[Congressional Record Volume 155, Number 95 (Tuesday, June 23, 2009)]
[House]
[Pages H7127-H7133]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                              HEALTH CARE

  The SPEAKER pro tempore (Mr. Maffei). Under the Speaker's announced 
policy of January 6, 2009, the gentlewoman from Maine (Ms. Pingree) is 
recognized for 60 minutes as the designee of the majority leader.
  Ms. PINGREE of Maine. Mr. Speaker, it's a great honor to be here 
tonight. The freshmen members like to take a little bit of time and 
come to the floor and talk about issues that we find are of great 
concern both to our country and back home in our district. And so 
tonight I am going be joined by a couple of my freshmen colleagues and 
we want to devote our time to talk about the issue of health care. 
Given the late hour, we may not see as many of our colleagues as we 
would at other hours of the day, but we know this is an important issue 
any hour of the day, and I am very happy to be here and to have this 
opportunity to talk a little bit about it.
  This is certainly an important time about the--for the issue of 
universal access to health care and expanding the access to health 
care. I don't know about other Members, but I would think it's a 
universal feeling out there that this is the number one issue for so 
many Americans.
  I started campaigning a long time ago. I got sworn into office last 
January. And I can say, during the entire time I was campaigning and 
since I have been elected to office, for so many people, this is their 
number one issue.
  I hear this from individuals who don't have health care coverage, 
people who have insurance and don't find that their company is there 
when they need it. I hear it from big business owners who are 
challenged by the cost of health care, from small business owners who 
don't know if they can continue to cover their employees.
  It is a universal issue. I hear it from providers, from doctors and 
nurses and others who say, You know, when I signed up to take care of 
people, to make sure that their health care needs were going to be met, 
I didn't expect a system that would fall apart in the way that it has. 
This is, as I say, a universal issue. People say to me, Health care 
ought to be a basic right. It is extremely important that this Congress 
does something about the issue of health care, and we want to see you 
do something.
  The good news is that this Congress is working very hard on putting 
together legislation. The President budgeted $634 billion for health 
care reform in the budget that we have already passed, and the Speaker 
of the House is committed to passing a bill by the end of July. The 
President has asked us for a bill on his desk this fall.
  The discussion draft was released in the House just this Friday, and 
I, personally, can say that I am happy to see a lot of the good things 
that are included in there, a public plan option, better insurance 
regulation, insurance companies won't be able to cut people out who 
have preexisting conditions, reasonable amount of cost-sharing and 
emphasis on prevention and wellness, investments in Medicare and 
Medicaid, many of the things that we have been talking about and that I 
hear about all the time from constituents in my district are in this 
bill.
  More than anything else, people say to me you need to pass universal 
access to health care. You need to do something now. And I feel like we 
are right here in the middle of this, and we are moving forward on 
this.
  In my own district, like many other of my freshmen colleagues, every 
chance I get during the break, on weekends, we have been meeting with 
groups of individuals. And as I said, this spans from constituents who 
I meet in the grocery store, who tell me about their individual 
challenges, to doctors, nurses, providers, nontraditional providers, to 
chambers of commerce. And, once again, what I hear is they all want 
change, and they want things to move forward.

  I had the good fortune of being a State legislator in the past, and 
this was, back when I first ran for office in 1992 as a State 
legislator, again, one of our number one issues. And it's amazing to me 
now, 17 years since then, it hasn't gone away, in spite of the many 
things we attempted to do in my home State, the State of Maine, to take 
on the pricing of prescription drugs to attempt to expand access to 
more individuals in our State. On each and every one of those we made 
progress but we haven't gone far enough.
  And when I hear from my colleagues, my former colleagues in the State 
legislature, my daughter, who is the Speaker of the House--and as you 
can imagine, I am very proud of her--the one thing they say to me is, 
You have got to do something about this. We have tried as hard as we 
can in our home State, but we can't go it alone. States across the 
country are feeling the exact same challenge, but they want now to have 
us at the congressional level to do something about this.
  Now there are many things that we could talk about tonight. We even 
have a few charts and graphs, but let me just get started by 
recognizing my good friend and colleague, Mr. Boccieri from Ohio. I 
know he is hearing about this quite a bit in his home district, and it 
would be great if you could just talk a little bit about some issues 
and concerns and then we can keep going on this topic.
  Mr. BOCCIERI. I thank the gentlelady from Maine not only for her 
extraordinary work on the House floor here but also on the Rules 
Committee. We appreciate your efforts to help move the country forward. 
There is no question, perhaps, the biggest issue that we will address 
in our freshmen tenure and perhaps for the time that we serve here in 
the United States Congress is health care. And there is perhaps 
arguably no more important issue that we could tackle as a Nation than 
to get our health care costs under control.
  And I know the gentlelady from Maine is hearing what I am hearing 
back in my district, and that is that people, working families in our 
district, are one accident, one medical emergency, one diagnosis away 
from complete bankruptcy. And, in fact, in 2007, 60 percent of all 
bankruptcies were due to medical costs, some accident that a family had 
sustained or some unsustainable costs that had arisen because they had 
contracted a disease or some sort of cancer. And we need to do our part 
here in Congress to make sure that we are working on this issue and 
getting these costs under control.
  They predict right now that 16 percent of our gross national product 
is for paying health care. And that in a few decades that cost could 
grow as high as half of our gross national product. That is absolutely 
unsustainable for our future.
  And we have an obligation to make sure that our country can be 
competitive, that we can have a workforce that is not only well 
educated and trained but has access to the basic fundamentals of 
prevention and healthy lifestyles and access to seeing the doctor that 
they choose.
  And when I speak to my constituents back in Ohio, in northeast Ohio, 
I talk about the five Ps of health care, the five Ps, the fact that we 
need to cover all people. Now, when we talk about covering all people, 
we need to understand that by not doing so it's actually costing all of 
us paying into the system more money. Those 46 million uninsured or 
underinsured people who can't seek access to their doctor because their 
health care effectively ended when they got their pink slip at the job, 
because they can't afford a COBRA payment, they are uninsured or 
underinsured.
  And when they use the hospital emergency room as their primary care 
physician, they are costing all of us paying into the system four if 
not five times more by using the hospital room, the emergency room as 
their primary care physician. We need to cover all people.
  And to those Americans who might be listening tonight, we need to 
understand that the American taxpayer right now is paying to make sure 
that every man, woman and child in Iraq has access to universal health 
care coverage. Now, it's inconsistent that we would pay for Iraqis to 
see the doctor they want to but yet not Americans.
  The second P is that we have portability, that our workers, when they 
get that pink slip, God forbid, that they can take their health care 
from job to job to job. Portability, covering all people.
  The third P that we have in our five Ps is making sure that we 
provide incentives for prevention, because prevention should be tied 
into all of this

