[Congressional Record Volume 155, Number 68 (Tuesday, May 5, 2009)]
[Senate]
[Pages S5122-S5126]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



  (At the request of Mr. Reid, the following statement was ordered to 
be printed in the Record.)

                      SPECIAL OTIS BOWEN LECTURES

 Mr. KENNEDY. Mr. President, I ask unanimous consent that 
remarks by Ralph Neas be printed in the Record.
  The being no objection, the material was ordered to be printed in the 
Record, as follows:

Remarks of Ralph G. Neas, CEO of the National Coalition on Health Care, 
  the Special Otis Bowen Lecture, University of Notre Dame, March 26, 
                                  2009

       Thank you. It is truly an honor and a privilege to be here 
     with you today as a participant in the Otis Bowen lecture 
     series.
       I want to express my appreciation to Dr. Mark Walsh for 
     inviting me, and commend all the conveners and hosts of this 
     gathering. I congratulate Indiana University and the 
     University of Notre Dame for the collaboration that brought 
     IU's medical school to the Notre Dame campus.
       I want to especially thank Otis ``Doc'' Bowen, the 44th 
     Governor of Indiana, and the Secretary of Health and Human 
     Services during the Reagan Administration. His leadership, 
     commitment to the public interest, and his contributions to 
     Indiana and the Nation are exemplary and should serve as a 
     model for us all to emulate.
       Dr. Bowen, both Dr. Henry Simmons, the visionary founder 
     and president of the National Coalition on Health Care 
     (NCHC), and former Governor Robert Ray of Iowa, the Co-Chair 
     of NCHC, send their warm regards. Dr. Simmons was one of 
     President Richard Nixon's top health care advisors in the 
     early 1970s and worked on the Grace Commission which in the 
     1980s found that one-third of all income taxes were consumed 
     by waste and inefficiency. He has devoted his professional 
     life to improving health care for all Americans. And Governor 
     Ray worked with Dr. Simmons and you many times over the past 
     several decades. I am so proud to be working with them.
       Our timing is propitious. Indeed, the conveners of this 
     event were prescient. We gather tonight at an extraordinary 
     moment in history: The Nation is facing the worst economic 
     crisis in more than seven decades and Americans urgently need 
     a better health care system; our health care system is 
     dysfunctional and represents an unsustainable drain on our 
     economy as a whole. It is inefficient and inequitable; urgent 
     action is required to systematically address what is an 
     incredibly challenging and morally troubling policy problem 
     affecting every American.
       In short, the health care system in the United States is in 
     desperate need of significant reform. However, we should 
     emphasize at the beginning that we need an American solution. 
     We can and should borrow from the best of what works 
     elsewhere. But we should recognize our unique history and the 
     special characteristics of the American people.
       The good news is that the President and Congress are 
     seriously considering health

[[Page S5123]]

