[Congressional Record Volume 155, Number 105 (Tuesday, July 14, 2009)]
[House]
[Pages H8071-H8078]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  THE MAJORITY MAKERS AND HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Kentucky (Mr. Yarmuth) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. YARMUTH. Mr. Speaker, it's a great honor for me to be here 
tonight to lead a discussion about the most pressing and the most 
significant problem to most Americans, and that is the question of 
health care. I'm here with Members of the class of 2006. We call 
ourselves the Majority Makers, and from time to time we are here to 
address matters of great national import with you. But this is a very 
special topic for the class of 2006.
  I remember very well when I began my campaign for Congress back then, 
in 2006, when many of the headlines of our Nation's newspapers and our 
television news operations were all about the Iraq war, and people 
would say to me, Well, I guess everyone's talking about the Iraq war to 
you. And I said, No, nobody's talking about the Iraq war. It's health 
care, health care, health care. Everywhere I went, neighborhood 
picnics, Catholic picnics on Friday night, festivals, businesses, 
schools, wherever I went, I heard story after story about how Americans 
were fed up with the health care system that was not serving them. In 
fact, it was, in many cases, killing them.
  Well, here we are, 3 years later, and while health care may not have 
been on the front pages of the newspapers up till now because we have a 
severe economic decline and many challenges we're dealing with, this 
Congress is ready to put health care back on the front pages. And 
President Obama has already indicated that this is his top priority in 
his first time in office, and the reasons that that is so are not hard 
to determine.
  It's pretty easy to look around us, look at the numbers and see why 
we have to take significant, decisive action to improve, to change our 
health care system. Just a few weeks ago, Dr. Christine Rohmer, who 
heads the White House's economic team, testified before the House 
Budget Committee that if we don't make significant steps to reform 
health care, to get a handle on cost, to bring prices down, that health 
care, which now comprises 17 percent of our economy, by 2040, would 
make up 35 percent of our economy.
  Well, you don't have to be an economist or a health care expert to 
know that if health care takes up 35 percent of our economy, it's going 
to squeeze out most of everything else. In short, it is an 
unsustainable number. And we can go on and talk about the dramatic 
impact of Medicare and those types of expenses on the Federal budget as 
well as on the general economy.

[[Page H8072]]

  But what most people are concerned about is not the big picture, not 
the macroeconomic picture; it's the kitchen table picture. It's what 
happens in your household, what happens to individuals, those people 
that we meet in all segments of our society from one coast to the other 
who have had significant difficulties with their health care system. 
They're small business people who have seen their premiums rise 15, 20, 
25 percent every year in spite of the fact that they have very low 
utilization, healthy people.
  We've seen story after story of individuals who, at 55 years of age, 
lose their job. They can't get COBRA for a very long period of time. 
They don't qualify for Medicare. They try to go out in the private 
market and buy insurance, but at 55, most everybody's going to have 
some kind of preexisting condition that makes them, under current, the 
current system, uninsurable.
  We heard from a couple yesterday in that exact same position. They 
came to testify to Congress. A woman has had epilepsy since she was 5 
years old. Her husband lost his job. Now they go out and try to shop 
for insurance in the private market, but because she has epilepsy, 
something totally beyond her control, obviously, the only insurance 
policy she could get cost $2,600 a month. Now, how many people in this 
country can afford $2,600 a month for health insurance? $30,000 a year. 
Well, not very many. But these are stories that are repeated time after 
time after time.
  I have to tell one that was a personal experience of mine, and then 
I'm going to let my colleagues from the class of 2006 contribute not 
just their stories about where health care needs to be fixed, but also 
what this Congress is proposing to do to set America on a sounder 
course for health care.
  Back during my 2006 campaign, we had a young worker, a young woman in 
her mid-twenties, was a volunteer in our campaign. She was severely 
disabled, so severely disabled she was wheelchair-bound. And she told 
me that if she were not covered by SSI, she would have spent, had to 
spend $3,000 a month just on her prescription medications, but because 
of SSI, she was able to manage her health care problems.
  Now, she had, and I hope she still has, a boyfriend, and they wanted 
to get married. Her boyfriend worked at a supermarket company. He was 
making $11 an hour, which, to them, was a great salary. But they 
couldn't get married, because if they got married, she would lose her 
disability coverage, and the company where her boyfriend was employed 
could not, would not put her on the policy because she was so expensive 
to cover.

