McCain Discusses Health Care in Tampa
John McCain
Thank you. I appreciate the hospitality of the University of South
Florida, and this opportunity to meet with you at the Moffitt Cancer
Center and Research Institute. Speaker Moffitt, Dr. Dalton, Dean
Klasko, thank you for the invitation, and for your years of dedication
that have made this campus a center of hope for cancer victims
everywhere. It's good to see some other friends here, including your
board member and my friend and former colleague Connie Mack. And my
thanks especially to the physicians, administrators, and staff of this
wonderful place.
Sometimes in our political debates, America's health-care system is
criticized as if it were just one more thing to argue about. Those of
you involved in running a research center like this, or managing the
children's hospital that I visited yesterday in Miami, might grow a
little discouraged at times listening to campaigns debate health care.
But I know you never lose sight of the fact that you are each involved
in one of the great vocations, doing some of the greatest work there
is to be done in this world. Some of the patients you meet here are in
the worst hours of their lives, filled with fear and heartache. And
the confident presence of a doctor, the kind and skillful attentions
of a nurse, or the knowledge that researchers like you are on the
case, can be all they have to hold onto. That is a gift only you can
give, and you deserve our country's gratitude.
I've had a tour here this morning, and though I can't say I absorbed
every detail of the research I certainly understand that you are
making dramatic progress in the fight against cancer. With skill,
ingenuity, and perseverance, you are turning new technologies against
one of the oldest enemies of humanity. In the lives of cancer
patients, you are adding decades where once there were only years, and
years where once there were only months. You are closing in on the
enemy, in all its forms, and one day you and others like you are going
to save uncounted lives with a cure for cancer. In all of this, you
are showing the medical profession at its most heroic.
In any serious discussion of health care in our nation, this should
always be our starting point -- because the goal, after all, is to
make the best care available to everyone. We want a system of health
care in which everyone can afford and acquire the treatment and
preventative care they need, and the peace of mind that comes with
knowing they are covered. Health care in America should be affordable
by all, not just the wealthy. It should be available to all, and not
limited by where you work or how much you make. It should be fair to
all; providing help where the need is greatest, and protecting
Americans from corporate abuses. And for all the strengths of our
health-care system, we know that right now it falls short of this
ideal.
Some 47 million individuals, nearly a quarter of them children, have
no health insurance at all. Roughly half of these families will
receive coverage again with a mother or father's next job, but that
doesn't help the other half who will remain uninsured. And it only
draws attention to the basic problem that at any given moment there
are tens of millions of Americans who lost their health insurance
because they lost or left a job.
Another group is known to statisticians as the chronically uninsured.
A better description would be that they have been locked out of our
health insurance system. Some were simply denied coverage, regardless
of need. Some were never offered coverage by their employer, or
couldn't afford it. Some make too little on the job to pay for
coverage, but too much to qualify for Medicaid or other public
programs. There are many different reasons for their situation. But
what they all have in common is that if they become ill, or if their
condition gets worse, they will be on their own -- something that no
one wants to see in this country.
Underlying the many things that trouble our health care system are the
fundamental problems of cost and access. Rising costs hurt those who
have insurance by making it more expensive to keep. They hurt those
who don't have insurance by making it even harder to obtain. Rising
health care costs hurt employers and the self-employed alike. And in
the end they threaten serious and lasting harm to the entire American
economy.
These rising costs are by no means always accompanied by better
quality in care or coverage. In many respects the system has remained
less reliable, less efficient, more disorganized and prone to error
even as it becomes more expensive. It has also become less
transparent, in ways we would find unacceptable in any other industry.
Most physicians groups and medical providers don't publish their
prices, leaving Americans to guess about the cost of care, or else to
find out later when they try to make sense of an endless series of
"Explanation of Benefits" forms.
There are those who are convinced that the solution is to move closer
to a nationalized health care system. They urge universal coverage,
with all the tax increases, new mandates, and government regulation
that come along with that idea. But in the end this will accomplish
one thing only. We will replace the inefficiency, irrationality, and
uncontrolled costs of the current system with the inefficiency,
irrationality, and uncontrolled costs of a government monopoly. We'll
have all the problems, and more, of private health care -- rigid
rules, long waits and lack of choices, and risk degrading its great
strengths and advantages including the innovation and life-saving
technology that make American medicine the most advanced in the world.
The key to real reform is to restore control over our health-care
system to the patients themselves. Right now, even those with access
to health care often have no assurance that it is appropriate care.
Too much of the system is built on getting paid just for providing
services, regardless of whether those services are necessary or
produce quality care and outcomes. American families should only pay
for getting the right care: care that is intended to improve and
safeguard their health.
When families are informed about medical choices, they are more
capable of making their own decisions, less likely to choose the most
expensive and often unnecessary options, and are more satisfied with
their choices. We took an important step in this direction with the
creation of Health Savings Accounts, tax-preferred accounts that are
used to pay insurance premiums and other health costs. These accounts
put the family in charge of what they pay for. And, as president, I
would seek to encourage and expand the benefits of these accounts to
more American families.
