well __PUNCT__ thank you veri __PUNCT__ veri __PUNCT__ much __PUNCT__
i am delight to be back at gw and i want to thank presid trachtenberg for hi kind introduct __PUNCT__ but he and hi wife francin have been lead advoc on behalf of higher educ and so mani other issu for as long as i known them __PUNCT__ and that goe back mani year __PUNCT__
and as joel said __PUNCT__ we share the experi of our children in high school __PUNCT__ and that wa inde an experi we both surviv __PUNCT__ so we grate to tell the tale __PUNCT__
i want to thank dr __PUNCT__ william __PUNCT__ and __PUNCT__ of cours __PUNCT__ dr __PUNCT__ becker __PUNCT__
i want also to recogn russ ramsei __PUNCT__ the chair of the board __PUNCT__ dr __PUNCT__ scott __PUNCT__ dean of the medic school and the ceo of gw medic faculti associ __PUNCT__ stephen badger __PUNCT__
it is an honor to be back at gw in order to talk about on of the most import issu face the health care commun __PUNCT__ and of cours __PUNCT__ our countri __PUNCT__
as i travel around america __PUNCT__ i have talk with peopl from all walk of life about the challeng that our countri is face __PUNCT__ from end the war in iraq to end our depend on foreign oil __PUNCT__ from improv our educ system to reduc our deficit __PUNCT__
and no matter where i go or with whom i talk __PUNCT__ whether it small busi owner or ceo __PUNCT__ doctor or nurs or patient __PUNCT__ i hear grow concern about the crisi in our health care system __PUNCT__ explod cost __PUNCT__ declin coverag and shortcom in care and prevent __PUNCT__
now __PUNCT__ i tangl with thi issu befor __PUNCT__ and i got the scar to show for it __PUNCT__
but i learn some valuabl lesson from that experi __PUNCT__
on is that we can't achiev reform without the particip and commit of health care provid __PUNCT__ employ __PUNCT__ employe and other citizen who pai for __PUNCT__ depend upon __PUNCT__ and actual deliv health care servic __PUNCT__
i think we final have a recognit that everyon see there is an econom imper to rein in cost __PUNCT__
there is a moral imper to extend coverag to all american __PUNCT__
and __PUNCT__ there is a practic necess to promot well and prevent ill wherev possibl __PUNCT__
i plan to put those lesson to work to ensur everi singl american ha qualiti __PUNCT__ afford health coverag __PUNCT__
there ar three part to my approach __PUNCT__
first __PUNCT__ lower cost for everyon __PUNCT__
second __PUNCT__ improv qualiti for everyon __PUNCT__
third __PUNCT__ insur everyon __PUNCT__
todai __PUNCT__ i will focu on the challeng of lower cost __PUNCT__
health care cost ar spiral out of control __PUNCT__
premium have almost doubl sinc __NUM__ __PUNCT__ increas four time faster than averag wage __PUNCT__
everi dai __PUNCT__ parent choos between pai the premium for themselv or their children __PUNCT__
small busi wonder how thei will stai afloat when their health care cost eat up their profit year after year __PUNCT__
ceo of major american compani worri about how thei will succe in the global economi when thei compet with foreign compani that spend significantli less on health care __PUNCT__
we spend __NUM__ percent of our gross domest product __PUNCT__ __MONEY__ trillion __PUNCT__ on health care __PUNCT__
and by __NUM__ health cost ar schedul to exce __MONEY__ trillion __PUNCT__ or almost __NUM__ __PUNCT__ of gdp __PUNCT__
that mean that within less than __NUM__ year __PUNCT__ __NUM__ cent out of everi dollar produc in america will be spent on healthcar __PUNCT__
no other countri spend more than __NUM__ __PUNCT__ a differ of more than __MONEY__ billion __PUNCT__
all other wealthi countri spend even less __PUNCT__
we spend __MONEY__ per patient __PUNCT__
the next highest spend countri __PUNCT__ switzerland __PUNCT__ spend __MONEY__ on patient __PUNCT__
yet __PUNCT__ thei cover everi singl on of their citizen and have an averag life expect that is three year longer than our __PUNCT__
now __PUNCT__ how have our cost spiral out of control like thi __PUNCT__ well __PUNCT__ about __NUM__ __PUNCT__ of the rise in health care spend is link to the doubl of obes among adult over the past __NUM__ year __PUNCT__
in other word __PUNCT__ if our obes level had remain at __NUM__ level __PUNCT__ we would be spend __NUM__ __PUNCT__ less on health care todai __PUNCT__ a save of __MONEY__ billion __PUNCT__
about two __PUNCT__ third of the rise in health care spend is associ with a rise in the preval of treatabl diseas __PUNCT__ like diabet __PUNCT__ asthma and heart diseas __PUNCT__