                              {time}  1815

  So what we have here are two people in love, wanting to get married, 
wanting to start a family, wanting to do what so many Americans want to 
do, and because of a health care coverage issue, they cannot get 
married. In this country, there is no excuse for that situation.
  Time after time, all of us run into situations in which people are 
having to make important life decisions based on whether there is the 
availability of health care coverage. There is someone who wants to 
leave a company and wants to start a small business of his own--not 
able to do it because of coverage. There is somebody who wants to leave 
a situation, in which he or she has coverage, in order to go back to 
school to further his education and advance his prospects--can't do it 
because of insurance coverage. We all know these scenarios all too 
well.
  So this Congress and this President have set out to change the health 
care system in this country to make sure that every American has peace 
of mind and security where his or her health care is concerned. That's 
what we're about, and that's why we're going to put health care back on 
the front pages and back as the lead story on America's newscasts over 
the next few weeks, because we are going to do for the American people 
what we know they want us to do and need us to do.
  With that, I would like to yield to my good friend and colleague from 
Maryland, Mr. Sarbanes.
  Mr. SARBANES. I want to thank my colleague from Kentucky for 
organizing this very important discussion today.
  We have got some terrific Members who have been very engaged in this 
health care topic for a long time, and I say ``a long time'' because, 
even though these are folks who came to this Chamber in January of 
2007, all of them are people who have been working on this issue for 
many, many years. So this is going to be an important discussion 
tonight, I think a stimulating one, and one that will be enlightening 
to all of those folks who are very concerned about where we are right 
now.
  Today was an incredible day because today there was introduced in 
this Chamber the Health Reform Act, which, I think, is going to form 
the basis of moving us forward in a very meaningful and significant way 
in this country. This has been a long time in coming, this day. We ran 
on this issue in 2006, not because we made it up out of thin air but 
because everywhere we went we heard from constituents and members of 
the public who were saying this was their number one issue. We ran on 
it again in 2008 because this was the number one issue that people 
brought to our attention and because of the stories like the one that 
John Yarmuth just told. There are legions of those stories that we've 
heard.
  I mentioned that this was the number one issue in '06 and '08 for a 
specific reason, and that is that there are some on the other side and 
there are even some in the public who are saying we're moving too fast 
on this--slow down--that we need to take more time to deliberate. It's 
a fair point but only to a point, because the people who we were 
elected by and the people from whom we hear every weekend when we go 
home to our districts have been clamoring for this kind of reform for 
decades, and they really can't wait to change the situations they're in 
right now. So this is a great day because, after decades of struggle 
and after the past few years when the call for this kind of change has 
reached a fever pitch, we are at this moment finally at the point where 
we are putting legislation on the table that is going to make a 
difference.
  I want to yield soon to my colleagues who are here, but let me just 
mention a couple of things and dispense with some myths.
  You know, before we began this exchange, I heard a few folks who were 
critical of the proposal saying we don't need a government takeover. 
Well, this bill couldn't be further from a government takeover. What 
this is doing in a very American way is offering more choices out 
there. Too many Americans feel that they have been shackled by a 
private health insurance industry that was more interested in seizing 
profits for themselves than in really providing high-quality and 
accessible care to most Americans. Folks are fed up with that. So we're 
not talking about a government takeover. We're talking about trying to 
get out from under the takeover that the private health insurance 
industry has had for so many years. That's what this is about.
  The second thing is that this bill invests in primary care and in 
preventative care. It does the kind of commonsense things that the 
American people have been calling for for so many years with respect to 
their health care coverage. Let's treat people on the front end, and 
keep them from getting sick in the first place rather than waiting for 
them to get sick on the back end. That makes common sense. The other 
thing is it invests in our health workforce. If we are going to 
presume, as we should, to cover everyone in this country and to provide 
them with health care coverage, we have got to make sure that there are 
enough caregivers to deliver that care to them.
  Let me close with this observation, which is what, I think, most 
Americans are thinking to themselves. They're thinking: If America 
could have accomplished all of the things that we've managed to 
accomplish over the last few decades, even as we were carrying this 
broken health care system around on our backs, imagine what we could 
accomplish as a society, as individuals, if we could fix this health 
care system. Imagine if your mother, who goes to work, who leaves a 
child at home who has got a fever of 100 degrees, but you don't have to 
worry because you know that your family has decent health care 
coverage. Imagine how much more productive you're going to be at work 
that day. Imagine you're a small business that wants to do the right 
thing

[[Page H8073]]

for your employees, but you could never afford to do it, but now you 
can. Imagine if you're a large business that's trying to compete with a 
competitor overseas that has more of a shared obligation from the 
public and private sectors to help it with the cost of health care. 
Imagine how much more productive and competitive you could be.
  So, given that America has been as successful as we've been all of 
these years, even with this monkey we've been carrying around on our 
back, just think of and just imagine the heights we're going to reach 
as a Nation and as individuals if we can fix this health care system. 
That's what this bill is all about.
  So I want to thank you, John, my colleague from Kentucky, for 
convening us today to talk about this very, very important issue. Let 
me yield my time back to you.
  Mr. YARMUTH. I thank the gentleman.
  He raises a point that, I think, is appropriate to make at this time. 
We will hear a lot over these few weeks as we're going to be actively 
engaged in this issue of trying to bring a bill to the floor and of 
passing it before August 1. You will hear a lot about the Canadian 
system, and you will hear a lot of fear tactics being thrown at the 
debate because, right now, those people who are opposing what we are 
trying to do really have nothing but fear tactics to throw at it.
  It's interesting, because we had a hearing in Ways and Means several 
weeks ago. A gentleman was there who was arguing against our public 
option, the public option part of the proposal, which basically is a 
government-run plan that would compete with private insurers and that 
would compete for your business, for the business of the American 
people. He kept saying, We don't want Canada. We don't want Canada. We 
don't want Canada with the long lines and all of these things--all of 
these myths that have arisen around the Canadian system.