[[Page H7128]]

with respect to healthy lifestyles ending the chronic diseases that 
plague so many.

                              {time}  2145

  And we have to end preexisting conditions--insurance companies using 
as a notion of disqualifying people from seeing their primary care 
physician the notion of preexisting conditions. And when that worker in 
a factory in Canton, Ohio, loses their job and they get hired by 
another factory with another set of health care principles and another 
set of health care opportunities, and they were a diabetic, God forbid, 
it becomes a preexisting condition now that they are seeking treatment 
from their physician for routine coverage that would have been covered 
previously.
  We need to end preexisting condition. Portability, covering all 
people, adding prevention, and making sure that physicians and doctors 
are making and prescribing the types of health care that our patients 
should seek. Those are the five Ps that I hope we have in this great 
and robust dialog here on Capitol Hill.
  So I thank the gentlelady from Maine for bringing this issue, and I 
hope that we have a very spirited discussion about how we can move this 
issue down the field.
  Ms. PINGREE of Maine. We're joined by another one of our colleagues, 
but you mentioned some of the cost issues. Since we have a couple of 
charts, I thought I might just put them up here right now.
  You talked a little bit about the expenses of health, and here's one 
that shows how our national health expenditures have really just, as 
they say, gone off the charts. This is one of those charts, actual and 
projected, that shows that we can no longer afford this.
  People always say to us, How are you going to pay for health care? I 
say, when I talk to businesses, individuals, I say, How are we going to 
afford the system the way it is? And this is one of the charts that 
really, really shows that.
  Let me just show another one right now. I think this is one that we 
don't have to tell any of our constituents. We, again, hear it all the 
time. We hear it from business owners who say they're worried that they 
can't cover the cost of their employees anymore or they have really cut 
back. But here's one that just shows, since 2000, health care premiums 
have doubled while wages have only gone up by just 3 percent.
  So it is no wonder that people everywhere we go are saying to us, 
We're just dropping our coverage. They're just going without coverage 
or they're going for the $10,000 deductibles. How many constituents 
have you seen that say, I've got a $10,000 deductible and a very 
expensive plan, and I spend the whole year paying that $10,000. Why do 
I even have insurance? That's just something I feel like I hear all the 
time.
  Why don't we welcome our other colleague, the other night owl here, 
Congresswoman Halvorson from Illinois. And we're just so pleased to 
have you join us and hold forth.
  Mrs. HALVORSON. Thank you. I want to thank Representative Pingree for 
leading this hour tonight. It's great to join you, as well as our other 
colleague, Mr. Boccieri.
  Health care has been a topic that comes up every year, but yet nobody 
finds the time to really, really put their nose to the grindstone and 
get something done about it. It's probably the top issue to all 
Americans every day, talking about how are they going to afford these 
skyrocketing costs. It's also an important topic for businesses across 
our country and especially for our national budget.
  Tonight, I want to focus, I think, on the urgent need for health care 
reform. And it's a personal story for me. It's personal to me and my 
constituents who are struggling with the medical costs, and it's 
personal for so many Americans that are struggling with these health 
care costs across our country.
  I know what it's like for someone to struggle with health costs 
because of a lack of access to good health insurance. I've seen my 
parents take this battle on. Growing up, my dad was self-employed, and 
my parents just couldn't afford health care. Being self-employed, it 
was virtually an expense that we could not take on. In fact, I'm not 
even sure I remember going to the doctor. It was just something we 
didn't do.
  Later on in life, my mom was only 49 when she was diagnosed with 
breast cancer. I can remember my parents spending all their time 
focusing on how to pay for the bills instead of focusing on her health. 
And it was very, very depressing for the whole family.
  I can remember her talking about--and, remember, she was only 49. 
She's okay today, but I can remember her spending the next 15 years of 
her life just wishing and hoping she could make it until 65 so that she 
would have health care again, because virtually with that preexisting 
illness she could never have health care again. And that was so sad to 
our entire family.
  And I'm not the only one that's been through it. I hear story after 
story after story, and certainly true with so many people with 
preexisting illnesses. My mom was very fortunate. She won her battle 
with breast cancer. But even today, many, many families find themselves 
in that same situation, and it shouldn't be that way. Even families who 
do have health insurance find these rising costs or they have the false 
sense of security that they have health insurance, only to find some of 
these costs and some of these tests, that they're denied.
  So, in order to compensate for the care for the uninsured, families 
are paying about $1,000, each family, in additional costs each year in 
their own health care plans to cover those without insurance. So, it's 
obvious we need health care reform.
  As Congress takes up this health care issue, we have to follow and 
focus on the following priorities. We need to reduce costs. We need to 
preserve everyone's choice of doctors and their plans. We need to 
improve the quality of care. These are the keys to successful reform 
health care and reforming of health care in America.
  The cost for an average American, for businesses, and for our country 
are out of control, and they're still rising. As Representative 
Boccieri said, 15 percent of our gross national product, and it's going 
up every year. And it's just becoming one of the biggest burdens not 
only on families, but on businesses also. So we need health care 
reform. We need to reduce these costs.
  Secondly, when we're talking about health care, I don't think there's 
anything more important than a person's relationship with their doctor. 
And we need the health care reform that's going to allow you to keep 
that relationship with your doctor and your health care plan if you 
like them.
  Finally, we need to improve that quality of care and we need good 
access to preventive medicine and we need to encourage Americans to 
stay healthy. This is a cultural thing, and it's not going to happen 
overnight. But we really need to invest in health and wellness and help 
change the culture of our society.
  So I'm just so glad that I have the opportunity to spend an hour here 
with my colleagues talking about some of the things that we need to do.
  Representative, thank you for having us tonight to make sure that we 
talk about this very important issue.
  Ms. PINGREE of Maine. Well, I know that not too many of the American 
people are still up and watching us on C-SPAN, but those who are and 
those who see this later I think will be just so grateful that they're 
hearing one more conversation about moving this forward.

