[Congressional Record Volume 155, Number 63 (Tuesday, April 28, 2009)]
[House]
[Pages H4898-H4905]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        HEALTH CARE FOR AMERICA

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Connecticut (Mr. Murphy) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. MURPHY of Connecticut. Mr. Speaker, I am glad to be back here on 
the House floor this evening to join you and our colleagues in talking 
about an issue that is of rising importance to millions of Americans, 
and that is the issue of guaranteeing a seamless and affordable and 
quality health care system for the American public.
  Mr. Speaker, we are here to talk about health care for America. It's 
a pretty simple concept, and over a number of years, the desire and the 
call from the American public has become more and more acute. I'm glad 
to be here with my good friend from Wisconsin, Representative Kagen, 
and others who may join us here throughout our hour or a portion 
thereof to talk about both the need for reform and some of the ideas 
that are floating around this Chamber to get us there.
  I stand here with new evidence from the American public that they are 
more desirous of change than ever, not a preservation of the status 
quo, not incremental reform, not a Band-Aid fix to the problem, but 
real reform.
  A recent survey of Americans by the Kaiser Health Foundation showed 
that over 60 percent of Americans believe it is more important now than 
ever, than ever, to pass comprehensive health care reform. Those same 
individuals reported that they are having more problems than ever, more 
problems than ever, accessing care.
  Forty-two percent of Americans in that recent poll said they relied 
on home remedies or over-the-counter drugs to take care of their 
illnesses because they couldn't afford the prescription. Thirty-six 
percent of people reported that they skipped dental care or a visit to 
the dentist because they couldn't afford it. Thirty-three percent of 
Americans said they put off or postponed care that they knew they 
needed because they could not afford it. Twenty-nine percent said they 
didn't fill a prescription because they couldn't afford it. And 18 
percent of Americans, nearly one in five, said that they cut pills in 
half that they were due to take because they wanted the prescription to 
last longer.
  Mr. Kagen, Mr. Speaker, and my colleagues, this is the most affluent 
country in the Nation, the most free, the most powerful. What does it 
say about the conscience of a nation that one in five Americans are 
sitting at their kitchen table, sitting and standing next to their 
bathroom sink, cutting prescription drugs in half because they

[[Page H4899]]

can't afford to pay for the full prescription? And what does it say in 
this country that forces so many Americans, most of whom are playing by 
the rules, doing everything we ask? We know that study after study 
tells us that of the nearly 50 million uninsured in this country, five 
out of six are a member of a family with a full-time worker. More and 
more often you're working, you're doing everything you're supposed to, 
and you can't get insurance or the insurance plan that your employer 
presents you puts more and more of the burden on paying it onto the 
employee. We know that for all these people that are playing by the 
rules, for all these people that don't have health care insurance, they 
live amidst a health care system that spends more on health care than 
any other country in the world. We spent $2.2 trillion on health care 
last year, Mr. Kagen, about an average of $7,400 per person, nearly 
double what every other country in the First World spends. And what do 
we get for it? We get a system that leaves almost 50 million without 
health care insurance, and we get a system that by and large ranks in 
the middle to lower tier with regard to health care outcomes in the 
world.
  In fact, another new study that just came out suggests that the 
United States amongst industrial nations ranks last, ranks last, in 
addressing the issue of preventable mortality; that in preventable 
deaths, this health care system does worse than every other 
industrialized nation in the world.
  The facts are clear. For too many people out there, health care has 
become unattainable. For too many that have health care insurance, 
they're going bankrupt just trying to pay their portion of the bills. 
And the system overall is bankrupting not just this government but is 
bankrupting and putting out of business too many businesses, both small 
and large, throughout this country. Big businesses, small businesses, 
families, individuals, all asking with voices louder than ever that 
this year right now this Congress step up and fix this problem. It's 
the right thing to do. It's the right thing to do from the perspective 
of conscience. It's the right thing to do from the perspective of 
health care, and it's the right thing to do from the perspective of 
economic recovery and revitalization. So we are here tonight to talk 
about this challenge that's laid before and presented to this 
government.
  Mr. Kagen and I came here in the same class, and we got here amidst 
probably a record degree of cynicism about what government can 
accomplish but in particular what Washington can accomplish. Now, it's 
gotten a little bit better since the election of President Obama, but 
there are still far too many people out there who look at the depth and 
the severity of this problem, the health care problem, and doubt 
whether Congress and this place has the ability to rise to the 
challenge.
  We're here to say that it absolutely does. We are here to say that 
this is a unique moment in time, coming fresh off of an election with a 
mandate on health care, with a House full of Members who want reform, 
with a Senate full of Members who want reform, and with an 
administration that has made it one of their priorities that we can do 
it now.
  Now, we may all have, as we will probably discuss over the course of 
the next hour, varying ideas on how we get there. And in the end for 
every single one of us when we go to press that green or red button on 
a comprehensive health care reform bill, there is going to be an 
element of a leap of faith. We are all going to have to cast aside the 
perfect for the benefit of the good. But it is time that we stopped 
arguing over the perfect system and started making some real 
improvements, big improvements, comprehensive, transformational 
improvements. I think that's where we will get to this year.
  And I'm glad to have some of my colleagues on the floor of the House 
to talk about this tonight, in particular the doctor of the House, 
Representative Steve Kagen. 
  Mr. KAGEN. Thank you, Congressman Murphy. It's good to be with you 
again on the House floor where we can begin to discuss with the 
American people about progress we can make together. And only by 
working together are we going to bring about the changes that we need.
  Now, we did come here in 2006, November. We came for orientation. And 
we came with a message, and the message was about positive change. Now, 
I will just give you the good news. Just in case people haven't heard 
it across the country, there has been a change in Washington. We now 
have a President who can actually think things all the way through, 
someone who's really on our side for the changes that we need. And what 
have we done so far?
  Well, for the Meronek family that I have the honor of representing, 
this is a photo of Wendy and her 3-month-old child. And they didn't 
have access to a doctor at the doctor's office. She had access at the 
emergency room because she didn't have any health care at all. She was 
qualified for SCHIP but it wasn't fully funded. We passed SCHIP in our 
first term here in the 110th Congress. We passed it and the President 
signed it. And the very first thing that the President did for this 
country this year was to pass legislation that guaranteed that children 
who are most in need have access to the doctor in the doctor's office. 
It reduces taxes, reduces our costs, increases the health for our 
children, and prevents problems from getting worse. It's good for 
people's health and it's good for our budget. So we began to take that 
positive change by helping children.
  We also passed a bill that may not seem to be too related to health 
care, Lilly Ledbetter. This was a bill that guaranteed equal pay for 
women.
  Now, of all of you here in the gallery, a few of you that might be 
here tonight, raise your hand if you're against equal pay for women. 
Raise your hand if you're against providing health care to children who 
are most in need at the doctor's office.