  I asked him if he knew how many countries in the world, how many 
industrialized nations, had a nationalized health insurance system. He 
said all of them except the United States. How many have universal 
coverage? All of them except the United States. How many have a blend 
of public and private where you have a basic level of coverage provided 
by the government but where people can buy private insurance to enhance 
their positions? He said, Well, all of them except Canada. I said, So 
you have chosen the one country in the world that is an outlier. He 
used that to undermine the arguments for an American plan when we 
haven't copied anything from Canada in this country, that I know of, 
except hockey. He really didn't have a response to that.
  The point is you will hear a lot of these myths thrown out, and they 
really don't relate to what we're doing or are trying to do, which is 
to create a uniquely American solution to a uniquely American problem.
  With that, I would like to yield time to my colleague from 
Massachusetts, Congresswoman Niki Tsongas.
  Ms. TSONGAS. I want to thank my colleague from Kentucky.
  It is an historic day, I think, to be here, discussing the issue of 
health care. You were talking about how many in our class campaigned on 
the very important issue of health care. I came in at midterm--a year, 
maybe 10 months after you all had been elected--as part of a special 
election process in which the issue of expanding coverage for children 
under the Children's Health Insurance Program was the defining issue. I 
ran on a campaign, as many in my class did, to expand children's health 
coverage. Finally, we have been successful this year with President 
Obama's signing that most important legislation into law.
  I also happened to be running at a time when the new Massachusetts 
system, which was designed to provide guaranteed access to affordable 
health care for Massachusetts residents, was coming into play. We had 
many, many questions around the potential it would have, around the 
difficulties it might present and around the costs it might impose. In 
fact, since we began that most important system, 439,000 residents of 
our State are now covered with quality, affordable health care.
  This legislation created a mechanism not unlike the exchange that we 
are talking about in the legislation that was being proposed today, 
which creates a place for people to go to assess the different 
possibilities of health care and to make sensible choices that make 
sense for them.
  What I learned from the Massachusetts experiment, which has become 
very successful, is that, while we talk very much about what the role 
of government is, in Massachusetts, the role of government was to be 
the architect of the system that brought everybody to the table--the 
employer, the individual and government--to sort out how best each 
player should play its role. Because we had that cooperative approach, 
which is what, I think, we see in the legislation that has come to the 
table today and the successes that that has generated, I think it is a 
remarkable model that says there is a role for government but that 
everybody has to play its most important part.
  So I think this is, really, a very exciting day for our country. It 
is the beginning of a process. I look forward to reaching out to my 
constituents, who will have slightly different perspectives because of 
their experiences under the Massachusetts model, and to getting their 
input as we go forward with the most important debate that we are just 
beginning. I thank you for beginning that today.
  I apologize for not staying longer, but the women of the House are 
playing a softball game later this evening, and I don't want to be too 
late, even though I'm only going to be cheering, because I don't want 
to end up in the hospital, in need of care, as a result of my poor 
game-playing talents. So thank you for beginning this most important 
discussion.
  Mr. YARMUTH. I thank the gentlelady, and I intend to be at the game 
myself in a most supportive role.
  I would like now to introduce one of the physicians of the House. Not 
too long ago, there was an article in the New York Times that talked 
about the number of physicians here. They make an extraordinary 
contribution to our efforts in this field and in many others.
  So it gives me great pleasure to yield to my good friend from 
Wisconsin, Dr. Kagen.
  Mr. KAGEN. Thank you, Congressman Yarmuth. I appreciate the 
opportunity to join with you and with other Members of the class of 
2006, the difference-makers, the Majority Makers, who brought a message 
of positive change here to Washington in January of 2007. What happened 
is we had another election in 2008, and we returned because we haven't 
finished the job yet.
  There is an inheritance that our President, Barack Obama, has taken 
on. I can't think of another time in American history when a President 
inherited so much in crisis: the housing crisis, where housing 
construction and prices were falling through the floor, and a financial 
crisis where the credit markets completely froze up and went into a 
medical coma--money wasn't being transferred between banks. He 
inherited a lot. He also inherited 3.7 million people who had lost 
their jobs during the previous year.

                              {time}  1830

  This economic recession that we've slipped into began under the watch 
of the previous President, and we have a lot of fixing to do. It's 
going to need a doctor in the House to get things going. But we do have 
hope now because we have a new way of looking at things. We're taking a 
positive approach, and we brought forward today a bill that begins the 
process of healing our fractured health care system.
  Now when I ran for Congress and when I got re-elected, I put together 
a health care advisory team in my district, in northeast Wisconsin, 
composed of physicians, of medical people involved in hospital 
administration, insurance people, nurses, everybody that's involved in 
health care, and we came up with 10 essential elements that should be 
included in a successful piece of Federal legislation. The first and 
most important element was no discrimination. We sought to apply our 
constitutional rights that protect us against discrimination to the 
health care industry to guarantee that no one would suffer from 
discrimination, not on the basis of the color of their skin but the 
chemistry of their skin or, in

[[Page H8074]]

