[Congressional Record Volume 155, Number 85 (Tuesday, June 9, 2009)]
[House]
[Pages H6387-H6393]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              THE 30-SOMETHING WORKING GROUP: HEALTH CARE

  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. Madam Speaker, I thank you and Speaker of 
the House Pelosi for allowing the 30-Something Working Group, which has 
been empowered by the Speaker's office, to come down to the House floor 
every so often and share with our colleagues here in the House really 
some of the burning questions of our constituents out there, especially 
those that affect younger individuals and younger families, and to talk 
about how this House, under new leadership with a new face in the White 
House, is rising to answer those questions and meet those challenges.
  We'll put this poster up at the end of the hour as well, but we are 
always eager to hear feedback from people who want to know more about 
the 30-Something Working Group. Madam Speaker, thanks to members of 
your class, we have a number of new members of the 30-Something Working 
Group and they've been coming down and joining us occasionally in these 
hours. We're glad to have Mr. Altmire with us and hopefully some guests 
to join us this evening as we try to focus our discussion this evening 
on an issue of just incredible importance to our constituents. That is 
the issue of health care for all Americans.
  We sit at a moment of great economic peril for this country and the 
people that we represent. There is not an hour or minute, frankly, that 
goes by when we are back in our districts where we're not talking to a 
family or to a shop owner, to a factory worker, to a small business man 
about the difficulty that they face in this economy. It's getting 
harder and harder to keep businesses open. It's getting harder and 
harder to hold onto your job. And for the now 9\1/2\ percent of 
Americans that are out of work, it's getting hard to find a way back 
into the workforce.
  For those of us who believe that now is the time to pass not 
incremental health care reform but major structural health care reform, 
we support that not just because we think that it's a moral imperative, 
as the richest Nation in the world, that we shouldn't be the outlier in 
the global health care system by which we still stand as the only 
country in the industrialized world that has such a high percentage of 
our citizens without access to our health care system; not just that, 
as the country which claims to be the leader of the free world, we 
still sit in a country where children go to bed at night sick because 
their parents can't afford a doctor; but because we believe that it's 
part and parcel of how we start to get this economy back on firm 
footing again.
  For families out there that have seen their wages remain flat over 
the last 5 years and have seen the percentage of their income dedicated 
to health care costs grow exponentially, they didn't

[[Page H6388]]

figure out that this economy was in trouble last fall when the banks 
collapsed. They knew it long ago. For our auto companies that have been 
struggling for a very long time to compete competitively on a global 
stage when $1,500 of every car that they sell is attributable to health 
care costs, $1,500 more than their competitors in Japan or Germany, 
they knew that the health care system was dragging this economy down 
long before last fall. And for small- and medium-sized businesses 
across this country who have seen their premiums dedicated to keep 
their employees insured grow by 10 or 12 or 14 percent a year, far 
outpacing the similar increase in revenues coming into their coffers, 
they knew that health care was weighing this economy down long before 
the newspapers discovered that this economy was in crisis and in 
trouble last fall.
  If we really want to emerge from this recession stronger than ever, 
if we really want to be competitive in the global stage, if we really 
want to recognize the strength of this economy lying in the hundreds of 
thousands of 2- and 5- and 10- and 20-person businesses out there in 
each and every one of our districts, then we have got to fix our health 
care this year. And we can't just do it with a Band-Aid here or there, 
pardon the pun. We've got to do it with real reform that at the same 
time lowers the cost of care and expands access to more people. I 
happen to think that it should be a right as a matter of being a 
citizen of the United States that you should get health care, but I 
recognize that the only way that you do that is by lowering the cost of 
care across the board.
  We spend twice as much as all of the other industrialized nations on 
health care, essentially, maybe a little bit less than twice as much, 
for a system that still leaves 50 million people uninsured. We can get 
access for everybody out there as long as we start spending less or, at 
the very least, that we start controlling the rate of growth.
  So I think we are going to talk about all these things tonight as the 
30-Somethings come to the floor. We are going to talk about health 
care, health care reform as a moral imperative, as a matter of 
conscience for this Nation. We're going to talk about it as an economic 
imperative, and we're going to talk about it both from the context and 
the perspective of getting care to people that don't have it today and 
trying to lower the cost of care so that all of us, whether or not we 
have it or don't have it, don't continue to pay for a system that far 
too often provides very expensive care without having accompanying 
results.
  So I'm glad to be here on the floor today with a good friend who has 
joined here for a number of Special Order hours, Mr. Altmire. Ms. 
Baldwin has joined us as well.
  I'm glad to yield the floor to Mr. Altmire.
  Mr. ALTMIRE. I thank the gentleman for yielding.
  I cannot think of a bigger issue to be dealing with right now. We 
have so many issues that this Congress is dealing with. Certainly 
energy, education, this enormous mountain of debt which we have 
accumulated over the years, all of these issues are critically 
important, and all of them are issues that this Congress is going to 
deal with. The issue of health care is an issue that impacts our 
national debt. We cannot dig our way out of this hole. We cannot 
achieve structural surplus like we had in the 1990s. We can't ever even 
approach that until we deal with the skyrocketing cost of health care.
  This is an issue that affects every American in this country very 
directly. It affects every family and it affects every small business 
in the country in ways that other issues that we deal with don't on a 
daily basis.
  So what we are talking about here tonight and what this Congress is 
doing over the course of this summer as we put together this health 
care reform bill is the three legs of the stool, as the gentleman 
pointed out, making sure that we find a way for every American in this 
country to gain access to our system and get affordable health care, 
making sure that we bring down the costs for everyone. Because we talk 
about the 47 million Americans who don't have any health insurance 
right now. They get treated. They show up at the emergency room, and 
they get their health care. It's certainly not the most cost-effective 
way. It's probably not the most efficient way, and it's probably not 
the best way for them to get health care, but they'll end up in the 
system somewhere. And as the gentleman knows, those of us who have 
insurance pay for them. They get covered. They get their treatment. But 
the cost shift that takes place is the reason why an aspirin costs $10 
when you go to the hospital.
  It's very easy to demagogue this issue if you're in it for political 
reasons, to say, well, here's what they want to do: They want to take 
your money and give it to those people who don't have health insurance 
because 87 percent of Americans in this country have health care. We 
spend a lot of time talking about those who don't, but 87 percent of 
Americans have health care. Now, they are in many cases one illness or 
injury away from losing everything, certainly one job loss away, and 
tens of millions of Americans that have coverage live in fear of losing 
it for those very reasons. Tens of millions more are underinsured. They 
have some coverage; they don't have what they need. And in many cases, 
the insurance companies have people, millions, approximately 2 million 
people, that are employed in this country specifically to find a way, 
if you are insured, to make sure that they can deny your claim, to 
redline you, to find a preexisting condition exclusion, to find a 
reason why they shouldn't have to pay your claim. Now, that's another 
of the issues. Lastly is quality. So you have cost, you have access, 
and you have quality.