                              {time}  1945

  I don't think we see a hand going up. Women and children first, that 
is what this 111th Congress has done with the help of President Obama 
and his leadership.
  I have here a few postcards I have received from my constituents in 
northeast Wisconsin that pretty well tell it like it is.
  David and Dianne from Appleton: ``We have health insurance, but 
cannot afford to use it.'' Now, that is a problem, when you have health 
insurance coverage and the only thing it guarantees is that the 
insurance company is going to take the money, then you have to fight 
like heck to get the money back. They have high deductibles and can't 
afford to use the insurance they have.
  From Luxembourg, Wisconsin, Jim says, ``My wife and I have 
preexisting conditions with our health. Right now, we pay $3,000 a year 
after 80 percent is already paid.''
  ``Preexisting conditions.'' It is time that we applied our 
constitutional rights that prevent us from suffering from 
discrimination by the health care industry. No discrimination. No 
citizen, no legal resident in this country anywhere should be 
discriminated against because of the color of their skin, and likewise 
they should not suffer from discrimination because of the chemistry of 
their skin. No discrimination based on the content of their heart. 
Well, what about the content of the arteries of their heart? We need to 
pass legislation that guarantees that no one will suffer from 
discrimination due to preexisting conditions.
  Here is a card from Albert from Crivitz, Wisconsin, who writes, 
``Without a job that pays a fair wage, I won't have money to pay for 
health care, for gas, for a war, for Social Security or anything 
else.''
  It is really tough to separate health care from our economy and our 
economic recession from the loss of the 6 million jobs during the last 
12 months. We have to put this thing all together. One thing directly 
affects the other.
  Here is Kathleen from DePere, Wisconsin: ``It is time for all 
Americans to have the same health care benefits as their 
representatives in Washington.''
  Well, that is not a bad start. I think people in our districts 
understand the situation just as well as we do here in Congress, and we 
are working very hard to bring about the changes that we need.
  I yield to my colleague from Florida, Ron Klein.
  Mr. KLEIN of Florida. Thank you, Dr. Kagen. Certainly it is an honor 
and privilege to be here and to talk about

[[Page H4900]]

this issue in the House of Representatives, because I know people at 
home are trying to figure out what it is that they can do, what ideas 
that they have, what ideas doctors have, hospitals have, caregivers 
have, to try to fix the system that in the long term is not 
sustainable.
  It is not sustainable through Medicare and Medicaid based on the 
costs. It is not sustainable if you are a private-sector business and 
you are providing health care to your employees. You obviously want to 
do whatever you can to keep them healthy. You spend a lot of time 
training them, and we want them to come to work every day and be 
healthy and not have to end up in the hospital where they don't have 
coverage and obviously all the problems that go along with that.
  So we have some serious issues out there, and I think this is one of 
those moments in time in America where we have to come together. This 
is not a Democrat, Republican or Independent issue. This is an American 
issue. This is something where we have to sort of in a nonpartisan way 
figure out what is working in the system and preserve that, and what is 
not working in the system and fix that.
  There are lots of issues we know that are not working, and I will 
just give one perfect example, which I know when I am speaking on the 
floor of the House this evening a lot of people will be able to share 
and empathize with this scenario I am going to give you.
  We have a very close friend. We have known them for many, many years. 
Their daughter has cystic fibrosis, and it could be any number of 
diseases that any of our families unfortunately have with their 
children.
  This gentleman owned a business, a family business, for decades, a 
long, long time, and the business, based on what is going on right now 
over the last number of months, had to close. Well, fortunately, for 
all the years that he has been raising his family, they have had a good 
health insurance plan that the business paid for. Obviously, it was 
something that gave them peace of mind, knowing that when their 
daughter needed hospitalization or therapy or treatments, she could get 
it.
  Well, when your business goes out, there is no COBRA, and a lot of 
people are not aware of that, because there is no underlying policy. 
The reality is for him to find an insurance policy, a health insurance 
policy right now that will take care of his daughter with her 
preexisting condition, that is what it is known as, it is almost 
impossible to get that coverage, and, if you can get it, it costs a 
fortune and usually has all sorts of exclusions and limitations.
  The same example for women who have had breast cancer. Literally 
millions of women that have had breast cancer, generally speaking after 
they have had breast cancer, they are going to have a difficult time 
getting coverage. And guess who needs it the most? Someone who has 
cancer. God forbid, if it ever comes back, you want to know if you need 
surgery or an oncologist or a second opinion or to have whatever, a 
lumpectomy or whatever it may be, that you will have the 
hospitalization and care.
  Unfortunately, this is a big gap. And ``gap'' is really not giving it 
the right feeling, because ``gap'' is just a word. But this is a 
crisis. This is a crisis for families who can't afford or can't get 
that kind of health insurance. And there is no reason.
  There is a very simple answer, obviously. What is insurance? 
Insurance is supposed to spread the risk. When you have a large pool, 
when a large corporation has 10,000, 20,000, 100,000 employees, they 
buy a policy and it spreads the risk. And, God forbid, if one of their 
employees has a serious illness or car accident, that is covered in the 
big pool by all the rest the employees. That is how insurance is 
supposed to work, whether it is homeowner's insurance or any kind of 
insurance you buy. Health insurance is the same.
  The tragedy, of course, is that over time we have allowed a system to 
develop where there are large gaps in our delivery of health care. We 
have to fix it. It is the right thing to do.
  I will turn it back to the gentleman from Connecticut who is running 
this discussion tonight and thank him for allowing me to participate.
  Mr. MURPHY of Connecticut. Thank you very much, Mr. Klein. I am glad 
you are here with us tonight.
  I want to turn over the podium to Representative Olver from 
Massachusetts. One of the statistics that stands out, and I know Mr. 
Olver is going to talk a little bit about the amount of money we are 
spending on health care, in 1970 about 7 percent of our gross domestic 
product was devoted to health care. Since 1970, in 30 to 40 short years 
we have jumped up to almost 17 percent of our gross domestic product is 
spent on health care. That number is going to very quickly hit 20, and 
could get up all the way up to 30 in a very short time if we don't do 
something about it.
  It is always going to be a necessary component of spending, but that 
kind of growth is just unsustainable as an economy, something that the 
Appropriations Committee, of which Mr. Olver is a senior member, will 
be no doubt grappling with, and I yield to him.

