[Congressional Record Volume 155, Number 96 (Wednesday, June 24, 2009)]
[Senate]
[Pages S6975-S6977]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                           Health Care Reform

  Mr. President, you are well aware from your State of Oregon and from 
my State of Illinois how much this health care reform debate means to 
everybody we represent. When you ask the American people what we can do 
about health insurance, 94 percent of people across America 
overwhelmingly support change in our current health care system. Some 
85 percent of the people across this country, Democrats, Republicans, 
and Independents, say that the health care system needs to be 
fundamentally changed.
  This is the time to do it. This is the President to lead us in doing 
it. We had better seize this moment. If we do not, if we miss it, we 
may never have another chance for years and years to come. That is 
unfortunate.
  Democrats want to build on what is good about the current system. It 
is interesting that so many people would say we should change the 
health care system, but about three out of four people say: I kind of 
like my health insurance.
  So what we have to do first is to say we are going to keep the things 
in the current system that work, and only fix those things that are 
broken. If you have a health insurance plan that you like and you trust 
it is good for you and your family, you need to be able to keep it. We 
should not be able to take it away from you. We do not want to. That is 
the starting point. And then when we start to fix what is broken in the 
system, we address some issues that I think are really critical.
  Health insurance companies today can deny you coverage because of an 
illness you might have had years ago, exclude coverage for what they 
call preexisting conditions, which sadly we all know about, or charge 
you vastly more because of your health status or your age.
  We want to make sure that the end of the day, after health care 
reform, we keep the costs under control, make sure you have a choice of 
your doctor, make certain you have privacy in dealing with your doctors 
so that the doctor-patient relationship is protected and confidential.
  We want to protect quality in the system, to make certain we bring 
out the very best in medical care, and not reward those who are doing 
things poorly. We believe we can do this on a bipartisan basis, with 
both parties working together.
  Some of the critics of this effort basically are in denial that we 
need to change our health care system. I do not think they are taking 
the time to look at it closely. Whether you talk to people, average 
families, or small businesses, large corporations, you understand that 
the cost of health care now is spinning out of control, and if we do 
not do something dramatic and significant about it, it will become 
unaffordable.
  I had a group of people in my office who were in the communications 
industry. They are union workers. They are worried because every year 
when they get more money per hour for working, it always goes to health 
insurance. They learn each year there is less coverage: pay more, get 
less.
  We have got to do something about containing the cost of a system 
that is the most expensive health care system in the world. We spend, 
on average, more than twice as much as the next country on Earth for 
health care for Americans. We have great hospitals and doctors. We have 
amazing technology and pharmacies. But the bottom line is, other 
countries get better results for fewer dollars.
  So the first item we must address is bringing down the cost of health 
care, stop it from going through the roof, so that families and 
businesses can afford it, and government can afford it as well.
  The second thing we have to make sure we do is protect the choice of 
individuals for their doctor and their hospital, their providers. There 
are limitations now. In my home town of Springfield, IL, my health 
insurance plan tells me there is one preferred hospital of the two I 
can choose, and I know if I do not go to that hospital, I can end up 
with a bill I have to pay personally. So there are limitations under 
the current system, and that is to be expected.

[[Page S6976]]

But we want to limit those to as few as possible so people are able to 
come forward and have the basic choice they want in physicians.
  Then there is a question about how to keep the costs under control. 
If we are going to build this new health care reform on private health 
insurance, the obvious question is: Will there be a government health 
insurance plan such as Medicare available as an option so you can look 
at all of the private health insurance plans you might buy, and also 
consider the government health insurance plan, the public health 
insurance plan, as an option?
  This is controversial. Health insurance companies say, if we have to 
compete with a government plan, they will always charge less and we 
will not be able to compete. Others argue that if you do not have at 
least one nonprofit entity offering health insurance, then basically 
the private health insurance plans will continue to be too expensive; 
they will not have the kind of competition they need to bring about 
real savings.
  Many people on the other side of the aisle have come to the floor and 
criticized the idea of a public interest health insurance plan. They 
argue it is government insurance, government health care. But most 
Americans know that government health care is not a scary thing in and 
of itself. There are 40 million Americans under Medicare. That is a 
government health care program. Millions of Americans are protected by 
Medicaid for lower income people in our country. That has a government 
component too.
  Our veterans come back from war and go to the Veterans' 
Administration, a government health program. I have not heard a single 
Republican come to the floor and say: We need to eliminate Medicare, 
eliminate Medicaid, close the VA hospitals, because it is all 
government health care. No. For most people being served by these 
programs, they believe they are godsends and they do not want to lose 
them.
  Yesterday, the minority leader, the Republican Senator from Kentucky, 
came to the floor and talked about a future which is fictitious. He 
said: A government plan where care is denied, delayed, and rationed.