  We have in many ways the best health care system anywhere in the 
world, and the challenge that we have in putting this bill together is 
we want to preserve what works. We want to say to the 87 percent of 
Americans who have health care, if you like your plan, if you enjoy the 
health care plan that you have and you want to keep it, we're not going 
to touch it and you can keep it. But if you want another alternative, 
we're going to find you another alternative. And if you have too much 
out-of-pocket costs, you're not satisfied with the situation that you 
have, we're going to give you another alternative. But we want to 
preserve what works in the current system. We want those who have 
health care to be able to keep it. And we want to make sure that our 
medical innovation, our technology, our research, which far exceeds 
anything available anywhere else in the world, is preserved. We want to 
fix what doesn't work and we want to preserve what does work.
  So we are going to increase quality. And we're going to talk about, 
tonight, ways we are going to do that, the approaches we are going to 
take. We are going to increase access, bringing everybody into the 
system, which helps us all. And we're going to do access, we're going 
to do cost, and we're going to do quality improvements in this bill, 
all the while preserving what works in the current system.
  And the gentleman used an example of how we're already paying for 
health care, something I mentioned earlier. Those who are afraid to 
bring new people into the system because they fear that this is going 
to increase their own costs, well, what I talk about when I have town 
meetings about health care is, again, they're already paying for people 
who don't have health insurance in a variety of ways. When that 
individual shows up at the emergency room, the cost shift takes place 
because the person without insurance gets their treatment and somebody 
else pays for it. Those of us who have health insurance pay for it. 
That's why an aspirin costs $10.
  I had knee surgery many years ago, and to make sure that they 
operated on the right knee, they put a black magic marker that said 
``L'' on my left knee. When we got the bill, I saw that that black 
magic marker to put that ``L'' on cost $20. That's because of the cost 
shift that takes place. Now, that's one example. Every American who's 
had to deal with the health care system has a similar example. If 
everybody is covered and everybody is in the same risk pool, we're not 
going to have that type of cost shift that takes place. But that's only 
one example of how we are paying for it.
  The gentleman talks about $1,500 of the price of every car made in 
this country is due to health care costs because American manufacturers 
have to pay for health care for their employees

[[Page H6389]]

and other countries don't have that burden in the manufacturing sector.