  What they don't want to hear from us is, Well, we talked it all over 
but we backed down. We just tinkered with it around the edges. We 
couldn't really pass anything. We couldn't find a way to get to a 
conclusion. That is definitely not what they want to hear from us.
  They want to hear, you're on the floor, you're working hard, you're 
going to pass a health care bill before you go home on recess.
  I just want to add one thing, then I hope you all continue with the 
stories that you're hearing from your district. Just as you said, there 
are so many families with those kinds of stories that say, We have 
never had health care coverage. I pulled a few out of our office this 
afternoon, and they're endless, the things that people tell you, the 
sad things that people come up and tell you.

[[Page H7129]]

  Here's one that says, I earn $20,000 a year. What good is a mandated 
policy that would cost me $400 a month with a 5K deductible? I have 
been stripped of my wealth over the past 30 years and in nonadjusted 
dollars I made more when I was 24 years old than I make now as a 53-
year-old. We need taxpayer-funded health care. If it's good enough for 
our elected officials--which we all know very well--it should be good 
enough for all of us. We want health care to pass right now.
  Here's another person who said to me something that I mentioned 
before. I feel like I hear this a lot in Maine. People who are self-
employed. We have a lot of fishermen and farmers, woodcutters in our 
area, who go out and get these plans with huge deductibles. It's all 
that they can afford.
  Here's somebody who said, I can only afford a catastrophic plan with 
a $15,000 deductible. It's essentially insurance to save my home if my 
wife or I get sick. I can't afford a colonoscopy, which would cost 
around $3,000 to $4,000. With a family history of colon cancer, the 
chances of my dying from this cancer are pretty good unless I was able 
to detect it early. But the health insurance industry doesn't care 
about my health. They only care about the profit and will help those 
who help them.
  He is just feeling angry and saying, you know, you have got to do 
something about this now. That's one of the things that you mentioned.
  We need a plan, and the proposals before us talk about wellness, 
early intervention, women getting mammography, getting those early 
checkups and treatments when you need it.
  Before I turn it back over, I just want to share my own story, or a 
little bit of it anyway. I had a brother who died of melanoma, which is 
almost always a tragic and difficult form of cancer. He was diagnosed 
20 years ago, so he would be about 60 years old today. He was 40 at the 
time.
  But without going into all the details--and sadly, most of them 
haven't changed, but his employer dropped his coverage. He was unable 
to get the kind of coverage that he needed. He and his wife had to 
basically turn over all their assets so they could be eligible for 
Medicaid.
  I can guarantee you that my brother spent the 18 months of his 
illness worrying about how he was going to provide for his family when 
he was gone. That shouldn't be. It shouldn't have been that way 20 
years ago. It's shocking to me to think that this is 20 years later 
and, really, people have the same problems, or worse.
  We haven't fixed the system. It's only gotten more difficult.
  So, hold forth.
  Mr. BOCCIERI. The gentlelady from Maine is absolutely correct about 
how this dilemma that is facing our country has impacted many families 
not only across our districts but across the country. We have a 
responsibility and an obligation to fix this issue so that we can 
remain competitive as a country and help our citizens.
  Now, I want to tell you about a personal story myself. As an Air 
Force pilot who was deployed all over the world, I had to get shots so 
that I wouldn't get sick when I went overseas. I received a couple of 
anthrax shots as part of our mobility deployment, and I was having 
these terrible reactions. My knees were swelling up. They were getting 
red. So the flight surgeon suggested that I should go see a rheumatoid 
specialist. I waited nearly 3 months to get in to see this rheumatoid 
specialist, and then I waited 2\1/2\ hours in the doctor's office when 
I finally got there.
  When the nurse ushered me into the doctor's waiting room there, I sat 
on the table for about 20 minutes. The doctor came in. He did some 
movements with my knee and he said, Son, you're getting older. I said, 
Doctor, I could have made that diagnosis. But, I said, These are 
recurring as a coincidence to these shots that I have been getting.
  So he went in the corner, wrote a prescription, and said, Call me in 
a month after taking these pills to see if this works. I said, Doctor, 
I'm 30-something years old. I'm in good shape. I want to figure out why 
this is happening. We went back and forth for a couple of minutes and 
he said, Son, I have got to get down the room to see 15 other patients 
so that I can keep the lights on in this building. And I thought to 
myself, Is that what we have reduced health care to? Is that what we 
have enabled our system to give and administer to our citizens? They 
deserve better.
  And that's why our choices for the bills that we are introducing are 
going to add some significant improvements. One, we're going to make 
sure that Americans have more choices to see the doctor that they want, 
to develop and sign onto the plans that they want and to make sure, 
number two, the number two guidepost we have is that bureaucrats and 
bean counters are not deciding the type of health care that our 
citizens should get.
  And, lastly, we want to make sure that families understand that 
there's enough money in the system. We hear from the other side about 
how are we going to pay for this. This is going to be more resources 
coming down here to Capitol Hill and being disbursed out.
  We know this much, that one-third of the $2.5 trillion that we spend 
every year on health care, one-third of that never reaches the doctors, 
never reaches the patients. It's lost somewhere out in the 
administration of the system.

