[Congressional Record Volume 153, Number 8 (Tuesday, January 16, 2007)]
[Senate]
[Pages S530-S533]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. WYDEN. Mr. President, for almost 13 years, it has been considered 
politically dangerous to come to the floor of the Senate and describe a 
fresh approach to fixing health care in America. I am going to do that 
this morning because I do not believe it is morally right for the 
Senate to duck on health care any longer.
  During the Senate's long absence, the skyrocketing costs of health 
care have hit American communities like a wrecking ball. 
PricewaterhouseCoopers estimates that health care premiums will rise 11 
percent this year, several times the rate of inflation. In America, 
with the world's best doctors, nurses, hospitals, and other providers, 
many with health coverage believe they are just one more rate hike away 
from losing the coverage they have, and more than 40 million Americans 
have little or no coverage at all.
  Just about all of us are baffled about how to purchase the health 
care that is best for us. In fact, it is easier to get information 
about the cost and quality of washing machines than it is to get 
information about health care that can mean life or death. I believe 
the combination of cost hikes, increases in chronic illness, our aging 
society, and the disadvantage American employers face in global 
markets, where their competitors spend little or nothing for health, 
means our current health system cannot be sustained.
  Since health care has been poked and prodded for so many years, I 
believe it is time for diagnosis and treatment. As usual, it makes 
sense to start with a look at the financial bottom line. Go there, and 
it sure looks as if we Americans are spending enough money on medical 
care. 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?
  My conclusion, after reviewing the numbers and expenditures for 
health care: America is spending enough money on medical services; it 
is just not spending the money in the right places.
  While the Senate has taken a pass on fixing health care and 
redirecting misspent health dollars, several State leaders have stepped 
forward. In my view, Arnold Schwarzenegger and Mitt Romney deserve 
substantial credit just for trying to lead on health care. I will 
discuss in a minute why I do not agree with their decision to continue 
the link between health insurance and employment, but Governors 
Schwarzenegger and Romney deserve America's thanks for making it clear 
that they will not sit quietly by while Washington, DC, slow-walks 
health care.
  As a member of the Senate Finance Committee, I intend to help State 
officials obtain the special waivers in Federal health programs they 
need to make Federal dollars in their States stretch further for health 
care. Having already stated that I believe enough money is being spent 
on medical services, I am especially interested in helping the States 
make better use of their existing funds. As a result of the new 
initiatives in California, Massachusetts, and other States, some in the 
Congress believe the next few years should be spent watching how the 
States fare in their efforts. Meaning well, these Congress people 
believe our role in the Congress should primarily be to ship more 
Federal money to the States for their reforms and then pretty much call 
it a day. Respectfully, I disagree. I believe there is no possible way 
the States can fix health care because the States did not create the 
major problems in American health care. Who did? The Federal 
Government, the big spender of health dollars in America, the architect 
of the policies now driving American health care toward implosion.

  Here is how it happened. More than 60 years ago, with wage and price 
controls in effect, our employers found that they could get good 
workers by giving them health care benefits. Employer-based health 
coverage was born and 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. Soon most workers 
came to get their health coverage through their employer. It became the 
norm for talented workers to quickly ask prospective employers: Say, 
tell me about your health package.
  Today, these Federal tax breaks total more than $200 billion 
annually. The cost, however, involves more than dollars. These tax 
breaks go disproportionately to the wealthiest in America and subsidize 
inefficiency to boot. A high-flying CEO at a major corporation can 
write off the cost of Cadillac health coverage or even getting a 
designer smile for his face, while the folks at the corner hardware 
store lack company health coverage and get nothing. With employer-
sponsored health coverage, an individual worker is largely in the dark 
about whether they have been overcharged for health care, and the Tax 
Code allows for a writeoff for wasteful spending. These Federal tax 
policies that reward regressive practices and inefficient health 
spending are taking a large and growing toll.
  For example, an increasing number of the uninsured work at small 
businesses, like the hardware store that fares so poorly under the 
Federal Tax Code. Because these small businesses cannot afford health 
care for their workers, these workers often ignore their illnesses 
until they can bear it no longer. Their next stop--the hospital 
emergency room, where the medical bills generated by the uninsured are 
often passed on to the insured and to taxpayers.
  My next picture shows where we are headed with the employer-based 
health coverage. In an era where such cost shifting is widespread and 
some companies spend almost as much on health care as they make in 
profit, employer-based health coverage is melting away similar to this 
popsicle on the summer sidewalk in August.
  If PricewaterhouseCoopers is right and health premiums rise another 
11 percent this year, those with employer-based coverage will face 
another round of big copayments for their health care, more 
deductibles, and additional benefit reduction this year. Their choice 
is likely to be worse coverage or no coverage.
  Recently, a woman in her fifties came to one of my town hall meetings 
in Oregon and said:

       I just hope my employer can keep offering health benefits 
     and I can hang in there until I get Medicare.

