ARLINGTON, VA -- U.S. Senator John McCain will deliver the
following remarks as prepared for delivery at the University of
South Florida -- Lee Moffitt Cancer Center & Research
Institute, in Tampa, FL, today at 10:00 a.m. EDT:
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.