Madam President, the time for health care reform is now. We cannot afford to wait any longer. For some time, Peter Orszag has warned that rising health costs are unsustainable and represent the central fiscal challenge facing the country. At $2.4 trillion per year, health care spending represents close to 17% of the American economy and it will exceed 20% by 2018 if current trends continue. And hospitals and clinics are providing an estimated $56 billion in uncompensated care. Meanwhile, businesses are squeezed on the bottom line, forced to reduce or drop health coverage for their employees. Without action, costs will continue to rise and waste will proliferate. We need to make health care affordable for everyone, and we need to reduce the waste and fraud that plagues the current system. So to my colleagues that are conjuring up reasons not to pass reform this year, using scare tactics about nationalized health care and engaging in fear-mongering, I would say we can't stay where we are. We can't stay where we are. They must be getting different mail than I am. I'm getting mail. I'm getting people coming up to me all over the state, even though our state has some of the most affordable health care in the country. They know their money's being spent in other states that aren't as efficient. They know that health care coverage, when the economy is tough, is very difficult to come by. That's what they're coming up and talking to me about. They're not saying let's stay the way we are. They're saying reform the system. In 2008, employee health insurance premiums increased by 5%, two times the rate of inflation. And the annual premium for an employer health plan covering a family of four averaged nearly $12,700. Families can't continue to bear the burden of runaway health costs. If we do not act, these costs are going to break the backs of the American people. We must remain committed to enacting a uniquely American solution to our nation's health care problem. We must keep what works and fix what's broken. As congress prepares to take up landmark health care reform legislation, many in Washington are looking to my state, the state of Minnesota, as a leader. Among them is the president of the United States. President Obama has provided leadership and vision on this issue, and in a recent weekly radio address, he has highlighted how the Mayo Clinic and other innovative health care organizations succeed in providing high-quality care at relatively low cost. As he has said, we should learn from the successes and promote the best practices, not the most expensive ones. In Minnesota, the Mayo Clinic isn't alone. Health Partners, Park Nicolette and Ascensia Healthcare are working to promote the best health care at the least price. Minnesota has a strong mystery of making sure that our health care system promotes both quality care and access, 92% coverage. Minnesota, Washington, Wisconsin, Iowa, Utah and North Dakota are just a few of the states that can help provide leadership as we work with congress to provide a quality health care system that improves health care outcomes. It is no coincidence that as we speak here today, the president today is in Wisconsin—another state that understands that to have high-quality care, you don't necessarily have to have high prices. In fact, it's the opposite. I'll distill this cost issue into some understandable language. I grew up watching the Minnesota Vikings, Madam President, and year after year after year our state has waited for the Vikings to win the super bowl. We have been to the super bowl four times and we have never won the super bowl. Well, all during that same amount of time the people of our country have been waiting for health care reform. They have been waiting for something to happen to make health care more affordable. The people of this country can't wait any longer. We might be able to wait on the Vikings. The people can't wait any longer. The importance of Minnesota's best practices can be outlined in a game plan for national health care reform with a few key pointers: Rewarding quality, not quantity; promoting coordinated, integrated care and focusing on prevention and disease management. We are never going to be able to move the ball into that next first down unless we start talking about costs. Otherwise we are just simply going to be having different people pay for the same expensive health care and not doing anything to reduce the cost. First, our game plan for health care reform to reduce cost, we need to be sure to keep score. That means measuring outcomes and rewarding providers who deliver quality results. Right now in many places we're not getting our money's worth from our health care dollars. In Miami, Medicare spends twice as much on the average patient as it does in Minneapolis, even though quality is much better in Minnesota - twice as much. If you look at this chart here, you'll see that the areas in dark blue right here are the higher-spending regions of the country. They receive a lion's share of Medicare payments. The light blue states such as Minnesota, Montana and Iowa are states where Medicare spending is low but quality of care is often high. In a recent "New York Times" article, some explained these differences in spending as they were trying to explain how could this happen that you would have twice the Medicare, twice the taxpayer dollars for the same kind of medical treatments as you would in another part of the