[Congressional Record Volume 155, Number 111 (Wednesday, July 22, 2009)]
[House]
[Pages H8562-H8569]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       30-SOMETHING WORKING GROUP

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Connecticut (Mr. Murphy) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. MURPHY of Connecticut. Mr. Speaker, we're here for the next 60 
minutes to talk about the need to get health care, affordable 
accessible health care to all Americans; but before we do, I want to 
yield to my good friend from Ohio who's going to join us for this hour 
to share with us some pretty exciting news about his home district.
  Mr. RYAN of Ohio. Well, we have in Youngstown, Ohio, we have a 
Youngstown business incubator, and we've had some debates on this floor 
about a variety of issues, earmarks, different things. And one of the 
issues that I have been pushing, and I know a lot of Members, is 
reinvestment back into communities in the Midwest that were once steel 
or rubber or industrial cities to invest in new technologies.
  And we have been doing that in Youngstown, Ohio. We have a great 
business-to-business software incubator there. And recently in the 
latest edition or latest issue of Entrepreneur magazine, you may or may 
not be able to read, the 10 best cities to start a business, and down 
here in parenthesis: Youngstown, Ohio, Anyone? So we're in there with 
some major metropolitan areas across the country who have been doing 
great things, but in Youngstown, Ohio, in the Mahoning Valley we're 
emerging, I think, from years and years of steel-making into advanced 
manufacturing and business-to-business.
  It's great. To the gentleman from Connecticut and the gentlelady from 
Maryland, this is the best issue of Entrepreneur magazine they've ever 
put out. And I commend to you this issue and read with great 
excitement, as we have.
  And we have a local convention center there that's doing great and 
has made money for the first time in the second quarter and they're 
doing tremendous. We have got a lot of great shows. We've got downtown 
living. Anyway, it's happening like a lot of cities in Connecticut, I 
think, that have made comebacks.
  So I wanted to just plug our local business incubator, thank Jim 
Costner who runs the incubator; Michael Brokerage who ran the company 
that was highlighted in here and look forward to our health care 
discussion as well, so that these small businesses can prosper in the 
future because we have a sane health care policy going here in the 
United States.
  Mr. MURPHY of Connecticut. If you pick up that issue, you can also 
read about pet airways and the shiny object of the month as well.
  Mr. RYAN of Ohio. Absolutely. Whatever you need, it's all in here.
  Mr. MURPHY of Connecticut. It's a good issue.
  Mr. RYAN of Ohio. This is ``the'' issue. In fact, they may just wrap 
it up and say we're never going to have a better issue than the one we 
just issued so we're done.
  Mr. MURPHY of Connecticut. Well, congratulations, Mr. Ryan of 
Youngstown, on a very well-deserved accolade, and you know, in some way 
it's a good segue to what we're going to talk about tonight, which is 
the need for this Congress to pass health care reform that revitalizes 
our economy, that cuts the cost of providing health care to employees 
for the thousands of businesses in Youngstown, Ohio; in Connecticut; in 
Maryland that are right now struggling to match revenue with 
expenditures to cut the cost of health care for the millions of 
Americans who don't have it today and desperately need it, you know, 
cut the cost of health care for the Federal Government that right now 
is about to bankrupt itself through major increases every year in the 
amount of money that we have to put out for health care.
  So, listen, families in my district, they didn't figure out that this 
economy was in trouble when the banks did and the investment houses did 
last October, November. You know, they knew this economy was in crisis 
long before that when they saw their wages stay flat over the last 10 
years while their employer heaped more and more of the cost of health 
care on their backs.
  They figured out that this economy was in trouble when they showed up 
to get an MRI and they were charged a $200 deductible. They found out 
this economy was in trouble when they went to get health insurance in 
the new town, new State that they moved into and found out because 
their daughter had a complicated preexisting condition that they were 
uninsurable and that they were going to bear the full cost of care for 
their family.

[[Page H8563]]