                              {time}  2200

  We know one-third of that money could be given and could be used to 
cover the 46 million uninsured and underinsured. So conceivably there 
is enough money in the system to pay for those people who are uninsured 
and underinsured. In fact, we hear that families have found that nearly 
7 percent, in 1987, 7 percent of their median household income was 
being used and devoted for health care. And now it has grown to nearly 
20 percent. In fact, Americans spend more than any industrialized 
country on health care, nearly $7,000 over the aggregate for a year, 
for a family, for a working family. And yet our health care and our 
life expectancy is on par with Cuba. It is on par with Cuba.
  So we have got to make systematic and fundamental changes, as the 
gentlewoman said, to focus on prevention. Four cents of every dollar is 
only focused on prevention. Yet we have some of the worst chronic 
diseases that continue over this period.
  So we want to stress that folks will have more choices, that 
bureaucrats and bean counters won't decide, but doctors and physicians 
will decide the type of health care that they get, and there is enough 
money in the system to pay for itself. Those are the three guideposts; 
those are the three beacons that we are using as we drafting the 
legislation here in the House.
  I yield back.
  Ms. PINGREE of Maine. I just want to reinforce one of the points you 
made about what you hear from physicians. I don't know about you guys, 
but I feel like every time I sit down and meet with a group of doctors, 
I feel like I'm in a completely different era than when I first ran for 
office in 1992. When I was first elected to be a State senator and I 
would meet with my local group of physicians, the first thing they 
would say was, you just keep your hands off health care reform. We are 
perfectly happy with the way it is going.
  I would meet the occasional member of the practice who would say, I 
have got a few sources of dissatisfaction, but I mostly would meet with 
resistance. And when I recently met with a group of physicians in my 
district, I thought I was in a completely different country. Just as 
you said, it was physicians who are saying, I don't have any time with 
my patients. I signed up to make people well. And now I feel like I 
turn people away. I can't take low-income patients because I can't 
afford it. I have a room full of people that just fill out the 
paperwork for the insurance companies, and then half the time, the 
things that I know my patients should have are denied. And the kind of 
treatment that they should be getting, they are not able to get because 
they are turned down time after time.
  I know people are going to find this hard to believe, but a group of 
Maine physicians, the Maine Medical Association affiliate, actually 
took a poll of themselves recently; and almost 50 percent, about 50 
percent of them said they were in favor of single-payer health care. 
Now we are not even debating single-payer health care in the current 
bill. But the idea that physicians now who once said to me, keep

[[Page H7130]]