                              {time}  2015

  So we're starting at a $1,500 disadvantage for that one product. 
Think about the supply chain. Think about the way goods and services 
end up in a consumer's hands. Think about the distribution from the 
person who manufactures it--from the company that manufactures it--to 
the people who distribute it, to the people who stock the shelves, to 
the people who operate the stores, to the people who run the cash 
registers. At every segment of that supply chain, there is a health 
care component to that. That company, that business is paying, in many 
cases, health care for their employees. That is what we're paying for.
  So, when you hear about people who don't have insurance and when you 
hear about the skyrocketing costs of health care, think about that part 
of it as well, not just what your copayment or your premium or your 
deductible is. Think about how every sector and every segment of our 
lives is impacted by that.
  Mr. MURPHY of Connecticut. Will the gentleman yield?
  Mr. ALTMIRE. I will.
  Mr. MURPHY of Connecticut. I want to just put an example to one of 
the points you made here, which is this cost shift that happens. You 
talk about the folks who don't have insurance or who are underinsured. 
They get it, right? We have universal health care in this country. 
You've just got to wait until you're so sick that you end up in the 
emergency room until you get it.
  In fact, President Bush, while he stalled on health care for 8 years, 
famously remarked, you know, don't worry about the uninsured--I'm 
paraphrasing--because they'll get health care when they need it. They 
just have to show up to emergency rooms.
  Well, I've told this story maybe even on this House floor before. I 
told it 100 times back in Connecticut. When we were debating health 
care reform in the State legislature, I'll never forget a woman who 
came and testified before us. She told this story:
  She said, you know, I was working. I was employed, but my employer 
didn't provide health care, and I didn't make enough to go and get it 
on my own. I think she might have had some kids, and she had gotten 
them insured, but she hadn't had insurance herself. She started 
noticing over the course of a couple of weeks that she had a real pain 
in her foot. The pain would sort of get worse, and then it would get 
better. She knew that she should go see a doctor, but she knew that a 
couple of things were going to happen: one, she was going to be billed 
a pretty exorbitant amount for the visit; two, she was going to have to 
go into the pharmacy and have to probably pay for some antibiotic to 
treat it. She was savvy enough to understand that, when she did that, 
she was going to pay the highest cost in the whole system. If you were 
uninsured, you were going to pay top dollar for that visit, and you 
were going to pay top dollar for that drug. You don't get the benefit 
of the bulk purchasing that the Federal government gets through 
Medicaid or through Medicare or that the insurance companies get 
through similar programs.
  So, one night, she finally decides the pain is just so unbelievable 
that she can't stand it anymore, and so she goes to the emergency room. 
She gets to the emergency room too late to save her foot. She has a 
foot infection that has gotten so bad that she has to have it 
amputated. For her, that is a life-changing event. Her life is never 
going to be the same. She is never going to be the same person or the 
same mother. She is going to have to deal with the disability for the 
rest of her life just because she didn't have the money or the coverage 
to get some simple antibiotics that would have treated that foot 
infection. That just doesn't make sense in the richest country in the 
world.
  Think about it from just a cost perspective. I don't know how much 
that surgery cost, but it was in the thousands of dollars, I am sure. 
She didn't have the money to pay for it. Maybe she got billed for it, 
but probably, more than likely, it just sort of got sucked into the 
unreimbursable cost by that hospital and got picked up, essentially, by 
the taxpayers in subsidies for that hospital or by those people who had 
the insurance, through higher insurance rates, in order to help the 
hospital to compensate for the people like that woman who didn't have 
care.
  So we paid for that surgery. You and I paid for a surgery that didn't 
have to happen. There is a woman walking around now with her life 
fundamentally altered simply because she didn't have access to 
insurance. Sometimes people need to hear these examples, Mr. Altmire, 
of what it really means when somebody only has health care when they 
get so badly sick or ill that they show up in emergency rooms.
  Mr. ALTMIRE. I thank the gentleman.
  That is just one example, and we're going to deal with a lot of 
policy options over the next several months. To talk about just one 
related to what the gentleman is talking about, prevention and wellness 
is something that everyone can agree has to be an important component. 
We have to incentivize doctors and hospitals and our health care system 
more generally to keep people healthy and to keep people out of the 
system and not wait until the last minute when a situation develops 
like the one the gentleman talked about.
  In western Pennsylvania, where I'm from, I'll just talk about one 
disease which is near epidemic proportion. That's diabetes. In some 
cases, it's preventable. In some cases, it's not. For every individual 
whom you can put on a program of wellness and can prevent diabetes from 
taking place or, at minimum, delay its onset, you're changing that 
person's life for the better. You're making a material difference in 
the life of that person and of his family. You're also, in a more 
global sense, saving money for the health care system. If you take that 
one person times the entire country and the entire group of people for 
whom you can delay the onset for not just diabetes but for any 
affliction which one may later get in life, you can prevent injuries if 
you keep people healthy. For the weekend warriors and so forth with 
joint injuries, with arthritis and its onset, these are very costly 
diseases to treat, and they can be debilitating in many cases, but they 
can be prevented or they can, at least, be made better in many cases.
  So this is the type of thing that we want to incentivize in our 
health care system for which, right now, there is no incentive. Under 
our current reimbursement in health care, we reimburse based on the 
number of times one shows up to a doctor's office. Their incentive is 
also for you to be sick. They make more money the more often you go to 
see them. We want the reimbursement system to be based on keeping you 
healthy and on keeping you out of the system, reimbursing based on the 
quality of care provided, not on the volume of services provided. So 
this is one example of the policy option that we are considering.
  I would be delighted to yield to the gentlewoman from Wisconsin at 
this time.
  Ms. BALDWIN. Well, I thank the gentleman.
  I also want to appreciate my friend and colleague, Congressman 
Murphy, for bringing us together on this really critical issue.
  You know, health care for all is the issue that brought me to 
politics in the first place, and it's certainly the issue that keeps me 
here. I join my colleagues tonight on the floor to affirm our fight 
that we must complete comprehensive health care, meaningful and 
affordable comprehensive health care reform, this year. We can no 
longer afford to wait for health care reform.