  Health care costs in this country, whether it be for individuals or 
businesses, have been weighing this economy down for way too long, and 
this health care conversation that we're having today, this bill that 
we hope to pass that we're going to talk a little bit about over the 
course of the next hour, is certainly about getting health care out to 
the people that don't have it in a country that is the richest and 
claims to be the most powerful in the world. There's just no reason why 
some little kid goes to bed at night sick just because his mom can't 
afford to get him to a doctor. That's just not right.
  But this is just as much beyond the moral considerations of 
conscience for a country that doesn't provide health care to those 
kids. This is about economic revitalization of this country, realizing 
that we are going to be forever at a competitive disadvantage, vis-a-
vis the rest of the world, so long as we have a health care system that 
costs twice as much as every other country health care system.
  And what we need to talk about is, yes, the cost of the bill that 
we're proposing and the cuts that are in the bill to providers and what 
that means, but we're also going to talk about the cost of doing 
nothing. We're also going to talk about the cost of the Republican 
proposal which is to sit on our hands for another 10 years and let this 
health care system spiral out of control for families and businesses.
  We cannot afford as an economy to continue to allow health care costs 
to strangle us. It is a tough issue to take on.
  There's a reason why this Congress has gone 30 years without passing 
major structural health care reform. It's tough. There are a lot of 
special interests involved in this thing, but for families and for 
businesses in Youngstown, in New York, in Connecticut, in Maryland this 
is the right thing to do and the right time to do it.
  So I hope that over the course of the next hour we're going to talk 
about the need for health care reform, and we're going to talk a little 
bit about the specifics, and we're going to push back on not the myths 
that have been created from the other side, but frankly the outright 
fabrications that have come from our colleagues on the other side of 
the aisle and the pundits who talk on the air waves and radio waves at 
night and try to clear the record as to what this means for our 
constituents.
  So, with that, let me welcome my friend from Maryland, Representative 
Edwards, for joining us here this evening for this Special Order hour.
  Ms. EDWARDS of Maryland. I thank my colleagues because I think there 
is probably no more important issue to talk about than health care, and 
not for us but for the American people.
  I thought about it for a bit, and before I came into the Congress, I 
started out the year 2000 working at a small nonprofit, and they paid 
all my health care, and the cost was about $12,000 per employee. Well, 
by the time I had been elected to Congress and came in in 2008, the 
cost for me and my son, you know, same network, was about $20,000. And 
that's true for people across the country, that premiums have 
skyrocketed about 114 percent over a decade.
  And I think that if you think of those wages, whether they worked for 
small or large employers or they're self-employed, there are few among 
us whose salaries have skyrocketed to 114 percent in the same time 
frame. And that's what we're talking about with health care.
  And so I know that we often speak a lot about those who are 
uninsured; and, clearly, the moral imperative for us to insure the 47 
million to 50 million people who don't have any health care coverage at 
all is really important. But tonight I want to spend some time actually 
talking about the 250 million people or so who have health care 
coverage and sometimes it's inadequate. Sometimes it doesn't meet the 
need when the time comes, and then other times the premiums and 
deductibles are going up, the copayments are going up, out-of-pocket 
costs are going up, and what began as an affordable plan has become 
really unaffordable for so many Americans.
  And it's a system anymore that's unsustainable. We think often about 
what it means to be sick as an individual, what it means to have a 
family member who's sick. Well, there's something that is really sick, 
and it's our health care system. It's really sick. It's on its last 
leg, and our job in the United States Congress is really, I think, to 
do some truth-telling about this system and to let the American people 
know that we really do have a plan that is going to lower costs, that 
is going to make health care really affordable for ordinary Americans, 
that is going to ensure that if you have coverage and you like it you 
can keep, it and if you want to have other choices you can have those, 
too, and that the government is not going to be out there choosing your 
doctor. You get to choose your doctor.
  You will have a system in which, you know, if you have an illness 
like my father had kidney disease, well, he wouldn't be able to be 
turned down by an insurance company because he had a preexisting 
condition.
  There are some insurance companies that turn women down who have 
experienced domestic violence because they define domestic violence as 
a preexisting condition. This is unacceptable, and so I think for the 
American people we are creating a plan that is indeed fiscally 
responsible. It is the moral imperative to do what's right by the 
American people, and we know that the kind of investment in prevention 
in community health and ensuring that we take care of primary practice, 
we will in fact achieve the kind of goals that we set out for the 
American people and invest in that competitiveness that we talk about 
all the time for the 21st century.
  And so I'm excited to be with my colleagues this evening because we 
have a task ahead of us, and it's a difficult one, and putting it off 
is not going to make it less difficult. And the enemy, those people who 
don't want reform at all, will try to say anything or do anything to 
kill reform, and we can't that let happen for the American people.

                              {time}  1900

  With that, I'd yield to my colleague from Connecticut.
  Mr. MURPHY of Connecticut. Thank you, Representative Edwards. I think 
you're exactly right. There are just a lot of forces of ``no'' here. 
Frankly, it's not the first time we've seen it. When we tried to free 
this country of dependence on foreign oil, there were a whole bunch of 
people in this House of Representatives who said ``no.''
  When we tried just 2 years ago--I mean, forget health care reform in 
the way we're talking about today. A couple of years ago in this House 
we just tried to extend health care coverage to 4 million more kids. 
Just 4 million more poor kids out there who just deserve a chance to 
get up healthy, on two feet, and learn every morning. We couldn't even 
get it to them. So there are a lot of people in this House who are 
against any change.
  Mr. RYAN of Ohio. Will the gentleman yield?
  I want to accentuate that point a little bit. We tried to provide 10 
million kids health care coverage through the State Children's Health 
Insurance Program, and President Bush vetoed it twice, with the support 
of a lot of people who come to this floor tonight and are fabricating 
things about this bill, talking about we're going to cover illegal 
aliens and this is a government-run operation that we're trying to 
promote here, that we're trying to drive small business out.
  This bill doesn't even start until 2013. What we pass, no matter what 
it is, doesn't even get implemented until 2013. And there's no coverage 
for illegal immigrants in this bill. That's why it doesn't cover 
everyone. It only covers 97 percent of folks here, and there may be an 
argument about that.
  But the fact of the matter is there is institutional support to 
undermine and sabotage health care reform, and someone's going to win 
and someone's going to lose. And who's been winning have been the big 
insurance companies, the people who like the system just the way it is, 
and the people who have been losing are the men and women and children 
that the gentlelady from Maryland was speaking about a few minutes ago.
  So, yes, this is a big fight. This is a pretty big deal that we're 
having. But the scare tactics--and it's funny, because our friends on 
the other side of the aisle, they're like a stable full of one-trick 
ponies, man. If there's not fear coming out to scare you, to make you 
so afraid of what is happening, but