__NUM__ __PUNCT__ of all health care spend __PUNCT__ roughli __MONEY__ trillion __PUNCT__ is associ with the __NUM__ to __NUM__ percent of patient who have multipl chronic ill and requir ongo medic manag over a period of year __PUNCT__ or even decad __PUNCT__
and __NUM__ __PUNCT__ of the total health care budget is spent on end of life care __PUNCT__
our administr cost ar by far the highest in the world __PUNCT__
todai more than on in four health care dollar goe to administr __PUNCT__
__NUM__ __PUNCT__ of privat insur plan __PUNCT__ administr cost ar dedic to underwrit health risk __PUNCT__ sale __PUNCT__ and market __PUNCT__
everi man __PUNCT__ woman and child in america spend __MONEY__ on health care administr __PUNCT__ nearli six time as much as other countri __PUNCT__
accord to a recent report by mckinsei __PUNCT__ the unit state spend __NUM__ billion more than other countri on excess administr cost that have noth to do with deliv good health care __PUNCT__
too much of the monei we spend is wast on care that doesn't improv health __PUNCT__
a studi in santa barbara __PUNCT__ california found that on out of everi five lab test and x __PUNCT__ rai were conduct sole becaus previou test result were unavail __PUNCT__
a recent studi report in the atlant monthli found that for two __PUNCT__ third of the patient who receiv a __MONEY__ surgeri to prevent stroke __PUNCT__ there wa no compel evid that the surgeri actual work __PUNCT__
at the same time __PUNCT__ in situat where the benefit of intervent ar clear __PUNCT__ mani patient still don't receiv the care thei need __PUNCT__
a recent studi in the new england journal of medicin found that __PUNCT__ overal __PUNCT__ american get need care onli __NUM__ percent of the time __PUNCT__
if we spend so much __PUNCT__ why doe the world health organ rank the unit state __NUM__ in life expect and __NUM__ in child mortal __PUNCT__ wors than cuba and croatia __PUNCT__ our health care system is plagu with under __PUNCT__ us __PUNCT__ overus and misus __PUNCT__
it is __PUNCT__ simpli put __PUNCT__ broken __PUNCT__
as presid __PUNCT__ i will make it my mission to fix it __PUNCT__ start by help the __NUM__ million peopl with public or privat insur who face skyrocket cost __PUNCT__ inadequ care __PUNCT__ and bureaucrat obstacl to coverag __PUNCT__
todai __PUNCT__ i announc a seven point plan to lower health care cost for all american and again to make our healthcar system __PUNCT__ without doubt from ani corner __PUNCT__ the best in the world __PUNCT__
build a nation consensu around these cost save is the first crucial step to cover all american with qualiti __PUNCT__ afford healthcar __PUNCT__
first __PUNCT__ we go to focu on prevent __PUNCT__ on well __PUNCT__ not just sick __PUNCT__
under my reform __PUNCT__ all american will have access to comprehens prevent care __PUNCT__ which will save monei in the long run __PUNCT__
todai __PUNCT__ we pai doctor and hospit to treat diseas and injuri __PUNCT__ but not to help prevent them from occur in the first place __PUNCT__
onli __NUM__ percent of adult receiv recommend colorect screen __PUNCT__ and roughli __NUM__ percent of children do not receiv recommend immun __PUNCT__
in fact __PUNCT__ our countri spend onli an estim __NUM__ to __NUM__ percent of nation health expenditur on prevent health care servic and health promot per year __PUNCT__
that is about the same percentag we spent in the 1920 __PUNCT__
for exampl we have mani more adult and young peopl be diagnos with type __NUM__ diabet __PUNCT__
while __PUNCT__ the cost of care for them ar increas exponenti __PUNCT__ mani insur compani won't pai for someon who pre __PUNCT__ diabet or who been diagnos with diabet to go to a nutritionist to learn how to eat properli __PUNCT__ to get prevent medicin or to go to a podiatrist to have their feet check __PUNCT__
but the compani will pai if you have to have your foot amput __PUNCT__
the insur compani will actual tell you thei don't want to pai for prevent health care becaus the patient might chang insur compani __PUNCT__ and the origin compani won't get the benefit of the monei thei invest __PUNCT__
but if a patient doctor tell them that a foot need to be amput __PUNCT__ well the compani is kind of stuck with that __PUNCT__
talk about a system that is upsid down and backward __PUNCT__
we clearli need a new approach __PUNCT__
we know we can save monei if we give insur compani incent to cover prevent care and well servic __PUNCT__ and my plan will do exactli that __PUNCT__