the case that you mentioned, the patient with epilepsy. We shall not 
discriminate against any citizen or legal resident based upon pre-
existing medical conditions, and that's in this bill that was submitted 
today for our consideration.
  Now the bill may not be perfect. It certainly hasn't been read all 
the way through yet. It's only 1,018 pages. But it does have within it, 
``No discrimination against any citizen or legal resident due to pre-
existing medical conditions.''
  The second most essential element of the Eighth Congressional 
District of Wisconsin's ideas was that we needed a standard plan, a 
health care benefit plan that was standardized such that each and every 
insurance company would offer in the marketplace, by openly disclosing 
the price, a standard plan. That's in this bill. The idea is to create 
competition, which doesn't exist today, create open and transparent 
markets that don't exist today because you can't call up an insurance 
company and ask for the price. They just don't know what to charge you 
until they find out how to cherry-pick you out or boost up your price. 
So no discrimination and a standard plan are in this bill. When we do 
that, when we have an open marketplace with a standard policy that's 
being sold in a very competitive fashion, I believe we can drive down 
the price of your insurance premiums by about 22 percent. That's a lot 
of money when the average cost today is $1,200 to $1,400 a month for a 
family of four.
  The third element, transparency. It's in the bill. The fourth 
element, incentives, financial incentives to begin to root out waste in 
the system. I believe, as many people here in Congress and across the 
country believe, that we're spending enough money across this country 
now on health care. It just needs to find a better home. Since 47 
percent is the overall overhead of the private insurance industry for 
small business, that means that when a small business sends a dollar in 
to an insurance company, 47 cents, in my view, is wasted. It's wasted 
on the bureaucracy within that insurance industry. We can and must do 
better. We must drive that overhead down to 15 percent; and when we do, 
we'll save America $39 billion a year which will go right back into our 
economy. I am absolutely convinced, as are many Members here, that when 
we reduce the cost of health care for everyone by using the marketplace 
to leverage things down, leverage the price down, we're going to 
stimulate our economy because there are two big overheads right now for 
any small business. It's called health care and energy. If you're in 
farming, if you are a small business on Main Street or the side 
streets, you've got an overhead that's health care, number one, and 
energy, number two. So I'm very pleased to see that these essential 
elements are in this bill. It's a great day for America. It's a very 
hopeful day.
  I yield back.
  Mr. YARMUTH. I thank Dr. Kagen for his expert contribution. As we 
move forward, we will rely more and more on those people who have been 
in the trenches. And for someone who has been in the trenches and knows 
the problems that face his patients and his colleagues in the medical 
profession, we will be able to craft a much better piece of 
legislation. So I thank him for his contribution tonight.
  Now it gives me great pleasure to introduce another individual who 
has been focused on health care throughout his political career, a good 
friend from Memphis, Tennessee (Mr. Cohen).
  Mr. COHEN. Thank you. I appreciate the gentleman from Kentucky 
bringing up this topic and joining Dr. Kagen, my colleague; Mr. 
Sarbanes and Ms. Tsongas, who was with us, in discussion.
  I look at the inscription that is over the Speaker's chair here in 
the United States Capitol, and it's Daniel Webster. Daniel Webster 
says, ``Let us bring the resources of our Nation, our institutions 
together,'' and may we do something here that is worth remembering and 
something worthwhile that may be remembered. I can't think of anything 
that would be more worthwhile to Daniel Webster's spirit than we could 
do to have people remember this 111th Congress and to provide the 
health care that's been sought for so many generations.
  I think back to Harry Truman who really had this original concept and 
wanted to see national health care. You think about what Mr. Yarmuth 
talked about, the only industrialized nation on the Earth that does not 
have health care for its people. It is the greatest country on the face 
of the Earth, but we don't provide health care, and that's somehow an 
omission that this country has glaringly overlooked. Dr. King would 
certainly be in favor of such a bill because this is a Nation that has 
forgotten so many for so long, and we cannot continue to do that and be 
considered the greatest country on the face of the Earth.
  This bill that President Obama talked about today, and has gotten 
through the committees with Mr. Miller, Mr. Rangel, Mr. Waxman and 
Speaker Pelosi, who have worked so hard on it--and there is a 
comparable bill in the Senate--will see to it that we save money, $500 
billion over the next 10 years in Medicare, securing for our seniors a 
Medicare system that will be affordable and available and offer quality 
care. It will see to it that we ferret out fraud and waste from the 
system and make savings that will help reduce our deficit that we're 
presently experiencing. So there is a fiscal mechanism to this bill as 
well. It will see that pre-existing conditions cannot be used, as Mr. 
Yarmuth's couple was used as an example, to deprive people of health 
care insurance. There is a lot of profit in the system now with 
advertisements on television, profits for insurance companies and 
tremendous salaries and profits that are there; and they need to be 
wrung out of the system. One way we're going to do it is by having this 
public option plan compete and force insurance companies, if they 
intend to remain active in the market, to compete with a national 
system that does not have those same costs and will keep costs down. 
This will be more quality at a cheaper cost and more people covered. 
You know, there is a tax that we already have in America. When you have 
47 million people--maybe 50 million at this point--without health 
insurance and 14,000 more people each month who lose their health 
insurance, when those people get sick, they still get care someplace, 
sometime, but it's paid for by higher insurance premiums, it's paid for 
by higher taxes. Where there are community hospitals, they go to 
emergency rooms. You pay for it--the most expensive care possible in an 
emergency room which wouldn't be there if the people had insurance 
because they could go to their doctors--and it's paid for through 
property taxes by citizens in an expensive manner. This will be 
eliminated. So for all those cities, including mine, where we have The 
MED, a community hospital, a trauma center that treats a lot of people 
that don't have insurance at an expensive rate in the emergency room, 
those people will have insurance, and they won't be coming to the 
emergency room, and it won't cost our taxpayers as much which means 
that that trauma center will be available for trauma care, as it was 
intended. In case there is a disaster, it will be available as well and 
that trauma center can survive. There won't be this tax that's put on 
everybody for taking care of the uninsured in uncompensated care, which 
hospitals do, and just charge it to you in a higher bill that you get 
from your physician or from your health care provider. We're paying for 
it but without any controls. So the system is really out of control. It 
needs to be restrained.

  Now Mr. Yarmuth talked about Canada. And I know that we probably 
don't want to compare anything we're doing here--except for hockey--to 
Canada. But I was with a Canadian minister yesterday in Memphis--not a 
minister in the clerical sense but a government official; and he told 
me that a lot of people compare our system to yours, he said, ``You 
know, our people live to an average of 81 years of age, and your people 
live to 78.'' He said, ``The increase in inflation in our health care 
is 1 percent a year, and in your system it's 10 percent a year.'' He 
mentioned some other figures, and this was his perspective. He said, 
``I wouldn't trade our system for yours for anything.'' Our system is 
the most expensive health care on the face of the Earth, but it's not 
the best. And we're paying for it. And that's wrong. Not enough people 
get health care. I'm happy to be a part of this Congress, to support 
this

