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AMA National Advocacy Conference

March 2, 2010

Thank you, Dr. Patchin.

The last time I got to visit with you was at your annual Congress on health system readiness in early December.  Back then, we were still near the height of the second wave of the H1N1 flu.  And I thanked you all your efforts to keep our families safe.

Since then, we’ve seen flu levels go down across the country.  And while the flu is still dangerous and we may see another uptick in disease, it appears that the worst is over.  So I want to take this chance to thank you again for the incredible work you did on the front lines of our public health system over the last 10 months.  Some of you who work in emergency rooms had your number of patients go up by 50 or 75 percent.  Others had phones ringing all day with calls from worried parents.

Under these added pressures, you continued to do what you do best: find a way to provide the care Americans need.  Thanks to your hard work, we’ve been able to vaccinate more than 85 million Americans against the H1N1 flu so far.  That’s a great achievement, and it’s another reason why I believe our greatest public health resource isn’t our antiviral stockpile or our vaccine factories.  It’s our talented health care professionals.

You showed that again when tragedy struck in Haiti earlier this year.  Many of you didn’t think twice about volunteering.  You got on the first plane you could.  My department had 275 medical workers on the ground, so I got lots of firsthand reports.  I heard about long days working in the sun interrupted only by a few hours of sleep each night in a tent.  I heard about surgeries conducted using miner’s headlamps for light, cardboard boxes for splints, and pressure cookers to sterilize implements.

These stories weren’t surprising.  You are the best in the world.  Americans can count on this same level of skill and dedication every time they walk into a hospital or doctor’s office.  And our department relies on you too.  You’re our partner in everything we do, from responding to public health crises to reducing childhood obesity to promoting health information technology.

But today, too many Americans are denied the benefits of these efforts by a broken health insurance system.  For the tens of millions of Americans without insurance and tens of millions more who are underinsured, there’s nothing automatic about getting to see their doctor.  For millions of others, the fear of losing their insurance and their doctor keeps them in plans they can’t afford or jobs they can’t stand.

You see the limitations of this system firsthand.  It’s a system where too many of your patients skip critical follow-up appointments because they can’t afford the co-pay.  A system where it’s not uncommon for you to have your recommendations questioned or treatments denied by an insurance company standing in between you and your patients.

Our system turns the world’s most gifted doctors into paper pushers for an average of three hours a week as you fill out piles of insurance forms.  It’s a system where you get usually get paid by the number of visits or procedures, not how much time you spend with your patients or the quality of care they get.

Under this system, too many Americans put off critical preventive care like the mother who waited until her son broke his arm one year and used up their entire deductible to go get her check-up.  Too many parents are forced to make a difficult choice when their child develops a high fever: do I hope it gets better or do I go to the hospital and go further into debt?

You see these same problems over and over again.   And if there’s one thing that last forty years have taught us, it’s that these problems are not going to fix themselves.  They’re going to get worse.

That’s why President Obama began a push last year to reform our health insurance system and put families and their doctors back in control of their health care choices.

This effort has gotten a lot of high profile support, whether it’s from the AARP or hospitals or consumer advocates.  But no one has more credibility than the nation’s doctors.  Patients trust you.  So do policy-makers.  So when you said we need to fix our health insurance system, America listened.

And over the last 12 months, we’ve seen more progress towards real reform than ever before in American history.  We had a strong bill pass the House.  A comprehensive bill didn’t just pass the Senate, it passed with a supermajority.

And these bills had the same common sense reforms.  Making insurance more affordable for families and small businesses.  Helping tens of millions of Americans get coverage.  Creating a new health insurance marketplace that will make it easy for families to shop for and compare different plans.

Preventing insurance company abuses and denial of care.  And putting our budget on a more stable path, by reducing the deficit by $100 billion over the next ten years.