  I believe this Senate ought to act when hard-working Americans go to 
bed at night worried about the prospect of losing their health coverage 
when they get up in the morning. Now, you could argue that 60 years ago 
employer-based health coverage made sense. That was before U.S. 
employers faced determined global competition, U.S. workers changed 
jobs seven or eight times by the age of 35, and American society became 
more mobile. It surely doesn't make sense today.
  I believe you cannot fix American health care without changing our 
system of employer-based health coverage and the Federal tax breaks 
that lubricate it. I believe you cannot fix American health care 
without changing the incentives that drive our choices and our 
behavior. Not a State in the Union has the power to bring this about. 
We in the Senate do.
  In a few days, after some additional consultation with colleagues, I 
will introduce legislation that offers a fresh and different approach 
to fixing health care in America. I call the legislation the Healthy 
Americans Act, and it is based on four judgments about health care I 
have made.

[[Page S531]]

  First, Democrats have been correct in saying that to fix health care 
everybody must be covered. This concept, of course, is known as 
universal coverage. Republicans, in my view, have been correct in 
saying there must be more personal responsibility and personal 
involvement in making health care choices than there is today.
  Second, there is a model for fixing health care that every single 
Senator--every Member of Congress--knows something about. It is the 
system that serves Members of Congress and their families, offering the 
Members of this body high-quality, affordable, private health coverage 
with lots of choice.
  Third, America doesn't have health care at all; it has sick care. For 
example, Medicare Part A will write checks for thousands of dollars so 
that a senior can be treated in the hospital after they have had a 
heart attack or a stroke. Medicare Part B--the part of the program that 
covers outpatient services--provides no incentives for changing the 
behavior that led to the chronic illness and landed the senior citizen 
in the hospital. Certainly, it is clear that preventing disease, not 
just treating disease, must be a bigger part of America's health care 
future.
  Fourth, in my view, you cannot fix American health care if you hurt 
the middle class who have coverage in order to help those who do not. 
To fix American health care, you must prove that all Americans have the 
opportunity to get ahead, starting with their first paycheck under a 
new health care plan--the Healthy Americans Act that I have drafted and 
has been posed at my Web site at wyden.senate.gov. Included at this 
site is a written evaluation of the legislation, done by the Lewin 
Group. The Lewin Group has been called the gold standard of health care 
actuarial data.
  Their evaluation is clear. Under the Healthy Americans Act, all 
Americans can be guaranteed a lifetime of private health coverage, at 
least as good as their Member of Congress receives, for no more than 
our country spends on health care today. In addition, fixing American 
health care can be done more quickly than imagined--within 2 years 
after a reform law is passed--and produce more than $4 billion in 
savings in the first year, while expanding coverage.
  The next chart is especially important because it shows that the 
Healthy Americans Act will slow the rate of growth in health care 
spending by almost $1.5 trillion over the next 10 years. The 
distinguished Presiding Officer is an expert in foreign affairs and our 
policy with Iraq. I am sure that as he looks at the chart, he can see 
that, according to the Lewin Group, the amount of money that would be 
saved in slowing the rate of growth in health care spending is several 
times--threefold--the amount of money our country has spent on the war 
in Iraq.
  Mr. President, it doesn't take long to explain how the Healthy 
Americans Act works. It starts by going where Arnold Schwarzenegger and 
Mitt Romney would not. It cuts the link between health insurance and 
employment altogether. Under the Healthy Americans Act, businesses 
paying for employee health premiums are required to increase their 
workers' paychecks by the amount they spent last year on their health 
coverage. Federal tax law is changed to hold the worker harmless for 
the extra compensation, and the worker is required to purchase private 
coverage through an exchange in their State that forces insurance 
companies to offer simplified, standardized coverage, and prohibits 
them from engaging in price discrimination.
  Now, requiring employers to cash out their health premiums, as I 
propose in the Healthy Americans Act, is good for both employers and 
workers. With health premiums going up 11 percent this year, employers 