     care reform. In fact, in just the past month we have seen a 
     presidential address to a joint session of Congress, a 
     presidential budget, and a presidential summit, all 
     prominently featuring systemic, systematic health care 
     reform. In addition, the Senate and House of Representatives 
     have already commenced comprehensive hearings.
       We must succeed. Too much is at stake: the health and well-
     being of millions of American families, and the future of the 
     Nation's economic and fiscal health. Also at stake, I 
     believe, is whether we can help restore the trust and 
     confidence of the American people in their government.
       So I cannot imagine a better time for us to be having this 
     conversation. And I couldn't be happier that it is happening 
     here. The University of Notre Dame, and people connected to 
     Notre Dame, have been central to my life in more ways than I 
     can count.
       I was a student here during the 1960s. As a young person I 
     had watched on television as Bull Connor turned dogs and fire 
     hoses on civil rights marchers. I had watched Martin Luther 
     King champion human dignity in the face of bigotry and 
     violence.
       Early on, I wondered whether I had a vocation to the 
     priesthood, but I found in Dr. King and the Kennedys an 
     inspiration to public service as a different kind of 
     vocation. And that brought me to Notre Dame. Father Ted 
     Hesburgh became the first of many Notre Dame role models, 
     teachers, and mentors who have sustained and guided me ever 
     since.
       The last time I spoke at Notre Dame was about 25 years ago, 
     in 1983. I was just a short time into my tenure as executive 
     director of the Leadership Conference on Civil Rights, and I 
     was asked to address a conference for Catholic laity on work 
     and faith in society sponsored by the U.S. Conference of 
     Catholic Bishops. I believe, like the late Senator Phil Hart 
     of Michigan, that politics can be a high vocation--that a 
     politician can be a lay priest of society.
       In preparing for that speech, I realized that I had learned 
     about human dignity and equality before God from my church 
     and my family long before I learned about the legal principle 
     of equality under the law from my college and law school 
     professors. Those principles have guided my life's work and 
     are central to what I am here to talk about today.
       Another principle that has guided my political life is 
     bipartisanship. I had the extraordinary good fortune to work 
     for two remarkable Republican senators early in my public 
     service career--Edward W. Brooke of Massachusetts, and David 
     Durenberger of Minnesota. They were politicians and public 
     servants who were less interested in ideology and political 
     positioning, and more interested in moving the Nation 
     forward, in finding workable solutions to the Nation's 
     problems. They weren't just willing to work across the 
     partisan aisle; it was central to who they were.
       These principles were at the core of my decision last month 
     to accept the position as CEO of the National Coalition on 
     Health Care. After I decided to step down as president of 
     People For the American Way, I had spoken with many other 
     health care coalitions and institutions. But I had a keen 
     personal and professional interest in working to achieve 
     health care reform in the most non-ideological and most non-
     partisan way possible. And I was impressed by what a great 
     fit there was between the National Coalition and my skills, 
     background, and approach to public policy.
       The National Coalition on Health Care is the largest, 
     broadest, most diverse coalition working to achieve 
     comprehensive health care reform. It is an alliance of 79 
     organizations representing business, unions, health care 
     providers, associations of religious congregations, 
     minorities, people with disabilities, pension and health 
     funds, insurers, and groups representing patients and 
     consumers. Our member organizations represent more than 150 
     million Americans. They speak for a cross-section, and a 
     majority, of our population.
       Our board includes Frank Carlucci, who served several 
     Republican and Democratic presidents in a range of 
     intelligence, national security, and ambassadorial positions, 
     and Israel Gaither, the National Commander of the Salvation 
     Army. It includes John Sweeney, the president of the AFL-CIO, 
     and William Novelli, the CEO of AARP. It includes John 
     McArthur, dean emeritus of the Harvard Business School, 
     Cheryl Healton, President of the American Legacy Foundation, 
     and John Seffrin, CEO of the National Cancer Society. These 
     are organizations and leaders who individually play a major 
     role in our society and in public policy making. Together 
     they represent an extraordinary breadth of expertise and 
     resources.
       The Coalition is rigorously nonpartisan. Former Presidents 
     George H. W. Bush and Jimmy Carter are our honorary co-
     chairs. Former Iowa Governor Robert Ray, a Republican, and 
     former Congressman Bob Edgar, a Democrat from Pennsylvania 
     are its co-chairmen. We believe it is essential to make 
     reform a bipartisan process and a bipartisan achievement.
       I am especially proud of two of the pillars of the 
     Coalition.
       One of those pillars is religious organizations. The U.S. 
     Conference of Catholic Bishops is a member of the National 
     Coalition on Health Care because the Catholic tradition 
     affirms that access to health care is a basic human right and 
     a requirement of human dignity. The Catholic bishops are 