  There was a recent report from the very respected Robert Wood Johnson 
Foundation that projects, if Federal reform efforts are not completed, 
that within 10 years the cost of health care for businesses could 
double, that the number of uninsured Americans could reach 65.7 million 
and that middle income families would really be the hardest hit. They 
would bear the brunt of our inaction.
  I represent a district in south central Wisconsin. Last month, I had 
the opportunity to gather and to meet with a number of stakeholders in 
my community. I got a chance to hear from diverse perspectives--from 
public and private urban and rural health providers, from patient 
advocates, from insurers, from businesses, and from labor. I always 
find it extremely helpful to hear divergent viewpoints and to get new 
suggestions as we prepare to write this bold, new legislation.

[[Page H6390]]

  No matter what their particular perspectives in this debate are, 
their main message was very clear, that the system is broken and that 
we have to fix it. Some would argue that we really don't even have a 
system intact anymore.
  I want to share just three quick stories from constituents, from 
Wisconsinites, that really symbolize what is broken in our health care 
system, that being the unaffordability of individual markets, the 
insurance discrimination based on preexisting conditions, and the 
struggles of small businesses. I really think it's important that we, 
as Americans and as Members of Congress, hear these stories. Our 
constituents, using their own words and telling their powerful and 
compelling stories, make the best case for health care for all and for 
the actions that we must take. So I'm just going to share with you 
excerpts of three letters that I've received.
  One is from Jean from Rio, Wisconsin. Jean writes, ``My husband, 
Steve, has worked hard his whole life, but as of last year, he has not 
been able to find work because of the downturn in the economy. Neither 
of the jobs that I have held have offered me health insurance. We have 
relied on insurance that we purchased in the individual market, which 
costs nearly $10,000 a year and has a $5,000 deductible, meaning that 
we pay out of pocket for basic doctor visits, screenings and 
prescriptions.
  ``Twenty years ago,'' Jean writes, ``Steve became very ill, and in 
the intervening years has developed multiple brain tumors that require 
extensive treatment and care. We eventually realized that he has 
recurring tumors due to a neurological disease and should be screened 
on an annual basis. Unfortunately, insurance does not cover these 
$13,000 procedures, and we cannot afford to pay that on an annual 
basis. We can only hope and pray that more tumors are not developing. 
It is just so infuriating that, in this wonderful country, we cannot 
get wonderful medical care.''
  Lorraine from Port Washington, Wisconsin, writes, ``When my husband 
filled out an insurance application in July of 2002, he was asked if he 
had ever been diagnosed or treated for cancer in the past 5 years. He 
replied, `No.' He had never been diagnosed with cancer nor operated on 
nor treated for cancer. What he did have was basal cells--small 
carcinomas--which are never malignant and have to be removed from most 
blue-eyed blonds in the course of getting older.
  ``When my husband was diagnosed with bone marrow failure disease, the 
insurance company denied any coverage for his medical care, citing a 
preexisting condition. We were left with over $125,000 in medical 
bills. My husband has now passed away, and I am just thankful that I am 
not in complete financial ruin.''
  Sally, from Madison, Wisconsin, writes me to say, ``I've had my own 
law office for 29 years. I employ two full-time employees and one part-
time employee. I provide health care benefits for our small firm, but I 
have faced an annual increase in premiums of 12 percent, forcing me to 
pass on higher cost-sharing to these three employees. One employee has 
diabetes and also extends coverage to her husband, who is a dairy 
farmer without health insurance coverage. Because of their high medical 
costs, it would have been very difficult for me to find new health 
insurance without facing even higher rates. Health insurance is 
becoming steadily less inclusive and more difficult to keep--and it's 
no wonder that, in today's economy, families count health care costs as 
one of their top pocketbook issues.''
  Madam Speaker and colleagues, these stories illustrate why 
affordable, quality health care for all is so important and is so 
necessary. Universal coverage is both a moral and an economic 
imperative if we are to succeed in the 21st century. For the first 
time, I firmly believe that health care for all is within our grasp. We 
must act now.
  Again, I want to thank my colleagues, my friend Congressman Murphy 
and my friend Congressman Altmire, for taking this fight up and for 
bringing us together to address this important issue.
  Mr. MURPHY of Connecticut. Thank you very much, Ms. Baldwin. I'm 
always amazed at how articulate your constituents are. It really is 
amazing to hear the stories firsthand because, as Mr. Altmire mentioned 
and as one of your constituents mentioned, there is an entire industry 
out there that is dedicated to trying to stop people from getting care. 
That's what you get when you build in the type of profit motivation 
that we have and the pressure on shareholder return. We treat health 
care and the economy around it just like we treat, basically, every 
other industry out there. I think there are a lot of us here who 
believe that there is something fundamentally different about health 
care than the auto industry or the cereal industry or the widget 
industry and that, when the consequences of somebody's not being able 
to get that product is life or death, maybe we should have some 
different rules that govern it. Maybe there is no problem with having 
some incentive built in for innovation, for success and for all the 
rest. Maybe there should be a limit to that, and there should be some 
constraints on the system.