[[Page H8564]]

the problem they have now is everyone's already afraid. Everyone's 
already scared. Everyone's already anxious about their kid and the 
middle of the night, if something happens, they've got to go to the 
emergency room because they don't have the kind of coverage that we 
want to provide here.
  So they can keep coming with the fear, but what we want to do is 
provide a little bit of hope for the American people and some sanity, 
and this chart, itself, shows it.
  We pay twice as much per person for health care in the United States 
than they do in France and Germany and in Canada. We have a lower life 
expectancy. We continue to spend more and more and more and more and 
not reap the benefits of it because we don't spend the money in the 
right areas.
  We need to put the money in the front end so that we have prevention 
and we stop a lot of these problems from happening in the first place.
  If you look in the United States from 1995 to 2006, we had an 83 
percent increase in health care spending. Public, private, all health 
care all together, 83.64 percent increase in health care spending; that 
is not sustainable. It goes on the backs of the small businesses. It 
goes on the backs of the individuals. We just can't continue to do it.
  Mr. MURPHY of Connecticut. I thank the gentleman from Ohio. I do now 
want to welcome to the floor a good friend, Representative Tonko from 
New York, who is joining us, a new Member, and just been a great 
proponent of trying to get more people in his district insured and 
lower costs for the folks as well.
  Mr. Tonko.
  Mr. TONKO. Thank you, Representative Murphy. Thank you for bringing 
us together in what is a very good exchange so that we can exchange for 
the sake of the American public the facts on a situation that finds us 
meeting a wonderful challenge that can pull us to a new day for health 
consumers in this country.
  With the leadership of President Obama and certainly with the 
leadership in the House, with the Speaker here in the House of 
Representatives and the respective Chairs, we're now developing that 
dialog that is long overdue, that needs to speak to the dignity of 
health care for each and every individual in this country.
  You know, I listened to the statements made by my friend 
Representative Edwards about those who are insured today. What is 
startling is to look at the business community and understand that in 
the last 15 years we went from a statistic where 61 percent of our 
small businesses offered employee health care coverage. Today, that 
number has dropped below 40 percent. Some 38 percent of our small 
businesses offer that. It's not that they have grown less compassionate 
or less sensitive to those needs. They simply cannot afford this 
system.
  So a plan that embraces universal insurance reform, that sharpens the 
pencils for our consumers, that drives the bottom-line bargain whereby 
it is affordable, where there's an exchange developed, where there is a 
plan, a customer, a consumer choice plan that will be actuarially 
sound, that will incorporate all of the basic health care measures 
essential for our families in this country, will compete with that 
private sector market in that exchange.
  That separate consumer choice plan will be sustained by premiums, not 
by government taxes. It will be a plan that will be modeled in a way to 
compete, and I believe effectively, so as to produce a market-driven 
outcome that is far better than what we see today.
  The cost of providing health care insurance by our business community 
is said to be about $430 billion today. In 10 years, doing nothing, we 
all know that that's been projected to grow to some $880 billion. We 
can't afford that. The plan of inaction is unacceptable.
  And you're right, Representative Murphy. When you talk about some of 
the similarities in the energy debate, there are those in this House 
that want to feed that discussion with facts. There are others who are 
happy to play with figures, and that fix has denied progress.
  Just this week, we celebrated the 40th anniversary of the Apollo 
mission, of landing a person on the Moon, being able to invest as a 
Nation because of a boldness of vision.
  Well, the boldness of vision here that we're now asked to respond to 
is about providing quality health care with reduced costs and equal 
access for everyone. With this exchange, there's the potential of 
having groups migrate toward that opportunity in areas of need, in 
elements of need, where 10 or fewer employee firms can join up, then 
moving to 20 or more, then moving to that universal system where we 
grow this opportunity to provide universal coverage. That is an 
important part of the equation.
  It also impacts our State governments and our Federal Government. 
When people talk about taxes they say, Cut that budget. Well, we can 
take $56 billion today of health care coverage that is provided for 
those who are uncompensated, $56 billion paid for by Federal and State 
sources, so as to allow for the care for those who simply do not have a 
plan.

  Well, we can avoid all of that. This is called preventative 
maintenance. We offer prevention in these plans. We provide the 
incentives to encourage people to move into these preventive models 
that will provide for outstanding benefits.
  This is a great opportunity to reform a system that has long been 
asking for reform, and we do it in a way that is consumer friendly, 
consumer driven, and the government stays out of that equation, as was 
made mention. They're not going to choose. The government is not going 
to choose your doctor.
  There are plans that empower our families and respond in a way that 
won't penalize them for catastrophic care, won't penalize them for 
preexisting conditions, won't penalize based on age, and will take care 
of our children in a way that shows us to be the compassionate Nation 
that I truly believe we are.
  This is a way to express it. This is a way to also be economically 
sound in moving forward with health care delivery so that our 
businesses can compete in that global marketplace, not strapped with 
the burdens of this system. But we do take what is good about the 
American system, keep it in place, and reform those elements that need 
to be reformed.
  It's a great opportunity for us to do academically sound work. And I 
applaud the efforts of leaders in town that are doing this with their 
eyes wide open, with their heart in the right place, and with the 
boldness of vision that they're sharing with the American public.
  Mr. MURPHY of Connecticut. Mr. Tonko, I think that if the Democrats 
had introduced a one-page bill that was a nice, pretty picture of a 
flower, the Republicans would have claimed that it was socialist 
medicine. It just didn't matter, right? It doesn't matter what is in 
the bill.
  A lot of our friends--not all of our friends, but a lot of our 
friends on the other side are going to scream, ``Government-run 
medicine and socialism'' because their pollsters have told them--and we 
got a 28-page memo from the top Republican pollster, Frank Luntz, who's 
laid it all out for them that if you want to kill health care reform, 
all you've got to do is go out there and shout, ``Government-run. 
Government takeover.''
  And so there are friends on the other side of the aisle and those 
outside this House who want to stop health care reform who've never 
read the bill, who have just decided to shout some slogans to try to 
stop it.
  Mr. TONKO. I think you're absolutely right. The issues of energy 
reform, energy security, the issues of health care reform cannot be 
resolved or determined by sound bites, by bumper sticker slogans, by 
billboards. They need to be done in a way that establishes a healthy 
dialogue, academically driven, and where facts rule and fiction is set 
aside.
  What I'm proud of is that the majority here has approached this 
situation in a way that allows us to push forward a very, very strong 
bit of reforms, including those in the insurance industry.
  Mr. MURPHY of Connecticut. Let me ask our good friend from Maine, 
Representative Pingree, to join us, somebody that I knew about long 
before she got here as a tireless advocate across this country and in 
her home State of Maine for health care reform.

