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The ASHTO Conference

Thank you, Dr. Monroe, for that introduction.  Dr. Monroe’s done a terrific job as head of ASTHO and I’m grateful to her for inviting me to visit with you this afternoon.

I’d also like to acknowledge Dr. Mary Wakefield, our terrific Health Resources and Services Administrator, who’s here today.  And our Assistant Secretary for Health Dr. Howard Koh and CDC Director Dr. Tom Frieden, whom you’re going to hear from later this week.

I’ve worked with public health officials for years, going back to my time as a state legislator.  And I want to start by assuring you that at this Department of Health and Human Services, Health and Human Services are back!

Keeping Americans healthy is one of this administration’s top priorities.  And that doesn’t just mean the absence of disease.  It means creating the conditions that produce mental and physical wellbeing as the World Health Organization motto states.  Our goal is for all Americans to live healthier, more prosperous, and more productive lives.

When people are healthy, they miss fewer days of work and get more done.  They spend more time at home and less time in doctors’ offices.  They can take care of their grandkids.  They can play softball.  They can volunteer at the town library.  They can walk to the grocery store.  They can get a good night of sleep.  They don’t have to take medicines that can have harmful side effects.

Being healthy is one of the greatest gifts we get in life.  And we want to partner with you to strengthen the public health infrastructure throughout America.

We believe we need to work towards better health constantly and proactively, both as individuals and as a country.  And we know that the biggest single step we can take to improve health in America is to pass comprehensive health insurance reform this year.

Yesterday, we passed a key milestone on the path towards that goal.  The Senate Finance committee reported a bill, which means we now have bills from all five committees.  In 70 years of fighting for health insurance reform, that’s never happened before.  This time, it only took 8 months.

Congress continues to show great leadership on this issue.  But momentum is coming from around the country.  There is a growing consensus that the status quo is unacceptable.  Ronald Reagan used to say that status quo is just Latin for “the mess we’re in.”  And he was right!

To me, reform has three parts.  There’s insurance reform, which has gotten a lot of attention.  But there are two other parts of reform that are just as important: changing our payment and delivery systems and shifting our focus to prevention and wellness.

It’s time for America to join the rest of the developed world and make sure that all our citizens have access to quality, affordable health insurance.  It’s the right thing to do.  And considering that American families are all paying an extra $1,000 a year to cover care for the uninsured, it’s also the smart thing to do too.

But as you all know, even if we fix our insurance system, we’re still going to have a big problem, which is that Americans aren’t getting enough bang for our buck!  We spend twice as much per person as some other rich countries, but are results are average or worse.

To give just one example, last year the journal Health Affairs rated nineteen industrialized countries on how many avoidable deaths they had before age 75.  These are deaths from conditions like bacterial infections, diabetes, and treatable cancers that are common but preventable.  The US wasn’t just below average.  We were dead last.

The problem isn’t our doctors.  We have the best in the world.  It’s not our technology.  No country is more advanced.  It’s certainly not our public health officials.  You’re extraordinary.

The problem is that the system that connects doctors and patients doesn’t work.  It has screwed up incentives.  It doesn’t measure results – and when it does measure results, it doesn’t pay enough attention to them.  It invests too little in prevention.  And it still relies on pencil and paper, which was an incredible technology back when it was invented by the Ancient Egyptians, but which doesn’t meet our current needs.

Americans’ health is too important to have a health care system that delivers so little value.   That’s why reform also has to transform our delivery and payment systems so that Americans get better care for a better price – something ASTHO knows all about.

Let me give you one example.  Here’s a statistic that should stop every American dead in their tracks: health care-associated infections are one of the ten leading causes of death in America.  More people die from health-care-associated infections than from car accidents and homicides combined.

What makes these deaths especially tragic is that they are preventable.  For example, in Michigan, they created a checklist that doctors had to use before placing a central line, which included simple steps like hand-washing.  Within 18 months, they cut infections by 66%, prevented 1,500 deaths, and saved $200 million.