keep peopl healthi todai will not onli keep our cost down in the futur __PUNCT__ but improv qualiti of life as well __PUNCT__
we know that prevent care work __PUNCT__
i could cite thousand of exampl __PUNCT__ but just consid the follow __PUNCT__ the incid of diabet wa __NUM__ percent lower among adult with elev blood sugar were enrol in a lifestyl intervent program than the control group that wa onli given drug __PUNCT__
among those ag __NUM__ and older the reduct wa __NUM__ percent __PUNCT__
and some of the research that wa done lead to these outcom wa right here at gw __PUNCT__
or look at what the privat sector ha tri to do __PUNCT__
safewai ha made a consciou decis to focu on prevent __PUNCT__
it pai __NUM__ __PUNCT__ of all appropri prevent care servic __PUNCT__ and it offer a __NUM__ __PUNCT__ hour hotlin staf by regist nurs __PUNCT__ and provid servic to help peopl manag chronic condit and incent design to promot healthier lifestyl __PUNCT__
again __PUNCT__ the result speak for themselv __PUNCT__
while averag cost went up __NUM__ __PUNCT__ across the countri __PUNCT__
safewai it health care cost will be flat __PUNCT__
and thei aren't the except __PUNCT__ motorola well initi show save of almost __MONEY__ per everi dollar invest __PUNCT__
under my plan __PUNCT__ all insur who ar alreadi particip in a feder health program like medicar or medicaid or the feder employe health benefit plan will have to cover prevent as a condit of do busi with the feder govern __PUNCT__
insur would encourag both individu and provid to us prevent servic by pai for benefit like cancer screen and immun __PUNCT__
my plan also pool and coordin feder spend on prevent to help redeploi high __PUNCT__ prioriti prevent servic __PUNCT__
work in collabor with the privat sector __PUNCT__ thi initi would pai for prevent care initi in school __PUNCT__ workplac __PUNCT__ supermarket __PUNCT__ church __PUNCT__ commun __PUNCT__
it would fund and train new health prevent outreach worker __PUNCT__ who understood the languag __PUNCT__ understood the cultur of variou constitu around our countri __PUNCT__
now __PUNCT__ we still have so mani peopl __PUNCT__ and i sure you see it in the hospit __PUNCT__ who come in unabl to speak english __PUNCT__ often time bring a child to interpret __PUNCT__
and we just not do a good enough job in get inform broadli avail to peopl who need it __PUNCT__
now __PUNCT__ of cours __PUNCT__ you can have the best insur plan in the world __PUNCT__ but if you don't take the medicin your doctor prescrib __PUNCT__ or follow lifestyl advic your doctor recommend __PUNCT__ you aren't go to improv your health __PUNCT__
if we go to reduc cost through prevent __PUNCT__ all of us all must take respons for take better care of ourselv and i will have more to sai about that later __PUNCT__
the second wai to bring cost under control is to bring our health care system record keep into the __NUM__ centuri __PUNCT__ final leav behind paper record and outdat __PUNCT__ obsolet __PUNCT__ __NUM__ centuri inform technolog __PUNCT__
right now __PUNCT__ if you rush to a hospit with a medic emerg __PUNCT__ thei mai not be abl to access your medic histori or to find out what medic you take __PUNCT__ what surgeri you had __PUNCT__ or even what your blood type is __PUNCT__
electron medic record would chang that __PUNCT__
thi is also import in the event of catastroph __PUNCT__
after katrina __PUNCT__ medic record were under water __PUNCT__ never to be recov __PUNCT__
a lot of peopl who were take prescript drug who fled their home or were rescu didn't even know the name of the drug thei were take __PUNCT__
onli __PUNCT__ those who had been bui drug from drug store that had electron medic record could immedi access to find out what the drug wa and what the prescript should be __PUNCT__
modern our system will improv qualiti of care and reduc cost __PUNCT__
todai __PUNCT__ process paper claim cost an averag of __MONEY__ to __MONEY__ per claim __PUNCT__
it cost __NUM__ cent for an electron claim __PUNCT__
a rand studi found that __PUNCT__ as a nation __PUNCT__ we could save more than __MONEY__ billion annual through the widespread us of electron medic record __PUNCT__ and these save could doubl with the addit of prevent and chronic diseas manag __PUNCT__
if the us of inform technolog impact our health care system as much as it ha impact other sector of the economi __PUNCT__ like for exampl __PUNCT__ the wholesal and retail industri __PUNCT__ we could see save as high as __MONEY__ billion annual or over __NUM__ __PUNCT__ of health care spend __PUNCT__