your hands off medical insurance and the health care system, are now 
saying, I can't take it anymore. I cannot run a practice. I can't be 
the kind of doctor I wanted to be. And I hear exactly the same thing 
from nurses, from everyone in the medical profession who just say, This 
is not working. How soon can you get it repaired so I can really give 
the care that people want? And I'm sure that you all have had similar 
or other experiences you want to share.
  Mrs. HALVORSON. And I think the reason being is because they spend so 
much time on paperwork, and it is so much like a fee for service. They 
want to take care of people. That can't even keep them healthy. They 
spend all their time just curing ailments. So I think as the culture 
changes how we want to keep people healthy has not been very good for 
the doctors. Just like with the hospitals, they are seeing so much 
uncompensated care, they can hardly keep their doors open. In my 
district, several hospitals have already closed. They are just not able 
to keep the doors open because people are just not paying their bills. 
So they feel that if everybody has some sort of insurance, maybe they 
would get something.
  When we talk about reform, do you know how much money we would save 
if hospitals didn't have to do all that cost shifting? They could 
spread the costs instead of charge people more who have insurance.
  One of the other things we haven't talked about yet is Medicare part 
D and how our seniors who fall into that doughnut hole very seldom come 
out of that doughnut hole. And that is something that I brought up last 
week and that is one of my priorities. It is a huge challenge facing 
our senior citizens. And I have been working with AARP on trying to 
figure out how do we close that doughnut hole.
  In fact, out of the entire country, Illinois has more seniors who 
fall into that doughnut hole than anybody else in the country. Thirty-
two percent of our seniors fall into that doughnut hole. And very few 
of them ever come out. So we are working together. We need to do 
something about helping them. Lately, as you have heard, the 
pharmaceutical companies are coming out talking about how. So I think 
we will be able to come up with a very good compromise on how we can 
all work together to help them. I think that we have to think about 
that.
  We think all of a sudden our seniors have Medicare or Medicare part D 
and that they are taken care of. Nobody thinks about the fact that once 
you hit a certain point you are on your own until you get to another 
point. There is a lot of money in there that you are going to have to 
pay on your own besides the cost of the premium. So there is a lot that 
we have to think of. And at the same time, I think there is a lot of 
places where we can find reform.
  Ms. PINGREE of Maine. I will just jump in on that only because the 
issue of the pricing of prescription drugs is a big part of my own 
personal history in politics and one of my great concerns. I think I 
have the oldest population in the Nation in the State of Maine. So 
between Mike Michaud and me and the two United States Senators, we 
cover some of the oldest Americans, and we are about 38th in per capita 
income. So we have a tremendous number of people who really struggle to 
make that decision every month: Do they pay for their medication or put 
food on their table or pay their heating oil bill?

  Now, everyone may not agree with my particular perspectives on this, 
but I think one of the big mistakes when the Medicare part D bill was 
passed was that Congress specifically prohibited negotiating with 
pharmaceutical manufacturers for a better price. So here we are, the 
biggest purchaser of prescription drugs in the world on the Medicare 
plan; and when the bill was passed, and luckily none of us were there 
so we don't have to take responsibility for that, but there was no 
provision for negotiating for drugs.
  Now, every other country in the world negotiates for a good price for 
prescription drugs. So in a sense, it is like we pay the highest prices 
in the world so that we subsidize everybody else. And I won't go on to 
my giant rant, but this was one of the bills that I passed when I was a 
State legislator on helping to regulate the pricing of prescription 
drugs.
  I will just say that one of the ways I really got involved in that 
and very interested in it was because Maine is a border State, we have 
a lot of seniors who get on buses, bus trips for seniors and go to 
Canada to buy their medication. And you can buy medicine in Canada, 
sometimes it is exactly the same drug that you would buy just across 
the border for one-third or one-quarter of the price. And it is not 
because it is a subsidized price up there, because these aren't people 
with the Canadian health care plan, but because the Canadian Government 
negotiates for a good price.
  So in my opinion, and I have signed on to H.R. 684, which is by our 
good friend and colleague, Representative Berry, that bill would force 
us to look at this and to do something about the pricing of 
prescription drugs. And I think that is one other thing we have to 
address if we are really going to bring down the cost of health care, 
the one thing we know is that when people take their medications, they 
stay much healthier, whether you are a senior citizen or a person with 
a high cholesterol rate hereditarily and you need to keep it down.
  So we know the importance of medication, and we know one way to drive 
down the cost of health care is to make sure that medicine is 
affordable. That is true of seniors and all people. And it is certainly 
one of the issues that concerns me and one of the things that I 
promised my constituents back home that even though we had passed this 
bill in Maine, I would take it on as an issue here in the United States 
Congress. And I know many share the same concern.
  Mr. BOCCIERI. Well, I applaud the gentlelady's perspective because 
there is no question that getting costs under control are the most 
important facet of any health care reform package. And we talk about 
the health care delivery system. Really, we have sickness delivery 
system where we are actually doing a fee for service where folks are 
paid with the number of patients that they see in their hospital or 
their doctor's office. Well, how about providing incentives to say 
that, well, we didn't see any patients today because they are all 
healthy? What a novel idea that would be to provide incentives for 
prevention.
  This is the type of plan we are embracing here. Our plan talks about 
prevention. It talks about rewarding citizens who are living healthy 
life styles, doctors who are able to have this relationship, as the 
gentlelady from Illinois suggested that we have to have a relationship 
with our doctor not necessarily one where you come in, you bounce in 
for 5 minutes, and he writes you a prescription, and you are out the 
door. That is not health care. That is not health care. That is not 
even health care delivery. To me that is something so far disconnected.
  So our plan is going to make sure that we have more choices, better 
time with our doctors, more choices in the types of who we get to see 
and who we are able to see and to make sure that doctors and physicians 
are describing and predicting giving and subscribing the type of health 
care that we should have.