[[Page H8075]]

bill with a strong public plan that will see to it that we can compete 
with the insurance industry to keep their costs down and to see that 
everybody has access to health care as this plan will.
  I would like to yield to my Wisconsin namesake Steve and, as my 
father was a doctor, a fine doctor, Mr. Kagen from Wisconsin.
  Mr. KAGEN. Thank you, Mr. Cohen. I want to thank you for your kind 
words about what we're about to do together. But let's agree--we're not 
Canada. We're going to have a uniquely American health care solution. I 
don't think anybody in this body, I don't think any one legislator 
here, I don't think anyone watching tonight or across America would 
argue, we're getting a menu. Now my son works at a pizzeria, and he's a 
pretty darn good cook. This is Appleton's First & Finest Pizzeria, 
Frank's Pizza Place. Now if we all go there together and we order a 
sausage 12-inch medium pizza, it's $12.50. It says it right here. Now 
if you order that same pizza, what are you going to pay? $12.50. Health 
care shouldn't be much more complicated than that. The price is openly 
disclosed at the pizzeria, and they don't discriminate against anybody. 
They are happy to take any customer on. And just like in health care, 
they're only as good as their last performance. So they have to compete 
for business. They compete with the Italian place down the street or 
the Greek restaurant or the Chinese restaurant or just your home 
cooking. So what we're suggesting here is that we use the leverage of 
the marketplace, that we have an open, transparent and competitive 
medical marketplace and guarantee universal access as we will do. The 
power of no discrimination, the power of equality, it is, after all, 
the foundation of our country and our culture. It is equality that we 
seek, not of outcomes, but equality of opportunity. I think it's time 
to apply that ``no discrimination'' theme not just to the insurance 
world saying, No, you can't cherry-pick and discriminate against 
someone because of a pre-existing condition. It's time to take our 
equality, our desire for equality and no discrimination to the level of 
the pharmacy counter. As a doctor, I can tell you, that is where the 
rubber meets the road. If I write a prescription for a patient, and 
they can't fill it because they can't afford it, if it's not on their 
list, we haven't done a thing. We haven't improved that patient's 
health. So we have to make certain that when you go to the pharmacy 
counter, you're going to pay the openly disclosed lowest price that 
they accept as payment in full from anybody.
  I'll use just one other example, and then I will yield back. Our 
veterans. Everywhere I go in Wisconsin, we subscribe, we volunteer; but 
our veterans didn't go into combat and didn't serve our country for 
themselves. They serve for our entire Nation. They didn't serve just 
for themselves; and yet they're the ones that have the VA benefit of 
that discount for their prescription drug. I think it's time that the 
soldier's wife or husband had that same benefit of that low-cost 
prescription drug and their children. And while we're at it, what about 
their next-door neighbor? What about their community? What about the 
whole country? If we could use the power, the purchasing power of these 
United States together in leveraging down prices for everybody, we 
could have affordable prescription drugs once again. That would bring 
equality to the pharmacy counter. It's something that needs to be 
defined very clearly in this piece of legislation. It isn't there yet, 
but we're going to work together and hopefully get that done.
  Mr. COHEN. I would like to ask you two questions before we yield to 
another Member who wants to participate. What's going to happen with 
the doughnut hole? The seniors are very concerned about the doughnut 
hole. Will we be working on that?
  Mr. KAGEN. The answer is, yes, we can, and yes, we will. By working 
together, we can close the doughnut hole; but it's going to take the 
opportunity and the power and the legality of leveraging down the price 
by using the government purchasing power. When we, the people, ban 
together in a purchasing pool to leverage down the prices for 
prescription drugs, we can get that price down. And I will give you one 
further hypothetical. If you are the owner of a drug company selling a 
pill in Mexico City for $1, thank you for openly disclosing that 
product and that price. That is the price it should be in New York 
State all the way through to California and the territories. Show me 
your price, and give every citizen and legal resident that same lowest 
price that you accept as payment in full. That's the power of the 
marketplace, and that is equality brought to the pharmacy.
  Mr. COHEN. Thank you, Dr. Kagen. Before I yield back to Mr. Yarmuth, 
I would just like to ask him a question.
  If you have an insurance policy now that you like, can you keep it?
  Mr. YARMUTH. Oh, absolutely. I think that's the uniquely American 
element of this plan that is most important to stress. No one is forced 
to do anything in this plan. If you like your coverage, if you have 
employer-sponsored insurance that you're happy with, you get to keep 
it. No change is necessary, no change is mandated. You get to keep your 
choice of doctors. You get to choose your hospital. These are the 
fundamental elements that we considered extremely critical to this 
legislation because we know many Americans are satisfied with their 
health coverage, and we don't want to change their situation.

                              {time}  1845

  We want to make sure that everyone is satisfied with their coverage, 
that everyone has coverage; and through the competitive American 
spirit, that we think we are building, creating this legislation, that 
we will be able to provide the type of environment where people who 
like what they have can keep it, people who don't like what they have 
can shop for something that better suits their family's needs; and 
that's what the entire purpose of this great legislation is.
  Mr. COHEN. And if you keep it, you are probably going to get it 
cheaper because where the uninsured will be insured, and you won't be 
paying for them through that hidden tax.
  Mr. YARMUTH. Well, I think that's the most essential part of this 
legislation. If we can't control costs in the health care system, if we 
can't see to it that people get what they need at a lower price, then 
we know, for instance, that if we don't have reform, it's projected 
that the average family's cost will increase $1,800 per year for the 
foreseeable future. That's unsustainable. We know that.
  So cost control through competition is the critical--and through 
changes we hope that we can incentivize in the way medicine is 
delivered, health care is delivered and practiced in this country, that 
we can make affordable, quality health care available to every 
American.
  Mr. COHEN. Thank you, sir.
  Mr. YARMUTH. And, you know, this is supposed to be a conversation of 
the Class of 2006, but occasionally we adopt Members from other classes 
because we know that they share the values that brought us to Congress.
  And it's now my great pleasure to introduce one of those colleagues, 
Mr. Ryan from Ohio.
  Mr. RYAN of Ohio. I thank the gentleman.
  And just as all of you do feel, this is such a critical issue for our 
country. And we started coming to the floor in 2002, Congressman Meek 
from Florida and I with the 30-something hour, and we were talking 
about at that point Social Security privatization and just a reminder 
of what the world would look like today if we would have privatized 
social security and if Democrats weren't here to prevent that from 
happening, where we would be now.
  But with what's going on, my district is in Akron and Youngstown, 
Ohio, northeast quadrant. Very industrial. Just a bit north from my 
friend in Kentucky.
  And when you look at what the problems that communities and families 
are having to deal with there--an example of steel companies that have 
closed, people, their pensions have gone to the PBGC, some lost their 
pensions altogether, some lost their health care altogether. Now we are 
dealing with, as the new GM moves forward, a lot of the old Delphi 
folks weren't included in the new deal. So now they're left on the 
outside whether they're union workers or salary workers that had put 
just as much time, effort, and intellect into developing Delphi and 
General Motors over the course of the