  Mr. OLVER. I thank the gentleman for yielding, and I want to thank 
the gentleman from Connecticut and my friends from Florida and 
Wisconsin for being here tonight to help to enlighten people about what 
has become a very, very critical issue for America.
  The only agreement that I can see about the debate that we are 
beginning to have on reform of the health care system is that virtually 
every American family, all across the board, knows that health 
insurance is too expensive. For the 50 million or so Americans who 
don't have any health insurance, it is obviously too expensive or they 
otherwise would already have it. For the next 50 million who have too 
little insurance or are underinsured, as it is called, they know it is 
too expensive when their insurance company refuses to pay for coverage 
that they thought they had or the insurance company makes a claim that 
there was a previous condition involved and that may have been why they 
are now are claiming that they shouldn't pay the money. Or there are a 
certain number of people who have lost jobs in this economy and thereby 
have lost their coverage for health insurance, and for them, obviously, 
the whole situation has gotten out of hand.
  Yes, our American health insurance is too expensive. Let me use this 
first chart and show you what the situation is here.
  This is a chart which shows the health care cost as a percentage of 
gross domestic product in the G-7 countries. The G-7 countries are 
America and the next six largest economies in the world, except for 
China. These data, it indicates that the Japanese data are for the year 
2005, whereas the other data are for the year 2008.
  You can see on the chart that the percentage of health care cost as a 
percent of their domestic product ranges from 8.2 to 11.1 percent in 
the other six next largest economies in this world, and here we are up 
over 15. And, by the way, these data, if you look at 09, fiscal 09, you 
would probably find that that number 15.3 percent is probably up to 16 
percent or a little higher because of the problems with the economy. 
Health care continues to go up, and people are struggling for that 
reason.
  So we have by far the highest. We are 40 percent roughly higher than 
the next-highest one of the largest economies, which is the industrial 
economies with which we compete all the time. And the average of the 
other six members, our partners in the G-7, their average number is 
only two-thirds. We are more than 50 percent higher than the average of 
those other six countries.
  So, yes, American health insurance is too expensive, and this huge 
gap between our health care costs, the burden that that puts on our 
industries, between that burden in this country versus the others of 
our major competitors, hurts American businesses and costs us jobs.
  You only need to look at the auto industry, where our old icons of 
Chrysler and General Motors now are struggling, and in large measure 
because the cost of their health care in this country is so much 
greater than it is for other countries producing automobiles.
  Well, that might be okay, or it might be acceptable, that kind of a 
cost difference, if we got the best health care. Everyone watching has 
probably heard a politician tell them that we have the best health care 
in the world.
  Well, we do have the most expensive health care in the world. That 
chart

[[Page H4901]]

very clearly illustrates that we do have the most expensive health care 
in the world. But I would like to examine that question of whether we 
have the best health care a little bit more deeply with this chart, 
which shows what the life expectancy is among the very same heavily 
industrialized countries, which are our major partners in industry and 
in commerce and trade around the world. Again, I leave out China, but I 
am using the G-7 countries. All seven of them are listed there.
  What you see on this chart is that life expectancy in the United 
States is less than each and every one of the other members of the G-7 
group, each of the other six partner members in the G-7 largest 
economies in the world. And if I average the life expectancies in those 
other six countries, it is 3 years longer than American citizens live. 
Now, that does not suggest that we have the very best health care in 
the world or the very best health care that we could have.
  Then on this last chart let me just illustrate one more measure of 
what our health care quality is, and this measure is one that directly 
affects a huge number of families at the very beginning of life. This 
is the question of infant mortality in the G-7 countries, where you see 
the listed number of deaths for children under the age of one. So it is 
deaths among new infants lower be than the age of one.
  Going from Japan, you see 2.7 per 1,000 births, on to 5.5 for Italy 
per 1,000 births, and the U.S., the highest number of infant deaths 
that are occurring before the age of 1 year. Again, if you average the 
six, you find that the infant mortality in the United States is more 
than 50 percent higher than the average of these six other nations.
  So, I think one has to ask the question, after going through all of 
that, and I have to look and see where the question is on my papers, 
one has to ask the question, is the assertion that the U.S. has the 
best health care in the world, basically is it true, is it not true, is 
it simply a lie?