                              {time}  2030

  So I thank you for joining us, and please stick around for a little 
while.
  Mr. Altmire, you are talking about the three pedestals here of 
access, cost and quality. I think it's just important for us to talk 
for a second about how we sort of have an assumption in this country 
that the more money you spend, the better care you're going to get, 
right? And what we have found, as we sort of surveyed one particular 
segment of the country to the next, is that isn't necessarily the case, 
that spending more money and just having more health care doesn't 
necessarily deliver better health care. There are great surveys from 
Dartmouth University and other places that show that, actually, if you 
can better coordinate care, if you can get physicians talking to each 
other, if you can get primary care doctors doing more work up front, 
you can spend more money on preventive health care, as you talked 
about, that you can get better health care out there. So one of the 
things when we talk about controlling cost is trying to actually get 
people to have a decrease rather than an increase in utilization. I 
think it will be a big central part of our discussion here about how we 
do that.
  There are very interesting ideas about how you try to encourage 
providers to work together, about how you invest more in primary care. 
But a subject that we have talked about on this House floor, which is 
going to be fundamental to this discussion, is giving those physicians 
and hospitals the tools to do that. The only way that you can try to 
get doctors talking to each other about complicated patients, the only 
way that you can try to really empower the consumers themselves to take 
more ownership over their own health care is to make sure that they 
have the ability, as physicians or providers, to track those patients 
through the system or, as a consumer of health care yourself, to track 
your care as you move through the system. Technology is really the key 
to that, and we have already taken a great step forward on that issue 
through the stimulus bill. There is $19 billion in the stimulus bill 
dedicated to building out the world's best, most connected, most highly 
technologically advanced health care information system so that as an 
individual walks into the emergency room, that that treating physician 
can immediately figure out what his medical history is, what tests he's 
already had, what's been ruled in, been ruled out relative to the 
illness that they present with. We can save billions of dollars just by 
having better information in the system. I am so glad that our 
President had the foresight to see those savings down the line by 
investing money in the stimulus bill to get that technology out as 
quickly as possible so that it can be a platform for those savings. 
There are going to be a thousand different ways that we talk about to 
save money in this system, and we know that that's how we get access. 
But I don't think any of it is going to be possible, Mr. Altmire, 
without that investment in technology, something that you talk a lot 
about.
  Mr. ALTMIRE. We have talked about that, and I do think that the money 
that was in the stimulus plan and then money in the succeeding budgets, 
which we're also going to make a priority, is going to make a big 
difference.

[[Page H6391]]