                              {time}  2210

  We should not have a bean counter at an insurance company deciding 
whether we should have an MRI, or a bureaucrat in Washington deciding 
if we should get this procedure or prescription drug. It should be left 
to physicians and doctors and our health care professionals.
  And our plan will address the amount of money that we spend on health 
care. By getting costs under control, covering all people and making 
sure all people have access to health care, we actually will reduce the 
cost of health care because that diabetic that lost their job in 
Canton, Ohio, now can't get the syringes that they need to give 
themselves insulin, and they can't buy their prescriptions, and all of 
a sudden they need to go to the emergency room because of an ulcer on 
their foot, and they are using the emergency room as their primary care 
physicians. And that is costing all of us in the system four if not 
five times more.
  By getting those costs under control, we will save money in the long 
run, more choices, better accessibility to the doctors we want to see, 
and making sure that we have the opportunity to contain these costs, 
keep them under control and making sure that doctors

[[Page H7131]]

and health care professionals are prescribing health care and not bean 
counters.
  This is what our plan addresses, and this is a matter of our 
competitiveness of the country and having citizens that are healthy. 
And the well-being of our Nation is at stake here.
  Ms. PINGREE of Maine. I am going to read a quote from one of the 
letters that I brought in because it reinforces your point. This person 
is talking about their issues with the health care system. It is a 
Maine constituent. It says: My wife and I struggled to get our provider 
to pay for special infant formula that our oldest son needed to live 
due to his protein intolerance. This was despite our specialist doctor 
showing us a letter in which the insurance company had agreed in 
arbitration from a previous case to pay in full for the formula in 
cases like our son's.
  This is clearly one of those examples where it is a bureaucrat or a 
bean counter who is denying it just to save the insurance company some 
money.
  This same person also says in another example my brother-in-law was 
denied cancer treatment that his doctors had recommended, and only 
began his treatment after the insurance company overturned the decision 
on appeal. The delay may prove fatal to him.
  Both of you have said this over and over again, people want to go to 
their doctor or their primary care provider and get the advice they 
need, follow the treatment plan that they recommend, and not be told by 
a bureaucrat in Washington or an insurance company that they can't do 
it just because they are trying to save money on your health. I agree 
with you, we need cost-saving measures, but not on people's essential 
treatment.
  Mrs. HALVORSON. That is so true. We hear story after story in our 
district office. I have a letter that was especially devastating to me. 
It caused me to actually put in a resolution or sponsor a bill. This 
constituent was a widowed mother of two. She was actually denied 
private health insurance because she attended grief counseling. Her 
husband, who was the primary wage earner, died suddenly at their home 
in front of the family. As a way to cope with the situation, she 
enrolled the family in group therapy. And at the same time, she was 
also faced with trying to find new health coverage for herself and her 
children because her husband just died in front of the family. While 
searching for that new private insurer, she was denied over and over 
again because she was participating in that grief counseling. So that 
is why I filed H.R. 2236, which we called the Grieving Families 
Insurance Protection Act, because we do not think health insurance 
companies should deny you health coverage due to family members needing 
grief counseling at awful times like this.
  Ms. PINGREE of Maine. They really wouldn't allowed her to have 
insurance coverage, and that was their stated reason?
  Mrs. HALVORSON. She could not get health coverage because she was 
attending grief counseling, so they would not give her health care. And 
isn't that a shame. This poor family, actually the father, the husband, 
died right there in front of them. The family obviously needed some 
help, and they couldn't get it.
  So these are the kinds of things that we should never be putting 
people through. That is the other thing, it is not just people not 
having health care. I don't want people to have health care and give 
them that false sense of security because then they think they 
automatically will be taken care of, and we need to make sure that 
people are being taken care of and they have health care, not just 
necessarily health insurance.
  Mr. BOCCIERI. Let me add something to the gentlelady's remarks. We 
talk about this notion of 46 million uninsured and underinsured folks. 
Let's explain for a minute what uninsured and underinsured means.

  Uninsured means you have absolutely no health care coverage. If you 
were injured or had to seek routine medical care, you couldn't go to a 
physician unless you paid out of our pocket.
  Underinsured are people who don't have quite enough insurance because 
they got caught in that preexisting net, that factory worker who lost 
their job and their health insurance with that pink slip, got rehired 
down the line but because they were a diabetic, that condition was 
preexisting, so they can't seek treatment. They are underinsured 
because they don't have enough insurance to cover all of their medical 
needs.
  We found in a medical study that was published last year that health 
care insurance companies spend $84 billion every year to block, deny, 
and screen patients from seeing their physicians; $84 billion. In that 
same study it showed that only $77 billion would be required to cover 
all of those 46 million uninsured or underinsured. It actually would be 
cheaper to cover all of the folks who are actually costing us more by 
not seeing their primary care physician.
  So we have an opportunity now with the bill that we have rolled out 
to end preexisting conditions, which have been one of the biggest 
albatrosses in health care in my opinion for such a long time; not 
being able to see the doctor because you have a condition that existed 
prior to your employment at some factory.
  So this is something that affects middle class Americans all over the 
United States. I think if we address this, preexisting conditions, 
portability from job to job, covering all people so they are not using 
their primary care physician in the emergency room versus seeing the 
doctor that they want to see, and making sure that we provide 
incentives for prevention so that people are living healthy lifestyles 
and we are able to provide prevention and allowing physicians to make 
those medical diagnoses, that is what is going to be the cure for our 
health care dilemma here.
  Ms. PINGREE of Maine. Preexisting conditions, it is kind of shocking 
when you hear those stories. I heard about a State the other day that 
didn't have a requirement that insurance cover you in spite of a 
preexisting condition. And someone told me about an insurance company 
that considered women of childbearing age a preexisting condition. So 
that didn't mean you had a child, it meant you could potentially get 
pregnant. You may have already decided never to have a child, and why 
shouldn't your insurance company cover you, but they weren't going to 
take any chances. Why don't they just say we only want healthy people 
who promise never to get sick. And if you get sick, we will deny you 
coverage.
  I come from the State of Maine, where the State legislature has 
already required that insurance companies cover you in spite of 
preexisting conditions, and that is really a great reform. Maine is one 
of the leaders in health care reform. We have a very high number of 
people who have some form of insurance coverage. Many of them are on 
Medicaid or our MaineCare system. But the fact is, what my colleagues 
in Maine tell me, and I certainly felt when I was in the State 
legislature, is States can't go it alone. Many States in the country 
have passed these kinds of regulations, but then it makes it hard to 
compete with the State next door that doesn't bother doing any of that, 
or charges all the sick people more than the people who are well, and 
doesn't have a community rating kind of plan.
  One of the issues that we are facing now, particularly in States that 
are having a hard time holding their own budgets together, is they are 
saying to us: Let's makes this universal. Let's make it the same kind 
of coverage from State to State. And you mentioned portability. There 
are a lot of people now, and I forgot what somebody called the term, it 
is something like job lock, people who stay in their job because they 
are terrified to leave that job because they can't go without health 
insurance, or their spouse is sick or one of their children is sick.

