[Congressional Record Volume 155, Number 90 (Tuesday, June 16, 2009)]
[Senate]
[Pages S6614-S6616]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. DURBIN. Mr. President, this morning the Republican Senate leader, 
Mitch McConnell of Kentucky, came to the floor to talk about health 
care. It is a timely conversation among Members of the Senate about the 
future of this important issue. I know Senator Wyden of Oregon is going 
to address it as well.
  Yesterday, in Chicago, IL, which I am honored to represent, the 
President came to speak to the American Medical Association, a 
gathering of doctors from all over the United States, to address this 
same issue. It is an issue of paramount importance to these medical 
professionals. They understand, as we do, that we want to maintain the 
best quality health care in the world. In order to do that, we have to 
face the realities of the shortcomings of our current health care 
system.
  Although we have many of the best hospitals and doctors and some of 
the best technology, we lead the world in the development of 
pharmaceuticals, we also know the cost of this system is spinning out 
of control. People feel it; whether it is individuals buying health 
insurance, businesses, governments--State and local and Federal 
governments--all understand that if the cost of health care continues 
to rise as it is currently going up, it will literally break the bank, 
not just for the Federal Government and all the health care programs we 
have but for individuals and families and businesses. That is the 
reality.
  If we do nothing, if we ignore this reality, we are doomed to face a 
situation where more and more of the dollars we earn as employees will 
go toward health care protection and health care insurance and the 
protection itself will diminish each year--because that is the other 
reality. As the cost of health insurance goes up each year, the 
coverage goes down.
  People know what I am talking about. When the health insurance 
company says we have a great plan for you but, incidentally, remember 
the cancer test you had last year, we will not cover anything related 
to cancer in the future, that is not much when it comes to insurance or 
protection or peace of mind.
  They also know that many health insurance companies make this a 
deadly game of a battle between what your doctor says you need and what 
some insurance company bureaucrat is going to negotiate. You end up on 
the phone with some clerk in a distant location

[[Page S6615]]

debating as to whether there is coverage and whether they can go ahead 
with the procedure they think is important for you or someone you love 
very much in your family. That is the reality of where we are today. We 
have to deal with cost and deal with it in a fashion that is 
appropriate.
  How do we deal with it? First, this system has a lot of money in it. 
We spend twice as much as any other country on Earth when it comes to 
health protection and health care. Yet when you look at the results, 
the actual survival rates for many of the serious illnesses that face 
us, it turns out that countries that spend a fraction of what the 
United States spends get better results. There is a lesson to be 
learned. There is waste in this system.
  One of the articles that is making the rounds on Capitol Hill was 
written in the New Yorker magazine on June 1 by a Boston surgeon named 
Atul Gawande. He went to McAllen, TX, and tried to understand why the 
cost per Medicare patient there, at $15,000 a year, was so high, 
dramatically higher than many other comparable cities in the State of 
Texas and around the Nation.
  What he found, to his surprise and disappointment, was that the 
doctors and hospitals in those areas were bundling up and charging 
people as much as possible, ordering procedures that were unnecessary, 
doing things that were not called for. The reason was obvious: there 
was money to be made. As long as they kept piling the medical bills on 
the patients through Medicare, they received more reimbursement. They 
didn't have healthier people. They didn't have an outcome that 
justified it. But they made a lot more money in the process.
  What the President has said to us is, with all this money in the 
system, we have to find ways to bring in more efficiency. It is one 
thing to say that 48 million Americans currently uninsured will receive 
protection. I think that is basic. That is moral. That should be one of 
our primary goals. But that costs money.
  When the Republican leader comes up and argues this is going to be an 
expensive undertaking, what he is saying is we cannot afford to insure 
people in America. I think he is wrong. I think there are ways to do 
it, and we must do it because, honestly, if they don't have health 
insurance, they are still going to get sick. They are still going to a 
doctor or hospital and all of us are going to pay for it.
  Right now we estimate that for an ordinary family in America, we are 
paying about $1,000 a year more in health insurance premiums to cover 
those who are uninsured. In other words, the health insurance policy I 
have through the Federal Government with the Federal employees costs 
$1,000 more than it ordinarily would so there is more money in the 
system to cover those uninsured. If we can bring those uninsured into 
insurance coverage, it gives them peace of mind, it relieves this 
hidden tax on families across America, and it means, frankly, that 
providers--hospitals, doctors, and others--are going to be adequately 
compensated for the care they offer to currently uninsured people.