I know that State Health Departments around the country are leading similar reform efforts.  And we’re determined to help.  That’s why $40 million out of $50 million in Recovery Act funding to lower infection rates is going straight to public health commissioners.  And health insurance reform will help these changes spread even more widely by requiring hospitals to report statistics like the percentage of patients who die from heart surgeries or have complications from anesthesia.

We also need to do a better job preventing and treating chronic conditions.  Seventy-five percent of our health care dollars today are spent managing chronic disease.  And it’s not just seniors like some people think.  Over half of all Americans with multiple chronic conditions are under the age of 65.

That’s why the President and Congress are also supporting coordinated care models like medical homes.  In medical homes, patients don’t just get care from their doctors.  They also get care from Community Health Teams, staffed by nurses, social workers, and behavioral health counselors who check up on patients and make sure they’re managing their chronic conditions.

Several states already have impressive medical home models in place.  And we recently announced that Medicare will join with Medicaid and private insurers to give providers incentives to participate in these models.  We’re supporting medical homes because they work.  When you look at medical home models around the country, you see the same results over and over again: patients are healthier, doctors are happier, and costs go down!

No one understands the benefits of these kinds of changes spread across populations than you.  And we need to do a better job integrating public health initiatives into the rest of the system.

But you also know that there will be a limit on how much improvement we can make as long as we continue to use pencil and paper in our health care system.  If doctors all carry around their own chart and their charts can’t talk to each other, it’s hard for them to coordinate care.  If hospitals can’t automatically track patient outcomes, it’s hard for them to provide that information to patients.

We all know electronic health records can take some time to get used to.  But in system after system where electronic health records are in place, doctors tell me they’d never go back.  It’s made them better doctors, it’s better for patients, and they’d never practice medicine any other way.  Yet despite this enthusiasm, only 10% of hospitals and 20% of doctors have adopted electronic health records so far.  The rest still use the paper system we’ve had since Hippocrates’ time.

We know that the states are the framework for an interoperable health information system.  That’s why President Obama and Congress committed over $560 million from the Recovery Act to set up State Information Exchange.  And health reform will advance these initiatives by lowering overhead costs, and more importantly by defining “meaningful use,” so that hospitals are not just plugging in a machine, but are using electronic health records to improve patient care.

Added together, these changes are going to create a virtually integrated system that is a pathway to the 21st century health care system of the future.

But the biggest change we can make isn’t how we provide health care – it’s when.  Right now, we have a sick care system, and we need to invest in a health care system.

Public health is the backbone of this new health system, and President Obama and Congress have also put this principle at the heart of reform.  From eliminating all co-pays for preventive care to encouraging weight loss and tobacco cessation, health insurance reform invests significantly in prevention.

Reform legislation also creates a dedicated health and wellness fund to invest community prevention and public health programs.  The need for public health doesn’t vary year by year and neither should the funding.  We’ve seen what happens when state budgets hit hard times, but the challenges you face don’t decrease with your funding!  There needs to be a dedicated source of funding for public health and Congress recognizes that.

We also need to know what really works to change behaviors and help Americans make healthier choices.  Prevention and wellness needs to have a community-wide focus that includes health leaders, civic leaders, schools, employers, and seniors.  For the first time in history, we’re making a national investment in this kind of state- and community-based prevention efforts.  Applications for funding are available right no, and we hope that many of you will lead innovative efforts to make America healthier.  Whether it’s bringing fresh produce to inner city neighborhoods or serving healthier school lunches, there are many proven strategies that we want to measure and scale up around the country.

In other words, transforming our health care system is not just about the bills making their way through Congress, though passing a health insurance reform bill will be a huge step in that direction.  This is a long-term effort to move towards the kind of high-quality, patient-centered, evidence-based care that we know is better for doctors, better for patients, and better for our national balance sheet.

I know that right now, many of you are being asked to do much more with much less.  Many state budgets are in crisis and the federal government has shortchanged public health for years.  That’s something this administration is committed to turning around.