there is no reason why peopl health file __PUNCT__ their test result __PUNCT__ lab record __PUNCT__ x __PUNCT__ rai __PUNCT__ can't be store secur and confidenti on a comput file access from a doctor offic or hospit __PUNCT__
in fact __PUNCT__ if all hospit us a computer physician order entri system __PUNCT__ an estim __NUM__ fewer advers drug event would occur __PUNCT__ save roughli __MONEY__ billion per year __PUNCT__
we can also us inform technolog to dissemin research __PUNCT__
a govern studi recent show it take __NUM__ year from the time of a new medic discoveri to the time clinician actual incorpor that discoveri into their practic at the bedsid __PUNCT__
why not __NUM__ second __PUNCT__ the moment we know the discoveri improv care __PUNCT__ the veteran medic system provid a perfect exampl of a fulli autom health inform system that support the need of patient __PUNCT__ clinician __PUNCT__ and administr __PUNCT__
it computer patient record system __PUNCT__ cpr __PUNCT__ contain everi detail of a patient health record __PUNCT__ includ laboratori test result __PUNCT__ medic imag __PUNCT__ bar code medic administr __PUNCT__ progress note __PUNCT__ and appoint __PUNCT__ all access from anywher within the va system __PUNCT__
the va start modern it program in __NUM__ us health it as well as other care manag techniqu __PUNCT__
and it deliv some of the best qualiti health care in the unit state with amaz effici __PUNCT__
between __NUM__ and __NUM__ the number of patient enrol in the va system increas by __NUM__ percent __PUNCT__ yet fund __PUNCT__ not adjust for inflat __PUNCT__ increas by onli __NUM__ percent __PUNCT__
so the va ha not onli ha becom on of the health care industri best qualiti perform __PUNCT__ it ha done so while spend less and less on each patient __PUNCT__
health care spend per capita averag __PUNCT__ as i said __PUNCT__ over __MONEY__ in the u. __PUNCT__ at the va __PUNCT__ howev __PUNCT__ the per __PUNCT__ patient cost is __MONEY__ and __NUM__ __PUNCT__ lower than the nation averag __PUNCT__ even though the averag ag of a va patient is __NUM__ __PUNCT__
last year i wa at the hospit here at gw announc legisl that ha sinc pass the senat that promot the us of inform technolog so we can end the paper chase __PUNCT__ limit medic error and reduc the number of malpractic suit __PUNCT__
it would allow us to us it to develop a nationwid __PUNCT__ interoper system __PUNCT__ to streamlin our healthcar cost __PUNCT__ and __PUNCT__ i believ __PUNCT__ reduc error as well __PUNCT__
now __PUNCT__ i proud of my legisl __PUNCT__ we didn't get it pass in the hous last year __PUNCT__ we go to try again thi year __PUNCT__
but if we don't get it pass __PUNCT__ i will have it as on of my highest prioriti as presid __PUNCT__
i go to build on that legisl by requir health provid that particip in feder program __PUNCT__ which is nearli all of them __PUNCT__ to adopt privat __PUNCT__ secur __PUNCT__ and interoper technolog __PUNCT__
and to help hospit and doctor modern their system and promot the widespread adopt of health it __PUNCT__ i would invest __MONEY__ billion a year in grant to help ramp up the system __PUNCT__
no more yellow paper record __PUNCT__ no more try to deciph messi handwrit __PUNCT__
third __PUNCT__ we final go to coordin and streamlin the care our chronic ill patient receiv __PUNCT__
american with chronic diseas such as heart diseas and diabet account for an astonish percentag __PUNCT__
when i first saw thi __PUNCT__ i couldn't believ it __PUNCT__ that it wa __NUM__ percent of our nation health care expenditur __PUNCT__
and improv the qualiti of their care will help limit cost __PUNCT__ and improv health __PUNCT__
to that end __PUNCT__ i propos establish medic __PUNCT__ home __PUNCT__ similar to those oper right now in oregon __PUNCT__
dr __PUNCT__ david dorra __PUNCT__ a primari care physician __PUNCT__ spoke at the senat ag committe __PUNCT__ on which i serv __PUNCT__ two week ago about the success of these medic home __PUNCT__
he told the stori of a patient __PUNCT__ ms __PUNCT__ viera __PUNCT__ a __NUM__ year __PUNCT__ old woman in oregon who suffer from five chronic ill __PUNCT__ includ diabet __PUNCT__ high blood pressur __PUNCT__ and mild congest heart failur __PUNCT__
she also had difficulti rememb what bill to pai and what pill to take __PUNCT__
now __PUNCT__ in most clinic across thi countri __PUNCT__ ms __PUNCT__ viera would receiv care from qualifi __PUNCT__ capabl doctor and nurs __PUNCT__