                              {time}  2000

  We ought really to think very carefully while we're doing the reform 
of our health care system, as we're going to do later this year. We 
ought to think very carefully about figures like this and a whole bunch 
of other measures. I could go through a series of other measures that 
show similar kinds of data, and show that we are not doing as well as 
we ought to be doing as the richest country in the world. There are 
reasons for that. We'll have other times to perhaps explore some of 
those other reasons.
  But I'm very pleased that the gentlemen, my friends from Connecticut 
and Florida and Wisconsin, are taking this up tonight, and that I have 
been able to bring some little bit of thought to how this is going 
forward in America. Thank you.
  Mr. MURPHY of Connecticut. I thank the gentleman. And those charts 
really are instructive to let us know what we're getting for the money 
that we're spending. I don't think it's the worst thing that we spend a 
little bit more money on health care in this country than the rest of 
the world. You know, we have relative affluence here. We have a 
citizenry that very rightly has high expectations, and so I don't 
necessarily think anybody has a problem that we spend a little bit more 
on health care. But two questions are raised. One, how much more money 
should we be spending than other countries; and what are we getting for 
that money because, listen, Americans, certainly in my district at 
least, are value shoppers and they're willing to spend money if they're 
going to get value for it. And the problem is not enough Americans 
understand that they're not getting what they should be from those 
health care dollars.
  Mr. KAGEN. Would the gentleman yield for a moment?
  Mr. MURPHY of Connecticut. Of course.
  Mr. KAGEN. Let's not let the facts get in the way of a good argument 
or a good conversation, but the fact is that 72 million Americans are 
having great difficulty paying their medical bills as of November of 
last year. About 47 to 50 million Americans have no health care 
coverage at all. But let's not let the facts get in the way.
  And I certainly appreciate Chairman Olver reassuring the people in 
Japan, if they're looking in tonight, or this morning, for them, you 
know, they've got it pretty good in terms of health care coverage. And 
our friends in Europe understand that, you know, they don't have to 
worry about getting sick.
  My way of thinking is, as a physician, if you're sick, you should 
have the reassurance that when you're sick, you're going to have the 
coverage that means you're going to be in your house, not the 
poorhouse. If you're a citizen, you should be in the risk pool. It 
should be just that simple. If you're a citizen, you ought to be in. 
And if it's in your body, it ought to be covered. We have to find a way 
to make certain that that works out.
  And before I turn and yield to somebody else here in this discussion, 
not everyone agrees with all these ideas. That's why we have a debate. 
Here's a person from De Pere, Wisconsin who says, ``I do not want the 
government involved in health care. The government mismanages money and 
thinks funds are endless.'' So you see, we have to reassure our 
citizens, not just in De Pere, but that good government can make a 
positive difference in your life.
  Medicare was a tremendous program when it was first initiated; 16-1 
was the ratio of people working versus retired. Now it's down to about 
4-1, so there are some things we have to talk about.
  Is Medicare sustainable in its current model? It's a great challenge. 
And can we somehow tease apart and differentiate our economic recession 
from our ability to pay for our health care costs? I don't think so.
  People in my district are telling me, Kagen, health care costs are 
just impossible. Small businesses, what are their greater components of 
their overhead? Energy and health care. And that doesn't matter if 
you're on Main Street, on Wall Street, or if you're a family farmer in 
northeast Wisconsin. So we have to attack the greatest cause of 
bankruptcy today in the country, which is the high cost of medical 
care.
  I am confident that we're going to be able to work out some details 
to guarantee that if you're a citizen, you're in; that there will be no 
discrimination due to preexisting conditions; that the price for health 
care services, for hospital services, for your pills and prescription 
drugs will not be whatever they can get. It won't be whatever they can 
get. It'll be whatever they openly disclose, and give every citizen 
that same discount.
  Mr. MURPHY of Connecticut. Will the gentleman yield for a point 
before Mr. Klein jumps in?
  You know, that constituent of yours is multiplied, you know, by 
hundreds in all of our districts. I mean, people throughout this 
country have a fear of government-run medicine, in part because they 
hear about anecdotes from some of the countries that Chairman Olver and 
others talked about in terms of the wait times. And, again, I think 
there are moments when facts are really necessary. Study after study 
shows that if you really do an empirical, data-based survey, wait times 
are, frankly, worse off in the United States than in many, if not most 
of those other countries.
  And with respect to the one country that does tend to have wait times 
greater than the United States, Canada, most of those, in fact, all of 
those, are really for nonessential procedures. And I think it's 
worthwhile to then sort of mirror back to the United States.
  In Canada, one of the things that comes up all the time is that if 
you want a hip replacement surgery you've got to wait about 6 or 8 
weeks. And that's true. And that's a long time to wait, and too long. 
In the United States, you've got to wait about 2 weeks to get that 
surgery. But you know who pays for that surgery in the United States? 
Medicare. The government. So our government-run health care system does 
a pretty good job at eliminating wait times.
  And for those of us who believe that ultimately you're going to have 
to have some increased footprint of a government-sponsored health care 
option for individuals and businesses, I think we can find solace in 
the fact that, although Medicare may not be perfect, it actually does 
pretty well with regard to at least that one indicator, wait times, 
compared to some of our other neighboring countries.
  Mr. Klein.
  Mr. KLEIN of Florida. I thank the gentleman. And just to add to that, 
I

[[Page H4902]]

know when I got elected in 1992 to the Florida Legislature, I had a 
group of people in south Florida that said single payer, that's the way 
to go. These are mostly senior citizens who thought that was just the 
best opportunity. Most of the doctors I was talking to who I knew in 
the community at that time were totally against that.
  Well, what's happened now is many of my doctors in our community, who 
do just wonderful service, are now the ones saying Medicare seems to 
pay quicker, more efficiently than a lot of the managed care 
organizations. And I'm not picking on managed care as a whole. There 
are some that are good and some that are more difficult to deal with.
  But I think the point of this all is that Medicare has generally 
worked fairly well. I think most seniors are pretty satisfied with a 
lot of things. It's not perfect, but I think that we understand that.