  When President Obama comes to the AMA and talks about covering the 
uninsured, there is usually a cheer. That is 48 million more paying 
customers, people who will actually pay into our system. But he also 
talks about something that is not as popular with many health care 
providers and that is reducing the cost of this system.
  What happened in McAllen, TX, is unacceptable; that you can have 
health care providers trying to run up the bill in an effort to make 
more money for themselves at the expense of the government, at the 
expense of health insurance companies but, frankly, not to the benefit 
of those who are being treated.
  The Senator from Kentucky frequently comes here and talks about how 
much he dislikes--I will use that word--government-related health care. 
Let's make it clear. I do not know of anyone, including the President 
or leaders of Congress, calling for a government health care plan to 
cover everyone. That is not what we are asking for. We want to make 
sure there is private health insurance that is held accountable and is 
competitive so we can help bring down the cost. But to argue there is 
something fundamentally wrong with government-sponsored health care, 
even if it is just an option, a voluntary option for customers across 
America, is to ignore the obvious. There are 40 million Americans today 
protected by Medicare. Forty million seniors and disabled people who 
have quality health care because of a government plan that has been in 
place now for over 40 years. There are also a large number of our men 
and women who serve in the military protected by the veterans health 
care system, another government health care system, who believe--and I 
think rightly so--that they are receiving some of the best medical care 
in America. I do not believe the Senator from Kentucky is opposed to 
the Veterans' Administration and the health care it provides, but it is 
a government plan.
  The same is true when it comes to the Children's Health Insurance 
Program. That is health insurance for individual children through 
private companies, but the Government has stepped in to make sure these 
kids are covered, and I, frankly, am very proud of the fact that when 
President Obama took office, we extended that coverage to 11 million 
uninsured children in America. That was a government effort to make the 
private health insurance effort in our country work better.
  We have to get down to the bottom line here. Are we going to succeed 
or fail when it comes to health care reform? If we ignore the obvious 
and ignore the challenges, there is a genuine chance we may come up 
short. But if we accept this historic challenge to come together on 
both sides of the aisle, I think the American people will cheer us on. 
They want to maintain what is good about the current health care system 
and fix what is broken. They want to make sure, at the end of the day, 
if they have health insurance they like, a plan they think is right for 
them and their families, that they can keep that. They want to make 
sure the health care reform is centered on patients and families and 
the doctor-patient relationship, not on a government bureaucracy. They 
want to end the health insurance company bureaucracies that are so 
frustrating and so expensive for families across America.
  When the Senator from Kentucky, the Republican leader, comes to the 
floor and comes up with a series of criticisms about any attempt at 
reform, I have a question to ask him: What is your option? What would 
you do? Do you accept the status quo? Do you think this is as good as 
it can be? I do not. I agree with President Obama. We can do better.
  The President said one last thing that I am going to say; that is, he 
said: If this were easy, it would have been done a long time ago. It is 
hard, and it will take bipartisan cooperation for it to succeed. I 
encourage my colleagues to join in that conversation at the Finance 
Committee, as well as at the HELP Committee, and I hope we can produce 
a product this year that shows we are going to move forward together to 
make sure we have affordable quality health care for every American.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Oregon.
  Mr. WYDEN. Mr. President, how much time remains on the Democratic 
side?
  The ACTING PRESIDENT pro tempore. There is 11 minutes 24 seconds.
  Mr. WYDEN. Mr. President, many Senators on both sides of the aisle 
are working constructively to fix American health care. For several 
years, I have spent time listening to colleagues, going to the offices 
of 85 Senators and at least that many in the House, and to thousands of 
others in the public and private sectors, about their ideas for fixing 
American health care. My aim with these discussions has been to find 
common ground and to chart a path so that this Congress and this 
President can do something this country has never done before: enact 
real health reform.
  Today, I come to the floor to lay out the specifics of real health 
care reform. The President said yesterday that there has never been a 
better opportunity to get the job done; to improve the lives of all 
Americans and guarantee quality, affordable coverage to all of our 
people.
  The question now is will Democrats and Republicans in the Senate rise 
to this challenge? Will this Congress and the President overcome the 
fear tactics