but her care would like not be coordin __PUNCT__ her provid wouldn't be talk to each other __PUNCT__ make sure that the treatment thei were prescrib were work togeth __PUNCT__
thi end up rais cost and increas the chanc that she will suffer complic or end up back in the hospit __PUNCT__
anyon who ha ever tri to coordin their own care __PUNCT__ or the care of a love on __PUNCT__ know that thi is all too common situat __PUNCT__
fortun __PUNCT__ her care wa address comprehens through care manag plu in oregon __PUNCT__ an it system with train care manag in primari care clinic to treat older adult with complic condit __PUNCT__
she is in good hand __PUNCT__
her care manag and her primari care physician address her symptom earli __PUNCT__ prevent problem rather than treat them after thei occur __PUNCT__
and she is help to navig the system __PUNCT__
under thi program __PUNCT__ senior with complex diabet have had a __NUM__ percent reduct in mortal __PUNCT__ a __NUM__ percent reduct in expens hospit __PUNCT__ and up to __NUM__ percent improv in control of their diseas __PUNCT__
everi patient should have access to a system with outcom like that __PUNCT__
that why my propos would requir that american with costli __PUNCT__ hard to manag ill have access to state __PUNCT__ of __PUNCT__ the __PUNCT__ art chronic care coordin model under feder __PUNCT__ fund plan __PUNCT__ like medicar and the feder employe health benefit __PUNCT__ fehbp __PUNCT__ plan __PUNCT__
thi propos would permit multi __PUNCT__ specialti clinic __PUNCT__ gw __PUNCT__ mayo clinic __PUNCT__ john hopkin __PUNCT__ partner healthcar __PUNCT__ provid __PUNCT__ sponsor organ and privat plan to bid on and provid servic such as care coordin amongst and between provid __PUNCT__ drug manag __PUNCT__ diet and exercis control and the promot of individu patient respons __PUNCT__
we know that thi coordin care model would result in signific cost save __PUNCT__
a recent rand studi conclud that chronic diseas manag __PUNCT__ preced by prevent and back by inform technolog __PUNCT__ could save __MONEY__ billion annual __PUNCT__
anoth studi found thi model could reduc the cost of diabet care alon by __NUM__ percent __PUNCT__ save us __MONEY__ billion dollar __PUNCT__
fourth __PUNCT__ my plan will offer will offer individu and small busi market access to larger insur pool that will lower cost and end insur compani discrimin against peopl with pre __PUNCT__ exist condit __PUNCT__
as part of a plan for univers coverag __PUNCT__ which i will discuss in detail in the come month __PUNCT__ we would creat larg insur pool that lower administr cost for small busi and individu by spread the risk __PUNCT__
in a system of univers coverag insur compani cannot as easili shift cost through cherri pick and other mean __PUNCT__
in fact __PUNCT__ accord to a recent mckinsei report __PUNCT__ insur compani in america spend ten of billion a year figur out how not to cover peopl __PUNCT__ do complic calcul to figur out how to cherri pick the healthiest person __PUNCT__ and leav everyon els out in the cold __PUNCT__
that is how thei profit __PUNCT__ by avoid insur patient who will be __PUNCT__ expens __PUNCT__ and then try to avoid pai up onc the insur patient actual need treatment __PUNCT__
i see thi all the time __PUNCT__
my offic spend countless hour argu with insur compani to get my constitu the health care thei have paid for __PUNCT__
for exampl __PUNCT__ a father call me from northern new york __PUNCT__ hi son had a rare ill __PUNCT__
now he and hi son were well insur __PUNCT__
he work for mani year for the same employ who provid a good polici __PUNCT__
but when hi son need a special oper __PUNCT__ that could onli be perform at on place in the countri __PUNCT__ the insur compani said __PUNCT__ sorri __PUNCT__ that out of network __PUNCT__ we not go to send you to have that done __PUNCT__
so my offic interven __PUNCT__
and in the end thei got permiss for the oper __PUNCT__
but i don't think peopl should have to go to their unit state senat to get their insur compani to give them what thei paid for __PUNCT__
as presid __PUNCT__ i will end the practic of insur compani cherri __PUNCT__ pick onc and for all by allow anyon who want to join a plan to do so and prohibit insur compani from carv out benefit or charg higher rate to peopl with health problem __PUNCT__
i also will call for rate reform to ensur that older and other vulner popul ar not discrimin against __PUNCT__
the whole point of insur __PUNCT__ lest we forget __PUNCT__ is to spread risk across a group of enrolle __PUNCT__