     joined in that belief, and in our coalition, by the Salvation 
     Army, the Religious Action Center of Reform Judaism, the 
     Presbyterian and Episcopal Churches, the United Methodist 
     General Board of Church and Society, and the National Council 
     of Churches.
       The backing and active participation of these religious 
     communities gives us access to their networks of local 
     religious leaders and lay people. We are well equipped to 
     engage policymakers and the public on the moral poverty of 
     leaving millions of Americans without access to quality 
     affordable health care, and on the moral urgency of tackling 
     that problem.
       Another especially significant pillar of our coalition is 
     the medical societies, which together represent hundreds of 
     thousands of doctors. They include the American College of 
     Cardiology, the American Academy of Pediatrics, the American 
     College of Surgeons, the American Academy of Family 
     Physicians, and the American College of Emergency Physicians. 
     Also included are the American Dental Education Association, 
     the Duke University Medical Center and Johns Hopkins 
     Medicine. And just yesterday the Association of American 
     Medical Colleges, along with the Council of Teaching 
     Hospitals, joined our Coalition. This is a very serious brain 
     trust of physicians, medical educators, and their advocates.
       During the last major health care reform effort in 1993 and 
     1994, many of the medical societies opposed that effort. But 
     they working with us now, I think, for several reasons. 
     First, the need for reform has become increasingly obvious 
     and urgent to everyone who cares about making sure that 
     people have access to quality health care. Second, I believe 
     that doctors have a better view than anyone of the current 
     system's problems, inefficiencies, and distortions. I 
     remember a time in the 1980s when a rallying cry from 
     conservative pundits was ``let Reagan be Reagan.'' Part of 
     what we're trying to accomplish here is to ``let doctors be 
     doctors!'' More than just about anything else, doctors 
     want to practice medicine.
       Also, this year, everyone has been invited to the table. My 
     own experience tells me that is how lasting progress is made. 
     In the early 1980s, I was selected to lead the Leadership 
     Conference on Civil Rights, the Nation's oldest and largest 
     civil rights coalition. Working with Republican and 
     Democratic leaders, with business and labor and public 
     interest advocates, we accomplished great things. The passage 
     of the life- and culture-changing Americans with Disabilities 
     Act. The strengthening of every major civil rights law with 
     huge bipartisan congressional majorities, and often with the 
     support of the business community.
       That could only be accomplished by building active 
     alliances across party lines, engaging business and nonprofit 
     leaders, public officials and community activists. We had to 
     find ways to address each community's needs with a pragmatic 
     and principled eye on the ultimate goal of advancing the 
     common good.
       The members and board of the National Coalition on Health 
     Care understand that all the elements of our health care 
     system are interdependent. So are the health care sector and 
     the broader economy. That is why any solution must be 
     systemic and system-wide if it is to be meaningful and 
     effective.
       And that's also why reform must be accomplished now.
       Let me make a case for urgency by discussing the nature of 
     our health care problem.
       There is no question that our system produces and includes 
     extraordinarily gifted medical professionals. I am alive 
     today because 30 years ago I had access to some of the best 
     medical care the world has to offer.
       But millions of Americans do not have affordable access to 
     that care. Indeed, nearly 50 million Americans do not have 
     health insurance--a number that grows with every layoff, or 
     with every employer who cuts health coverage to avoid cutting 
     jobs. Every 2 years, some 90 million Americans go without 
     health coverage. Another 20 million are underinsured.
       What does that mean to individuals and families? It can be 
     disastrous for their physical and financial health.
       People without insurance--or without sufficient insurance--
     are less likely to get preventive care that will keep them 
     healthy. They are less likely to go to a doctor when they 
     become ill. Their serious illnesses are diagnosed when they 
     are more advanced and harder to treat. They put off 
     treatments they need but cannot afford.
       And when they do face serious injury or illness, the cost 
     of treatment can be devastating to their families.
       There are a lot of numbers and statistics that we use to 
     analyze and describe the current state of our health care 
     system. One that really leaps out to me--that is especially 
     heartbreaking--is that currently one-half of all personal 
     bankruptcies, and one half of all foreclosures, are caused by 
     an inability to pay medical expenses.
       Think about what that means.
       Thousands and thousands of families, already traumatized by 
     serious illness or tragic accident, are punished even 
     further. They go through a medical crisis and are forced into 
     a financial crisis. They say good-bye to a loved one--and are 
     forced out of their home. And there is no telling the toll on 
     communities of citizens who are sidelined--or worse--by a 
     condition that could have been treated less expensively and 
     more effectively if the cost of care had not kept people 
     away.