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that have derailed past efforts? But maybe equally as important: Will 
this Congress and our President dare to pass real reform?
  The pitfall, as I see it, is that too often we have been afraid of 
failure. If we draft legislation with an eye only on what we think can 
get passed, on what we think the American people will buy, if we play 
it too safe, my fear is that we will miss the opportunity for real 
reform. I believe that passing a reform bill that does not reform the 
health care system is about as wrong as not passing any bill at all.
  President Obama said yesterday he will only support legislation that 
``earns the title of reform.'' I agree with the President, which is why 
I am going to use this morning to lay down a similar marker for what I 
believe is necessary to ``earn the title of real reform.''
  First, real reform means that all of us, and especially the powerful 
interest groups, must accept changes resisted in the past. Insurers are 
going to have to change the way they do business. Pharmaceutical 
companies will have to be more responsive to purchasers that insist on 
more value and transparency. Doctors and hospitals will be held 
accountable for the quality of care they provide. Malpractice suits 
will be held to stricter standards.
  Individuals will have to take greater responsibility for their 
health. Real health reform means changing the way business is done in 
the private insurance market. It means an end to insurance companies 
cherry-picking, a practice where the companies take the healthy people 
and send sick people over to government programs more fragile than they 
are. No longer should anyone make money by denying care to someone who 
needs it. That is wrong, and this Congress will make it illegal.
  Real reform means everyone is guaranteed coverage by their choice of 
insurer. Under any new system, insurance companies must be required to 
cover everyone and they must be required to price with fairness so you 
do not get discriminated against because of your gender or your health 
status or your age. It means you will no longer be denied coverage or 
charged more because you were sick 5 years ago or today or you might be 
sick 5 years from now.
  Real health reform guarantees that all Americans can choose their 
doctor and their health plan. The President said yesterday: Real reform 
will give every American access to the insurance exchange where they 
can choose to keep the care they have or pick a better plan that meets 
their families' needs. That means if you like the care you have, you 
can keep it. But it also means that if you do not like the care you 
have, you can reject it. You can reject it and choose a better plan.
  Real reform would not only cover the uninsured, but it will make the 
lives of all of those who have insurance coverage better. Right now the 
majority of Americans who are lucky enough to have employer coverage 
have no choice in where they get their insurance. I believe these 
Americans deserve choices too.
  Some might say that this undermines the employer-based system. No, it 
does not. Rather, it makes the employer-based system more accountable 
at the same time that it makes health care more portable. Real health 
reform means that if you leave your job or your job leaves you, you 
will not lose your health care coverage.
  Real reform will once and for all end the entrepreneurial tax in 
which Americans are afraid to go into business for themselves because 
they cannot take their health care with them. The President himself 
said it best when he wrote in 2006, ``With Americans changing jobs more 
frequently, more likely to go through spells of unemployment, and more 
likely to work part time or to be self-employed, health insurance can't 
just run through employers anymore, it must be portable.''
  Real reform will guarantee that all Americans can afford quality 
health care. No longer should families be forced to pay more for their 
health insurance premiums than they pay for their housing. Our goal 
should not be to exempt those Americans who cannot afford to pay, our 
goal should be to guarantee that every American can afford the health 
care they need.
  Real reform will be affordable for the Nation and for our taxpayers. 
It will reduce current costs and bring the rate of health care 
inflation in line with economic growth. Failure to meet this test would 
result in massive new government obligations and no means to pay for 
them.
  Real reform must end the health care caste system in which low-income 
Americans are treated as second-class citizens. No longer should low-
income Americans have less access to doctors than their Member of 
Congress or any other American. Today, 37 million adults and 10 million 
children effectively lack access to a primary care physician. Those are 
Americans who have health insurance but who cannot find a doctor to 
care for them. Real reform means ending the caste system in America 
that, in my view, discriminates against the most vulnerable and most 
impoverished among us. Real reform means that when you need a doctor 
you will be able to see one.
  Real reform will reward Americans for making smart choices. Americans 
should be rewarded for choosing the right insurer for their families, 
and they should be rewarded for choosing a healthy lifestyle. This 
means creating a health system that no longer focuses primarily on sick 
care, but puts a priority on prevention as well.
  Real reform will change the incentives that drive behavior in the 
American health system. It will reduce the demand and desire for 
unnecessary health care services. Health care institutions will no 
longer profit from the quantity of procedures they run up but will 
instead be rewarded for quality care.
  Real reform will take an axe to administrative costs. Americans will 
sign up just once for health care. They will have their premiums taken 
from their withholding so they do not have to worry about making 
payments. They will go into large efficient groups so they are no 
longer left on their own in the individual market.
  In today's non-system, people are an afterthought to the self-
perpetuating bureaucracy of medical billing, reimbursement fights, 
coverage fights, and outright fraud, waste, and abuse. Like the 
President said yesterday, real reform will: ``Replicate best practices; 
incentivize excellence; close cost disparities.'' In effect, he wants 
to see health care dollars go to pay for quality, efficient health 
care. And that is what I have described today.
  Real reform means providing care. It means guaranteeing that all 
Americans have good, quality, affordable coverage, coverage that is 
portable. It means ensuring we end the caste system so all Americans 
can see doctors when they need one. And it means creating a system that 
is more intent on keeping people healthy than profiting from illness.
  The central question, when it comes to real reform, is not who pays, 
but how we pay. Because everyone knows that ultimately the American 
taxpayer is the one footing the bill. It is now Congress's job to 
create an accountable system that puts the focus where it belongs, not 
on misguided incentives, not on shedding risk, not on quarterly 
profits, but on providing quality, efficient care for all our people.
  That is what Americans want from this debate about health care 
reform. That is what I think can bring Democrats and Republicans 
together, working with the President under the banner of real reform. 
The country deserves it. It is time for this Congress to give it to our 
people.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Arizona is 
recognized.

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