Health care is the only major industry in the country remaining that 
has not gone to an interconnected, interoperable computerized system. 
And I would ask my colleagues to think about the fact that--the 
gentleman's from Connecticut, and I'm from Pennsylvania--if we go to 
San Diego, and we put our bank card in the machine, we can pull up all 
of our financial records in a safe and secure way and never think about 
privacy or any type of intrusion. You just take for granted that that's 
going to work. But if you show up on that same trip at the emergency 
room in San Diego, well, they don't have any of your records. They 
don't have your history. They don't have your family medical history. 
They don't have your allergies. They don't have any of your imaging, 
your x rays and so forth. And they're going to ask you half a dozen 
times when you're there, what are you allergic to, and can you fill out 
these forms and, most importantly, how are you going to pay, what's 
your insurance? But if we were to go to a system, like every other 
industry in America has, where you have an electronic health record 
that goes with you everywhere you go and has your family history 
records, your personal medical history, your allergies, and yes, all 
your insurance information, then when you show up at the emergency 
room, they're not going to have to ask you half a dozen times. They're 
going to be able to get right down to the business of treating you for 
whatever the reason is you find yourself in that situation. We have to 
make sure that as we move forward as a country, we reward those who 
have already taken matters into their own hands. There are a lot of 
major health systems in this country from coast to coast that have 
spent hundreds of millions of dollars of their own money to make this a 
reality, to connect their own systems. The problem that we have in 
implementing this is, if you're a wealthy community and you have a 
system that's making a lot of money, a hospital system, you can afford 
to do that. But if you're a rural physician, a health care provider in 
central Pennsylvania or anywhere in this country 80 miles from the 
nearest hospital, you can't afford hundreds of thousands of dollars to 
upgrade your computerization to interconnect your records with the 
nearest hospital. It's just something you can't even consider, and 
that's where this money is going to go. We're going to move towards 
having an interconnected system in this country to resolve some of the 
issues that the gentleman has talked about. We're not going to allow it 
to get to the point--with the Department of Defense, for example, which 
has a wonderful health care information technology system, and the 
Department of Veterans Affairs, which also has a wonderful health care 
information technology system; but there's one problem. They literally 
cannot communicate with each other. What they do is, if you're one of 
the brave servicemen or -women who are serving our country as part of 
the Department of Defense, you're a part of their program, and they 
have all of your medical records; but when you leave the military and 
become a veteran and enter the VA system, under the current system, the 
Department of Defense sends a PDF file by e-mail to the VA, and 
somebody has to open up that file. They can't manipulate it in any way. 
They have to type by hand your entire career's medical history--if 
you've been there for 30 years, think about what we're talking about--
into the new system for the VA.
  Now Secretary Shinseki and Secretary Gates have announced that moving 
forward, they're going to merge the systems for the new people who 
enter the military. So moving forward with the newer generation of our 
military men and women and our veterans, we're not going to have this 
problem. But for the millions who have served up to this point, it's 
not interoperable. They cannot communicate with one another.
  Mr. MURPHY of Connecticut. Mr. Altmire, scale it down. There are 
thousands of hospitals, some of which are in the State of Connecticut, 
that have competing systems, even within their own hospitals, that 
don't talk to each other. There are hospitals that have one electronic 
records system for their emergency room and then one electronic medical 
records system for their in-patient unit. So the same thing that 
happens as you move from active service out to be part of the 
veterans health care system works within a matter of days in a hospital 
setting. When you come in and present to the ED, you then aren't on the 
same record system when you move over to the inpatient unit. Now that 
is because we do not have a sort of nationally agreed-upon platform for 
how systems communicate with each other. And a lot of hospitals say to 
themselves, well, I have got one really good system for emergency 
rooms, and then I want to buy this other really good system for in-
patient care. We have got to have some national standards that 
basically say to any hospital or physician's office that's buying into 
a records system that you can be guaranteed that you are going to get a 
system that presents you with all the data and tools that you need and 
will be able to communicate with everybody else. In fact, there's no 
way that we're going to spend that stimulus money without some national 
standards to guarantee that that happens. But as a sort of preview as 
to how politicized and how politically charged this debate can become, 
when we were debating that portion of the stimulus bill, which really 
is a commonsense investment in information technology, something that 
there should be no reason why Republicans and Democrats should 
disagree. I don't want to put words in Mr. Burgess mouth. He is a 
Republican Member from Texas. He comes down to the floor very often to 
talk about the crisis in our health care system, and he talks in a very 
articulate way about the need to upgrade our information system. So 
there's a lot of potential agreement on this issue between Republicans 
and Democrats. But it didn't stop the sort of right wing in this 
country from going out and spreading lies that this investment in 
information technology was the Federal Government's attempt to have a 
Big Brother takeover of health care, and this was the Federal 
Government reaching in and controlling all of your health care 
information and knowing everything about every illness that you've had 
or prescription drug that you're on. It's the furthest thing from the 
truth. We're just simply trying to standardize private health care 
investments that have been made by hospitals and doctors across this 
country. But I think it speaks to how difficult this debate is going to 
become. There is a group of folks out there who are either just 
ideologically opposed to having the government have any role in health 
care, or folks who are part of the status quo who are making their 
fortunes off of health care today that don't want the rules of the game 
changed. Even when it comes to what should be fairly noncontroversial 
issues, like investments in information technology, I mean, my God, you 
know, it's boring to say, right, but it's so important. It's just not 
that controversial. We're still going to find a lot of people on the 
outside that are going to fight us on this issue, as they will on many 
others, Mr. Altmire.

  Mr. ALTMIRE. There are many issues that are just like that, as the 
gentleman knows; and this gets to the complexity of the bill that we 
are going to be bringing to this floor and to the other body over the 
course of the next several weeks. If you look at what we expect, at 
minimum, the outcome to be on the insurance side, I think everyone 
would agree that a very likely outcome is going to be the insurance 
industry will not be able to redline you. They're not going to be able 
to use pre-existing conditions to exclude you from care. They're not 
going to be able to do the lifetime limits for people with chronic 
diseases. Basically, they're going to have to take all comers, and 
they're not going to be able to set your rates based on your individual 
health status. I think we would all agree that is a likely outcome to 
this debate.
  Now the insurance industry makes a compelling case, and I think an 
actuary would tell you that the only way that works is if we find a way 
to make sure everybody is included in our health care system. You can't 
just have the sick people or the people who are about to become sick 
part of the risk pool. You have to have everybody. That's why it's so 
important that we expand access to the entire Nation, include these 47 
million Americans who don't have health coverage, the tens of millions 
of more that are underinsured

[[Page H6392]]