  But if we think about, you know, what is it that, again, recognizing 
the different pieces here. We have a lot of people that retire to 
Florida, where I live, pre-Medicare; 55, 58, 59 years old. Maybe 
they're in business or work for some government up in the northern part 
of the country or from some other part of the country, and all of a 
sudden they don't have health care that transfers to Florida, and they 
can't buy health care because of a preexisting condition or any number 
of other things.
  So what some of them have said is, why aren't we allowed to buy into 
Medicare on our dime? No government subsidy, just allow us to pay 
whatever the premium would be. And that's a very interesting idea. I 
think, again, just trying to think outside of the box, and there's not 
one silver bullet that's going to solve all these things. There may be 
some ideas for us to consider.
  And another idea is, a lot of small businesses, we know that we like 
the idea of small businesses pooling their 12 employees here and 16 
employees there, and 5 employees here, and 80 there to get to the 
larger critical mass so they can spread the risk again. Better price, 
better service, spreading the risk.
  Why not allow those small businesses to buy into our State health 
care system or the Federal, you know, the employees for the Federal 
Government, again, on their dime. But we already know, we did some 
pricing on this, and the cost is far below what the private insurance 
companies would charge them.
  So, you know, there are a lot of ideas out here. And I think what we 
really need to be doing right now is asking Americans, and all of us, 
as Democrats and Republicans in our Chamber here, ask Americans, what 
do you think is the right thing?
  There's only so much pie to go around. We know we're spending, as Mr. 
Olver recommended through his charts, more than any other country in 
the industrial world, at least of the G-7. The money's there. Where's 
it going? And how can we make sure that that doctor/patient 
relationship that Dr. Kagen has with his patients and I have with my 
doctor and many other people have with their doctor really is one that 
is nurtured and supported. We know we get better quality medicine when 
my doctor is the same doctor over many years, as opposed to I get a new 
managed care list and now I have to choose a new doctor and all the 
kinds of things that really make for less good quality care medicine.
  So again, I think this is opportunity for us to have the discussion, 
bring a lot of ideas forward, think outside the box a little bit and 
come up with some answers.
  Mr. KAGEN. Well, Mr. Klein, I appreciate what it's like to be in 
Florida. I had a small medical practice there studying the fire ant 
allergy for a couple of years. I wanted to come up with a vaccine that 
would prevent people from having allergic reactions to those venomous 
creatures. We could talk an hour about the fire ants.
  But on that hot subject, wouldn't it be nice if Medicare actually 
covered the overhead expense, or if Medicaid covered the overhead 
expense? You see, there's a subject called cost shifting. One of the 
reasons that the prices are so high is that everybody else is paying 
for the unpaid for health care that occurs not just in the emergency 
room but in doctors' offices and hospitals all across the country. And 
that takes place when Medicare does not cover the overhead of essential 
medical services.
  And I guess it wouldn't shock too many people to understand that we 
don't have the data yet that actually determines and allows us to know 
here in Congress what the overhead expense is within a metropolitan 
statistical area. You know, I don't want to have to pay in Green Bay or 
Appleton, Wisconsin what they're paying for medical procedures in 
Florida or in New York City or in Los Angeles or other large 
metropolitan areas, certainly not Washington, D.C., where my first 
hamburger, fry and a Coke was $22.50.
  So the cost for health care has to be brought down, I think, in large 
part by creating a real vibrant, open and transparent medical 
marketplace. And, you know, I can go on my communication device--I'm 
not going to mention the brand. I don't want to promote a given 
product. I can go on the Web, the Internet, and search for the price of 
a car, the price of a book. How about the price of my prescription 
drugs that I might need, and map it out within the area in which I 
live?
  I want the pharmacies to openly disclose the price and give every 
citizen the same lowest price that they accept as full payment for that 
product. I think it's time that the hospitals showed us their prices 
and then charged everybody the same. Wouldn't that be wonderful?
  Mr. OLVER. It really would. I must say, it's daunting to be taking 
part in a discussion with an M.D. who has been through this so 
intimately and has so many examples that he can put forward. We have 
two or three other medical doctors here in the Congress, and I'm glad 
we're not having this discussion among just them and me because I would 
feel completely out of place.
  But I did want to comment to something that my friend from 
Connecticut had said after I finished my chart talk essentially, and 
that was, yeah, we should be willing to accept a higher cost in this 
country. True. I said that it would be perfectly acceptable if we were 
getting outcomes that correspond to the cost that is going in.
  We do have a very productive workforce, and the total value of our 
economy is so high that I think you would find, per person, per member 
of the workforce, that the value of our economy, the gross product per 
member is substantially greater than most, if not all of these. I don't 
have the data on that, but I think I have seen them. And so you would 
expect that you should be able to spend more in real dollars than 
others and still maybe not be hurting the economy. But when it gets so 
out of range, then you really have to look at what are the outcomes.
  One other outcome that I would just like to mention, because I used 
first the life expectancy of our people at large, from the time that 
they are born until they join their Maker, and then the infant 
mortality, but then look at the other question, the question of 
maternal mortality, which very closely mirrors the data on infant 
mortality, though that goes from the birth until 1 year of age, whereas 
maternal mortality would refer only to women who die in childbirth. And 
there, again, our value is, in this country, with supposedly the best 
health care in the country in the world, our number, again, is about 
twice, almost twice as high as it is in the other major industrial 
partners of ours in this whole world economic system. So that's just 
one more--I did not bring that chart along, but that's just one more of 
those measures of the many kinds of measures that you could look at.
  Mr. KAGEN. Would the gentleman yield?
  Mr. OLVER. I would be happy to yield.
  Mr. KAGEN. Some years ago I sponsored for citizenship a Ph.D. in my 
research laboratory. And when I was about to enter the political 
discussion in 2005, I asked my Ph.D., Dr. Muthiah, how did he look at 
our American health care system, because he grew up in Sri Lanka and 
then graduated from Southern India, Madras, and how did he look at the 
American system? And he said, well, Boss, American health care is 
upside down because if you go to the hospital and you have insurance, 
you get a discount.

