[Congressional Record Volume 154, Number 82 (Monday, May 19, 2008)]
[Senate]
[Pages S4301-S4302]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. NELSON of Florida. Madam President, and, of course, to my 
distinguished colleague from Pennsylvania, this Senator certainly did 
not mind waiting because it was a matter of great concern. And it was 
obvious to this Senator in the elevator that the Senator from 
Pennsylvania had a matter of great weightiness that was something that 
he wanted to share with the Senate.
  I shall always defer to the eminent scholar of the Senate, and I am 
glad that the Senator has spoken, and spoken his mind. This Senator 
would like to speak his mind on a subject that is heavy on the hearts 
of the American people; that is, what is the future of their health 
care.
  It is clear people are concerned because health care has become 
something that dominates someone's thinking, if they do not have the 
assurance of having that health care. The number of insured has reached 
47 million people. It looks like that number is going to increase, 
particularly as we are going into an economic downturn that plagues us 
and seems it will continue to do so. In the meantime, the American 
people also know health care costs are increasing at a rate much higher 
than their average paycheck. So that worries the American people.
  It is a fact that Americans spend more money on health care than any 
other country in the world. Sometimes we don't have as good results. 
For example, one recent study says life expectancy among certain groups 
of women in the United States is actually going down due to the 
prevalence of growing chronic disease.
  In Florida, the problems are no less severe: 19 percent of all 
children in Florida are uninsured, one of the highest rates in the 
country; 25 percent of all nonelderly Floridians are uninsured, a 
quarter of the nonelderly Floridians, those not covered on Medicare. Of 
course, the people are getting concerned because we in Washington are 
unable, between the executive and the legislative branches, to strike a 
solution.
  The long and short of it is, there are some solutions that are 
starting to percolate to the top. There is one that has 7 Democrats and 
7 Republicans, 14 of us, bipartisan cosponsors. What it does is, it 
insures everybody universal coverage, the 47 million people who now do 
not have health insurance who, by the way, get health care because they 
get it at the most expensive place when they get sick, which is the 
emergency room, and they get it at the most expensive time, because 
they haven't had preventive care, when the sniffles turn into pneumonia 
so the treatment is all the more expensive, so the most expensive place 
at the most expensive time. Guess who all is paying for it. The rest of 
us are paying for it because they do not pay and do not have the health 
insurance that goes into the overall absorption of those costs.
  The rest of us, who are fortunate to have health insurance, pay in 
the rates we pay for the care we get. That is one important principle 
of what this group of 14 bipartisan Senators, led by Senator Wyden and 
Senator Bennett, have come out with.
  The next important principle of this proposal for completely 
revamping and reforming the health insurance delivery system is that 
you let the principle of insurance work for you. That is, to get the 
largest possible group--in other words, millions of people--over which 
to spread the health risk. So if you spread that health risk over 
millions of people who are representative of the whole population, 
young and old, sick and well, you are going to bring down the per-unit 
cost for the premium per policyholder. That is in significant contrast 
to the fact of a small group, where the actuarial soundness in order to 
set the premiums for a small group--let's say 5 or 10 people, just a 
few lives over which to spread that health risk--is extremely high.
  That is one of the reasons why in taking that principle of insurance, 
you have to decouple from saying that insurance should be organized on 
the basis of an employer. If an employer is large, with 100,000, a 
couple hundred thousand lives, then, in fact, you have a large 
population over which to spread the health risk. However, if the 
employer is a mom-and-pop grocery store, with only a handful of lives, 
you see the prohibitive cost of that insurance and, therefore, what is 
happening is, employers are at the point that they are not able to 
afford it anymore. More and more people of those 47 million in this 
country who are not insured, in fact, are adding to those rolls.
  So what this bipartisan bill, called the Healthy Americans Act, is 
attempting to do is to say: We are going to bring in all those people 
out there who are uninsured so we spread the base, and we are going to 
organize the private marketplace upon which private insurance companies 
will compete for that business. We are going to organize it ideally 
around millions of people. The way the bill is structured, it organizes 
it around the State. But if that State is a small one, there is nothing 
that would prohibit that State from joining with several other small 
States to create a sizable population that the health insurance 
companies would, in fact, compete for.
  Then, the next principle in this insurance is that the consumer will 
have choice. The basic underpinning of the minimal value of a health 
insurance policy is the same kind we have. We, as Federal employees, 
have a minimal health benefit package from the Federal Government. We 
spread our insurance cost over 9 million Federal employees and Federal 
retirees. Therefore, we can get the economies of scale and let the 
Federal size work for us. So, too, the reorganization in this bill, the 
Healthy Americans Act, to allow the greater numbers to bring down that 
per-unit cost or the cost, in other words, of what the individual 
policyholder makes.
  It is a very complicated system, how you transition out from an 
employer. There is a certain amount that the employer has to pay into 
the system, according to the size and the payroll. Individuals would 
have the responsibility of paying for their health insurance. They 
would pay for that by deductions from the Federal income tax, just like 
withholding tax is deducted now. By decoupling from their employer's 
insurance, if they chose to do that--and if they wanted to stay with 
the employer, they could, but by decoupling, they would not get less 
money because there would be the so-called cashing out of the employee, 
so the employee would get the same financial benefit from the employer 
they got before, when the employer was paying for their health 
insurance premiums. It is all very complicated.
  The Congressional Budget Office has done a cost analysis and says 
under this law the Federal Government will break even financially in 
the year 2014, when it is implemented, if it were to first be 
implemented starting this year. So it basically requires the 
responsibility on the individual, the employers, and the Government to 
come together to make this funding for health care work. You get the 
efficiencies of competition in the private marketplace. You get the 
economy of scale. That economy of scale is not only brought in by 
expanding the pools

[[Page S4302]]

over which that insurance is applied but expanding those pools even 
more by bringing in the 47 million uninsured.
  The bill emphasizes prevention to improve the health of Americans. It 
certainly improves their access to care, once they get sick, and also 
access to care by giving them preventive incentives to go in and do the 
kind of things with medical advice before they would ever get sick in 
the first place.
  There are things in the bill that, as we continue to discuss it, 
certainly I wish to see. I wish to make absolutely sure that those 
currently covered under the Children's Health Insurance Program, which 
would be folded into this, as well as Medicaid, which would be folded 
into the program, I wish to make sure they receive affordable insurance 
of quality comparable to or better than what they currently receive. 
There are other concerns that will come up from time to time.
  There is no one who has filed this legislation who thinks it is going 
to be enacted or seriously taken up this year, but there has to be a 
starting point. A great responsibility will rest on the shoulders of 
the next President because the American people are not only crying out 
for health care reform, they are demanding it. Because the cost of that 
health care is extending beyond their reach, it is incumbent upon us to 
be visionary and creative. It is certainly incumbent upon the next 
President to be visionary and creative and cooperative, cooperative 
with the Congress so we can forge a solution to help America solve her 
health insurance problem.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. WHITEHOUSE. Madam President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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