are going to be glad to be exempt from these increases. With the extra 
money in their paycheck, workers have a new incentive to shop for their 
health care and hold down their cost. If a worker in Virginia can save 
a few hundred dollars on their health care purchase, they can use that 
money so that one of the constituents of the Presiding Officer can be 
on their way to Oregon to get in some sensational fishing.
  In addition, the Healthy Americans Act is easy to administer and 
guarantees lifetime health security. Once you have signed up with a 
plan through an exchange in the State in which you live, that is it; 
you have completed the administrative process. Even if you lose your 
job or you go bankrupt, you can never have your coverage taken away. 
Sign up, and the premium you pay for the plan and all of the 
administrative activities are handled through the tax system. For those 
who cannot afford private coverage, the Healthy Americans Act 
subsidizes their purchases.
  Businesses that have not been able to afford health coverage for 
their workers, under the new approach, will pay a fee--one that is 
tiered to their size and revenue, with some paying as little as 2 
percent of the national average premium amount per worker for that 
basic benefit package. Mike Roach, the owner of the 8-person Paloma 
clothing firm in Portland, OR, is a 30-year member of the National 
Federation of Independent Businesses, and he was instrumental in 
ensuring that this legislation was small business friendly every step 
of the way.
  Mr. President, that is pretty much it, in terms of how the Healthy 
Americans Act actually works. It will be easy to administer, locally 
controlled, with guaranteed coverage as good as your Member of Congress 
gets; and on top of it, there is a model for delivering it that the 
distinguished Presiding Officer and everybody else in this body knows 
about. Page 12 of the Lewin report on my Web site shows how the Healthy 
Americans Act expands coverage for millions of people, guaranteeing 
health benefits as good as their Member of Congress gets, while saving 
$4.5 billion in health spending in the first year. Money is saved by 
reducing the administrative costs of insurance, reducing cost shifting, 
and preventing those needless hospital emergency room visits. Also, 
there are substantial incentives that come about because insurance 
companies would have to compete for the business of consumers, who 
would have a new incentive to hold down health costs, which I have 
already described as the Virginian's opportunity to go fishing in 
Oregon.
  There are other parts of the Healthy Americans Act I wish to describe 
briefly.
  As the name of the legislation suggests, I believe strongly that 
fixing American health care requires a new ethic of health care 
prevention, a sharp new focus in keeping our citizens well, and trying 
to keep them from falling victim to skyrocketing rates of increase in 
diabetes, heart attack, and strokes.
  Spending on these chronic illnesses is soaring, and it is especially 
sad to see so many children and seniors fall victim to these diseases. 
Yet, many Government programs and private insurance devote most of 
their attention to treating Americans after they are ill and give short 
shrift to wellness.
  Under the Healthy Americans Act, there will be for the first time 
significant new incentives for all Americans to stay healthy. They are 
voluntary incentives, but ones that I think will make a real difference 
in building a national new ethic of wellness and health care 
prevention.
  Parents who enroll children in wellness programs will be eligible for 
discounts in their own premiums. Instead of mandating that parents take 
youngsters to various health programs--and maybe they do and maybe they 
don't--the Healthy Americans Act says when a parent takes a child to 
one of those wellness programs, the parent would be eligible to get a 
discount on the parent's health premiums.
  Under the Healthy Americans Act, employers who financially support 
health care prevention for their workers get incentives for doing that 
as well. Medicare is authorized to reduce outpatient Part B premiums so 
as to reward seniors trying to reduce their cholesterol, lose weight, 
or decrease the risk of stroke. It has never been done before. For 
example, Part B of Medicare, the outpatient part, doesn't offer any 
incentives for older Americans to change their behavior. Everybody pays 
the same Medicare Part B premium right now. The Healthy Americans Act 
proposes we change that and ensures that if a senior from Virginia or 
Oregon or elsewhere is involved in a wellness program, in health care 
prevention efforts, like smoking cessation, they could get a lower Part 
B premium for doing that.
  The preventive health efforts I have described are promoted through 
new

[[Page S532]]