[[Page S5124]]

       These are not just tragic stories. They are evidence of an 
     unforgivable level of cruelty in our current health care 
     system.
       And, of course, all these consequences are not limited to 
     the uninsured and underinsured. The consequences are shared; 
     the burden is shared, by everyone. The costs of emergency 
     room care for the uninsured are shifted to other parts of the 
     system, to other payers. According to a study by Emory 
     University health care economist Kenneth Thorpe, the cost of 
     providing uncompensated care to uninsured patients adds more 
     than $1,000 per year to the average cost of employer-
     sponsored family coverage.
       And that leads us to the second part of the problem we must 
     address--the staggering cost of health care in this country, 
     which is growing in ways that Americans and America cannot 
     afford.
       The cost of insurance is an increasingly heavy burden even 
     for those who have it. Over the past decade, employers and 
     workers have seen their health care costs rise 120 percent. 
     On the other hand, wages only increased 34 percent during the 
     same period (while inflation rose 29 percent). The average 
     cost to families rose from just over $6,000 per year to 
     about $12,000 per year. That is a huge amount for many 
     middle class families. It is an insurmountable burden for 
     working families.
       And unless we act, it will only get worse. Richard Johnson 
     and Rudolph Penner of the Urban Institute projected that in 
     2030, out-of-pocket health care costs will consume more than 
     35 percent of after-tax income for older married couples. 
     That is more than double the 16 percent that health care 
     costs took from those couples in 2000.
       As a Nation, we spend $2.5 trillion in health care costs 
     every year. That is a sixth of our national economy, or about 
     $6,000 per capita. That is twice as much as the average of 
     all industrialized countries, and 50 percent more than the 
     next Nation on the list. (And remember, those countries cover 
     all their citizens, while 15 percent of Americans have no 
     coverage at all.)
       Costs have been consistently rising at a much higher rate 
     than the consumer price index. We as a Nation simply cannot 
     afford double-digit growth in health care costs year after 
     year. They make it harder for businesses to provide health 
     care coverage for their employees--and those employees find 
     it harder to pay the growing share they are asked to 
     contribute to that coverage.
       The increasing cost to small and large businesses is a dire 
     challenge to their profitability, competitiveness and 
     survival. It drains funds from research and development, 
     makes it more expensive to hire new employees, and makes it 
     less affordable to offer workers increased wages. Increasing 
     costs undermine the viability of pension funds. And they 
     increasingly put American businesses at a competitive 
     disadvantage to companies abroad who have much lower health 
     care costs.
       And the fiscal drain to state and federal governments is 
     ruinous. It has been estimated that by 2050, Medicare and 
     Medicaid combined will consume more than double their current 
     share of our gross national product. Our country's financial 
     health--as well as that of individuals, families, and 
     companies--requires that we get costs under control.
       Closely connected to the problem of runaway costs is the 
     national epidemic of substandard care. It may be hard to 
     believe, but every year 100,000 Americans die from 
     preventable medical mistakes. Another 100,000 die from 
     infections contracted in U.S. hospitals. Millions of others 
     are injured or affected, with cascading consequences for 
     their families, their employers, their communities. It has 
     been estimated that preventable health care accidents, 
     errors, and poor quality of care are the Nation's third 
     leading cause of death after cancer and heart disease.
       A few years ago a major study by the RAND Institute 
     examined the medical records of thousands of patients from 12 
     metropolitan areas and evaluated the care they received using 
     indicators of quality developed by specialty expert panels. 
     They found that patients got about 55 percent of recommended 
     care. We should not be willing to accept or tolerate this 
     mismatch between standards and actual practices.
       And here is more evidence of the interconnected nature of 
     these problems. Two different research studies have estimated 
     that dealing with defects in the quality of our health care 
     could reduce the total cost of health care by 30 percent. 30 
     percent. That's $750 billion per year. That is a huge 
     financial incentive to deal with the quality of care and the 
     waste and inefficiencies of our current system.
       So that is the outline of the health care challenge we 
     face--uncontrolled costs, unacceptable quality of care, and 
     unconscionable lack of access to care for millions of 
     Americans.
       Acting urgently is both a moral and financial imperative.
       The current economic crisis is putting more families out of 
     work, putting greater strain on companies that struggle to 
     provide health care, and putting enormous fiscal strains on 
     Federal and State budgets.
       President Obama has called for lawmakers to take action 
     this year. In response, some pundits and critics have 
     suggested that the Obama administration is putting too much 
     on its plate--that it should hold off on health care reform 
     while it figures out how to deal with the financial crisis.