because the only way the risk pool works is if you have the young and 
the healthy, people who aren't going to use the services right now 
today to offset the risk for those who are. But as the gentleman 
indicates, there is still going to be opposition to this concept when 
we move forward and when we talk about ways to move people into the 
system that currently don't have access.
  One of the ideas that we talk about, which the gentleman from 
Connecticut is very involved in, is the idea of having a choice for 
people to join a plan that would compete with the private insurance 
industry. We hear a lot of talk about how the private sector always 
does it better than government. They're more efficient. They're more 
cost effective. The government is too bloated. So I would say to those 
who make that case, well, then, what are you worried about? What are 
you worried about the competition from the government if the private 
sector always does it better than government? The difference in this 
case, if we do it right--and certainly there are ways you can structure 
it that wouldn't be the correct way--but if we establish a level 
playing field for the competition, you are going to have a situation 
where there's not going to be a profit motive, and there's not going to 
be any reason for someone to choose that plan who's involved in 
shareholding and so forth. You're not going to have that. You're not 
going to have people who are employed to try to deny claims. That might 
be a difference in the way these plans compete. But if we do it right, 
it would be a level playing field.
  Mr. MURPHY of Connecticut. The gentleman knows that I think this is, 
for me, critical to reform going forward. I really do think that if you 
empower consumers to have real choice, that that is one of the ways in 
which we're going to control cost. Right now when you decide you want 
health care insurance, if you are a business or an individual, it's a 
real cloudy picture out there. You don't know exactly what you're 
buying. You don't know the combination of deductibles and premiums that 
are going to force costs on you. You can't ever be sure exactly what 
the benefit plan is, whether pre-existing conditions are covered here 
and not here. So one of the things that we're talking about that is 
fundamental to this reform is really trying to standardize the market, 
creating some national standards for health insurance; that you've got 
to have this basic benefit package that covers preventive services and 
real catastrophic care; that you can't discriminate against people that 
have pre-existing conditions; that you can't have lifetime limits; to 
basically give people some certainty that when they go out and purchase 
insurance, that they're going to get insurance, that they're going to 
get something they can actually use.

                              {time}  2045

  So, a lot of us say, well, you know, why not give people the option, 
if they don't like the private insurers who are inevitably going to 
take a piece of their premium and pay the CEO a big salary or pay back 
shareholders or turn it into profit, why not give them the option to 
purchase a nonprofit, government-issued plan?
  Now, Mr. Altmire, you are right, that that only works if that 
government option, that government health care option, has to finance 
itself; that it doesn't get a subsidy from the Federal Government to 
help it compete with the private plans. But if that public insurance 
option has to pay for itself, just like every private insurance company 
has to, they collect premiums, pay for care and it all has to be self-
financing, then you are exactly right, what is the problem?
  If the government is so inefficient, then they will end up having an 
insurance plan that costs more than the private insurers, and nobody is 
going to buy that. But if our theory is correct, that by not having the 
profit motivation that the private insurers have, that they can run a 
more cost-effective product, then why shouldn't consumers have that 
choice?
  The people in this Chamber who are going to say there can be no 
public insurance option available to individuals are taking choice away 
from consumers. I would rather have my 700,000 constituents be able to 
have as many choices as possible. I want them to decide whether they 
think that private insurance or public insurance is better for them.
  Everybody will answer that question differently. But I think that 
those of us that are going to be favoring a publicly sponsored health 
care plan as one of the options for individuals and businesses out 
there are going to be on the side of consumer choice, and I think if we 
give consumers that choice, it is going to create a really competitive 
structure that will end up with some people having public insurance, 
some people having private insurance, but a real competition by which 
we lower health care costs, Mr. Altmire.
  Listen, I get it. The devil is in the details of making sure that you 
don't give a little competitive advantage to that public option, but I 
think that it is really a linchpin of health care reform going forward, 
if we can get it right.
  Mr. ALTMIRE. Think about the competitive advantage that businesses 
have in this country. Some are able to offer health insurance, some are 
not. Less than half of small businesses in this country are able to 
afford to offer health care to their employees.
  What we want to create is a system where everyone in America will be 
covered and every business that chooses to do so will be able to afford 
to offer that benefit to their employees and to their potential 
employees to be able to recruit and retain the highest quality worker. 
That might be a benefit that small businesses would like to offer. We 
want to give them the opportunity to afford that benefit if they so 
choose.
  But, again, we want to preserve what is working in our current 
system. We want those who have coverage and like it to not be touched 
in this. And that has to be a part of this. But for those that want to 
have another option, those who want to make a change, maybe the family 
status has changed over time, the plan that you are in doesn't work for 
you any more, we want to give them as many options as possible, and we 
want to give them the ability, as the gentleman indicates, to do some 
comparative shopping, to compare apples to apples, to look at what the 
costs are for the family situation across the different plans. Right 
now you are unable to do that.
  If you are a Federal employee and you have the Federal Employees 
Health Benefits Program, it is a little bit easier. That is a plan 
where you are able to look at some of the paperwork and get on the 
computer and do comparison shopping. We want every American to have the 
same ability that Federal employees have today.
  I would say to the gentleman, when we talk about this idea of the 
employers being required in some way to either offer health insurance 
to their employees or to pay into the system so that those employees 
will have the ability to make that choice, we don't want to do that in 
a way, and I want to be very clear about this, we don't want to do that 
in a way that is going to incentivize employers to say, well, you know 
what? I will just stop offering health care coverage and all of my 
employees can go into the plan. That is not what this is about.
  We don't want to add one more financial burden to half of the small 
businesses in the country, the ones I am talking about that are already 
unable to afford health care. We don't want to add to their financial 
burden. We recognize that this is a very complicated issue and it is 
going to be very difficult to achieve these goals.
  Mr. MURPHY of Connecticut. Mr. Altmire, we spend so much time with 
our business community, our chambers of commerce, when we are back home 
and when they come visit us down here, that we know what the reality is 
out there.
  These folks that right now can't afford to give health care to their 
employees desperately want to do that. They want to do it first because 
it is just the right thing. They are members of their community like 
anybody else is, and they want to be able to provide health care to 
their employees, whether they have two employees or 40 employees. That 
is just the kind of people that are out there running small businesses 
by the skin of their teeth across this country.
  But they also need to do it from an economic standpoint. They know 
that to the extent that they can't offer