But we can’t wait for our public health infrastructure to be rebuilt to deal with the current crisis we face.  I will need your help now more than ever as we battle the H1N1 flu this fall.

State health officers have been our valuable partners since the flu was first detected in April.  You were crucial to the success of our flu summit in July.  Since then, we’ve been grateful for your ideas, advice, and for all your hard work in developing vaccine distribution plans.  The first H1N1 vaccine went out last week, and all 50 states, the District of Columbia, and most of the territories have placed orders.

The vaccine is arriving at a critical time.  As predicted, the H1N1 flu is hitting young Americans, pregnant women, and people with underlying conditions especially hard.  The American people are starting to pay attention.

Now, our job is to take our plans and put them into action by making sure the vaccine reaches the people who need it.  I know you’re dealing with delays in vaccine availability.  While some vaccine arrived ahead of schedule, it’s coming in more slowly than we’d like.  But during this initial period, before vaccine is more widely available, it’s crucial that we ensure that those at highest risk for complications from H1N1 flu not only know they should get the vaccine, but also know where and how to get it.

You’re on the front lines of this fight.  And I saw your hard work firsthand last week when I visited a school in Maryland with Maryland’s Deputy Public Health Secretary Frances Phillips and your Executive Director, Paul Jarris, among others.  The school was a seasonal vaccine distribution site, but Maryland had substituted the H1N1 vaccine to address the new threat.

Each state, territory, and locality is different, and you each have your own ways of reaching your high-risk and vulnerable populations.  I know many of you are working with CDC to encourage the doctors serving these populations to either become vaccinators themselves or link up with hospitals or other facilities to get these patients vaccine.  Others are providing vaccine access to high-risk individuals at local health departments themselves.  However you do it, please make sure you get the word out to these physicians and patients as early as possible, and please use to help you. is already getting 5 million hits a month, a number that keeps rising.  It has become one of the best resources we have for reaching people about prevention, treatment, and vaccine.  It works best when we have the latest data on where H1N1 is presenting around the country and where vaccine will be offered. links to each of your websites, making it easy for anyone in the United States to learn about the situation in their community.  You’re our number one source for this local information.  We’re committed to keeping you updated on our latest information and plans, and we need you to keep us updated, too.

Our hope is that will be a resource not just for us, but for everyone.  I’d encourage you to download our widget and put it on your website, and to send people to the site.  You know as well as anyone that during public health emergencies, people can get conflicting information from many different sources.  With, we have a dependable, one-stop clearinghouse where concerned Americans can get any question answered.  The site can also reduce the burden on your state and local communities by reducing the calls you receive and by making the H1N1 Flu Self-Evaluation available to site visitors.

We’re also finding new ways to reach out to the American people.  As I speak, we’re holding a vaccine safety webcast on  We’ve released specific guidance for small and large businesses, schools, universities, childcare providers, and community and faith-based organizations.  We’ve taped flu prevention PSAs in English and Spanish with members of Congress that have aired around the country.

Tomorrow, we’re going to give you a chance to record your own PSAs.  We’ll have a crew set up from 1:30 to 5:30 in conference room 7 and pre-written scripts that you can personalize for your states.  When you’re done, we’ll post the PSAs on our state map on, so that Americans can see what their local health officials are saying about the flu.

We’ve also taped a special episode of the PBS series Sid, the Science Kid, which will be airing later this month.  It will be a great resource for parents, and I encourage you to find ways to promote it.

Thank you again for all you’re doing to protect public health, in spite of being underfunded and overworked.  While the immediate task is daunting, our success will pay dividends, not only in terms of illness prevented and lives saved in the near term, but also in terms of our national commitment to public health in the long term.

Whether it’s an imminent public health threat like the H1N1 flu or a crumbling health care system that we’ve been trying to fix since before the invention of color television, this Administration has made improving the health of Americans a top priority.  We know we have a long way to go.  But with your help, we’re committed to achieving better health for all Americans with all the benefits that brings.

Thank you.