[[Page H8565]]

  So I'm happy you're here to join us.
  Ms. PINGREE of Maine. Well, thank you so much for letting me say a 
few words here and thank you for convening us all here on the floor to 
counter some of what we hear on the other side, as you mentioned, that 
this would be the worst thing we could ever do and what is wrong with 
this. I'm glad to be here for a while to talk about what is right about 
this.
  You mentioned that I have been working on this for a little while. I 
often tell people I may be a freshman in Congress--and I truly am one 
of the freshmen and proud to be here--but I've been working on this 
since I was first elected to the State legislature in 1992, which was 
also a year we all thought we were running on health care and when we 
promised the American public we were going to do something about this.
  And what I would say is most significant about talking about the 
issue now when I'm back in the district--and I, like most of my 
colleagues, have held forums of doctors and businesspeople and 
individuals who have health care, individuals who can't afford their 
health care, everyone across the spectrum.
  What is different is, when I first ran in 1992, I would sit down with 
a group of the doctors in my home county, Knox County, and they would 
say, Keep your hands off medicine. Don't want socialized medicine. 
Leave this alone.
  And when I meet with the doctors today, they say, How soon are you 
going to fix this system? They tell me, We can't work anymore. We can't 
provide our patients with the care that they need.
  This will be surprising, but they took a poll of the doctors in 
Maine--and, look, we're not a completely liberal State. We've got two 
Republican United States Senators. But our doctors said, with a 50 
percent margin, that they wanted single-payer health care now. Now, 
we're not voting on single-payer today. We are working on a bill that 
is an excellent bill. But that just shows you how far the medical 
profession has come. Doctors, nurses, alternative providers, they're 
all saying that.
  Certainly, my Chambers of Commerce, when I sit down with them, it's 
same thing. They don't say to me anymore, Keep your hand off medicine. 
They say, How soon are you going to do this? We can't afford to cover 
the cost of our employees. And they want to. They know that it's better 
to have your employees covered.
  These aren't people trying to run away from the bill. These are 
people who are saying, with the costs going up, with a limited number 
of providers, We cannot not afford to be in the system any more.
  Recent figures in Maine show, if you have health care insurance--and 
you all may have mentioned this before I came into the room--but if you 
have health insurance today, $1,200 of your payments are going to a 
cost shift to cover everybody else. When people say to me, Don't tax me 
to cover health care, you're already paying a tax if you have health 
care coverage.

                              {time}  1915

  One other thing I want to say and then get back into the dialogue. My 
good friend from New York mentioned the challenges of being a State 
legislator. Certainly States today, as we all know, are struggling 
under the weight of trying to cover the uninsured, the charity care in 
hospitals. I am fortunate to have a daughter who is the Speaker of the 
House in the State of Maine.
  I can guarantee you, as they made budget cut after budget cut after 
budget cut, every time she could pick up the phone and call me, she 
would say, Mom, when are you guys in Washington sending the money back 
to our State because we can't afford this anymore? And I am one of 
those who have valiantly tried health care reform. We have many of the 
insurance reforms that we are talking about in this bill, but frankly, 
they don't go far enough. You can't count on the insurance companies 
just to do it out of the goodness of their hearts.
  We've tried it all in our State. States are struggling under the 
weight of this. We need a Federal plan, just like the bill we're 
working on today. It's an excellent piece of legislation. It's a very 
good start, and I am very excited to be here with all my colleagues 
tonight.
  Mr. MURPHY of Connecticut. It's amazing to me how we can all 
represent districts as different as they may be who are all struggling 
with the same problem. There are uninsured folks in every single one of 
our districts, whether they be affluent districts or poor districts, 
African American districts, Caucasian districts, whatever it may be. 
And the fact that some of the Members of this House come with no 
solution at all, no answer for their thousands, if not tens of 
thousands, of constituents who don't have health care, whose families 
who are amongst the 50 percent of bankruptcies that are caused by 
health care costs. We can have a constructive debate as to what the 
best solution is. But the debate right now, which is between something 
and nothing, Mr. Ryan, is just unbelievable to a lot of us that are 
hearing these stories back home.
  Mr. RYAN of Ohio. We do have a chart of the Republican health care 
plan. You may be able to see it from where you are. But it is a series 
of question marks with arrows pointing in all kinds of different 
directions because they've had no plan. So it becomes very easy to come 
down here and be critical and scare people about what the Democrats 
want to do. But the one key statistic that everyone needs to remember 
is from 1995 to 2006, per person, there was a $3,000 increase in health 
care spending per individual in the United States of America. An 85 
percent increase under the do-nothing plan.
  Our people did not elect us to come down here and just continue to 
let problems compound and compound and compound. We're trying to do 
something. We all know the problems. We all have the uninsured in our 
communities. We all have the underinsured in our communities. In my 
district almost 1,600 families go bankrupt just because of health care. 
How do you go back and say, Well, you know, we couldn't really get the 
political muscle to push something through? How do you tell this to 
these families in America today?
  And with all the changes going on in the economy--and earlier I 
showed communities converting from industry to high-tech businesses. 
There's a lot of unseemly transition going on here from people who have 
worked in the auto industry and steel industry that eventually will get 
retrained and may eventually work their way into a newer part of the 
economy--hopefully the green economy that we tried to deal with a 
couple weeks ago. But shouldn't we say in America that you at least 
have some basic level of health care, you at least don't have to worry 
about that as you go about getting retrained or your kids are in 
college or your kids are in school?
  When you look at what we would save--we went back and we did a little 
research--if we spent on health care at the level that France spends, 
we would save $805 billion a year. That's how much we would save. And 
we could take a portion of that savings--which is what we want to do, 
which is how we're paying for half of this to begin with, savings in 
Medicaid and Medicare--and put it on the front end so we have 
preventive care. That's why these other countries are saving money, 
because people don't end up in an emergency room, costing us hundreds 
of thousands of dollars. They have some card so they can go or some 
plan so they can go and get a prescription. That is common sense. That 
is basic common sense.
  Our plan is very uniquely American. It takes the best of what happens 
around our States and our communities, blends them together, and makes 
them work by driving down costs, focusing on prevention, and making 
sure if something happens to you and you have heart disease and you 
lose your coverage and then try to go to another insurance company or 
another plan, who say, Whoa, you've got heart disease. Sorry, you can't 
come in here. Oh, you have got diabetes? Sorry, you can't come in here. 
Cancer? Sorry. Too bad. You can't come in.
  That's not right. So what we're saying is, everyone will be covered. 
Everyone. And we have a lot of the money within the current system that 
we have now to do it. When you look at the statistics in all of our own 
districts with the doughnut hole and a lot of other things, this bill 
is going to be in