country, some have said, "Well, it's a difference in cost of living, sicker people, there are more teaching hospitals." But research shows that those factors only explain 18% of the variation in spending. It's no surprise. Most health care is purchased on a fee-for-service basis, so more tests and more surgeries mean more money. Quantity, not quality pays. According to research at Darthmouth Medical School, nearly $700 billion per year is wasted on unnecessary or ineffective health care. $700 billion per year. That is 30% of total health care spending. So to my colleagues who are fear-mongering and saying we should do nothing, I say how about $700 billion, 30% of total health care spending that we have the opportunity to change around to benefit the people of this country. Just look at this fact, if you want to look at quality care. The Mayo Clinic ranked as one of the highest-quality institutions in this country. You know what? If you look at how the last four years of chronically ill patients, some of the most difficult times for people in this country, an independent study from Darthmouth came out and look what Mayo did. They have a team of doctors working together, quality ratings incredibly high and then they looked at what was going on in some of the other hospitals in some of the other regions in this country. If all the hospitals in this country used the same protocol that Mayo Clinic uses in the last four years of a patient's life, where the quality rating is incredibly high, we would save $50 billion. $50 billion every five years in Medicare spending. $50 billion. So, no, I don't think the answer is to throw away health care reform and do a bunch of fear-mongering. I think the answer is to work together to bring this kind of cost savings to the rest of the country. There is general consensus, Madam President, that Medicare should reward value, and value consists of both quality and efficiency. However, value is not taken into account when Medicare determines payment for providers. To begin reining in costs, we need to have all health care providers aiming for high-quality, cost-effective results. That's why I plan to introduce legislation with Senator Cantwell and others that would authorize the U.S. Health and Human Services Secretary to create a value index as part of the formula used to determine Medicare's fee schedule. Hang for value. This indexing will help regulate overutilization because those who produce more volume will need to also improve care or the increased volume will negatively impact fees. You have to have those incentives in place, and how you do the payment or you're never going to reduce costs. By adding a value index, my bill would give physicians a financial incentive to maximize the quality and value of their services instead of the volume. Linking rewards to the outcome for the entire payment area creates the incentive for physicians and hospitals to work together to improve quality and efficiency. I'm also interested in the idea that the President has proposed to give increased consideration to recommendations made by the Medicare Payment Advisory Committee created by a Republican congress. MedCAPS recommendations for payment reform include bundling which have potential significant cost savings. Giving the recommendations made by experts increased authority could be a valuable tool to help rein in health care spending and improve quality in a responsible way. The first part of our game plan for reducing costs for health care, the first part of it was focusing on value. The second part of the game plan for making health care more affordable is to focus on team work. Understandably patients like it when their health care providers talk with one another and even work together. This means higher-quality care as well as more efficient care. In too many places, however, patients must struggle against a fragmented delivery system where providers duplicate services and sometimes work at cross-purposes, an x-ray here, an expert there, an expert there. It is like a football team with 11 quarterbacks, but no wide receivers, no running backs and no offensive line. This doesn't work in football and it's not going to work in health care. The beauty of integrated care systems is that a patient's overall care is managed by a primary care physician in coordination with specialists, and other care providers as needed. In rural hospitals they provide quality care in their community with a team of providers. To better reward and encourage this collaboration, we also need to have better coordination of care and less incentive to bill Medicare by volume. Increasing the bundling of services in Medicare's payment system has the potential to start encouraging quality integrated care. When it comes to improving care, changing who pays the doctor will make no more difference. The lesson of high-quality, efficient states like Minnesota and Wisconsin is that someone has to be responsible for the care of the patient from start to finish, from one goal line to the other. Bundling will ensure that, that practice is rewarded. Now, as you can see here, this is a very interesting chart. It doesn't look interesting, Madam President, but it is. I think a lot of people think, well, the more you pay, the better quality care you get. This was a MedPAC analysis of county level fee-for service expenditures, a national study. You know what they found? They found that those areas of the country, those