June 03, 2008

Speech: Wyden Addresses OHSU Graduates at 2008 Commencement

"Creating a Future of Health Care that Works"

Senator Ron Wyden (D-Ore.) delivered the following speech at Oregon Health and Science University's Commencement Exercises on Tuesday, June 3, 2008.

Dr. Robertson, graduates, parents, distinguished guests. I'm Senator Ron Wyden, the United States Senator who you may know as the author of the "all-important" amendment to the amendment to the amendment on some bill or another. I'm also proud to be known as the father who watched Dr. Mark Nichols, his OHSU staff of nurses, physician assistants and other health care superstars deliver our twins. Dr. Nichols and his team did a superb job delivering Ava Rose and William Peter Wyden. With the objectivity of a dad, I can report the twins are sweet, smart, gorgeous babies.

So, now for your commencement address and what has come to euphemistically be known as the "words of wisdom." I think I can divine what you are thinking. After all the sweat and toil to reach this day, who do we get as a commencement speaker? Some guy from the universally admired, ever-beloved, U.S. Congress. So, point number one for the graduates: There are some initial disappointments in the post-graduation world.

Now, there isn't enough time to figure out why each of the graduates was attracted to the health care field. I'm especially curious about how many were attracted to medicine by Grey's Anatomy, the television show that makes medicine out to be a magnet for sizzling romance and puts co-workers on the cover of People magazine. Did I mention initial disappointment already?

My sense is the graduates tonight went into medicine to help people, especially to be forceful, assertive advocates for their patients. The graduates tonight want to use what they've learned during those body-numbing late-night hours to help people be as healthy as possible.

Now, the students graduating aren't completely sure what's ahead for them professionally. Yet, they are absolutely certain that they're headed for a byzantine world of insurance codes, reimbursement rates and acronyms. I know you know that you are entering bureaucracies that will try to wear you down with red tape and Catch-22s that would make downtrodden heroes of pulp fiction look like they had it easy.

So that's the bureaucratic challenge ahead. Now what does Congress have to do with medicine? Again, potential disappointment lurks: The U.S. Congress will have far more relevance and impact on your professional life as a health care professional than Katherine Heigl or Doctor McDreamy.

For me, the story about government and health care begins more than 60 years ago, when there were wage and price controls. Employers couldn't raise workers' salaries, giving the workers extra money to buy health care. So, after a little discussion inside Congress, government told employers, "You do it. You offer health care." And employers said "We'll be glad to, but we will have to pass the costs of these health benefits on in the form of higher prices for goods and services."

Thus, employer-based health coverage was born. Soon, it was generously greased by the adoption of Federal tax policies that make employer-based health coverage a deductible expense for employers and a tax-free benefit for workers.

That system was probably okay 60 years ago, when workers stayed at the same job from their teenage years until they got a gold watch and a big steak dinner retirement. And it wasn't so bad when employers were competing against the person down the street, rather than competitors across the ocean in China and India.

It doesn't make much sense now, when the typical worker changes their job seven times by the time they are thirty-five, and the typical American employer is at a competitive disadvantage with rivals overseas who pay far less for health care.

That's what I hope, with your help, I can change. I've introduced legislation - the Healthy Americans Act - that has for the first time in history brought together a significant number of Democratic and Republican Senators determined to fix health care. I'm not going to go into the details of the legislation now because you have parties to go to tonight, but here are the highlights:

First, we start with straight talk for workers and employers. We tell workers a major reason their real take home pay isn't going up is because of the increase in health care costs. We tell employers, "It's not all your fault. You weren't around in the 1940s." So to address the needs of both the workers and the employers, our legislation helps both groups with the first paychecks issued after the Healthy Americans Act is passed. Under the legislation, both workers and employers get more health care choices, which promote competition, and new opportunities to contain costs.

For doctors, nurses and other health care providers, we'll liberate you from administrative hassles with simpler, uniform payment and billing systems. In addition, you'll benefit from modern technologies paid for by insurers and other payers, rather than, for example, recent graduates of OHSU who are already struggling with big student loans.

Insurance companies are prohibited from discriminating against those with pre-existing conditions, and must compete for business on the basis of price, benefits and quality.

The legislation reforms the medical liability laws to reduce defensive medicine, freeing you up to treat patients without waking up in the middle of the night sweating out the prospect of a frivolous lawsuit.

Finally, and perhaps most importantly, the HAA is based on the idea that there needs to be more health care, not sick care. Parents who enroll their kids in anti-obesity and other wellness programs would get a reduction in their premiums.

Right now, Medicare shows the craziness of all this - huge sums under Part A of Medicare are now spent for hospitalization… and there are no rewards under Part B outpatient services for lowering blood pressure or cholesterol.

Does this sound like common sense to you? I believe that after six decades of debate that goes back to the Truman Administration this is the time when real, common sense health reform is possible. There is bipartisanship for the first time. The budget experts say the numbers work, and you won't have to raise taxes to fix health care.

Just last month, the Congressional Budget Office and the Joint Committee on Taxation released a report - the first analysis they'd ever done together - on the Healthy Americans Act. Their analysis showed that, under the changes made to our health care system by the act, the system would be self-financing once it was up and running in 2012. Then it would return surpluses to the Treasury by 2014.

The fact is America spends enough on health care already, it just doesn't spend it in the right places. Last year, according to the Center for Medicare and Medicaid Services, Americans spent $2.2 trillion on health care. There are about 300 million of us. You divide 300 million into $2.2 trillion, and it would be possible to send every man, woman, and child in America a check for more than $7,000.

Here is another way to look at it: For the money Americans spent on health care last year, we could have hired a group of skilled physicians, paid each one of them $200,000 to care for seven families, and all Americans would have quality, affordable health care. Whenever I mention those figures to a physicians group, it takes about 30 seconds before a doctor stands up and says: Ron, where do I go to get my seven families?

OHSU has prepared you well for the challenges ahead in medicine. But unlike the preceding generations who worked in health care with the hand they were dealt, you and I -- working together -- have a chance to change things. I firmly believe that if you take the same energy you used to get your degrees and turn it towards creating a better future for health care, together we can make it happen.

Here's my vision of health care in the future: It's a future where employers and employees together enjoy a modernized health care system with more choices and more affordable, portable coverage. It's a future where doctors, nurses, and every health care professional spend their time and energy helping heal patients instead of filling out forms or fighting for payments from insurance providers. It's a future with a radically different model of private health insurance. And it's a future with many fulfilled providers who get new opportunities to focus on their patients' health and wellness because patients don't just show up when they are well into the throes of serious illness.

It's a future that depends on you.

I want to close with one of my favorite Robert Kennedy quotes, whose family is so much on our minds this week and who gave us so much inspiration: "Few will have the greatness to bend history itself; but each of us can work to change a small portion of events, and in the total; of all those acts will be written the history of this generation."

Your generation has a chance to change the course of health care in this country. My generation needs your help to make it a reality. By working together, we can make health care work for all Americans.

Congratulations, graduates, on taking the crucial first step into America's better health care future. I've got your back.