  Those are fighting words, because no one wants their coverage denied, 
they do not want to wait in a long line for surgery, and they do not 
want to believe they are victims of rationing. It is important for them 
to have medical care given to them.
  The language we hear from the other side of the aisle is language we 
are all too familiar with. The miracle of the Internet is that people 
can come up with a written document now, and by pressing a button or 
clicking a mouse, they can send that document to lots of different 
people.
  A couple of months ago, a Republican strategist named Frank Luntz 
wrote a 28-page memo to give to Republican Senators on how to defeat 
health care. Dr. Luntz--he calls himself ``doctor''--Dr. Luntz said: 
Whatever they come up with, here is the way to beat it.
  He had not seen the health care reform plan that President Obama 
might support or the Democrats might produce. But he says: This is how 
we stop them from passing anything, how we delay things, deny things. 
And he used those words. He said: We have got to use words that 
Americans will identify with, buzzwords like ``deny,'' ``delay,'' 
``ration.'' And those are the words we hear every week now from the 
other side of the aisle.
  The reason I mentioned the Internet is it turns out somebody punched 
the wrong button on their computer, clicked the wrong mouse button, and 
the next thing you know that memo spread across Washington. Everybody 
has it.
  So we have seen the play book. We kind of know the plays they are 
running. We know their speeches before they give them. But they still 
come down and give these speeches over and over again.
  I guess the starting point is this: Some of my colleagues and friends 
on the other side of the aisle want to keep the current health care 
system. They think it is fine. They do not want to change it. Well, I 
do not join them, and most American people do not join them either.
  There are winners in the current system. There are people making a 
lot of money under the current health care system. Health insurance 
companies were one of the few sectors in the economy last year, 2008, 
that showed profitability when most American companies that were not 
health insurance companies were not profitable. So were oil companies, 
incidentally. But the health insurance companies that are making a lot 
of money do not want to see this system changed. It is a good, 
profitable system for them. By and large, they want to keep it the way 
it is. There are some providers who are doing quite well under the 
system, some specialists are making a lot of money, some hospitals are 
making a lot of money. They want to keep it as it is.
  But we know we cannot. It is unsustainable. It is too expensive for 
individuals, families, and for businesses and for government, for us 
not to get the cost under control.
  The Republican resistance to change in health care reform is not 
surprising. Last week we had a cloture vote and 30 hours of debate to 
proceed to the consideration of a bipartisan noncontroversial bill. We 
have been through cloture votes and delays all of this week. We are in 
the middle of one right now. That is why those who are visiting the 
Capitol are wondering where all of the Senators are. This is a 
situation where the Republicans have decided they are going to force us 
to wait 30 hours before we do something, a waste of time that we cannot 
afford, and we have faced it before.
  We have to understand that we need to have health care reform. The 
President is right that this opportunity comes around so rarely.
  We have pretty good health insurance as Members of Congress. But I 
want to make it clear for the record, we do not have ``special'' health 
insurance. I have heard that argument being made. If you can get the 
same health insurance the Senator has, you would be set for life. We 
have great health insurance. But it is the same health insurance 
available to all Federal employees, 2 million Federal employees; 8 
million employees and their families. We have a Federal health benefits 
program. We have an open enrollment each year to pick, in my case, from 
nine different health insurance plans available to me in my home State 
of Illinois for my wife and myself. That is a luxury most people can 
only dream of. All Federal employees have it, and so do Members of 
Congress, because we are considered Federal employees. But it is 
something most Americans do not have and we can make available to small 
and large businesses alike. It is important that we do this.
  I hope we can get some support, some support from the other side of 
the aisle. Today in America, while we are going about our business, 
14,000 Americans will wake up and realize something: Yesterday they had 
health insurance and today they do not. Every day in America, 14,000 
Americans lose their health insurance.
  I cannot imagine what life is like without health insurance. There 
was a time in my life when I did not have it. It was scary. I was a 
brandnew married father, baby on the way, and no health insurance. It 
happened. We made it through with a lot of bills that we took years to 
pay off. That goes back a long time.
  Currently, if you are without health insurance, you are one diagnosis 
or one accident away from being wiped out. So going after bringing the 
cost of health insurance down is our first priority, but the second is 
to make sure everybody has some basic form of health insurance.
  We have to understand that those of us who have health insurance pay 
more for our health insurance because some 47 million Americans do not 
have it. They present themselves to the doctors and hospitals, and in 
this caring Nation, we treat them and their bills are then absorbed by 
a system that spreads them around for all of the rest of us to pay. It 
is about $1,000 a year. It is a hidden tax for families, $1,000 more 
each year on health insurance premiums to take care of the uninsured in 
our country.
  So now we have a chance to bring the uninsured into coverage. By 
bringing them into coverage, we will not only give them peace of mind, 
make them part of the system, we will reduce that $1,000 hidden tax 
every family pays who has health insurance. So we have an opportunity 
to do something positive about health insurance.