       But that is not possible. Health care is such an enormous 
     part of the economy, is so interwoven with individual, 
     corporate, and governmental crises, that it is not possible 
     to address our economic woes without taking up health care 
     reform. We have reached the point where the public's most 
     pressing domestic concerns--economic growth, jobs, and 
     retirement security, and health care--are fundamentally 
     intertwined. The first three concerns cannot be addressed 
     effectively unless health care costs are contained. The cost 
     of doing nothing far exceeds the costs of taking action now. 
     And if we implement real systemic reforms now, we will save 
     trillions of dollars in the long run.
       As economist Peter Orzag says, the road to fiscal 
     sustainability runs through health care reform. Ben Bernanke, 
     the chairman of the Federal Reserve System, puts it this 
     way:
       ``The decision we make about health care reform will affect 
     many aspects of our economy, including the pace of economic 
     growth, wages and living standards, and government budgets, 
     to name a few . . . As the public interest in these issues 
     testifies, the stakes associated with health care reform, 
     both economic and social, are very high.''
       So, act we must. But how?
       It is easy to be dismayed at the size and complexity of the 
     problem--and by past failures to address it. But we cannot 
     shy from reform. Nor can we let a political stalemate grind 
     the process to a halt.
       I am a veteran of many difficult battles in Washington. 
     I've been part of them for 35 years. And I've never seen a 
     bigger challenge, substantively or politically.
       But I am cautiously optimistic about the possibilities for 
     real reform this year. There exists a rare confluence of 
     economic, political, and historic circumstances. There is a 
     much broader consensus on the need for ambitious reform. And 
     we are seeing all the stakeholders coming to the table, not 
     with the goal of turning the table over and maintaining the 
     status quo, but to seek some kind of resolution to the 
     systemic problems that can no longer be denied or 
     rationalized away.
       That's what the National Health Care Coalition is committed 
     to doing this year.
       And, I'm proud to say, we're ready because we've already 
     done our homework. I've been talking a lot about the problem. 
     Let's talk about the solution.
       The Coalition spent 18 months working with our board, 
     member organizations, and health care experts to reach a 
     consensus on principles and specifications for reform. 
     There's no more detailed or comprehensive proposal on the 
     table that I'm aware of.
       The overarching requirement is that reform be both systemic 
     and system-wide. With that as an understanding, we have laid 
     out five principles for reform and specific and achievable 
     approaches within each category.
       The first principle is coverage for all Americans. We 
     believe coverage should be defined clearly and 
     comprehensively. It should include emergency care, acute 
     care, prescription drugs, oral health care, early detection 
     and screening, preventative care (including smoking cessation 
     programs), care for chronic conditions, and end-of-life care. 
     There should be no exclusion for pre-existing conditions.
       We recognize a range of options--and possible combinations 
     of options--can be used to achieve this goal: employer 
     mandates, supplemented with individual mandates as necessary; 
     expansion of existing public programs that cover subsets of 
     the uninsured; creation of new public programs targeted at 
     groups of the uninsured; or establishment of a universal 
     publicly financed system.
       Participation must be universal, and there must be 
     subsidies provided for those least able to afford coverage. 
     But none of these options requires a government-run system.
       The second principle is cost management. The numbers that I 
     talked about earlier make it clear that it will not be 
     possible to achieve sustainable reform without tackling the 
     cost issue head-on.
       Cost management must be a multi-faceted undertaking. It 
     should include: a plan to make health insurance premiums 
     easier to compare by requiring insurers to establish separate 
     premiums for the core benefit package and any supplemental 
     coverage; a rational mechanism for increasing the cost-
     effectiveness of capital spending; cost-sharing and other 
     tools to provide more and better information and incentives 
     for patients to make good choices about health maintenance 
     and care, and reduce over-use and under-use; an increased 
     emphasis on prevention and early detection of disease; a 
     commitment to improving quality of care; investment in a 
     health care information infrastructure; and steps to 
     modernize and simplify the administration, and dramatically 
     reduce the administrative costs of the health care system.
       It is true that successful reform of all the areas we have 
     talked about will produce significant long-term savings. But 
     it is also essential to begin immediately to bend the cost 
     curve and slowing those double-digit increases that are 
     outstripping our ability to pay for them. The increases in 
     health care costs and insurance premiums for the core package 
     of benefits should be brought into line with percentage 
     increases in per-capital gross domestic product. And we 
     should aim to achieve that goal within 5 years after the 
     enactment of legislation.