[[Page H8566]]

the best interest at the end of the day for businesses in the United 
States of America. They're going to have a more healthy, more 
productive workforce and, quite frankly, when you talk to some of 
these--and I just want to share one story.
  I was at a wedding last week and was talking to someone who employs 
about 150 people, but he was also a provider. He does equipment and 
different services, so he sees this from both sides. His insurance 
rates went up over the past 5 years 42 percent. So the insurance 
companies were making more money off him. But on the provider side, he 
got the goose egg for any increase. So he felt the insurance companies 
raise his rates on his 150 employees; but they didn't say, Okay, we're 
raising your rates, but here's a little bit more reimbursement for you. 
That's not how it works. They squeeze the providers; they increase your 
rates; they make a lot of money at the expense and on the backs of a 
lot of the American people.
  I yield to my friend from Maryland
  Ms. EDWARDS of Maryland. I thank the gentleman from Ohio.
  You raise an interesting point and it really has to do with what 
small employers need, small businesses. I know I have them in my 
congressional district out in Maryland. When I talk to the barber shop 
owners and the small IT firms and the engineering firms, they want to 
be able to provide health care for their employees. But you're right. 
They're being squeezed. The irony of it is that because they're so 
small, they have no capacity to negotiate with these big insurers. So 
their rates, if they do choose to provide health care, those premiums 
actually really, really go up in comparison to even premiums for the 
larger employers. So we've created a system here where there are 
disincentives even for the smaller employers to provide health care for 
their employees, despite the fact that they want to.
  Now what is it that we do in this plan to go at lowering some of 
those costs? Well, I think one of those things that's really important 
to me, and I know important to so many people in my congressional 
district and in my State, is providing a robust public plan that really 
is going to drive competition. I'm often amazed because the same people 
who argue for the free market, when it comes to talking about a robust 
public plan option that competes in the marketplace on a level playing 
field with a doctor network, those same folks actually don't want 
competition.

  So I say, bring on the competition. Bring on the competition with a 
robust public plan that relies on a recognized provider network and 
that makes sure that reimbursement rates really reflect care delivery 
so we can bring in more patients and then competes on a level playing 
field. I think that, in fact, will bring down costs for all of us who 
are insured--our premiums, our deductibles, our copays, all of those 
out-of-pocket costs that really burden average families.
  And for our small businesses, we give them some options. Folks talk 
all the time about choice. I want to talk about the choice that people 
don't have right now under the current system. You know, if you have an 
employer that just has a set plan, whether it's good or not, you don't 
have a choice. You may be in a plan where your doctor is not part of 
that network. You don't have a choice. So there are a lot of things 
that you don't get to choose about. And guess what, we now are actually 
opening up a system that provides average consumers with far greater 
choices than they have under the current system.
  So I think it's actually an exciting time for the American people. I 
think that when it's all said and done, the naysayers will be out there 
trying to beat this plan down; but I know that there's not a single 
person in my congressional district who doesn't have a horror story to 
tell about their insurer, about their neighbor, about a family member, 
about the potential loss of a home or a bankruptcy because this system 
is so broken. In the future, whether it is 5 years down the line or 10 
years down the line, we'll have a story to tell about healthier people 
because we've invested in prevention. We'll have a story to tell that's 
about small businesses who can provide the insurance and the coverage 
that they want for their employees. And we'll have a story to tell 
about the American people who aren't enduring the ever-skyrocketing 
costs of health care.
  With that, I yield to my good friend from New York (Mr. Tonko).
  Mr. TONKO. I thank the gentlewoman from Maryland, Representative 
Edwards.
  You know, you talk about the choice that empowers the consumer, that 
empowers families and children across the country. But there's also 
continuity that is important. As we look at this recession that this 
administration has inherited, as they struggle with it, we've been 
told, Go to Washington and fix the health care system. Go to Washington 
and provide for energy security and green up our thinking and, oh, yes, 
fix the economy.
  Well, in order to fix the economy, the health care situation is a key 
ingredient in the equation for success. So just why do we need to do 
that? Well, since this recession began, which may be one of the most 
devastating economic crises faced in our given lifetime, 4 million 
additional Americans have lost insurance. The stats are indicating that 
some 11,000 people per day, workers per day are losing insurance 
coverage.
  So the continuity in the equation, in the outcome is an essential 
ingredient, because when people lose a job or if they even choose to 
change a job for better opportunities or are relocating as a family, 
they'll have opportunity to continue in a system. That's key. That is 
critical. And again, not held back if they're in the midst of a 
catastrophic illness or have some sort of pre-existing conditions. 
Those sort of factors are incredible. When we're fixing the economy, 
again, we need to hold off that $880 billion balloon, which will expand 
in 10 years, that the business community will pay if it tries to keep 
its insurance coverage for its employees. That's a huge catastrophe 
waiting to happen.
  So this is about prevention. This is about choice. It's about 
continuity. And it's about utilizing our resources. The $2.4 trillion 
that we are historically willing to invest in a system can be used in a 
better way. Otherwise, that $2.4 million, Representative Murphy, turns 
to $4.4 million in just a matter of a decade. It is unacceptable.
  Mr. MURPHY of Connecticut. Will the gentleman yield?
  Mr. TONKO. I yield to the gentleman from Connecticut.
  Mr. MURPHY of Connecticut. I want to talk about choice. In half the 
States in this country, there is one insurer that controls 50 percent 
or more of the market. In about 75 percent of the States, there are two 
insurers that control about 75 percent of the market. As Representative 
Edwards pointed out, for a lot of employees, they only have one option 
to begin with, even if their employer offers them insurance. I mean, 
this mythology that we've got a really competitive marketplace out 
there is just that, mythology.
  I think about my small employers in Connecticut. They just got notice 
about 2 weeks ago that the big gorilla in the room in our State, Blue 
Cross/Blue Shield, is going to increase their rates this year--get 
this--by 32 percent, a 1-year increase for individuals and small 
employers of 32 percent.
  Well, those small employers are going to look at Medicare, which this 
year will increase its costs by about 3 percent. They'll look at the 
health care plan that we're all on, the Federal Employees Health 
Benefits Program, which is going to raise its rates by 3 or 4 percent. 
Some of the plans in our network are actually lowering costs this year. 
And they're going to scratch their heads when they hear the Republicans 
saying that they shouldn't have the option to buy into a publicly 
sponsored plan. They're going to say to themselves, What kind of choice 
is that for me if all I can do is stay on a plan that's going to raise 
my rates 30 percent, and these Members of Congress are on a plan whose 
rate of increase is 10 times lower? I want that choice. I want to be 
able to buy into that.
  And that's what it is, choice. Listen, we can talk about a lot of 
myths, a lot of fabrications that come from the Republican side. But 
one of them is this notion that anyone is going to be forced on to a 
particular health care plan by the Democrats' plan--that we hope will 
get some Republican votes in the end--just isn't true. We are simply