it on of the reason that the administr cost of medicar ar so much lower __PUNCT__ becaus thei ar actual insur everyon __PUNCT__
everyon is in the pool __PUNCT__ and we have to figur out how to better control the cost within medicar but thei start with an advantag becaus thei have such a consider lower administr cost __PUNCT__
final __PUNCT__ insur would be requir to prove thei were spend much less on market and scheme to avoid provid insur to high __PUNCT__ risk american __PUNCT__ and more on direct care __PUNCT__ give __PUNCT__
now most busi and some state have becom tough purchas of health insur __PUNCT__ insist on fair market and crack down on high overhead __PUNCT__
we should follow their lead __PUNCT__
on of the thing i advoc now for __NUM__ year is a common vocabulari and a common form that everi insur compani must us __PUNCT__
thi sound like a pretti common __PUNCT__ sens idea __PUNCT__ so you can actual compar and contrast what you pai for __PUNCT__ but when i propos in back in __PUNCT__ __NUM__ and __PUNCT__ __NUM__ it wa __PUNCT__ shall we sai __PUNCT__ vigor object to __PUNCT__
becaus we need more transpar and we need that common vocabulari in order to get cost down __PUNCT__ and that opposit of what the insur want to happen __PUNCT__
by insur all american through account public and privat plan __PUNCT__ we can get rid of administr cost that do noth but add to insur compani __PUNCT__ bottom line __PUNCT__
in such a reform system __PUNCT__ risk would be wide spread and we could reduc administr cost by as much as __MONEY__ to __NUM__ billion a year __PUNCT__
fifth __PUNCT__ i will work to improv the qualiti of care which will also help us drive down cost __PUNCT__
i start by establish an independ public __PUNCT__ privat best practic institut __PUNCT__
thi institut would be a partnership among the public and the privat sector __PUNCT__ to financ compar effect research __PUNCT__ so that doctor __PUNCT__ nurs and other health profession __PUNCT__ as well as consum and busi __PUNCT__ would know what drug __PUNCT__ devic __PUNCT__ surgeri and treatment work best __PUNCT__
thi would reduc the us of ineffici and ineffect treatment __PUNCT__ and i believ that it would have tremend benefit becaus we could get evid __PUNCT__ base medicin into the bloodstream of the countri much more effect __PUNCT__
i spearhead a similar propos to author the agenc for healthcar research and qualiti to start do research on compar effect at the depart of health and human servic __PUNCT__
eight report have been releas and dozen more ar underwai __PUNCT__
on of the thing thei find is a lot of these so __PUNCT__ call __PUNCT__ blockbust drug __PUNCT__ ar no more effect __PUNCT__ and sometim less effect __PUNCT__ in treat condit than old standbi that have been around for a long time __PUNCT__ and don't have all the advertis of __PUNCT__ you know __PUNCT__ peopl run through field of wildflow that convinc patient that thei need the new drug __PUNCT__ as oppos to the on that ha work well __PUNCT__
too often __PUNCT__ doctor and patient don't know which medic intervent ar most effect __PUNCT__ and which have littl benefit __PUNCT__
a recent studi by dartmouth research show that close to on third of the __MONEY__ trillion we spend goe to care that is duplic and fail to improv patient health __PUNCT__ in fact __PUNCT__ the research posit that it mai even make health wors __PUNCT__
more care is not necessarili better care __PUNCT__ and ineffici care mai do more harm than good __PUNCT__
my plan will provid incent to encourag doctor to keep up with the research and prescrib the most effect treatment __PUNCT__
the univers of michigan and pitnei bow ar do just that __PUNCT__ link out of pocket drug cost to clinic benefit for patient __PUNCT__
the more effect the medic __PUNCT__ the less that patient ha to pai for the drug __PUNCT__
as of __NUM__ pitnei bow had save more than __MONEY__ million dollar us thi method __PUNCT__
anoth innov idea is the geising health system suggest of a medic warranti __PUNCT__ it charg a flat fee for surgeri that includ __NUM__ dai of follow __PUNCT__ up treatment __PUNCT__
current __PUNCT__ there is littl incent to seek out the most effect treatment __PUNCT__ becaus if a treatment regimen or surgeri doesn't work __PUNCT__ the patient simpli return for more costli treatment __PUNCT__
the warranti is an incent to do it right the first time __PUNCT__ becaus there is no extra bill if more care is need __PUNCT__