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       There must be short-term cost constraints that would 
     include rates for reimbursing providers for care encompassed 
     by the core benefit package, and limits in increases in 
     insurance premiums for the core benefit package. We are not 
     advocating for cuts in reimbursement rates. But slowing the 
     rate of increase is vital--and will reduce the likelihood of 
     sudden cuts made under the stress of financial crisis.
       We recommend that these efforts to manage costs be 
     established and administered by an independent board 
     chartered and overseen by Congress.
       The third basic principle is one I just mentioned in terms 
     of cost containment--that is a national effort to improve the 
     quality and safety of care.
       This includes accelerated development of a national 
     information technology infrastructure, as well as increased 
     emphasis on prevention and early detection of disease, and 
     research on comparative effectiveness and practice guidelines 
     to reduce waste and improve the safety and effectiveness of 
     health care.
       The members of the National Coalition on Health Care 
     recommend that national practice guidelines be developed by 
     panels of leading health care professional based on reviews 
     of research on the effectiveness and impact of technologies 
     and treatment. Conforming to these best practice guidelines 
     could not only reduce unnecessary treatment and costs, but 
     could also help protect medical professionals against 
     frivolous or marginal lawsuits.
       Fourth, we must make the financing of health care more 
     equitable and reduce or eliminate cost-shifting.
       Again in this area we have identified a range of mechanisms 
     that could be used, individually or in some combination, to 
     fund the costs of necessary reforms and assuring that every 
     American is covered: general revenues, earmarked taxes or 
     fees, required contributions from employers, required 
     contributions from individuals and families, which would 
     include co-payments, deductibles, and contributions toward 
     premiums.
       Subsidies should be provided, or financial obligations 
     varied, based on relative ability to pay for less affluent 
     individuals, families, and employers.
       And fifth, we must simplify the administration of health 
     care. The United States spends more than any other Nation--
     hundreds of billions of dollars every year--to administer our 
     health care system. Administrative expenses incurred by 
     private health insurers rose 52 percent between 1999 and 
     2002.
       Our system's complexity is not only expensive; it is also 
     confusing and frustrating for patients and doctors. And its 
     lack of transparency undermines both accountability and the 
     ability of individuals and organizations to make market-based 
     decisions.
       Assuring coverage for all Americans, and establishing a 
     core benefit package, would create a consistent set of ground 
     rules for patients, providers and payers.
       An integrated technology infrastructure would not only 
     reduce administrative complexity and costs, but help to 
     reduce medical errors, protect patients' safety, and improve 
     outcomes.
       These principles--coverage for all, cost containment, 
     quality and effectiveness of care, simplified administration, 
     and equitable financing--are interdependent. And we must deal 
     with them that way.
       Taken together, the National Coalition on Health Care 
     specifications provide an ambitious and achievable guide to 
     our Nation's lawmakers. We know what investments and policy 
     changes we need to make now in order to improve access and 
     quality of health care in a way that the Nation can afford.
       We have a road map. Now we need to keep policymakers 
     focused on the journey.
       President Obama, who recently hosted a bipartisan summit on 
     health care reform at the White House--has urged Congress to 
     give him reform legislation this year. He has put a 
     significant down payment for reform in his budget.
       While I do not think the Administration has yet been 
     ambitious enough--dealing, for example, in a realistic way 
     with the need to contain costs--I believe the White House has 
     learned important lessons from the experience of 1993 and 
     1994. They are including all stakeholders from the beginning. 
     They are putting forward broad principles and counting on 
     Congress to write the legislation. And they are moving in a 
     bipartisan fashion, inviting Republican and Democratic 
     congressional leaders into their conversations.
       I believe bipartisanship is essential not just because we 
     need 60 votes in the Senate, but because a bipartisan 
     consensus would be good for the country as we move forward in 
     this enormous, and enormously important, undertaking.
       We must understand fully that time is our most formidable 
     foe. We must achieve health care reform now, not only to 
     protect and advance Americans' health, but to shore up our 
     reeling economy. We must take advantage of the political 
     momentum for change. We must overcome those who might be 
     tempted to see the failure of reform as a political 
     opportunity.
       Reform must be enacted this year--and as of today the year 
     is already almost one-quarter behind us.
       In Congress, there are at least seven major committees that 
     have some jurisdiction and will be involved in crafting 
     reform legislation. That means multiple subcommittee hearings 
     and markups, full committee markups, House and Senate floor 
     debates and votes, and the House-Senate conference committee. 