Americans need new choices beyond those offered in employment-based
coverage. Americans want a system built so that wherever you go and
wherever you work, your health plan is goes with you. And there is a
very straightforward way to achieve this.
Under current law, the federal government gives a tax benefit when
employers provide health-insurance coverage to American workers and
their families. This benefit doesn't cover the total cost of the
health plan, and in reality each worker and family absorbs the rest of
the cost in lower wages and diminished benefits. But it provides
essential support for insurance coverage. Many workers are perfectly
content with this arrangement, and under my reform plan they would be
able to keep that coverage. Their employer-provided health plans would
be largely untouched and unchanged.
But for every American who wanted it, another option would be
available: Every year, they would receive a tax credit directly, with
the same cash value of the credits for employees in big companies, in
a small business, or self-employed. You simply choose the insurance
provider that suits you best. By mail or online, you would then inform
the government of your selection. And the money to help pay for your
health care would be sent straight to that insurance provider. The
health plan you chose would be as good as any that an employer could
choose for you. It would be yours and your family's health-care plan,
and yours to keep.
The value of that credit -- 2,500 dollars for individuals, 5,000
dollars for families -- would also be enhanced by the greater
competition this reform would help create among insurance companies.
Millions of Americans would be making their own health-care choices
again. Insurance companies could no longer take your business for
granted, offering narrow plans with escalating costs. It would help
change the whole dynamic of the current system, putting individuals
and families back in charge, and forcing companies to respond with
better service at lower cost.
It would help extend the advantages of staying with doctors and
providers of your choice. When Americans speak of "our doctor," it
will mean something again, because they won't have to change from one
doctor or one network to the next every time they change employers.
They'll have a medical "home" again, dealing with doctors who know and
care about them.
These reforms will take time, and critics argue that when my proposed
tax credit becomes available it would encourage people to purchase
health insurance on the current individual market, while significant
weaknesses in the market remain. They worry that Americans with
pre-existing conditions could still be denied insurance. Congress took
the important step of providing some protection against the exclusion
of pre-existing conditions in the Health Insurance Portability and
Accountability Act in 1996. I supported that legislation, and nothing
in my reforms will change the fact that if you remain employed and
insured you will build protection against the cost of treating any
pre-existing condition.
Even so, those without prior group coverage and those with
pre-existing conditions do have the most difficulty on the individual
market, and we need to make sure they get the high-quality coverage
they need. I will work tirelessly to address the problem. But I won't
create another entitlement program that Washington will let get out of
control. Nor will I saddle states with another unfunded mandate. The
states have been very active in experimenting with ways to cover the
"uninsurables." The State of North Carolina, for example, has an
agreement with Blue Cross to act as insurer of "last resort." Over
thirty states have some form of "high-risk" pool, and over twenty
states have plans that limit premiums charged to people suffering an
illness and who have been denied insurance.
As President, I will meet with the governors to solicit their ideas
about a best practice model that states can follow -- a Guaranteed
Access Plan or GAP that would reflect the best experience of the
states. I will work with Congress, the governors, and industry to make
sure that it is funded adequately and has the right incentives to
reduce costs such as disease management, individual case management,
and health and wellness programs. These programs reach out to people
who are at risk for different diseases and chronic conditions and
provide them with nurse care managers to make sure they receive the
proper care and avoid unnecessary treatments and emergency room
visits. The details of a Guaranteed Access Plan will be worked out
with the collaboration and consent of the states. But, conceptually,
federal assistance could be provided to a nonprofit GAP that operated
under the direction of a board that i ncluded all stakeholders groups
-- legislators, insurers, business and medical community
representatives, and, most importantly, patients. The board would
contract with insurers to cover patients who have been denied
insurance and could join with other state plans to enlarge pools and
lower overhead costs. There would be reasonable limits on premiums,
and assistance would be available for Americans below a certain income
level.
This cooperation among states in the purchase of insurance would also
be a crucial step in ridding the market of both needless and costly
regulations, and the dominance in the market of only a few insurance
companies. Right now, there is a different health insurance market for
every state. Each one has its own rules and restrictions, and often
guarantees inadequate competition among insurance companies. Often
these circumstances prevent the best companies, with the best plans
and lowest prices, from making their product available to any American
who wants it. We need to break down these barriers to competition,
innovation and excellence, with the goal of establishing a national
market to make the best practices and lowest prices available to every
person in every state.
Another source of needless cost and trouble in the health care system
comes from the trial bar. Every patient in America must have access to
legal remedies in cases of bad medical practice. But this vital
principle of law and medicine is not an invitation to endless,
frivolous lawsuits from trial lawyers who exploit both patients and
physicians alike. We must pass medical liability reform, and those
reforms should eliminate lawsuits directed at doctors who follow
clinical guidelines and adhere to patient safety protocols. If Senator
Obama and Senator Clinton are sincere in their conviction that health
care coverage and quality is their first priority, then they will put
the needs of patients before the demands of trial lawyers. They can't
have it both ways.