[[Page H8567]]

saying to people that you get to keep the coverage you want, but if you 
want to go on to a cheaper plan that might be sponsored by the 
government, you have the option to do that. There is absolutely nothing 
in this bill that forces one single person in this country to make that 
choice.
  I'm going to tell you, faced with a 30 percent increase in 
Connecticut, there are going to be tens if not hundreds of thousands of 
people in my State who are going to be clamoring to get access to the 
same kind of health care that Members of Congress have, if it can save 
them some money.
  Ms. PINGREE of Maine. Will the gentleman yield?
  Mr. MURPHY of Connecticut. Absolutely.

                              {time}  1930

  Ms. PINGREE of Maine. You know, it's interesting. I want to just talk 
about this point for a minute.
  I was doing a Statewide radio talk show the other day, and I got the 
question that, I think, a lot of us get when we talk about the public 
plan, and I completely agree with you about this issue of choice.
  In my State, two insurance companies control 88 percent of the 
market, and one of them is controlling 78 percent of the market. So, 
you know, we've tried all kinds of alternative, and insurance companies 
just don't want to participate. You're right. There is no choice. A lot 
of States are faced with the same kind of increases.
  Somebody asked me on the call-in show, Well, how are you going to 
make sure there is a level playing field? Is this going to be fair to 
insurance companies? I said, Wait a minute. It's not my job to support 
insurance companies that are declaring 32 percent increases or 15 
percent increases or whatever is going on in your State. It's not my 
job to make sure insurance companies can pay CEOs huge salaries and 
have huge administrative costs. My job is to make sure that everybody 
in my State and in this country has access to affordable health care. 
The hospitals can keep operating. The doctors can keep seeing patients. 
It's not my job to make sure insurance companies make huge profits. 
It's my job to make sure that everybody has access to health care.
  The reason we have a public plan, as my colleagues have so eloquently 
stated, is so that there is some choice in competition out there. Isn't 
that what we're here for? When people say to us, Government should act 
more like a business, well, that's what we're doing. We're trying to 
create a more businesslike atmosphere out there so there really is 
choice and competition.
  I just want to read a couple of interesting facts and then turn it 
back to my colleagues.
  You know, in looking at some of the numbers in my own State--and I 
know we've all been doing this--it is really fascinating. I think a lot 
of people don't know how amazing this bill can be if and when we get it 
passed, and I believe we will soon. In my district alone, there are 87 
seniors in the district who are hitting the doughnut hole in that they 
are forced to pay full drug costs. Well, under this plan, we're going 
to do something about that doughnut hole. That's a huge difference in 
our State. The legislation also cuts brand name costs in the doughnut 
hole. This is a huge change for all of us and for many seniors who are 
already struggling.
  You know, I looked at another interesting fact. In my district in 
2008, there were 690 health care-related bankruptcies. How many times 
do we hear a story about somebody who has put his health care bills on 
his credit card, about somebody who just can't afford to get by anymore 
because he couldn't pay for his health care costs? Well, this bill not 
only will provide health insurance for almost every American, but it 
will cap your annual out-of-pocket costs with $10,000 a year. That 
ensures that no citizen is going to get to that position. It's going to 
make a huge difference. We're talking about things that people will 
feel in the economy in their daily lives.
  If we want to talk about, as many of my colleagues have said, the 
economy and what could make it a lot better, I know in my State it 
would be by lowering the costs of health care and by making sure 
everyone has access and by making sure everyone is covered from 
lowering those costs.
  Mr. RYAN of Ohio. If the gentlelady would yield.
  Ms. PINGREE of Maine. Absolutely.
  Mr. RYAN of Ohio. We hear a lot about this--run your government like 
a business. That's exactly what we're trying to do here, which is to 
make a decision as we look at the facts as they're presented to us, as 
we look at the costs that have gone up 84 percent over the last, you 
know, 10 or 12 years. A businessperson looking at this would say, Hmm, 
we wait until someone gets really, really sick. Then we provide 
universal health care as opposed to saying, As a businessperson, if I 
just spent a little bit of money up here on the front end, we would 
save all of this money on the back end.
  Look at all of these hospitals, whether they're in the cities or 
whether they're in the rural communities, that spend enormous amounts 
on charity care. Somebody is paying for that. We're paying for that. 
Taxpayers are paying for that already, and that's the problem here.
  Everyone says, Well, why are you asking the rich to pay for it? It's 
the top 1 percent that we're going to ask to pay a surcharge. The rich 
are already paying for it. They're already paying. These people don't 
have health care, so they show up in the emergency rooms, and they get 
public money to help the hospitals so that the hospitals don't go belly 
up.
  So what we're trying to say with the business mind is let's put a 
little bit of money up here and give these people preventative care, 
and let's make sure that they get prescriptions instead of ending up in 
the emergency rooms a week later and costing everybody $100,000 or 
$200,000. Let's make sure you have a mammogram instead of ending up, 
you know, in the hospital after being diagnosed with breast cancer. 
Let's make sure you have a cervical screening so you don't end up with 
cancer weeks or months later because you don't have preventative care.
  This is common sense, and I think that's what frustrates the American 
people. It's like get your act together, and get this done. We can do 
this.
  As you said, there will be more choice with a public option, and the 
public option will then, as it competes, drive costs down. When there's 
a public option hanging out there, Blue Cross-Blue Shield will not be 
able to get away with a 32 percent increase. It just will not happen. 
People will flock somewhere else. So, inherently, this public option 
will drive down the costs of health care.
  Again, the idea of doing nothing, which basically has been the case 
over the past 10 or 15 years, and of saying we hope this all just goes 
away and that we hope the free market works, has led to an 85 percent 
increase from 1995-2006 per person, almost a $3,000 increase. We can't 
sustain it. We are going to build the political coalition here and 
exercise the political muscle necessary to make sure that our small 
businesses that can thrive under this plan get the kind of benefits 
that they deserve, and the people and the increase in productivity will 
increase, too, in the United States.
  Mr. MURPHY of Connecticut. Will the gentleman yield?
  Mr. RYAN of Ohio. I would be happy to yield.
  Mr. MURPHY of Connecticut. I just wanted to add a statistic here. You 
mentioned about how a public option is going to provide competition. 
There have been those critics of the bill, those proponents of the ``do 
nothing'' strategy, who have said, Well, you know, if you have this 
public option, it's going to mean all of these people are going to lose 
their private insurance, and the private insurers are going to go out 
of business.
  Well, you know, we have this thing here in Congress called the 
Congressional Budget Office. Do you know what? Sometimes we like them 
and sometimes we don't because they play it pretty straight. They're 
nonpartisan. They provide analysis of the bills that we do, and they've 
said it pretty clearly on this issue of whether or not people are going 
to lose their private health care insurance.

  They actually show, over the course of this bill, over the 10 years 
that this bill will be in implementation, that more people will be 
insured through their employers at the end of this 10-year period than 
when we started and that 2 million more people will be insured through 
their employers than

[[Page H8568]]