[[Page H8076]]

years and now finding themselves left behind with a $14,000 or $15,000 
health care bill.
  So what we are talking about here--why you're coming to the floor, 
why I'm coming to the floor, why President Obama is so forceful in 
persuading the American people that this has to happen now, why Speaker 
Pelosi and Senator Reid are all on this issue is because this is an 
issue that the American people want. They know that they are paying too 
much for their health care. They've experienced the fear of having a 
pre-existing condition and trying to go out into the market and trying 
to get somebody to cover them. They deal with this every day.
  So I don't want to get too much into the weeds because I think over 
the course of this next 3 weeks as you come down here and the 30-
somethings comes down here and we all get ratcheted up and we all lean 
on the doctor here to tell us, you know, how this works once it hits 
the ground, but I think it's important to know that some of the 
principles here are that no one--once you get your health care--that 
with these new plans that you will be able to get into--your health 
care situation will not bankrupt your family; your health care system 
or your health care plan will not bankrupt your business. You will have 
coverage. You will have some place to go.
  Now, that to me doesn't seem like too big of an ``ask'' in America 
today with all of the money that is in this system. And I think that's 
the beauty, looking at the draft plan and knowing it has to go into all 
of the different committees and get worked through, I think the magic 
of what's happening here is that a lot of the costs are going to be 
squeezed out of the current system that has been inflicted because 
everyone gets their little piece of the action. And we are saying we 
squeeze it and reinvest that money.
  And in many ways we look--we have some kind of universal coverage 
now, but it's through the emergency rooms. That's no way to administer 
health care, Doc. No way to do it. It's more expensive.
  So what we're saying is with the preventative proposals that are in 
here is that there's no cost share to go check-up; there's no cost 
share to participate in any kind of the preventative measures that a 
specific plan may have that's going to make you healthier, that's going 
to make sure that you get a prescription instead of end up in the 
emergency room a week later and cost the whole system $100,000 when it 
could have been taken care of for a $20 prescription. That's what we're 
talking about here.
  And I'm sure there are going to be a lot of TV ads.
  I will be happy to yield to my friend.
  Mr. KAGEN. So if I understand you correctly, you're saying if you're 
a citizen, you're going to be in. If it's in your body, you're going to 
be covered.
  And would you also agree that much like we had a systemic financial 
risk with our financial meltdown, isn't it also true with the crisis in 
health care, with the impossible costs for everyone, it presents a 
systemic risk to our economy and if we do not confront it, our economy 
may be in shambles?
  Mr. RYAN of Ohio. There is no question about it, and our economy is 
in shambles now in part because of the burden that's placed on a lot of 
the businesses.
  I remember about a year ago I was in a roomful of about 15 or 20 
businesses, primarily manufacturing businesses in northeast Ohio, 50, 
100, 200 people; and we were talking about health care, and they were 
all talking about how their health care costs went up 15, 20, 30 
percent depending on the situation of the people that worked at the 
factory. And when asked if they would somehow be willing to pay more 
and get health care off their books completely, would they be willing 
to do that, they were all like, Sign me up right now. You mean I don't 
have to deal with this anymore? I can focus on making this product that 
I make?
  And part of what we're trying to do here is to say get all of this 
waste out of the system, put it on the front end where we can have 
prevention. Let's stop all of this stupidness of saying you don't get 
any health care because of whatever reason and you end up with the 
emergency room costs. Put it up front. Let's squeeze the fat. Let's 
bring in PhRMA and take some of the savings from there and help fill 
that donut hole the gentleman from Tennessee was talking about earlier, 
and let's get ourselves healthy.
  And I yield back to my friend.
  Mr. YARMUTH. I thank the gentleman for his very important 
contribution.
  And someone else who's been very much engaged in the development of 
the legislation that was introduced today, the gentleman from 
Connecticut, who's a member of the Energy and Commerce Committee. I 
yield to Mr. Murphy from Connecticut.
  Mr. MURPHY of Connecticut. Thank you very much, Mr. Yarmuth. So good 
to see my friend, Tim Ryan, back wearing a path in a familiar spot on 
the House floor speaking truth to the American people.
  Listen, what you are talking about is this invisible cost, Mr. Ryan, 
to the health care system that we kind of pretend doesn't exist. We 
didn't get to 17 percent of our gross domestic product by accident. We 
did that by ignoring some fundamental problems in our health care 
system. And the fact is that we kind of just, you know, boxed our ears 
and shut our eyes and tried to sort of wish this problem away.
  Well, you know, every employee has started to feel this crunch, 
right? The percentage of their income that is devoted to health care 
has inched up and inched up every single year. But a lot of the costs 
they don't see because employers out there are eating it and are paying 
these 10 or 12 or 15 percent increases in health care premiums that 
they're getting every year; and instead of passing the cost of that in 
its entirety over to the employee, they just don't give as big a wage 
increase as they might have that year, or maybe they don't give any 
wage increase. Maybe they actually furlough folks 1 day a month.
  These health care costs that companies are taking on are causing 
wages to remain flat. That's what we've seen over the last 10 years. 
The GDP in this country is growing. I mean, we're making more stuff if 
you look at the 10-year window. Obviously in the last 2 years that has 
not been the case. But in the last 10 years, GDP is growing, but wages 
are staying right here. There are a lot of reasons for that. Some 
people up at the real high end of the income spectrum are pretty fat 
and happy, but a lot of that is because all of the extra money that 
companies are making is going to pay health care rather than going to 
their employees.
  So that's one way in which the costs of our health care system are 
sometimes invisible, because employees just assume that they don't get 
wage increases because their company didn't make as many widgets that 
year or didn't sell as many pieces of product line. No. A lot of the 
reason is that they sold more this year; they just took all of that 
extra profit and paid for health care.
  The second thing is what you guys, I'm sure, have been talking about 
already. It's that we've got a system of universal health care in this 
country. It's just the worst, most backwards, most inhumane, most 
inefficient, most unconscionable system of universal health care system 
in the world because we basically say to people, We will guarantee you 
health care--our Federal law guarantees you health care but only when 
you get so disastrously sick that you show up to the emergency room.
  A woman in Connecticut came and testified before one of our State 
legislative committees, and she told a real simple story. And I've told 
it on the floor before. Had a pain in her foot. Had no insurance. 
Worked for a living. Did everything she was supposed to. Just didn't 
have insurance. She knew that she had some sort of infection so she 
knew what she was going to have to pay for it. She was going to have to 
go to the doctor, she was going to have to pay probably $100 for that 
visit, and she was going to get an antibiotic or she was going to get 
some medication to make it go away. That was going to be a couple 
hundred more dollars. She didn't have it. She knew she didn't have it. 
So she decided to just live with the pain.
  Well, finally, one night it was just unbearable. She had to go to the 
emergency room. So she showed up to the emergency room, and it was too 
late. That foot was infected so badly it had to be amputated. And 
that's a terrible, terrible outcome for that woman.