We also know from experience that coordinated care -- providers
collaborating to produce the best health outcome -- offers better
quality and can cost less. We should pay a single bill for
high-quality disease care, not an endless series of bills for
pre-surgical tests and visits, hospitalization and surgery, and
follow-up tests, drugs and office visits. Paying for coordinated care
means that every single provider is now united on being responsive to
the needs of a single person: the patient. Health information
technology will flourish because the market will demand it.
In the same way, clinics, hospitals, doctors, medical technology
producers, drug companies and every other provider of health care must
be accountable to their patients and their transactions transparent.
Americans should have access to information about the performance and
safety records of doctors and other health care providers and the
quality measures they use. Families, insurance companies, the
government -- whoever is paying the bill -- must understand exactly
what their care costs and the outcome they received.
Families also place a high value on quickly getting simple care, and
have shown a willingness to pay cash to get it. If walk-in clinics in
retail outlets are the most convenient, cost-effective way for
families to safely meet simple needs, then no policies of government
should stand in their way. And if the cheapest way to get high quality
care is to use advances in Web technology to allow a doctor to
practice across state lines, then let them.
As you know better than I do, the best treatment is early treatment.
The best care is preventative care. And by far the best prescription
for good health is to steer clear of high-risk behaviors. The most
obvious case of all is smoking cigarettes, which still accounts for so
much avoidable disease. People make their own choices in this country,
but we in government have responsibilities and choices of our own.
Most smokers would love to quit but find it hard to do so. We can
improve lives and reduce chronic disease through smoking cessation
programs. I will work with business and insurance companies to promote
the availability and use of these programs.
Smoking is just one cause of chronic diseases that could be avoided or
better managed, and the national resources that could be saved by a
greater emphasis on preventative care. Chronic conditions -- such as
cancer, heart disease, high blood pressure, diabetes and asthma --
account for three-quarters of the nation's annual health-care bill. In
so many cases this suffering could be averted by early testing and
screening, as in the case of colon and breast cancers. Diabetes and
heart disease rates are also increasing today with rise of obesity in
the United States, even among children and teenagers. We need to
create a "next generation" of chronic disease prevention, early
intervention, new treatment models and public health infrastructure.
We need to use technology to share information on "best practices" in
health care so every physician is up-to-date. We need to adopt new
treatment programs and fi nancial incentives to adopt "health habits"
for those with the most common conditions such as diabetes and obesity
that will improve their quality of life and reduce the costs of their
treatment.
Watch your diet, walk thirty or so minutes a day, and take a few other
simple precautions, and you won't have to worry about these
afflictions. But many of us never quite get around to it, and the
wake-up call doesn't come until the ambulance arrives or we're facing
a tough diagnosis.
We can make tremendous improvements in the cost of treating chronic
disease by using modern information technology to collect information
on the practice patterns, costs and effectiveness of physicians. By
simply documenting and disseminating information on best practices we
can eliminate those costly practices that don't yield corresponding
value. By reforming payment systems to focus on payments for best
practice and quality outcomes, we will accelerate this important
change.
Government programs such as Medicare and Medicaid should lead the way
in health care reforms that improve quality and lower costs. Medicare
reimbursement now rewards institutions and clinicians who provide more
and more complex services. We need to change the way providers are
paid to focus their attention more on chronic disease and managing
their treatment. This is the most important care for an aging
population.
There have been a variety of state-based experiments such as Cash and
Counseling or The Program of All-Inclusive Care for the Elderly (PACE)
that are different from the inflexible approaches for delivering care
to people in the home setting. Seniors are given a monthly allowance
that they can use to hire workers and purchase care-related services
and goods. They can get help managing their care by designating
representatives, such as relatives or friends, to help make decisions.
It also offers counseling and bookkeeping services to assist consumers
in handling their programmatic responsibilities.
In these approaches, participants were much more likely to have their
needs met and be satisfied with their care. Moreover, any concerns
about consumers' safety appear misplaced. For every age group in every
state, participants were no more likely to suffer care-related health
problems.
Government can provide leadership to solve problems, of course. So
often it comes down to personal responsibility -- the duty of every
adult in America to look after themselves and to safeguard the gift of
life. But wise government policy can make preventative care the
standard. It can put the best practices of preventative care in action
all across our health-care system. Over time that one standard alone,
consistently applied in every doctor's office, hospital, and insurance
company in America, will save more lives than we could ever count. And
every year, it will save many billions of dollars in the health-care
economy, making medical care better and medical coverage more
affordable for every citizen in this country.
Good health is incentive enough to live well and avoid risks, as we're
all reminded now and then when good health is lost. But if anyone ever
requires further motivation, they need only visit a place like the
Moffitt Center, where all the brilliance and resourcefulness of
humanity are focused on the task of saving lives and relieving
suffering. You're an inspiration, and not only to your patients.
You're a reminder of all that's good in American health care, and we
need that reminder sometimes in Washington. I thank you for your kind
attention this morning, I thank you for the heroic work you have done
here, and I wish you success in the even greater work that lies ahead.
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