[[Page S6977]]

  For those who are following this debate closely, they probably heard 
this mentioned by others, but I want to make a point of it. There is an 
important article for people to read, and they can go online to find 
it. It is from the June 1st New Yorker magazine.
  A man who is a surgeon in Boston, an Indian American, whose name is 
Dr. Atul Gawande, wrote an article about health care in America today. 
I will not go into detail about what he found, but it is an eye opener 
because he went to one of the most expensive cities in America when it 
comes to treating Medicare patients. It is McAllen, TX. He could not 
figure out why in McAllen, TX, they were spending about $15,000 a year 
for Medicare patients--dramatically more than other towns in Texas and 
around the country.
  What he found, unfortunately, is that many of the doctors in that 
city were treating elderly patients by running up their charges, by 
ordering unnecessary tests, by ordering hospitalizations and things 
that were not being ordered in other cities. The reason is, there was a 
financial incentive. The more tests, the more procedures, the more 
hospitalizations they can charge to Medicare, the more the doctor was 
paid.
  Well, Dr. Gawande went down and met with the doctors and confronted 
them with it. There was no other explanation. That was it.
  Then he went to Mayo Clinic in Rochester, MN--a place I respect very 
much, a place that has treated my family and treated them well. He 
found out the cost for treating Medicare patients in Rochester, MN, is 
a fraction of what it is in McAllen, TX.
  At the Mayo Clinic it is cheaper to treat a Medicare patient than it 
is in McAllen, TX. Why? Well, it turns out it is pretty basic. The 
doctors who are on the staff of the Mayo Clinic are paid a salary. They 
are not paid by the patient or by the procedure. So their interest is 
not in running up a big medical chart of tests. Their interest is 
getting that patient well, and doing it effectively. They do it with 
fewer procedures and less money spent and better results at the end of 
the day.
  So now we have a choice in this health care debate: Do we want to 
continue the example of McAllen, TX, which is abusing the system, 
charging too much, and not giving good health care results, or do we 
want to move to a Mayo Clinic model, one that basically is much more 
efficient and effective, keeps people healthier, at lower cost? I hope 
the answer is obvious. It is to me. I would like to see us move toward 
incentives such as the Mayo Clinic system.
  The President spoke to the American Medical Association in Chicago 
last week. It was a mixed review. They were very courteous to him. 
There were a few people dissatisfied with his remarks, but it is a free 
country. We can expect that. Some of those doctors in that room 
understand it is time for change and some of them do not. Some of them 
think change is going to be bad for them and bad for our country. But 
most of us understand if we work together in good faith, 
conscientiously, we can change this health care system for the better, 
reduce its costs, preserve our choice of doctors and hospitals, make 
certain quality is rewarded, and also make certain we cover those 46 or 
47 million uninsured Americans and come up with a health care system 
that does not break the bank--not for families, not for businesses, and 
not for governments in the future.
  Mr. President, I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Ms. KLOBUCHAR. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.