This legislation would provide security and stability for tens of millions of American families.  When California’s largest insurer recently made the news by raising premiums for 800,000 people by up to 39 percent, I got inundated with letters. Some of them were from angry California families.  But many of them were from Americans in different states, saying “What happened in California is bad, but you should see what my insurer just did.”

I am reminded of two dads I talked to on the same trip.  One stopped me in an airport in Chicago, and introduced me to his 11 year-old son Patrick who was returning from a soccer tournament. Patrick had gone through two heart operations: one at one week and one at 3 years. He’d had no problems since then.  Yet, the family premiums before this last round of increases were $30,000 a year.

Then Rich Colby approached me at an event in Columbus, Ohio. He pays over $30,000 a year to cover himself and his wife and son. Both his wife and daughter had cancer; his wife survived, his daughter did not. He is desperate and doesn’t know how much longer he can afford insurance.

Both of these dads are self-employed and so far, can pay these staggering rates. But they are frightened about what happens next, to themselves and their families.

If we don’t act, we know that more and more Americans are going to have that same fear.  The percentage of Americans who gets insurance from their employer goes down every year.  We know that over the next decade, one out of every two Americans under 65 will go without health insurance.

These trends mean a growing number of medical decisions will come down to a negotiation with an insurance company, by either you or your patient.  And that’s unacceptable.  That’s why President Obama is determined to build on the progress we’ve made so far and pass health insurance reform this year.

Now, we believe that putting doctors and patients back in control of health decisions is not just a Democratic idea.  In fact, the House Bill, the Senate Bill, and the President’s own proposal are all very similar to the plan co-drafted at the Bipartisan Policy Center by two former Republican Senate Majority leaders, Bob Dole and Howard Baker.  They’re also similar to the reforms implemented in Massachusetts by a former Republican Governor Mitt Romney.  And there’s a good reason for that.  These plans don’t just include ideas Republicans have supported.  They include dozens of amendments that were actually written by Republicans.

So when the President held the bipartisan health care meeting last Thursday, he hoped we could have an open, honest, productive discussion to find out where we agreed, where we disagreed, and how we could move forward.  And I think that’s what you saw.  Both parties agreed on a lot of the substance from the need to give families and small businesses more affordable insurance choices to the importance of cracking down on waste and fraud.

There is one major policy difference.  The Republican proposals leave 30 million Americans without health insurance.  The President feels that is unacceptable.  And there is also a disagreement about what to do next.  Several Republicans at the meeting suggested that we start over.

But the President and I believe that after 12 months of hard work, we can’t afford to do that.  We can’t afford to postpone reform again as we have so many times in the past.  Not when 15,000 Americans are losing their insurance every day and premiums are on pace to double again in the next ten years.

So as you heard from President Obama on Thursday, we’ll welcome input from any Republicans and happily work with them on a final bill.  But we’re also willing to move ahead without them for an up or down vote on a comprehensive bill.  We’ve worked hard to get as far as we have, and later this week the President will outline the next steps he thinks we need to take to finish the job.

That means the coming weeks will be critical for reform.  Your support will never mean as much as it does now.  We’ve come 95 percent of the way.  The hardest work is already done.  Now we need whatever energy you have left to help us finish the job and fix our health insurance system to make it work better for all Americans.

But we don’t have to wait for a final bill to start making our health care system work better for doctors and American families.

As you know, the House recently passed a temporary extension of the sustainable growth rate fix, but the bill hasn’t yet passed the Senate.  To give the Senate more time to resolve this issue, I’ve instructed the Centers for Medicare and Medicaid Services to hold reimbursement claims for ten business days.  We’re working hard with the Senate to pass the extension without disrupting your practices or seniors’ care.

But let me be clear: we can’t continue to rely on temporary extensions.  We need to make this fix permanent.

At a time when you’re working harder than ever, there’s no reason you should have to come to Washington every year to lobby for an extension.  Making the fix permanent is the right choice for doctors.  It’s the right choice for patients.  And it’s the right choice for transparent budgeting, which is the only kind of budgeting we want to do.