                              {time}  2220

  I meet people who say, you know, I've got a great idea for starting 
my own business. I'm ready to go out on my own, and I could create a 
job vacancy for somebody else here who would really like to come and 
work at this company because I'm ready to go do something else. But 
they can't take that risk. People who have just enough set aside to 
retire who say, I am ready to retire, but I don't dare be out there 
without health care coverage, so they don't retire at 57 or 58. And in 
this economy, where we can use any job we can find, having health care 
coverage

[[Page H7132]]

would do more to boost the economy, I think, than many other things.
  I often say about the State of Maine, where, as I mentioned, a lot of 
people are self-employed, we have a lot of fishermen, or they run a 
small business or some kind of little entity that they are making 
enough money, people say to me all the time, We make enough to get by. 
We do okay. We own our own home. We make our own home repairs. We're 
doing all right, but it's health care coverage that we're worried 
about, our health care coverage that we can't afford and then we go 
without.
  And exactly what you mentioned earlier, those are the very people 
who, when they do get sick, have to go to the emergency room, who often 
depend--and they hate it, they depend on charity care at the hospital, 
uncompensated care. And I have the same situation, a lot of rural 
hospitals who depend on fund-raising drives just to keep the doors 
open, who are desperately coming down to see us all the time to say, We 
can't keep the hospital open. What are we going to do? And that is a 
vital part of our infrastructure.
  Mrs. HALVORSON. And something else that we haven't talked about is 
the outreach that I've tried to do--and I know a lot of Members of 
Congress have done--is with our FQHCs, our Federally Qualified Health 
Centers. There is a very important place for them because there is so 
much that they can do in the meantime for those who don't have 
insurance or those who aren't able to get the health care they need. 
I've toured so many of them in my district. They do a wonderful job. 
And so, in the meantime, we should be doing everything we can to make 
sure that people have a place to go where they can have a medical home, 
where they can feel comfortable and take their children.
  I know in Illinois we have FamilyCare, where every child has health 
care. There are things, but we should not be doing this State by State. 
We spend a lot of time and effort doing these things State by State. 
That is part of the reason I ran for Congress. Even though I was a 
State senator and I spent so much time working on health care, we knew 
this was a Federal issue. So this is something that needs to be done on 
a national level, and it's something that everybody working together is 
going to be able to get accomplished.
  Mr. BOCCIERI. Will the gentlelady yield? I know that there might be 
some apprehension out there from our seniors about health care reform. 
And let me stress to you that our plan allows you to keep the doctor 
that you want to keep. If you like the doctor that you're seeing, you 
can continue seeing that doctor. If you don't like the doctor that 
you're seeing and you would like to get into a different plan, it will 
allow you to go into a different plan.
  There will be more freedom under this bill. There will be more 
freedom under these proposals. And we're going to make sure that 
physicians are telling our seniors, health care professionals are 
telling our seniors the type of health care that they need, whether 
this MRI was authorized, whether this cancer treatment was necessary 
and prudent. We want health care professionals to do that. We do not 
want bean counters making decisions based upon what the bottom line and 
dollars are going to be.
  Now, the gentlelady was talking about what she did in the State 
legislature. In Ohio, we had a very similar situation where insurance 
companies were delaying payments to doctors who ultimately run a 
business. When you see your primary care physician, they have staff. 
They have a payroll. They have to keep the lights on. They have to pay 
utility bills just like any small business. But when you do look-backs 
and you suggest whether this MRI was really necessary or authorized, 
whether this x-ray was necessary or authorized and you delay those 
payments over a time period, the physician can't keep the lights on in 
the building, and that should end. We passed a bill in the State 
legislature called Prompt Pay to make sure that insurance companies 
were making best efforts to pay those bills on time so doctors could 
keep the lights on.
  Additionally, we were doing health care simplification so that we 
could involve a little bit of health care IT, medical IT, so that when 
you roll into a hospital, God forbid, after an accident that's in your 
region, when they pull up your name, when they pull up your 
identification, they're able to identify who you are and your health 
care records.
  The military has been doing this for years. In fact, on our military 
identification card, we have the medical technology to pull up all my 
medical records. If I rolled into a hospital or to a VA facility or to 
a military hospital, on my card, they would scan it in and my complete 
medical history would come up. And on that, you would be able to tell 
whether you were diabetic, what type of treatments you've had. And that 
ultimately is going to cost hospitals less because they're not going to 
run these battery of tests to see if this person is a diabetic because 
they know that John Doe, when they came in, has a medical history and 
it's on their card.
  Perhaps this is something we should do. We're doing it in the 
military. It's something that we ought to explore for Americans so that 
they can have quick access to their medical records.
  I yield to the gentlelady.
  Ms. PINGREE of Maine. You know, absolutely. I think it's one of the 
reasons why earlier this year we went along with the President's 
proposal and invested so much in health information technology. It has 
been clear to people for a long time that so many different insurance 
companies and so many different kinds of forums just make it difficult 
for practitioners to run a business and hospitals to operate, and as 
you said, for people to get the kind of medical care that they really 
need.