voluntary incentives under the Healthy Americans Act, not heavy-handed 
mandates. Under the Healthy Americans Act, there is no national nanny 
established under the legislation to watch who is hitting the snack 
food bowl.
  What this legislation says is--let's make it more attractive for 
people to stay healthy, to change their behaviors, to promote the kind 
of wellness practices we all know about but somehow don't seem to find 
time to actually get done in our hectic schedules.
  Finally, and most importantly, the Healthy Americans Act does not 
harm those who have coverage in order to help those who do nothing. The 
legislation makes clear that all Americans retain the right to purchase 
as much health care coverage as they want. All Americans will enjoy 
true health security with the Healthy Americans Act, a lifetime 
guarantee of coverage at least as good as their Member of Congress 
receives.
  Most American families will obtain this coverage with either their 
premiums reduced from what they pay today or for less than a dollar a 
day more. That can all be seen in the Lewin chart as No. 10 at my Web 
site. In addition, all Americans benefit from the reduced 
administrative costs the legislation produces, the insurance reforms, 
and, of course, the new focus on prevention.
  I am now going to explain briefly how care for the poor is handled 
under the Healthy Americans Act and why this is good for both low-
income people and taxpayers. This is especially important in light of a 
recent article in the health policy journal, ``Health Affairs.''
  This article points out that more than half of the Nation's uninsured 
are ineligible for public programs such as Medicaid, but do not have 
the money to purchase coverage for themselves.
  At present, for most poor people to receive health benefits, they 
have to go out and try to squeeze themselves into one of the categories 
that entitles them to care. So what we have, Mr. President, in 
Virginia, in Oregon, and elsewhere, is citizens trying to crunch 
themselves into one of these boxes, one of these categories that might 
make them eligible for health care in Virginia or Oregon.
  As former Oregon Gov. John Kitzhaber has noted, there are more than 
20 different categories of Medicaid. Administrating all of this takes 
funds, in my view, that ought to be spent caring for poor folks in 
America.
  Under the Healthy Americans Act, low-income people will receive 
private health coverage, coverage that is as good as a Member of 
Congress gets, automatically. Like everyone else, they will sign up 
through the exchange in their State. When they are working, the 
premiums they owe are withheld from their paycheck. If they lose their 
job, there is an automatic adjustment in their withholding.
  In addition, under the Healthy Americans Act, it will be more 
attractive for doctors and other health care providers to care for the 
poor. Those who are now in underfunded programs, such as Medicaid, are 
going to be able to have private insurance that pays doctors and other 
providers commercial rates which are traditionally higher than Medicaid 
reimbursement rates.
  Because low-income children and the disabled are so vulnerable, if 
Medicaid provides benefits that are not included in the kind of package 
Members of Congress get, then those low-income folks would be entitled 
to get the additional benefits from the Medicaid program in their 
State.
  I am now going to explain how Medicare is strengthened by the Healthy 
Americans Act.
  As the largest Federal health program, Medicare's financial status is 
far more fragile than Social Security. Two-thirds of Medicare spending 
is now devoted to about 5 percent of the elderly population. Those are 
the seniors with chronic illness and the seniors who need compassionate 
end-of-life health care. The Healthy Americans Act strengthens Medicare 
for both seniors and taxpayers in both of these areas.
  In addition to reducing Medicare's outpatient premiums for seniors 
who adopt healthy lifestyles and reduce the prospect of chronic 
illness, primary care reimbursements for doctors and other providers 
get a boost under the Healthy Americans Act. Good primary care for 
seniors also reduces the likelihood of chronic illness that goes 
unmanaged. This reimbursement boost is sure to increase access to care 
for seniors--and I see them all over, in Oregon and elsewhere--who are 
having difficulty finding doctors who will treat them.
  To better meet the needs of seniors suffering from multiple chronic 
illnesses, the Healthy Americans Act promotes better coordination of 
their care by allowing a special management fee to providers who better 
assist seniors with these especially important services.
  Hospice law is changed so that seniors who are terminally ill do not 
have to give up care that allows them to treat their illness in order 
to get hospice. In addition, the Healthy Americans Act empowers all our 
citizens wishing to make their own end-of-life care decisions.
  The legislation requires hospitals and other facilities to give 
patients the choice of stating in writing how they would want their 
doctor and other health care providers to handle various end-of-life 
care decisions.
  The tragic case of the late Terri Schiavo came before the Senate 
before the distinguished Presiding Officer of the Senate had joined 
this body, but I was particularly struck during that debate and 
afterwards how strongly the American people feel about making sure that 
the patient and not Government gets to drive all of the decisions 
surrounding their end-of-life care. Under the Healthy Americans Act, 
that would be the norm rather than the exception.
  In writing this legislation, I spent a lot of time looking back--
looking back literally over 60 years--since Harry Truman tried to fix 
health care in the 81st Congress in 1945. I tried to make sure, 
particularly, that the lessons of 1994 were ones the Senate would pick 
up on and make sure that the same mistakes were not committed again.
  For example, in 1994, the last time this Senate considered fixing 
health care, the principal piece of legislation before the Senate was 
1,369 pages long. The Healthy Americans Act posted at my Web site saves 
a lot of Oregon trees by coming in about 1,200 pages shorter.
  In 1994, getting to universal coverage was, in effect, put before 
securing the savings to responsibly finance an expansion of coverage. 
The Healthy Americans Act, as noted in the Lewin report, generates 
billions of dollars in savings in the first year as the legislation is 
implemented.
  In 1994, the principal method of financing universal coverage was an 
employer mandate. The Healthy Americans Act requires no such employer 
mandate, provides financial relief for employers competing in tough 
global markets, and still ensures that every business takes some 
measure for financing health care in a way that is going to allow those 
businesses to be competitive in tough global markets. In 1994, there 
was never a coalition of employers, union leaders, and patient 
advocates behind a specific piece of legislation. Now, Andy Stern, 
president of the 1.8 million-worker Service Employees International 
Union; Steve Burd, CEO of Safeway with more than 200,000 workers, 
patient advocates representing various points of view, and employers of 
all sizes have joined behind the Healthy Americans Act.