geising doctor have identifi __NUM__ essenti step to bypass surgeri __PUNCT__ and thei establish procedur to ensur thei alwai follow __PUNCT__
the best practic institut will empow with inform and evid those who have to make the decis __PUNCT__
it will not onli be benefici with respect to pharmaceut but also medic devic and even practic protocol and i think that it will give a lot of doctor ammunit against insur compani __PUNCT__ drug compani and even sometim patient about what work better than other option __PUNCT__
the oregon drug effect review found by governor john kitzhab in __NUM__ is a collabor partnership between state and non __PUNCT__ profit that conduct review of wide us drug to promot the most effect on __PUNCT__
north carolina ha us such review to educ provid __PUNCT__ save the state an estim __MONEY__ million in __NUM__ alon __PUNCT__
now i can't extrapol how much we would save as a nation __PUNCT__ but i believ it would obvious be in the billion __PUNCT__
sixth __PUNCT__ if we want to get health care cost under control __PUNCT__ we need to get prescript drug cost under control __PUNCT__
we know that american pai the highest price in the world for prescript drug that we have alreadi in most instanc fund the research on fund the clinic trial on __PUNCT__ done the fda evalu of __PUNCT__ then we put it into the market place and we end up still pai the highest price __PUNCT__
studi have shown that brand drug price ar __NUM__ to __NUM__ percent higher in the u. __PUNCT__ and top __PUNCT__ sell medic a full __NUM__ time more expens compar to other industri countri __PUNCT__
over the past decad __PUNCT__ prescript drug account for __NUM__ percent of the total increas in health spend __PUNCT__ even though thei account for onli about __NUM__ percent of what other countri spend __PUNCT__
let start get drug cost under control by allow medicar to negoti for lower drug price and to lower those cost for everyon __PUNCT__
we also have to crack down on the overpay in medicar to privat plan __PUNCT__
these privat plan payment rate ar around __NUM__ percent higher than medicar tradition pai to treat the same beneficiari __PUNCT__
reduc these overpay could save medicar __MONEY__ to __MONEY__ billion dollar a year __PUNCT__
senior don't want to lose the benefit thei have under these plan __PUNCT__ but under my reform thei would not __PUNCT__
we should also allow the import of drug from certain countri to lower cost and let remov barrier to gener competit __PUNCT__
while __NUM__ percent of all prescript ar gener medicin __PUNCT__ thei account for onli __NUM__ percent of total pharmaceut cost __PUNCT__
a on percent increas in the us of gener could yield __MONEY__ billion dollar in govern save __PUNCT__
we need to break the monopoli that biotech pharmaceut compani have over their product __PUNCT__ which can cost us so much monei __PUNCT__
most american have no idea that right now __PUNCT__ under current law and fda practic __PUNCT__ gener biopharmaceut ar preclud from go to the market __PUNCT__
and busi and consum ar pai for that __PUNCT__
you know the cost differenti between gener and non __PUNCT__ gener drug is astound __PUNCT__ in __NUM__ the averag cost for a on __PUNCT__ dai suppli of non __PUNCT__ gener drug wa __MONEY__ but onli __MONEY__ for gener drug __PUNCT__
there is bipartisan support for provid the long overdu author for the fda to approv gener product that ar the biolog __PUNCT__
alreadi __PUNCT__ an unpreced coalit of patient __PUNCT__ group __PUNCT__ labor __PUNCT__ busi __PUNCT__ pharmacist __PUNCT__ governor and a number of forward look biotech compani have unit to support legisl that i introduc with senat charl schumer and congressman henri waxman __PUNCT__
provid such competit is project to save __MONEY__ to __MONEY__ billion dollar a year in save to busi and consum __PUNCT__
the final point that i would make todai about lower cost is to reduc cost through medic malpractic reform __PUNCT__
while some have overst the role that malpractic insur plai in the health care crisi __PUNCT__ i think we can all agre that we need reform that work for doctor and patient alik __PUNCT__
i have offer on solut that ha been us successfulli at the univers of michigan hospit system __PUNCT__
it call the nation medic error disclosur and compens __PUNCT__ medic __PUNCT__ act as i have borrow it from the univers of michigan to put it into law __PUNCT__
it a novel approach to improv patient safeti and the qualiti of health care while protect patient __PUNCT__ right __PUNCT__ reduc medic error and lower malpractic cost __PUNCT__