So my pledge to you today is that we’re going to work with you and Congress to take the sustainable growth rate off the lists of things you have to worry about so you can spend more time keeping your patients healthy.

We also know that it’s getting more and more expensive to enter the medical profession.  Many of you leave medical school today with hundreds of thousands in debt that stays with you for years.  If you choose to go into primary care or work in an underserved community, it might take decades.  That’s why we’re making one of the biggest investments in our health care work force in American history.

As part of the Recovery Act, we’re adding $500 million to health care workforce programs.  Over half of this investment – $300 million – will go to double the size of the National Health Service Corps.  That means twice as many aspiring primary care doctors, nurses, and dentists will receive up to $50,000 in academic loans in exchange for a two year commitment to practice in the areas with the greatest provider shortages.  We know this investment is working because within six weeks of this announcement, more than 2,000 practitioners had applied for admission to the Corps.

We also added $200 million in aid to colleges and universities that will support medical educations for more than 14,000 students.  And both of these areas received additional funds in the President’s 2011 budget, which reflects the high priority this administration puts on supporting our doctors and nurses.

We’re also working to address another concern that I know many of you have, which is the way lawsuits can get in the way of delivering the best care to your patients.  As you know, in September, the President instructed our department to provide $25 million in grants to states and health care communities for medical liability demonstration models with the goals of putting patient safety first, strengthening communication between doctors and patients, ensuring fair compensation for victims of medical injuries, and bringing down liability premiums.

States and health systems have tried a variety of reforms in the past and would like to do more.  But progress has been slow because we know shockingly little about how these reforms affect doctors’ liability premiums, patient safety, and the number of frivolous lawsuits that are filed. That’s why this program is so important: it will allow states and health care providers to expand current models and experiment with new ones, and we’ll be rigorously evaluating the outcomes of all these efforts.

We’ve already collected the applications for these funds, and we’ll award the grants later this spring.  I want to stress to you that we’re going into this process with an open mind.  And we welcome your input on this issue.  With nearly 100,000 Americans dying each year from medical errors and so many doctors with real concerns about the costs of defensive medicine, surely we can do better.

These are some of the issues on which we’ve heard your concerns and are responding.  But I believe there are other steps we can take in the next year to build a health care system that’s better for doctors, better for patients, and better for family and government budgets.  Many of these are changes we’ve talked about for years, but have put off.  Now, we need your help to usher in a new era.

One of those areas is health information technology.  Last June, President Obama joined you in Chicago and told you about our plan to help doctors and hospitals adopt electronic health records.  In the last eight months, we’ve been putting that plan into action.

We’re making this investment because we believe this technology can cut costs, eliminate paperwork, and most of all, give doctors more time to spend with their patients so they can deliver high-quality, coordinated care.

We’ve seen these benefits for patients across the country.  At one health system, they used electronic health records to identify older women who hadn’t received an osteoporosis screening and mail them personal letters encouraging them to get screened.  Screenings went up 300 percent.

But I’ve been even more impressed with the benefits for providers.  When I talk to doctors who are using electronic health records that have been well-designed with input from providers, they all tell me the same thing: patient results are better, their work is easier, and they’d never go back to paper files.

So a key part of strengthening our health care system is creating new financial incentives for doctors and hospitals to make meaningful use of these technologies.

Now I know there’s some concern about what these meaningful use guidelines will be.  A lot of you who are part of small practices may not have a big IT staff.  Some of you probably are the IT staff.  So I want to assure you that the final rule will be written with the needs and capacities of small practices in mind.

I also want you to know about an announcement we made earlier this month.  As part of the Recovery Act, we’re providing $375 million to create 32 Health IT Regional Extension Centers around the country.  These centers will work like Agricultural Extension Centers did for American farmers.  They’ll be local and regional organizations where you can go with questions, whether it’s which health record system fits your needs or how to get the most out of it once it’s installed.  And they’ll have staff who can come to your offices and provide hands-on assistance.  Eventually, we hope these centers will support more than 100,000 primary care providers around the country, particularly small practices in isolated areas.