     All of this takes time. As I tell my law school legislative 
     process classes, there are 100 decision-making points in the 
     legislative process, and each of them is a point at which 
     compromise can take place.
       If we are to have reform enacted this year, we must have a 
     bill through the Senate with a bipartisan consensus by Labor 
     Day. So each day is enormously consequential. We have no time 
     for ideological warfare or partisan posturing. This truly is 
     a time for pragmatism to trump ideology. We need to be 
     focused on what works. And we cannot allow the perfect to be 
     the enemy of the good.
       We can do this.
       A few years ago, my father-in-law was in Rome. He was at 
     the Vatican when he collapsed with a heart problem. He was 
     attended to by the Pope's doctor--the finest care he could 
     have asked for. And when he had recovered and asked how much 
     he owed, the answer was ``nothing!'' His health care in Italy 
     was free. I know it's a simple story, and our quest for an 
     American solution is anything but simple, but there's no 
     reason we cannot achieve the same kinds of access to 
     affordable quality care that other nations provide.
       There is another story that explains why I am so committed 
     to making this work--and why I have faith that it can.
       In 1979, as a young man of 32, I was diagnosed with 
     Guillain-Barre Syndrome, a disease that paralyzes the nerves 
     and muscles. Over a period of weeks I became completely 
     paralyzed, unable to breathe on my own or move a muscle. I 
     was put on a respirator for 75 days, and was eventually given 
     general absolution when it was not clear that I would 
     survive.
       Three of my doctors in St. Mary's hospital in Minneapolis, 
     Minnesota, were Notre Dame graduates, including chief of 
     staff Pat Barrett, who was the football team's doctor on the 
     road. They helped me survive and recuperate. But no one was 
     more important than my mother, who traveled to Minneapolis 
     from a suburb of Chicago and sat at my bedside, holding my 
     hand, for 50 of my first 100 days in the intensive care unit. 
     And then there was Sister Margaret Francis Schilling, a nun 
     who had survived Guillain-Barre 25 years earlier, and who was 
     celebrating her 50th anniversary as a nun in 1979, who talked 
     to me every day, who prayed with me every night, and who 
     helped save my life and renew my faith.
       You can probably understand why, when given the opportunity 
     to be transferred to the Mayo Clinic, I told my parents that 
     I wanted to stay at St. Mary's. Sometimes the appearance of 
     near-mystical serendipity trumps all other considerations.
       The experience taught me many things, most notably how 
     vulnerable each of us is, and how dependent we are on each 
     other. I had been a young hot-shot on a fast track 
     congressional career. I thought I could do anything. As long 
     as I worked hard and never gave up, I would not need anybody. 
     I learned the hard way how wrong I was. I learned first-hand 
     how quickly our lives and health can take a turn. I came out 
     of that experience with a renewed commitment to public 
     service, and with a sense of how interdependent different 
     vocations--like Sister Margaret's, my doctors', and mine--
     could be.
       After I finished my physical rehabilitation, and recovered 
     my physical and mental stamina, I began interviewing for 
     jobs. My parents, Senator Brooke, and Senator Durenberger 
     were all advocating that I join a law firm and begin a more 
     traditional way of life.
       In the middle of my deliberations, John Sears, a Notre Dame 
     grad, a lawyer, and the former campaign manager for Ronald 
     Reagan, gave me contrary advice. He told me that I could join 
     a law firm at any time. But the Nation in 1981 was about to 
     begin a historic debate about civil rights, social justice, 
     and the role of the Federal Government. He told me that if I 
     had an opportunity to have a leadership position, I should 
     seize the moment. He told me how important it was to be on 
     ``the front lines of history.'' Only then could you make a 
     dramatic difference for your family, your community, and your 
     country.
       And that is the opportunity and the challenge that we all 
     face at this moment.
       The great Irish poet Seamus Heaney has written:

     History says, Don't hope
     On this side of the grave.
     But then, once in a lifetime
     The longed-for tidal wave
     Of justice can rise up,
     And hope and history rhyme.

       We all have a chance, working together, to make hope and 
     history rhyme.
       Regardless of where you stand on the health care issues 
     before us, I urge you to get involved. This is a time for all 
     of us--of whatever vocation--to come together. We must all be 
     willing to sacrifice for an accomplishment that would address 
     a great moral failing, that would strengthen our Nation's 
     economy as well as its social fabric, that could point the 
     way toward dealing constructively with other systemic 
     challenges ahead.
       I hope you will support the principles of the National 
     Coalition on Health Care. But the most important thing, in 
     the words of Oliver Wendell Holmes, is to ``share the passion 
     and action'' of one's time.
       Please do not sit on the sidelines. Immerse yourself, 
     passionately, in this historic moment.

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       Please know how much it has meant to me to be here. I am 
     profoundly grateful for the opportunity to be with you 
     tonight.
       Thank you.

                          ____________________