[Congressional Record Volume 155, Number 79 (Thursday, May 21, 2009)]
[Senate]
[Pages S5805-S5807]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. LEAHY. Mr. President, very few people in America today would 
argue that our health care system is not in need of reform. It is a 
travesty that in the richest, most powerful country in the world, there 
are more than 47 million people without health insurance. That is an 
absolutely shocking number. It represents roughly one in six people who 
are going without regular trips to the doctor, forgoing needed

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medications and resorting to emergency rooms for care because they have 
nowhere else to turn. These are our friends, our neighbors, and 
millions of our children.
  An estimated 87 million people--one in every three Americans under 
the age of 65--were uninsured at some point in 2007 and 2008. While my 
home State of Vermont has made significant strides in creating a plan 
for comprehensive coverage, there are still far too many Vermonters 
without health insurance. While we beat the national average, roughly 
10 percent, or 66,000 Vermonters remain uninsured.
  Those Americans who are fortunate enough to have health coverage 
often cannot afford to access care. Every day, Americans across this 
country are struggling to afford premiums for health insurance, which 
have nearly tripled since 2000. In fact, new estimates show that the 
cost for health care for the average American family is more than 
$16,000 per year--an increase of over $1,100 from the previous year. 
Health care reform has been put on hold for far too long and cannot be 
delayed any further.
  It is encouraging that this Congress has already taken a few 
constructive steps toward insuring more Americans and making our health 
care system more effective. One of the first bills that President Obama 
signed into law was the reauthorization and expansion of the Children's 
Health Insurance Program. This bill has extended and renewed health 
care coverage for over 10 million children and provided 4 million more 
with new coverage. As part of the American Recovery and Reinvestment 
Act, Congress extended health benefits for Americans who lost their 
jobs as part of the economic downturn and invested over a billion 
dollars to help States implement electronic health records to help make 
care more efficient with strong personal privacy protections, which I 
was proud to coauthor with others. While these bills have moved our 
country in the right direction, it would be a mistake to stop short of 
larger scale changes to our health system. The need for comprehensive 
reform has never been more urgent.
  Health care reform legislation must create a system where all 
Americans have the opportunity to access health insurance that is 
affordable and provides adequate coverage. For far too long, an 
unregulated health insurance market has cherry-picked healthy Americans 
to provide coverage to, while offering unaffordable coverage to 
individuals with ``pre-existing conditions.'' Many others who have 
insurance do not have adequate coverage and are insured only for 
certain conditions. Others have high premiums or unaffordable 
deductibles so accessing care is unrealistic.
  Competition among private insurers has not driven down costs to 
consumers and the current private insurance market has a clear 
incentive to offer coverage only to the healthiest Americans. 
Comprehensive health care reform can change this calculus and that is 
why I support the creation of a federally backed, public health 
insurance option. For those who are satisfied with their current 
insurance there is no need to change. A public option would only give 
consumers more choices to purchase an affordable and quality health 
insurance plan and will help drive down overall health care costs by 
introducing real competition into the health care market. I was proud 
to join Senator Brown and over twenty other Senators to introduce a 
resolution stating our support of a public option as part of 
comprehensive health care reform legislation.
  I appreciated the recent news that leaders of the health care 
industry are working with the Obama administration and have unveiled a 
plan to voluntarily trim roughly $200 billion in health care costs per 
year. While this is a movement in the right direction, this should not 
distract from the fact that coverage must be affordable for Americans 
or the larger goal of reducing overall costs will not be realized. A 
public option should recognize an individual's ability to pay and offer 
subsidies for those who are still unable to afford care. Leaving 
individuals without insurance drives up health care costs for us all, 
and we must work toward a goal of insuring all Americans.
  Insuring more Americans is of no use unless we work toward 
incentivizing people to become nurses, doctors, and health care 
professionals. My wife Marcelle is a nurse, and I understand the threat 
that nursing shortages pose to health care access and safety. 
Additionally, with the costs of a medical education rising, many 
aspiring physicians are choosing to specialize instead of pursuing a 
career in primary care. Especially in a rural State like Vermont, we 
are struggling to maintain primary and preventative care services 
throughout the State. I have heard from far too many Vermonters who use 
the emergency room for everyday health care needs because there are not 
enough primary care physicians to handle the demand for services. I 
support efforts to establish programs to help students repay their 
loans should they choose to practice in underserved fields or areas 
high in need of physicians and nurses across the country.
  Strengthening our primary care workforce will also help Americans 
access preventative services to help maintain good health and reduce 
the incidence of debilitating chronic conditions. Chronic diseases are 
often preventable or manageable with treatment, yet currently account 
for 75 percent of our health care spending. Already we have seen a 
movement to target preventable diseases by focusing on ways to promote 
healthy lifestyles and choices. As part of its Blueprint for Health, 
Vermont has begun a series of pilots across the State to enhance health 
care coordination and patient outcomes through patient centered medical 
homes. Vermont is seeing good results and is finding that a coordinated 
approach to health care prevents repeated hospital visits and the 
emergence of chronic conditions. Prevention must be seen as a 
cornerstone to both reducing costs and keeping Americans healthy.
  Some argue that in our current economic climate it would be 
irresponsible to reform health care because we simply cannot afford it. 
What we cannot afford is to stick with the status quo, which is 
crippling our economy and neglecting millions of Americans who want 
coverage but cannot afford it. Health care costs currently consume 16 
percent of the United States's gross domestic product, which is 
expected to double in the next decade if nothing is done to slow the 
trend.
  Strengthening our enforcement efforts to crack down on rampant fraud, 
waste, and abuse in the health care system is vital to lowering costs 
associated with health care. The scale of health care fraud in America 
today is staggering. According to conservative estimates, about 3 
percent of the funds spent on health care are lost to fraud--that 
totals more than $60 billion a year. For the Medicare Program alone, 
the Government Accountability Office estimates that more than $10 
billon was lost to fraud just last year. Unfortunately, this problem 
appears to be getting worse, not better.
  The answer to this problem is to make our enforcement stronger and 
more effective. We need to deter fraud with swift and certain 
prosecution, as well as prevent fraud by using real-time internal 
controls that stop fraud even before it occurs. We need to make sure 
our enforcement efforts are fully coordinated, not only between the 
Justice Department and other agencies, but also between federal, state, 
and private health care fraud investigators. Much has been done to 
improve enforcement since the late 1990s, but we can and must do more.
  Health spending cannot be controlled without a comprehensive approach 
that focuses on all aspects of our health system. We cannot afford to 
stop the growth in health spending without ensuring that Americans have 
access to primary care to prevent and treat chronic conditions before 
they begin. We must target inefficiencies and fraud within the system 
and incentivize quality of care not necessarily quantity of care.
  We have the opportunity to create a system that maintains patient 
choice, gives all Americans access to quality care and reduces overall 
health spending. We cannot afford to neglect true reform to our health 
system any longer.
  I look forward to working with the Finance and HELP Committees and 
all Senators to pass a comprehensive health care reform bill this year.

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