[[Page H8077]]

Changes her life for the rest of her time. But it cost the system the 
thousands of dollars that that surgery and all of that follow-up care 
required versus the couple hundred bucks we could have gotten in 
preventative care up front.
  We're paying for that. You don't see it because you never met that 
woman and you never see the thousands like her who end up showing up in 
the emergency room with crisis care that could have been prevented. 
That's more invisible costs, but it's all there.
  One last point, Mr. Ryan and Mr. Yarmuth.
  People are going to hear the cost of these bills when they come out. 
They're going to see that the cost of the bill from the House is X 
billion dollars; the cost of the bill of the Senate is X-plus-Y billion 
dollars. Here's what you have to do. You have to look at that cost 
versus the cost of doing nothing. And every credible survey, every 
credible examination is going to tell you this: that the cost of the 
bill that we produce is going to be half of the cost of sitting and 
accepting the status quo. That's why we have to pass health care reform 
here.
  Mr. YARMUTH. I thank the gentleman because he talked so much about 
the higher level of care at the emergency room, most of which is 
uncompensated for those providers and are shifted to the private-pay 
customers. I know there are estimates out there that indicate that 
there is somewhere around a hundred billion dollars a year that's 
actually care administered in the emergency rooms to people by 
hospitals who do it as part of charity work, but it's all being shifted 
to the people who are covered.
  So when we talk about a health reform plan that's going to cost 
roughly $100 billion a year for 10 years, we're already spending that 
$100 billion. So it's not money new to the system, which is, I think in 
the example of we have plenty of money spent in this country on health 
care right now.
  Mr. RYAN of Ohio. If the gentleman will yield.
  Mr. YARMUTH. I yield to the gentleman.
  Mr. RYAN of Ohio. Just for an example for Medicare Advantage. 
Fourteen percent overpayment on average for Medicare Advantage, that is 
over what Medicare pays. That is wasting the taxpayers' dollars. That's 
the money we're talking about that we can shift from that current 
program into what Mr. Murphy was talking about earlier, these kinds of 
cost savings that we need.
  Mr. YARMUTH. I yield to the gentleman from Wisconsin.
  Mr. KAGEN. I'm glad you brought this subject up because not every 
Medicare Advantage plan is identical, and not every community is 
identical as well. And there are some areas of the country where 
Medicare Advantage plans, like in some regions of New York State and 
some regions of Wisconsin, are very advantageous. They have a lot of 
prevention planned in them, and they're not really overcharging at all. 
They're really bringing about all of the evolution in our health care 
system that you'd like to see, squeezing out the waste and an emphasis 
on prevention and primary care.
  But no legislation is perfect. And nothing that we codify in law here 
that the President will sign will instill better judgment in every 
patient that is going to exist. It still comes down to personal 
responsibility. We can't possibly instill all of the good judgment into 
our children, don't you know.

