural areas are less likely to have access to employer-provided health insurance, which means more people rely on the individual insurance market or public programs like Medical Assistance and, in Minnesota, MinnesotaCare. Rural Minnesotans also tend to be older and may have to travel long distances to visit their health care providers. Similarly, we must ensure that all Americans have access to primary care physicians. We are facing a shortage, especially in rural areas, and research suggests that improving access to primary care can reduce reliance on specialty care and improve the efficiency and quality of the health care we receive.

Finally, it is imperative that health care reform does not ignore the importance of elder care. Seniors want to be able to live independently and stay in their own homes as long as possible. Family support is essential to making that option available. However, elder care responsibilities can result in high out-of-pocket health and long-term care expenses for families that care for aging parents and relatives. I have sponsored three pieces of legislation, the AGE (Americans Giving care to Elders) Act, the Long-Term Care Affordability and Security Act, and the Long-Term Care Insurance Consumer Right-to-Know Act to assist families who care for aging family members and to improve understanding of long-term care insurance policies. The legislation is designed as a starting point to relieve the financial and other burdens faced by family caregivers.

Time and time again, the President has used Minnesota as an example of cost-effective, high-quality care because Minnesota is ahead of so many states when it comes to health care. Before supporting any specific health care plan, I want to make sure that it works for Minnesota-that is makes health care more affordable for families, individuals and small businesses in our state. Unless we make a long-term effort to reduce costs, we will not make health care more accessible and responsive to Americans.

Since coming to the Senate, I have focused on these health care priorities:

Make health care more accessible:

• Expand health care coverage for more Minnesotans and Americans. More than 46 million Americans are uninsured, including 8 million children. I strongly supported the Children's Health Insurance Program Reauthorization Act of 2009, which extended health coverage to children who do not qualify for Medicaid and whose families cannot afford private insurance. The passage of this legislation ensures health care coverage for an additional 4.1 million uninsured children and was signed into law by President Obama on February 4, 2009. With nearly 82,000 uninsured children in our state alone, I am happy that we have taken the necessary steps to make health coverage for our nation's children a top priority. I look forward to continuing to work with my colleagues as we take the next steps in reform our health care system so that we are able to provide all Americans with comprehensive, affordable, and quality health care.
• Strengthen Medicaid. The Medicaid program provides health insurance for our families, children and seniors who need health care the most. I sponsored legislation to block efforts to drastically cut payment for vital (and fiscally-sound) Medicaid "case management" services which help children and seniors obtain necessary medical and community services. I also fought to secure necessary Medicaid dollars for Minnesota as a part of the American Recovery and Reinvestment Act of 2009.

Make health care more affordable:

• Crack down on excessive costs and health care fraud. In order to make health care more affordable, we need to reduce administrative waste. Over 30 percent of each health care dollar is being spent on paperwork and administration. That money should be going to medical care, not paper pushers. We must modernize our health care system and to this end, I supported efforts to invest in health information technology in the American Recovery and Reinvestment Act of 2009. We must also look at other areas where we can help reduce inefficient health care spending. Law enforcement authorities estimate that health care fraud costs taxpayers more than $60 billion every year. These criminals scheme the system to rob the American taxpayers of money that should be used to provide health care to those that need it most. We must put a stop to this. To help deter health care fraud, I've introduced a bipartisan bill that would require direct depositing of all payments made to providers under Medicare and Medicaid.
• Reform and strengthen Medicare. To ensure that Medicare continues to provide the quality care that Americans deserve, we must bring costs under control and reform it to reward efficient, high-quality care. With harmful cuts looming to Medicare services, I cosponsored the Medicare Improvements for Patients and Providers Act, which aimed to avert those payments cuts and institute reforms to reward doctors and hospitals for delivering high-quality care. I also fought to end the geographic payment disparities that penalize high-quality, low-cost states like Minnesota. In 2005, Medicare spent more than $15,000 on the health care of a typical beneficiary living in Miami, but for patients living in Minneapolis, it spent only about $7,000. If we reform Medicare so it's buying the best care at the best price, we can improve the quality of care for our seniors and save huge sums for taxpayers.
• Fight price gouging by pharmaceutical companies. Pharmaceutical companies appear to be targeting outrageous price increases at selected drugs used by vulnerable populations or for rare diseases. Children's Hospitals and Clinics of Minnesota brought one example to my attention: a drug known as Indocin I.V. For many years the drug has been crucial in treating a heart condition in premature babies. But after Ovation Pharmaceuticals acquired the rights to the drug, the company quickly increased the drug price from $100 to $1,875. I asked the Federal Trade Commission (FTC) to investigate Ovation for anticompetitive practices and price manipulation and together with Senator Chuck Schumer (D-NY), I then called for a broad Government Accountability Office (GAO) investigation into prescription drug pricing. Acting on this complaint, the FTC is now taking legal action in U.S. District Court in Minnesota, charging Ovation with violating federal antitrust laws and artificially inflating the price of the two drugs.

Move health care forward:

• Invest in science. In Minnesota, we believe in science. The National Institutes of Health (NIH) is our nation's primary entity for biomedical research, and I supported increased funding of the NIH so our scientists can concentrate on finding life-saving cures and not on finding money to do their research. I also introduced, and Congress passed into law, the Paul Wellstone Muscular Dystrophy Act to strengthen research and determine best care practices for people suffering from muscular dystrophy.
• Support stem cell research to seek new cures. Stem cell research promises to be the pathway for a new generation of life-saving cures, offering hope to millions of Americans and their families. I voted in favor of the bipartisan Stem Cell Research Enhancement Act of 2007, which would expand the number of embryonic stem cell lines accessible to federally-funded scientists who are seeking new treatments and cures for severe medical conditions such as juvenile diabetes, Parkinson's disease, Alzheimer's disease, Lou Gehrig's disease, spinal cord injuries and certain types of cancer. Under a new Administration we will push to pass this vital legislation.
• Utilize technology. Information technology is transforming all aspects of our modern society, and it holds the same promise for the health care industry. I have sponsored legislation that would give health providers the resources they need to establish secure and effective health IT systems that will reduce administrative costs and bring health care into the 21st century.