counties that had low utilization—in other words, maybe people called a nurse line because people worked as a team, or a doctor referred them to one specialist instead of them going to three on their own—they found that they actually had the highest quality care. Why is that? It makes sense. You have one primary doctor that knows exactly what's going on and is checking your charts and can send them to one specialist, so there aren't mistakes made. You go to some specialist that doesn't know you have a certain medication and you're allergic to another. Highest quality care with low utilization. Lowest quality care with high utilization. Probably the opposite of what most people in this country would think. But, literally, you get the highest quality care in those parts of the country where you're paying less money. As I said, if people start to say our area of the country is so expensive, only 18% of that difference with the high-quality, low-cost states and the low-quality high cost states, only 18% of that can be attributed to cost of living. Research has shown moving to a coordinated delivery system will save Medicare alone up to $100 billion a year. If people don't want to talk about reform and they want to throw out fear-mongering statements let them explain to the American people why we're not going to save $100 billion per year. Finally, the last point is that the best offense is a good defense. My dad covered football his whole life for the newspaper so this is what he would always say to me. If it works on the football field then it works in health care. It's a lot better for both the patient and the patient's pocketbook if a chronic medical problem can be prevented or managed early to stave off complications. Right now, physicians are paid to treat diseases, not prevent them, yet a payment system that encourages prevention and disease management could generate enormous savings. There could be enormous savings with prevention because a large portion is devoted to treating a small number of people with chronic medical conditions. Let me show you an example of this: This is Health Partners, a clinic in Minnesota, all over our state and they have a lot of patients that are members. They looked at how to do a better job with diabetes in the 4th quarter of 2004 compared to the 4th quarter of 2008. You see an increase in quality for the patients, an increase in percentage of patients with optimal diabetes control. They put in some practical protocols and you see a major decrease in the cost per parent, that's the green line. Yellow line is increase in the parents with optimal diabetes control as the doctors determine. And green line is decrease in cost. The red line is patients with diabetes who asked if they would recommend Health Partners clinics. So, as they saw the dramatic reduction in costs, they were still on the up in terms of recommending using Health Partners clinics. Most people don't like their H.M.O.'s and they have reasons to complain so I think this is amazing, that they were able to show this kind of result. And another hospital has initiated a heart failure program with Medicare and in three years it has saved $5,000 per patient per year. Diabetes, congestive heart disease and back problems contribute to the excessive cost in growth in our health care system and cause decreased productivity in our economy. One study found that most costly 20% of Medicare patients in a given year account for 84% of total Medicare spending. By contrast, the least costly 40% of Medicare patients accounted for just 1% of overall spending. As examples from Minnesota and other places demonstrate, effectively managing these and other chronic illnesses is essential to health care reform. A recent New Yorker magazine article showcased the Mayo Clinic in the contests of health care's costs problem. According to an author, a physician, we're in a battle for the soul of American medicine. On one side is a fragmented volume-driven model that too often crosses into profiteering. There are good parts, believe me. I know this. I live in Minnesota. We have to maintain those. But we have to fix this broken cost structure. On the other side, you see this model offered by Mayo and other institutions across the country where doctors collaborate to provide the best, most efficient care for their patients. On one side it is financially and morally unsustainable. On the other side is a new direction that promises to curb costs and it is time to choose sides. For the sake of fiscal health and the sake of millions struggling to afford the care they need I urge my colleagues to choose the ladder. Yesterday, I met with a bipartisan group of senators. I have to tell you I still have hope we're going to get this done. I have hope there will be bipartisan support for this. The things I am talking about today -- cost reduction, putting incentives in place -- this isn't a Democratic issue or Republican issue—this is an American issue. This is an American cause that we can find a uniquely American solution to this problem so that we can reduce costs and make health care better quality. And I can tell you, having spent the entire life, my life, in the state of Minnesota having a daughter born very sick, couldn't even swallow when she was born I know we can get high quality health care at lower cost. They do it every day in my state. We can do it in the rest of the country. Thank you, Madam President. I yield the floor.