                              {time}  2015

  If you have no insurance at all, you get the big bill.

[[Page H4903]]

  So, you see, what we have to do is prevent the cost shifting, and by 
preventing cost shifting we can bring prices down. I think when we 
finally come to have an agreement that we should have a Federal 
standard. I mean, we have Federal standards in the United States for 
everything, making cars, we have OSHA, we have the environmental 
standards. We have standards for making clothing.
  But we don't have a standard basic insurance policy that guarantees 
that if you get sick you are going to be in your house, not the poor 
house. We don't have a basic insurance policy that all the insurance 
companies, if they are going to be in business, should be offered an 
opportunity to sell, to compete within the marketplace.
  I will give you, just an example, and I am not too good with 
examples. A few years ago I wanted to buy a Chevrolet Impala. At the 
time it was the highest percent American made car. I went out shopping 
for the Impala. I had five dealers with the same car. Now, they 
competed for me.
  I didn't get it for free. I got a skinny deal. The dealer made money, 
the manufacturer made money, and there was an economy, a real 
marketplace, a competitive and transparent marketplace. What consumers 
want in health care is transparency. They want an opportunity to be 
able to afford the medications that they need so that they don't have 
to skip a meal or skip a pill, or as you referred to some minutes ago, 
cutting your medication in half.
  There are a number of stories I could tell you that would make you 
cry. There is Jenny, who has two young children who came to see me. 
They were asthmatic. I made a wonderful diagnosis, I wrote the 
prescriptions for her and her children. I said come back in a month, 
they will be back in school, they will be fine.
  And she came back a month later, and I examined the children, and 
they were not fine. They were still wheezing. Being right to the point, 
I came down pretty hard on her. I said, you know, the funny thing about 
these medications, they only work if you put them in the kids' mouths. 
And she lifted up her sack, which contained her own personal property 
and also some diapers, unzipped it, held out the prescription. It was 
the same ones I had written.
  And she said, Dr. Kagen, I took these prescriptions to the pharmacy, 
and I could see the medications behind the counter, but I couldn't 
afford to put them in my kids' mouths. Now, what are you going to do to 
help me? I said, well, that's it, I'm going to have to go to Congress 
because I can't go to the State House to fix this.
  This is really a national crisis, one that can't be solved State by 
State. We can't have these incubators of democracy, as it has been 
referred to. We can't have one-State solutions like Massachusetts or 
another State, or Oregon. We need to find a national solution wherein 
there is going to be a real transparent medical marketplace to allow a 
drug company to produce a great medication, to openly disclose that 
price. And if it's $1 in Mexico City, hey, thanks. If it's $1 in New 
York City, Chicago, L.A., and everywhere else in between, we need to 
allow them to compete in an open, transparent medical marketplace.
  But, first, we here in this Congress have to make a commitment, to 
make sure we get it right, to think it all the way through, and above 
all else let's find out what the real overhead cost is, because if 
Medicare doesn't cover the overhead costs for something, it's going to 
cause cost shifting or that service or product is just going to 
disappear.
  Mr. MURPHY of Connecticut. The stories are heart-breaking and, 
unfortunately, the longer you serve in this place or any other level of 
government, the more that you hear.
  It gets back to that statistic that I started with, which is that 
some people have an impression that maybe folks that don't have 
insurance, people that don't have access to health care, well, it's 
their fault. You know, they are living off the dole, they are 
freeloaders, free riders. It's not true.
  Study after study shows you that 80 percent, or somewhere in that 
neighborhood, of individuals who don't have insurance are part of a 
family in which somebody or both parents are working full time. They 
just happen to work for an employer that doesn't offer insurance or 
that their insurance is kind of 50 percent insurance. It gets you part 
of the way there, but not very far. These are the folks that we are 
really talking about.
  And I think that in this moment of great economic crisis--a poll came 
out the other day that showed that 70 percent of Americans are fearful 
in the next few months that either they or their spouses will lose 
their jobs, that more people today are conscious of the fact that they 
are just one paycheck away from losing all their health care benefits. 
And should they get sick, as they have watched their parents or their 
relatives or their coworkers do, that their life could be over as they 
know it.
  As Representative Kagen said, the number one cause of bankruptcy in 
this Nation is medical bills, individuals who have had an illness, a 
cancer, an injury, that they could not have foreseen or prevented. And 
it has fundamentally changed their lives. They have lost their house, 
their car and their livelihood.
  That's who we are really talking about here. Mr. Kagen is right. 
Representative Kagen said you can't do this one State at a time.
  I am wholly supportive of States like Massachusetts. My home State of 
Connecticut is endeavoring to try to produce a system of universal 
coverage today. I am very supportive of their efforts to do so. But 
their efforts should highlight the fact that ultimately this has to be 
a national solution. Why? Because the only way you ultimately get costs 
down is to use the leverage of the Federal Government, ultimately, to 
bring those costs to a reasonable level.
  Now, we certainly do have to put the money into the Medicaid and the 
Medicare system to make sure that we aren't shifting money off to the 
private sector. But, so many of us are supportive, as Mr. Klein 
mentioned, of opening up the Medicare system or opening up the Federal 
employees' health system to more Americans because we see that as a way 
to try to use the purchasing power of the Federal Government to get 
costs down.
  A poll that I referenced about Americans' support for a major health 
care reform bill also shows that 77 percent of Americans favor allowing 
the government to offer a plan that would give them an option to join a 
publicly sponsored program or to keep their private health care 
insurance. And, in fact, it pretty much cuts across all parties. We 
said at the outset this has nothing to do with Republicans and 
Democrats. Whether or not you have insurance has absolutely nothing to 
do with the party that you registered with or where you sit on the 
spectrum of our American belief system. This is a nonideological, 
nonpartisan problem.
  And so although the numbers vary a little bit, the support for a 
publicly sponsored option for individuals and businesses to buy into, 
one that would be one of the best and I think most cost competitive 
options in the marketplace, show that greater than 80 percent 
of Democrats favor it, greater than 50 percent of Republicans favor it 
or just under 50 percent of Republicans favor it. But amongst 
Republicans, 33 percent say they don't have any opinion, so you almost 
have a 2 to 1 support versus opposed ratio. So you have folks of all 
parties and all persuasions supporting major reform.