when this bill started. They also show that the price of insurance is 
going to come down over time.
  So, yes, there are going to be some people who will choose the public 
option, but what will really happen is that everybody's insurance is 
going to get less costly and that more employers are going to be able 
to provide it and will provide it to their employees because their 
costs will have been brought down.
  With that, I am so glad that our good friend from New Mexico has 
joined us on the floor. He is another new Member who has been a great 
champion in his district for affordable health care.
  Mr. LUJAN. I thank my friend as well.
  I will tell you and my colleagues here on the floor that, as I was 
sitting in the office, watching the discussion that was taking place, I 
felt compelled to come down because, in my office, we were looking at 
some of the letters that have been sent to my office. I'll tell you 
there is story after story, whether it's in writing or by e-mail or by 
phone or in person, as we talk to our friends in the district, of the 
concerns that we have of those who have insurance but who say when that 
bill comes in and when they see that denial on there, Well, I was 
paying into the system. I was working hard, I was paying my bills. I 
thought I had coverage. I went to go see the doctor because I was sick. 
Then they get the rejection letter and denial after denial.
  There is something that's not being talked a lot about today. Some of 
those who are opposed to health care reform, to the public option and 
to the legislation that we're working on aren't talking about some of 
the protections that are in this legislation, even to those who have 
coverage today. As we've been talking about this and as we've been 
advocating for a strong public option to give competition and to 
provide choice for our patients out there for those who are so in need 
of good care today, the other element of this is, if they like the 
coverage they have, they can keep it.
  One of the problems that exists therein, though, is how insurance 
companies are denying these claims one after another. This whole idea 
and this notion that government is going to get in the way of people 
being able to make decisions about their health care with their 
physicians couldn't be more wrong. The problem that exists today is 
that the bureaucrats who are in place today within some of the 
insurance companies and who review these claims one at a time are not 
your physicians. They get this submittal from a doctor, and they ask, 
Well, should we provide coverage or not? Then they reject that letter.
  You know, before I came to Congress, I was part of a commission that 
had the State superintendent of insurance under it. It was where the 
State regulatory reform took place. We had the responsibility of having 
to work with patients to look at some of those denials. I'll just share 
one little story with you.
  There was one young lady whom I ran into who asked, Ben, don't you do 
something with insurance? I explained to her, yes, I did. What was 
going on? Well, she and her husband were trying to have a baby, and 
they were not having much luck. They had a 1-year-old son, but they 
weren't having much luck. So she went to see the doctor, and the doctor 
diagnosed her, and said, Well, there may be something wrong here.
  Well, it turns out what they diagnosed her with was related to 
something that wasn't included in her coverage. They were trying to 
say, Well, we diagnosed you with this illness about 2 years ago, but 
now that they were trying to have a son, to grow their family and to 
live the American dream in their home that they had just purchased, the 
insurance company said, Well, we're not going to cover this. As a 
matter of fact, you have to go back and pay 2 years of bills that we've 
been treating you for.
  Well, the family was in dire need because, when they tried paying 
this bill, they were going to have to sell their home. They were going 
to be out on the street. There was no telling what was going to happen 
to them. Well, it turns out that the insurance company wrongfully 
denied this claim.
  Now, how many more millions of people are out there who have coverage 
today who are getting those claims denied?
  One of the strong elements of this piece of legislation is all of the 
consumer protections that are built in. It's important that we talk 
about those because, as we talk about building a strong public option 
and about providing protections, about extending coverage, and about 
lowering costs, it's important that those who have coverage today are 
going to get the protections they deserve. Those who are opposed to 
this legislation aren't talking about those protections.
  It's important that we continue to advocate for them because people 
across this United States and across my district, I'll tell you, want 
coverage and need coverage, and they're crying out every day. It's 
about time that we start listening to them. That's why I had to come 
down here to my colleagues, to my good friends who are all down here 
visiting with the American people about the importance of this 