  There is also a moral question I would like the Senate to consider. 
Given what I have just outlined, how can this Senate justify denying 
all Americans health care coverage as good as Members of Congress 
receive? The Lewin report proves it can be done--proves it can be done 
without spending more money than the country spends now and, in fact, 
can be done saving more than $4 billion in the very first year.
  There is a model for putting reforms in place: the system enjoyed by 
all the Senators serving in this body today. Fixing health care under 
the Healthy Americans Act will reduce administrative hassle and expense 
and allow all our citizens finally--finally--to go to bed at night 
without fear of losing essential medical care.
  I want 2007 to be the year when the Senate, as well as the various 
State governments, step up on health care. The States deserve our 
support, but they cannot possibly remedy the health problems created by 
Federal leaders in this city more than 60 years ago. The Senate can 
provide this remedy. Here on this floor, the Senate can

[[Page S533]]

acknowledge that the employer-based system of health coverage that 
worked back in 1945 no longer makes sense for 2007. We can acknowledge, 
as I have done today, that I think Democrats are right about making 
sure that everybody gets covered and Republicans are right about 
promoting personal responsibility and more personal involvement in 
making health care choices. We can end 13 years of ducking on health 
care, 13 years of slapping Band-Aids on health care, and roll up our 
sleeves and go to work. A lot of it--and I know the distinguished 
President of the Senate has been to many community meetings in his home 
State of Virginia--simply means following up on what constituents say 
at home.
  Every time health care comes up when I have community meetings 
somebody usually says, ``Well, I guess we ought to go to what is called 
a single payer system. You know, one where the Government essentially 
runs it and you don't have these private insurance companies.''
  After somebody at a town meeting says we ought to have a single payer 
system, somebody else says, ``No, we already voted on that.'' In fact, 
Oregonians did. They voted against a single payer system by more than 3 
to 1 just a few years ago.
  But the other speakers say, ``We don't want all that Government. We 
don't want the Government to make all the decisions.''
  So after a bit, somebody raises their hand at one of my townhall 
meetings and says, ``Ron, what we want is what you Members of Congress 
have. We want health care coverage like you have.''
  Then everybody in the room shakes their head in agreement.
  So much of what I propose in the Healthy Americans Act comes from 
those townhall meetings that I hold in all of Oregon's 36 counties. I 
have an approach that guarantees benefits like Members of Congress 
have; that is delivered in the same way; and that can actually be 
implemented with the very first paycheck that a worker gets under the 
new system.
  Part of the reason I have written this legislation as I have has been 
to ensure that the Congress and the Federal Government could pick up 
some lost credibility on health care. My sense is that after the debate 
of 1994 on health care in America a lot of Americans said: The United 
States Congress can't figure out how to put together a two-car parade 
let alone a reform that involves one-seventh of the American economy.
  That is why I have written this legislation so it can be understood 
and the effects can be seen from the time the very first paychecks go 
out under the legislation. The legislation works in a way that will be 
attractive to both workers and employers.
  So I have spent a lot of time listening to my constituents as I 
brought together the various principles that are contained in the 
Healthy Americans Act. I know colleagues in this body have other ideas.
  I would like to wrap up by simply saying I think health care has been 
studied enough. It has been commissioned. It has been blue-ribboned. It 
has been the subject of white papers, blue papers, pink papers, papers 
of every possible description. It is time for the Senate to act. The 
Senate has ducked on health care for almost 13 years. Health care and 
Iraq are the driving issues that our citizens care about most. It is 
time to fix health care, and I think with the Healthy Americans Act, 
this body can get the job done.
  Mr. President, I yield the floor, and I note the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. WYDEN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

                          ____________________