thi act would encourag physician __PUNCT__ hospit and health system to provid liabil protect for physician who disclos medic error to patient and offer to enter into negoti for fair compens __PUNCT__
at the univers of michigan __PUNCT__ these polici have alreadi result in greater patient trust and satisfact __PUNCT__ more patient be compens for injuri __PUNCT__ fewer malpractic suit __PUNCT__ significantli reduc administr cost and between on and three million dollar in litig cost save __PUNCT__
the rise in malpractic rate ha spur state like texa and nevada to allow doctor to creat their own risk retent compani as an altern to tradit liabil insur __PUNCT__
becaus a larg percentag of actual malpractic is commit by a veri small percentag of doctor who won't be includ in insur group that other doctor control __PUNCT__ therebi lower malpractic rate for all __PUNCT__
now as i have made clear in these seven point __PUNCT__ we know that if we continu on our present path __PUNCT__ health care cost in the u. __PUNCT__ will doubl within a decad __PUNCT__ we know that we will spend increas amount and we aren't sure __PUNCT__ and i think it is fair to sai we know __PUNCT__ that we won't improv qualiti and outcom __PUNCT__
now how will thi actual work __PUNCT__ well it ha to be implement over time accord again to rand who ha been studi healthcar cost intens now for sever year __PUNCT__
we could save __MONEY__ billion dollar from the inform technolog chang i have recommend __PUNCT__ __MONEY__ to __MONEY__ billion dollar in administr save everi year __PUNCT__ __MONEY__ billion in save from overpay for pharmaceut and health plan __PUNCT__ and there ar billion more in countless other ineffici that could be rung out of our often wast health care system __PUNCT__
we also will have to move toward a system where it is doctor __PUNCT__ patient center and consum driven if we expect to realli get the result that we need __PUNCT__
now there is no question that at least __MONEY__ billion dollar in project save that i have includ in my plan ar not onli reason __PUNCT__ but extrem conserv __PUNCT__
now i know that a lot of thi is kind of overli wonki __PUNCT__ which is why i am glad there is an audienc of peopl here todai who realli understand a lot of these issu __PUNCT__ but i imagin __PUNCT__ you know __PUNCT__ mani peopl wonder what all thi add up to __PUNCT__
well the busi roundtabl ha recent estim that just with a system that us inform technolog __PUNCT__ the typic famili would save __MONEY__ dollar __PUNCT__ and i think that is a pretti impress outcom for us do what we need to be do anywai __PUNCT__
the monei we save from the wast we elimin and the wai we chang how we care for peopl should be us to help financ coverag for the __NUM__ million american who have no insur __PUNCT__
also __PUNCT__ when you insur everyon __PUNCT__ it will maxim the impact of the prevent program i have recommend __PUNCT__ with earlier care as oppos to emerg care __PUNCT__ as well as cut administr cost __PUNCT__
our present system is outdat __PUNCT__ ineffect __PUNCT__ and unsustain __PUNCT__
we know how to do thi __PUNCT__
mani of you in thi audienc could give me ten more suggest that we need to do immedi __PUNCT__
well the kei is to develop the polit will to make it happen through a coalit of those who ar most directli affect __PUNCT__
the peopl who deliv care __PUNCT__ our doctor __PUNCT__ our nurs our pharmacist and other __PUNCT__ the peopl who pai for care __PUNCT__ our busi and our govern and the peopl who receiv care which is all the rest of us __PUNCT__ becaus i know veri well that everi on of these recommend will run into consider opposit from forc that do not want chang in our system __PUNCT__
so i believ that equal importantli to have a plan __PUNCT__ we have to have a polit consensu and that is what i am try to develop as i talk about healthcar and engag in a convers with the american peopl becaus i think american ar readi for chang __PUNCT__
thei ar readi for a healthcar system that produc better result at lower cost and end the shame of us not cover __NUM__ million plu of our fellow american __PUNCT__
i look forward to your idea about how we can pursu these goal and i hope you will join with me in be part of thi broad base __PUNCT__ nation coalit that will not onli talk about and demand chang __PUNCT__ but work to make sure __PUNCT__ start in __NUM__ that our polit system actual deliv the chang we all know our healthcar system desper need __PUNCT__
thank you all veri much __PUNCT__