  Just one more point before I turn it back over to you, Mr. Kagen, is 
your notion of having a level playing field and having transparency is 
so important, because there are a lot of people in this Chamber that 
support a single payer Medicare-for-all system, you know, go to a 
European style system of health care. But this is the United States of 
America. We have unique needs. We are not Canada, we are not England, 
we are not France or Germany.
  We are going to create our own universal health care system here, 
informed by the unique needs and desires and expectations of our 
citizens. And I think most of us agree that that's going to maintain, 
maybe in not as great a percentage of our system as it is today, but it 
is going to maintain our private health care insurance system.
  And the way to get to a system that is fairer and more equal is to 
allow for that health care insurance exchange, allow for a marketplace 
where, as you

[[Page H4904]]

said, everyone can go and compare prices, can know when they are buying 
that product that they aren't going to be ruled out just because they 
have a preexisting condition, an issue that there is no greater leader 
in the Congress on than Mr. Kagen, know that if they work for a 
business that they are not going to cause that business to not be able 
to provide health care insurance simply because they are the one 
employee of six that has higher health care costs than everyone else, 
that we are going to have equal coverage, a fairness in benefit levels 
and a transparency in price that will give, I think, a level of surety 
to people as they buy that insurance product that they are going to be 
covered and that they are going to get the best deal.
  Right now if you are an American health care consumer, you don't know 
either. You don't know whether you bought the cheapest product, because 
there is no one place to go. There is no one aisle in the supermarket 
where you go and compare prices. You also don't know whether you are 
going to keep that insurance.
  Because even if you got in as the bell rung, there is a thing that 
happens now called post-claims underwriting where even after you get 
sick, a lot of insurance companies will try to kick you off your health 
care, claiming that you should have known that you were going to get 
sick when you signed up in the first place. So I am very excited about 
this idea of the health care insurance exchange and glad, Mr. Kagen, 
that you have been leading on it.
  Mr. KAGEN. The consumers of America need to be able to compare apples 
to apples. And really the only way to get that done is to come up with 
at least a basic Federal standard, an insurance policy, one that will 
cover the basics and keep you in your house if you get sick, one that 
every insurance company has to offer to every willing purchaser, every 
citizen and legal resident within a metropolitan area where we can 
create the largest risk pool possible to leverage down prices for 
everyone.
  Here I have someone in rural America. This is really a telling story. 
She is from Waupaca, Wisconsin, and, quote, ``no health insurance for 4 
years, one son in the Army on active duty, my son shipping out. He is 
guarding our home, but we are not taking care of our families here at 
home. We are taking care of people overseas.
  ``We know numerous people over 50 who have lost their jobs so 
companies can cut health care and payroll costs and then can't find any 
other work and no longer have health insurance.''
  Now this is being multiplied all across the country as this recession 
rolls across not just the United States but across other nations as 
well. We have to establish a basic insurance policy so we can begin to 
have an open and transparent and very competitive marketplace for 
insurance process.
  Mr. MURPHY of Connecticut. Let's think about that soldier that comes 
back from serving his country overseas and goes and gets a job that 
pays a decent wage but works for a struggling company that just can't 
afford to continue to employ people and give them health care benefits.
  And so he, returning from serving his country abroad, putting his 
life on the line, comes back and gets a decent, hardworking, fair-
paying job and has no health care benefits. And then he looks to this 
House. He looks to the people that he sent to Congress who sit here in 
this nice air-conditioned Chamber with pretty decent health care.
  And he wonders to himself, I fought for this country, I came back and 
got a job, did everything that I was supposed to. And the people that I 
send to Washington, D.C. get a pretty good health care plan, and what 
am I left with.
  I think that whatever we do, whatever Federal regulatory scheme that 
we come up with for health care insurance, it should at least guarantee 
that everybody out there gets to have health care like we do. That if 
you are going to elect men and women to go to Congress who are going to 
enjoy the benefits of the Federal employee health care plan, that every 
American out there should have access to that, certainly those that 
come back from duty overseas and are playing by all the rules we ask 
them to when they return.
  Mr. KAGEN. Well, be careful there, because you may just get what you 
want. There is nothing to say really that the health care that you have 
is the best available.
  I will bet you don't understand completely what you have got for 
insurance, because it's so hard to read and interpret that policy. We 
have got an idea here that's kind of a good idea, but like many things 
here in Congress, if it makes sense, it just may not happen.
  So what we really have to do is just clear away all the clutter and 
ask some very basic questions: Do you want to have an opportunity to go 
to the pharmacy and pay the lowest price available for that 
prescription? I think you do.
  Is there any reason why someone should be discriminated against? Now, 
let's say there is five of us standing in line to get the prescription, 
30 pills of drug X at a pharmacy.
  Why should we pay five different prices? Why shouldn't they just put 
the sign up on the wall and say here is what it is. Put it on the 
Internet, here is what it is. And let's get some competitive forces to 
leverage down these prices.
  When insurance companies have to compete in an open marketplace, we 
are going to leverage down that price, my best guess is about 22 
percent before they really begin to compete for the customer, just like 
the auto dealers competed for my precious dollars for that Chevrolet 
Impala. So I look forward to a competitive marketplace.
  As you know, I chose not to select health insurance when I got here. 
It was offered to me, and I was quite surprised. They said, ``Well, 
Congressman, before you leave to go back to Wisconsin, would you like 
to hear about the benefits?''
  And I said, ``Lady, are you kidding me? What are you talking about?'' 
And she showed me a list of health care benefits, of cafeteria plans I 
could choose from. I had to go catch a plane.
  I said, ``Well, okay. What did you take?''
  ``Oh, I took the Cadillac plan,'' she said, ``$250 deductible. They 
have got to take you because you are a government employee.''
  I said, ``Well, I'll tell you what. As soon as you can make that same 
offer to everybody else that I have the honor of representing, I will 
be happy to make my choice.''