                              {time}  1900

  So we have to have an understanding of what our limitations are in 
terms of government. We have to set up the table and set up the rules 
of engagement wherein we can have an open and transparent medical 
marketplace, allow the marketplace to do what it does best, bring down 
prices for everybody and increase access. But it begins with this piece 
of legislation that we had submitted today, with no discrimination 
against anyone to preexisting conditions and a standard plan, a plan 
that guarantees if you get sick you will be in your house, not the 
poorhouse.
  Mr. COHEN. I was thinking of an old saying, and you might know where 
it comes from. You know, an ounce of prevention is worth a pound of 
cure, and what was the origin of that? Does that not apply to the idea 
of having wellness programs?
  Mr. KAGEN. I thought it was my grandmother.
  Mr. COHEN. And I thought it was, too. But doesn't that apply to this 
program where we have wellness programs now, and if you can pay for 
wellness programs and preventative care, you don't have to pay for that 
emergency room care? It's as simple as a traditional slogan like that, 
a saying comes from Saturday Evening Post or wherever, an ounce of 
prevention is worth a pound, and that's where we're going to save a lot 
of money.
  Mr. KAGEN. The other thing, the idea that was commonplace up until 
this point in time is to divide and conquer, and that's what the 
insurance industry did. They cherry-picked and they separated neighbor 
from neighbor based on preexisting condition. They went so far as to 
separate a husband and a wife based on medical conditions, in some 
cases a mother from her child.
  We're going to have to go back to community, the community-based 
ratings. We're going to have to go back to community here in Congress 
where we reach across the aisle and work together to solve these very 
complex problems.
  I'm so very glad that this class of 2006 and our recent adoptee from 
Ohio is taking on not just health care but energy and education. These 
are the three essential problems that the President has been leading us 
on.
  Mr. MURPHY of Connecticut. If I can just add something, Mr. Kagen 
brings in energy policy, and we just got through a long, hard struggle 
of passing an energy bill on this floor, and we're right now engaged in 
the muck of trying to change this health care system.
  I think it's just worth reminding everybody out there how hard this 
is going to be, right, how hard it's going to be to try to reform a 
health care system where, as Mr. Ryan said, a lot of money is being 
wasted. But that money that is being wasted, it's not like you're 
wasting heat in your house and it just sort of escapes into the 
atmosphere.
  When we talk about wasting money, we talk about money that actually 
ends up in people's pockets, right, that makes them rich and creates 
their fortune. So when we talk about saving money within the health 
care system, that involves taking on some pretty powerful institutions 
around this city of Washington, D.C., and around this country that are 
going to have to live with a little bit less in order to get average 
Americans a little bit more.
  And I think people are going to read all these stories in the paper 
about, boy, how long it's taken to pass health care reform and how 
tough it is to get the Senate and the House to agree. Listen, when you 
are taking on one-seventh of the economy, when you're taking on the 
industry which by years of Republican neglect has allowed for some big 
players in the health care industry to make their fortunes off of the 
fact that some people can't afford it, then it's going to take some 
time, going to take some heavy lifting to fix a problem that has 
festered for a long time.
  Now, the same thing is going to go for energy. That's why energy is 
going to be so hard to do. It's taking on a lot of similar interests, 
but health care reform is not just a nice, practical policy discussion 
amongst intellectual peers. This is about taking on some vested 
interests.
  Mr. RYAN of Ohio. About 2 years ago, I heard a number, and I think 
this is roughly correct, where the insurance industry had increased 
their employment by maybe 5 or 6 or 7 percent, and they decreased the 
amount of services that they were providing by, like, 25 or 30 percent. 
So they were taking this money, hiring people to knock people off the 
rolls, to not cover, to make them jump through these hoops. I call, I 
got denied. Well, I'm sick. I need to go now, call. I get denied. Call, 
you get denied. Then eventually maybe they call us and maybe we make a 
call and who knows what happened, you get lucky, you get somebody.
  But to your point, that person who's hiring people, growing their 
business at the expense of all of these other people is not the way 
this is going to keep going because America is better when all of these 
people together are healthier and more productive and participating in 
the system.
  And I want to yield to my friend from Tennessee because he caught me

[[Page H8078]]

before my friend from Wisconsin, but there was an article yesterday 
that was brought to our attention about people in technology businesses 
that, for whatever reason, want to go out and start their own business 
but can't because someone in their family or they have a preexisting 
condition, so they need to stay in their current job because they don't 
have the coverage when they could be out in the market using what's 
best in America, the entrepreneurship, to generate new employment.
  Mr. COHEN. Before we yield back to Mr. Yarmuth to close, I just want 
to thank Mr. Ryan for bringing up the issue of bankruptcy. I chair the 
Commercial and Administrative Law Subcommittee of Judiciary, and next 
week we're going to have a hearing on bankruptcies and health care. 
Health care is the major cause of bankruptcies in this country, and 
Elizabeth Edwards will be one of our witnesses.
  But when people go bankrupt because of high medical bills, then other 
folks lose out because they don't get paid either. Merchants don't get 
paid because of that bankruptcy. So that's another cost of not having 
this health care system, and I want to thank each of you.
  Mr. YARMUTH. I'd like to yield again to the gentleman from Wisconsin.
  Mr. KAGEN. I'd like to dovetail on both of these conversations and 
say that Mr. Ryan from Ohio pointed out the difference between health 
insurance and health care, and what we are talking about in this bill 
is health care, getting the care that you need. You have the choice, 
you've got the coverage, and you've got the costs coming down. That's 
exactly what this bill aims to do.
  Mr. YARMUTH. I appreciate all the comments from my colleagues, and 
I'd like to close by reading a letter that I received from a 
constituent of mine who's 10 years old.
  It says: ``Dear Congressman Yarmuth,'' My name is Matthew Gregory, 
and I am a 10-year-old that lives in Louisville, Kentucky.
  ``I am writing this letter because I have a younger brother with 
autism, and I want you to cosponsor the Autism Treatment Acceleration 
Act.'' Not the piece of legislation we're talking about now, but 
relevant.
  ``I would really appreciate the efforts you would provide to 
cosponsor the bill that would help end autism insurance discrimination. 
My parents spend $50,000 per year for my brother's autism, and I think 
it's a national crisis.

  ``It seems like families that have not had their State's autism 
insurance bills passed have to pay unnecessary expenses just because a 
child is different.''
  And here's the kicker. ``It's just not fair, and this is a fair 
country and everybody, no matter who they are, including my brother 
Eric, should be treated equally.''
  So there you have it. A 10-year-old understands the essential 
unfairness of the system we have now, the fact that so many people are 
uninsured, the fact that so many people pay too much for the insurance 
they have, have to make life decisions based on whether they can get 
insurance or not, and that's what this Congress is determined to 
correct.
  We have an historic opportunity here to create a just, fair health 
care system, one that is affordable and sustainable for this country 
and which will make sure that every American citizen has the health 
care he and she needs for their families well into the future.

                          ____________________