  Well, we are at about time to wrap up here. I will just kind of go 
over again from my perspective, and certainly will let the gentleman 
from Ohio close with a few thoughts as well, but I just want to 
emphasize again that from my perspective, in my home State--and really 
what I hear across the country and everywhere I go--people say, Can you 
get a health care plan passed? Are you going to do something about all 
of the things that we've been talking about tonight? People want the 
coverage, they want a choice. As we've said many times, if you like 
your plan, you can keep it; if not, there will be real alternatives.
  They want affordability. People are willing to buy health care, but 
they want to know that they can afford it. This plan that has just been 
released has a shared responsibility from employers and individuals 
alike. It has real components to control costs. It makes a serious 
investment in prevention and wellness and invests in the health care 
workforce, something we haven't talked much about tonight. But I know I 
come from a State where there is a tremendous shortage of health care 
practitioners--doctor, nurses, those people that are needed to do this 
job to make sure that we can have good care, and that is part of the 
legislation is to really look at investing in our workforce.
  I feel very hopeful, I feel hopeful that we have already moved us 
forward as far as we can, that there is a sense around here really from 
both sides of the aisle that we don't have to debate anymore whether or 
not there is a problem with the system. We may have differences about 
how we go about fixing it, but there is a real commitment to go ahead 
and fix it.
  And I am very impressed with the President, who has just made it 
clear that this is something he wants to do on his watch. He wants to 
do it in the first year, and I think this is a tremendous commitment to 
really pass a health care package that works for America and get on 
with it.
  And I yield to the gentleman from Ohio.
  Mr. BOCCIERI. I thank the gentlelady for assembling this dialogue on 
health care. This is very important. And we know those Americans who 
might be listening in, those folks who are still awake after perhaps 
punching the time clock and working long hours, we want you to know 
that we are working on this issue. But we have studied it long enough. 
We've talked about it long enough. Now it's time to take action. 
Leadership is defined by action, not position, but by action. And what 
I applaud this President for is his bold efforts to step forward and 
take action on an issue that remains a dilemma for America. This is 
about us, as a Nation, being competitive with our foreign competitors. 
This is about how much

[[Page H7133]]

we spend on delivery of health care and making sure that all Americans 
have access to the quality of care that we want, not just because you 
can afford it but because you're American. And let me just say these 
things:
  Number one, if you like your doctor, you will keep your doctor. If 
you don't like the plan that you're in, you can move to another. There 
is going to be freedom of choice, and there will be broad choices in 
the plan that has been unveiled in this Chamber.
  Number two, we want to make sure that health care professionals and 
physicians and doctors and nurses are prescribing health care and 
administering health care and not necessarily the bean counters or 
bureaucrats that we find too often who are making health care decisions 
for too many Americans.
  And the third issue that we need to emphasize is that there is enough 
money in the system already to pay for health care. The 46 million 
uninsured and underinsured folks who are out there, we know that there 
is enough money in the delivery of health care--$2.5 trillion we spend 
every year, 16 percent of our gross national product. We spend more 
than any other industrialized nation in the world, but yet have a life 
expectancy on par with Cuba. There is enough money in the system that 
is out there that we can make sure that 46 million uninsured or 
underinsured people have access to health care.

                              {time}  2230

  How are we going to do that? With the five P's. Making sure that all 
people have access to health care. If they don't, it is going to end up 
costing all of us more because when they use the hospital room as their 
primary care physician, they will actually cost all of us more.
  Making sure they have a portable plan that allows them to take it 
from job to job to job. End this notion of preexisting conditions, that 
if you're working at one place and you go to another job that somehow 
being pregnant or being a diabetic or having a chronic disease somehow 
eliminates you from seeking health care from this new provider. End 
preexisting conditions.
  Making sure that we provide incentives for physicians to not only 
enter the field but also that physicians are making the health care 
decisions.
  And, lastly, prevention, prevention, prevention. Four cents of every 
dollar that we spend on health care is for prevention.
  We can do a better job. We have to do a better job. The President has 
called us to action. The Nation has suffered for too long under a 
system that has excluded a few and allowed others to seek access. And 
this delivery system that we have should be about health care and not a 
health sickness plan that we have that's a fee for service but that 
encompasses all the things that we talked about here tonight.
  I thank the gentlewoman from Maine for allowing me to be a part of 
this.
  Ms. PINGREE of Maine. I thank my colleagues from Ohio and Illinois 
for being willing to be here.

                          ____________________