This is going to make it easier for you to get the information you need to deliver the best care.  That’s better for doctors and better for patients.  But we won’t be able to do it without your help.  We’re going to need your input to make sure our policies have the right design.  And we’re going to need your leadership to help spread the technologies that work for you.

Another area where we can reform our health care system to make it work better for families and doctors is our payment system.  The payment system should provide incentives for best care practices, and currently, too often, you must alter your practice to seek reimbursement.  We need to change that.

For example, we know that one out of every five Medicare beneficiaries who is discharged from a hospital is back within a month.  Many of these readmissions are unavoidable.  But some aren’t.  And part of the problem is that as far as our payment system is concerned, high-quality follow-up care doesn’t exist.

So last year, we announced a new pilot project in 14 communities called the Care Transitions Project that will experiment with different ways to promote better coordinated care between hospitals and follow-up care providers to reduce readmissions.  We hope to learn lessons in these communities that we can take and apply around the country.

Another example is medical homes.  As you know, these are models where providers can get paid more for delivering the kind of coordinated care that’s proven to deliver better results.  It’s common sense.  Medical teams can help make better use of physician’s time and skill and maximize outcomes.

But until this year, Medicare hasn’t supported medical homes.  So we changed our policy, and we expect to begin implementing these projects later this year.

We’re also counting on doctors to be part of two new initiatives to improve the health of our children.  As all of you know, one of the first bills President Obama signed last year was the CHIP Reauthorization Act.  Since then, we’ve signed up 2.6 million more kids for health insurance through CHIP and Medicaid.

But we also know there are still 5 million kids out there who are eligible for health insurance but aren’t signed up.  That’s 5 million kids who may be just a few pieces of paperwork away from getting the health care they need.

So we’re challenging our partners across America – our Cabinet partners, state and local governments, faith-based organizations, community groups, and most important, America’s doctors – to help us enroll these 5 million kids in the next five years.  If you have any questions, you can go to our redesigned website  Every kid deserves a doctor, and we need your help to make it happen.

I’m also asking you to join the First Lady’s new national campaign against childhood obesity.  Today, one out of every three kids is obese or overweight.  That’s four times the rate of 40 years ago.  And there are huge health consequences.

We used to call Type II diabetes “adult-onset.”  Now we don’t even use that term because so many kids are presenting with diabetes.  The CDC recently estimated that the average ten-year-old has a 1 in 3 chance of getting diabetes in their lifetime.  Overall, scientists estimate we spend nearly $150 billion a year to treat obesity-related conditions, more than treating all forms of cancer.

To engage this battle, the First Lady has launched a national movement to end childhood obesity in a generation.  She’s calling on everyone from city planners to grocers to parents to participate, but doctors have a special role.

You are a family’s most trusted source of health information.  A warning from you means much more than a statistic from our agency.  So we’re asking America’s doctors to make a BMI measurement part of every check-up and to be as diligent about prescribing a better diet and exercise as you are about prescribing antibiotics.  And we’ve got a new website for this initiative too:  I encourage you to visit, sign up for updates, and share it with your patients.

At the department of HHS, we want our work to be guided by the best science and our policies to be implemented in partnership with health care providers.  If we can work together in all these areas, we can build a stronger health care system where patients get more bang for their buck and doctors get more quality time with their patients.  But having access to your patient’s history on an electronic health record doesn’t do you much good if their insurance company won’t cover the treatment.  And having a more sensible insurance payment system doesn’t help the mom who can’t get coverage because of her diabetes.

There are barriers to Americans getting the best care and to you doing your job that only health insurance reform can remove.  Working together, we need to get rid of those obstacles and put families and their doctors back in control of their health care.

So I appreciate your support for reform.  I appreciate your partnership.  And I look forward to working with you over the next year to build a healthier America.

Thank you.