[[Page H6393]]

health care or can't offer the kind of generous plan that they would 
like to, they are at a disadvantage against their competitors who can 
offer that type of health care. They are at a disadvantage against the 
big employers who can steal their employees away.
  So this is really an issue that our small businessmen are waiting to 
be a part of the solution, and if we can offer them, whether it is 
through a public option or through lower rates on private plans, a more 
affordable health insurance option, they are going to take it. They are 
going to grab it.
  You are right, we don't want to set up any incentives where they are 
going to push people off to the public plan. But we know the majority 
of folks are going to want to be part of the solution out there, just 
for reasons of conscience, but also for reasons of their own salvation 
as a particular business.
  Mr. ALTMIRE. And the gentleman hits the nail right on the head, 
talking about bringing down the costs. That is where we started this 
discussion. We are going to pass a health care reform bill this year. I 
am confident in saying that. The public support is there, the support 
in this Congress is there. We need to certainly finalize the details, 
and that is going to take some work. But this issue is too important, 
it is too important to this country, it is too important to families, 
it is too important to businesses, and it is too important to every 
individual in this country for this not to become law this year. I am 
confident that will happen.
  We have to bring down the costs of health care. That is why this is 
so important. We have to bring down the costs for our families, we have 
to bring down costs for our businesses, and we certainly have to bring 
down the costs for our government.
  As I started our remarks tonight by saying what this is about is the 
structural deficit over the long term that we have in our budget, and 
addressing the issues like energy and like education that have led to 
the skyrocketing deficit and debt that we have over the long term, and 
the only way you can begin to bring that under control is by bringing 
down the cost of health care for everyone in this country at every 
level, both in the private and the public sector. That is what this 
bill is going to do, that is what this discussion is about.

  So, to close it out, I would yield back to the gentleman.
  Mr. MURPHY of Connecticut. I thank Mr. Altmire and Ms. Baldwin for 
joining us tonight.
  Let's make no mistake about this. This is going to be a fight. This 
is going to be a fight, because to do this right, you are going to have 
to take on some folks who have gotten real fat over this health care 
system. You are going to have to take on some ideologues that just 
don't believe that the government has any role in trying to get health 
care to people.
  There is a polling memo going around Washington written by Newt 
Gingrich's pollster essentially outlining in 28 pages how you stop 
health care reform from happening. That is the agenda of a lot of 
people in this town, a lot of folks on the other side of the aisle, 
that they do not want health care reform to happen.
  Now, some of it is for good, honest policy reasons. I believe it is 
an incredibly mistaken belief that the private sector can just fix this 
on their own. They haven't done it for the last 50 years. How can we 
expect they are going to do it overnight?
  Some of it though is very cynical politics. Some of it is due to 
people that look back to 1994 and the failure of the Clinton health 
care plan in the 2 years prior, and believe that if folks can stand in 
the way of President Obama or this Democratic House passing health care 
reform, that they will gain some electoral advantage out of that.
  Now, I hope that is the minority of people that are standing in the 
way of this bill. But make no mistake, there are people out there who 
simply see political advantage against Democrats in general or against 
the President of the United States in stopping health care reform from 
happening.
  Now, they may have succeeded back in 1993. I wasn't here, Mr. Altmire 
wasn't here, so we can't speak to all the reasons that happened. But 
that is not going to happen this time. Not because you have got smarter 
people in the House of Representatives or you got necessarily a better 
strategy moving forward, but because the American people are not going 
to stand for the status quo.
  They know this economy is tough and they feel more conscious than 
ever of the fact that they are just one paycheck away from losing their 
health care and becoming one of the tens of thousands of individuals 
out there who have been forced into bankruptcy because of health care 
costs.
  The status quo is not good enough for people out there, and despite 
28 pages of polling telling the folks on the other side of the aisle 
how to stop this from happening, I believe that the will of the 
majority of Americans is going to bring us together to get a good bill 
passed.
  We are here as 30-somethings in the Democratic Caucus talking about 
that tonight, but I believe that there is going to be a groundswell of 
public support that is going to force us, both parties, to come to the 
table and do something, not small, not minor, not temporary, but 
something big and permanent to fix all of the underlying problems in 
this health care system, to make sure that more people have it and less 
businesses are burdened by it.
  So, again I would like to thank Speaker Pelosi for once again giving 
us the opportunity as the 30-something Working Group to come down here 
tonight, and remind folks that they can e-mail us at 
[email protected]. If you have any questions for us, any 
feedback on what you have heard this evening, www.speaker.gov/
30something is where you find us on the Web.

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