legislation that we're working on as we advocate for lower costs, for 
squeezing what we can out of the system to make sure that we're looking 
after the general welfare of the American people and to make sure that 
we're providing the consumer protections that Americans deserve.
  So, with that, I yield back. It's an honor to be here with you, and 
we'll continue working day in and day out to make sure we're able to 
advocate for the well-being of the American people. Health care reform 
is what we need.
  Mr. MURPHY of Connecticut. I thank my friend.
  You know, I'm feeling pretty good. Something Mr. Ryan said must have 
really galvanized folks because we're getting a crowd down here.
  We've got a few minutes left, and I want to yield to my good friend 
from Virginia to kick in to help end our discussion here.
  Mr. PERRIELLO. Well, I was listening to some very important 
conversation about the choice that we're going to give to patients 
under this plan, but I also want to talk a little bit about the choice 
we're giving the doctors. I come from a family of pediatricians, and 
the thing that I hear over and over again from our primary care doctors 
in particular is that they will prescribe something to a patient, and 
will be told by the insurance company that it's not all right. We have 
insurance companies invading this relationship between the doctor and 
the patient.
  So many people got into medicine because they wanted to make people 
well or, better yet, because they wanted to prevent them from getting 
sick in the first place, but they get zero reimbursement in many cases 
for doing the very preventative medicine that we should be encouraging. 
So, when my sister takes a call late at night from a patient who's sick 
or when she follows up a couple of weeks later to make sure a person is 
doing whatever routine she has prescribed to him, she gets 
reimbursed zero for that.

  We are literally bankrupting our primary care doctors for doing the 
very things they got into medicine to do, which is to take care of 
people and to help cure people. So I think this is also about trying to 
re-empower our doctors and to protect that relationship and to get the 
insurance companies to not be standing there every second between that 
doctor and that patient.
  With that, I yield back.
  Mr. RYAN of Ohio. I think it's important to know that one of the 
major endorsements is the AMA. The American Medical Association has 
endorsed this bill.
  If you go back 40-50 years when we tried to do something, they'd put 
the kibosh on it. You talk about health care reform in the early 1990s. 
The docs did not want anything to do with it. They have endorsed this 
bill. It has gotten that bad.
  I would yield to my friend.
  Mr. TONKO. Representative Ryan, I want to go back to what you talked 
about earlier, which is common sense. I know we have to close our hour 
here, so I'll make this quick.
  There is another aspect I'd like to underscore, which is that of 
economic justice. When you see since 2000 that the premiums have more 
than doubled on average for working families in this country and that 
the salaries have stayed on a flat line, there is a need for us to step 
in and to fix a broken system. When 60 percent of bankruptcies in this 
country are due to medical

[[Page H8569]]

costs, we need to step in and do something.
  Representative Murphy, I want to thank you for bringing us together 
so we can share together with the American public our messages of 
enhancing the quality of services, of reducing costs and of providing 
access for everyone as we move forward in this health care discussion 
and reform. Thank you so very much, Representative.
  Ms. EDWARDS of Maryland. Thank you.
  Before we close out, I do want to say before we get out of this that 
we've been about clearing up the mythology about what is and is not in 
our health care bill, and one of those myths really has to do with our 
seniors.
  So, Mr. Speaker, I want to say to all of our seniors across this 
country that we're protecting you, that we are going to make sure that 
we phase in completely by filling in that doughnut hole that has left 
you covering the brunt of your costs for prescription drugs. We're 
going to eliminate co-payments and deductibles for preventative 
services under Medicare, and we're going to limit cautionary 
requirements in Medicare Advantage plans to the amounts that are 
charged for the same services in traditional Medicare coverage. This is 
really important for our seniors. We're going to improve low-income 
subsidy programs in Medicare by increasing asset limits for programs 
that help Medicare beneficiaries pay premiums and cost-sharings.
  So let's be really clear with the American people and especially with 
our seniors. Don't let them scare you out of supporting this plan for 
our seniors. This is a good plan for our seniors. It is a good plan for 
middle-income families. It is a good plan for working families. It is a 
good plan for people who have insurance, and it surely is a good plan 
for all of those who don't.
  With that, I'll yield back.

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