                              {time}  2030

  I agree with you that we have to have choices, but they've got to be 
openly disclosed, and we need to get a basic insurance policy that 
really says, if you're a citizen, you're in.
  Now, one of the things that I am really pleased about with this 
President is that President Barack Obama gets it. He doesn't just get 
it in his mind. He gets it in his heart. He actually feels what we feel 
and what my patients feel, and he has taken the single, most essential 
element in health care as his number 1 element, and that is no 
discrimination due to preexisting conditions. When we frame health care 
around our civil rights, we're not saying you have a constitutional 
right to this or that service. We're saying that you shall not suffer 
from discrimination, like we passed last year, based on your genetic 
potential. You will not suffer from discrimination at the pharmacy 
because you have less money in your pocket than somebody who is getting 
a discount and not you.
  You mentioned our veterans who served not for themselves but for 
their country. Isn't it appropriate that when a veteran comes home that 
his wife and his family get the same discount on that medication that 
they might need? What about their neighbors? What about their whole 
community? What about their entire country? Isn't it appropriate, if 
the pharmaceutical company is making a profit at the VA price, that we 
all benefit from his service or her service at that leveraged down 
discounted price? We have to begin to use the leverage of the 
marketplace.
  I'll finish up with my comments by saying that we have witnessed in 
the last year the collapse of the housing bubble. That repercussion, 
that ripple effect in the economy, has just taken down many millions of 
jobs. It has taken away businesses left and right, and it continues to 
do so.
  I believe we're also looking at another bubble, and that bubble is in 
the price of health care. It's simply out of reach for ordinary 
families, averaging $1,200 to $1,400 a month for insurance

[[Page H4905]]

premiums, and it guarantees only one thing: that, every month, the 
insurance company is going to take your money and that you'll have to 
fight like hell to get it back. Having insurance today doesn't 
guarantee that you're going to get the services that you need. That's 
how Chairman Olver was able to show us all the data.
  We are spending a lot of money for health care. We are not getting 
the value. So I think it's time to begin to ask the question if we 
shouldn't begin to change the process of how we're going to reward the 
delivery of health care, to change the process and reward value, not 
just per head or per prescription. We have to begin to reward value and 
prevention. Look, you are exactly what you eat.
  As my father says, ``Steve, boy, pollution begins at your lips. If 
you don't put it in, it won't stay on you.''
  ``Well, okay. I'm doing my best to lose weight, Dad,'' but the 
reality is we can do this by working together.
  It will take Democrats, Republicans, Libertarians, and Independents. 
The American people don't want any more argument about this. They want 
us to come up with a solution that works for their budgets, that works 
in their homes and that works within a framework that guarantees that, 
if you're a citizen, you're in. If it's in your body, it should be 
covered.
  I am more confident tonight than ever before that, this year, we're 
going to achieve that goal of guaranteeing access to affordable health 
care for everyone who is legally here.
  Mr. MURPHY of Connecticut. Thank you, Mr. Kagen.
  We have sort of run the gamut this evening of the problems that 
underlie the existing system--the lack of transparency in insurance 
markets, the discriminatory practices of insurance companies, the lack 
of cohesion in prices when you walk into a pharmacy or into a hospital, 
the amount of money that it puts on top of businesses that are already 
struggling to compete in this world.
  When you talk about health care, it may be the most complex topic 
that we ever talk about here. It seems insurmountable sometimes. It 
seems like there's too much to try to take on at one moment, but there 
are simple solutions here, as you said: Pay for performance instead of 
pay for volume. Pay for prevention rather than crisis care. Give people 
options that they can see and understand.
  I think that there are some solutions here that can cross party 
lines, as you said, Mr. Kagen. I think that we can achieve a real 
victory in health care for America, in health care for America this 
year, this session, that guarantees that for citizens of the most 
affluent and the most powerful country in the world. Just because you 
can't afford to see a doctor doesn't mean you're not going to get sick. 
I hope we get the chance to do this more often and to bring our 
colleagues to the realization that the time for reform is now.
  I yield back the balance of our time, Mr. Speaker.

                          ____________________