[Congressional Record Volume 155, Number 115 (Tuesday, July 28, 2009)]
[Senate]
[Pages S8152-S8156]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mrs. MURRAY. Mr. President, a few moments ago, the Republican leader, 
on the floor, talked about a concern about ``rushing'' to a health care 
reform debate and bill. I want to assure everyone that no one is 
rushing to anything. Everyone is working hard to come up with a good, 
strong health care reform bill that addresses an urgent need in this 
country.
  In fact, last week, President Obama spoke to the Nation about the 
urgent need to reform the health care system. He spoke about premiums 
that have doubled over the last decade. He talked about the out-of-
pocket costs that have been shooting up by over a third. He talked 
about deductibles that all of us have seen skyrocket. He talked about 
the families and the small business owners who have to work harder and 
harder to stay afloat. President Obama spoke about the work that has 
been done to put a health care reform plan together.
  I sit on the health care committee in the Senate. We spent months 
having hearings and working through some of the tough, difficult 
challenges. We spent weeks and hours working through a debate on a 
health care reform package. We looked at hundreds of amendments, many 
of them Republican, a lot of them accepted into our health care bill 
before it passed out. We are working very hard now with the Finance 
Committee for them to work through the challenging issues and come up 
with a solution, as the House is as well.
  We are working hard to come to a solution with the health care reform 
plan that protects patient choice, that reins in those costs I talked 
about, and provides coverage for millions of Americans who don't have 
any today.
  The President of the United States spoke frankly about some of our 
Republican colleagues who are speaking out for the status quo. 
President Obama spoke plainly to Americans about the devastating costs 
of inaction--the devastating costs of inaction if we do nothing, and 
what will happen if we maintain the status quo. I am telling you what 
would happen if we do nothing: Premiums are going to continue to rise, 
benefits will continue to erode, out-of-pocket costs are going to 
continue to skyrocket, and more and more employers will do what I have 
seen too many in my State have to do: drop coverage for their workers. 
We talk about 47 million Americans today who don't have coverage at 
all. That will seem like the good old days if we do nothing.
  Despite what some of our colleagues wish us to believe, Americans do 
want health care reform. They need health care reform desperately, and 
they are not going to accept another year of talking and bickering and 
stalling.
  Last month, I sent a letter to families across my State of Washington 
asking for their help as we work very hard to reform the health care 
system. I told them I wanted to pass a plan that protects existing 
coverage when it is good, improves it when it is not, reins in costs 
today, and lowers them long term, and guarantees care for the millions 
of people who don't have health care today.
  I asked my constituents to share with me their stories and ideas 
about how to make this vision a reality. I told them that I know health 
care is a very personal issue, but I also told them their personal 
stories have the power to change minds and transform debate. The 
response I got was overwhelming. I came to the floor last week several 
times and shared some of the over 5,000 stories that have now poured 
into my office from my State. I underscored the need to fix this broken 
health care system and do it this year.
  I come to the floor to share a few more stories, and I want to talk 
about a specific aspect of health care reform I have been working very 
hard on, and that is, as we reform this health care system, we have a 
skilled health care workforce that is ready to step up and provide the 
care we need.
  Judy Allen, from Moses Lake, WA, sent me a story about her son. She 
said he had been diagnosed with cystic fibrosis at the age of 5 and was 
given a 50-50 chance of making it to his ninth birthday. Judy said she 
and her husband had good health insurance, but they had to travel over 
3 hours to get to a clinic with the resources her son needed. They 
could not move close to this facility, because moving would force them 
to switch health care insurance providers, and they knew if that 
happened, they would get rejected because of their son's preexisting 
condition. Sadly, Judy's son died 3 years ago, but the reforms we are 
working on will help mothers such as Judy across the country.
  We want to stop insurance companies from spending our premium dollars 
on figuring out ways to exclude people from coverage. We are going to 
ensure that nobody will be denied health care coverage even if they 
have a preexisting condition.

[[Page S8153]]

  Unfortunately, Judy's story is not unique. Millions of Americans who 
have insurance today--good insurance--struggle with a broken health 
care system. They struggle with the skyrocketing costs, with the 
complicated system that works for the insurance companies but not for 
the patients. So I agree with President Obama that we need to reform 
the health care system this year.
  As we work to provide quality affordable health care coverage to all 
Americans, we have to make sure there are enough health care 
professionals to provide that care. We can write and pass a bill that 
improves the coverage and reins in the costs, but without an educated, 
accessible system of doctors, nurses, x-ray technicians, physical 
therapists, and other health care professionals, that coverage isn't 
going to mean much. If we provide health care coverage without the 
workers, it is like building schools and not hiring any teachers. So it 
is common sense, but it makes economic sense as well.
  Not only does this shortage make it hard to access care even if you 
have insurance today, it makes it more expensive. That is why we have 
made a number of investments that are going to create and sustain good-
paying jobs and ensure access to care so that Americans stay healthy 
and productive.
  We all know today that too few medical students are going into high-
demand general care fields. Many students enter specialty fields, in 
part to pay for the cost of medical school, and because they tend to be 
more lucrative long term. So the health care bill we passed out of 
committee on health care includes incentives such as loan repayment 
programs, scholarships, and grants to encourage students to go into 
high-need fields and to work in underserved areas. It invests in 
education, training, and retention efforts, not just for new health 
care workers but for all of those who are already providing quality 
care in this country.
  Investments in our health care workforce create jobs, ease the strain 
on overworked health care professionals, and keep Americans healthy, so 
they can be productive on their jobs. I am going to keep working to 
make sure these investments remain a priority.
  Quickly, before I yield the floor, I want to reiterate the critical 
need I talked about a minute ago to fix the health care system. I want 
to share a story.
  Sharon Alexander wrote to me from Steilacoom, WA, about her battle 
with brain cancer--the same type Senator Kennedy suffers from. Sharon 
had health insurance, but she wrote and told me that while she was 
running from doctor to doctor and undergoing radiation treatments, she 
and her husband had to spend a great deal of time navigating different 
copayments and acceptance policies of all of her doctors. She told me 
she was lucky she had insurance, but she still had to jump through hoop 
after hoop to get the care she needed. Sharon discovered that in our 
broken health care system, high-priced insurance doesn't guarantee 
high-quality health care.
  That is why we need to act. We need to lower the cost of health care, 
we need to ensure Americans have affordable health care and, in these 
difficult times, with all of the challenges Americans have with 
premiums rising three times faster than wages and every day 14,000 more 
Americans losing their health insurance, we are not rushing; we are 
working hard to get this right, and it needs to be done this year.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Pennsylvania is 
recognized.
  Mr. SPECTER. Mr. President, I have sought recognition to comment 
about the status of efforts to legislate comprehensive health care 
reform.
  Recently there was a comment by a Senator opponent of President 
Obama, who disclosed what has been known for some time as to the 
tactics of President Obama's opponents. The Senator who opposes 
President Obama said this:

       If we are able to stop Obama on this, it will be his 
     Waterloo. It will break him.

  This is essentially the same tactic that was used by President 
Obama's opponents on the stimulus package. I am not betraying any 
confidence about matters that were on the public record, but 
immediately after the inauguration, within 2 weeks, when the Senate 
took up the stimulus package, it was apparent that President Obama's 
opponents in the Senate were simply going to say no and obstruct the 
matter. It is a matter of public record that only three then-Republican 
Senators would even talk to the Democrats about the stimulus package--
Senator Collins, Senator Snowe, and myself. Now it is apparent, with 
what the Senator opponent of President Obama has said what the plan is.
  Now that we know we will not vote on comprehensive health care reform 
until September, there is time for a little bipartisanship--perhaps 
even a little statesmanship--to come together on this issue. We have 
been sent by our constituents to Washington to solve problems, not to 
obstruct potential solutions. There are many items where we can all 
agree. There are many potential savings available, which I outlined a 
few weeks ago in an extensive floor statement. For example, on advanced 
directives, estimates are that as much as 27 percent could be saved on 
Medicare. So much money is spent in the last few hours, few days, few 
weeks of a person's life. We know from the statistics that funding from 
the National Institutes of Health can prevent illness and can cut down 
tremendously on the cost.
  We also know that by changing the prosecution on Medicare and 
Medicaid fraud and imposing jail sentences, there would be a deterrent 
to that tremendous amount of fraud and abuse. A fine is simply a 
license.
  We know also that substantial savings are possible by covering those 
47 million Americans so that we have medical care at an earlier stage 
to avoid chronic illnesses that are so very expensive, so that we could 
come together on these items where I think there is general agreement.
  The Senator opponent of President Obama is referred to in this 
morning's Washington Post as saying that he is in favor of fixing the 
system, it has been one of the main causes of his career, and a 
specific:

       We need some real health care reform.

  Well, it would be worthwhile to have that Senator opponent of 
President Obama say whether he believes we ought to cover the 47 
million Americans now not covered. I believe there is a consensus that 
that ought to be done. But if there are differences of opinion, let 
them be stated, because if we agree that the 47 million Americans have 
to be covered, then the next question a responsible elected public 
official would have to ask is: How do we pay for it?
  But if someone is going to say ``I am not in favor of covering the 47 
million Americans,'' let him or her answer to his constituents. The 
Senator opponent of President Obama ought to note, as reported in the 
Post this morning, that there are 700,000 of his State's residents who 
are uninsured. If he believes we ought not to cover those 47 million 
Americans, including the 700,000 in his State, let him respond and say 
so.
  It may be that there is a political price to pay if you face up to 
that. But if you move beyond the question of whether we need to have 
health care for all Americans, then we need to move forward.
  When you talk about the Waterloo of President Obama, it sounds as if 
we are fighting some foreign power as opposed to the collegiality which 
is supposed to be present in the Senate, reputedly the world's greatest 
deliberative body.
  I was pleased to see the Senator who is opposing President Obama with 
his Waterloo statement--I am glad to see a number of his colleagues on 
that side of the aisle distance themselves. But as yet we have not had 
a proposal which comes from the Republican side of the aisle, just as 
we did not have a proposal coming from the Republican side of the aisle 
on the stimulus package.
  It was my view, as I spoke on the floor on February 6, that the 
problems about sliding into a 1929 Depression were present. We faced 
that risk. Complaints have been made about the stimulus package that it 
has not worked, but there have only been 5 months which have elapsed.
  Yesterday I was in Pennsylvania at a major interchange, I-81 and 
Route 39, announcing $12 million for road repairs; earlier, at the 
Philadelphia International Airport announcing a substantial grant; in 
western Pennsylvania in Pittsburgh announcing millions of dollars for 
locks and dams.

[[Page S8154]]

  It may be that a better proposal could have been crafted on the 
stimulus package. But there were negotiations.
  President Obama was sworn in on January 20. In the week of February 
2, within 2 weeks from the inauguration, taking the oath of office, we 
were already having obstructionism.
  It is my hope that while we adjourn for the August recess, there is 
time to have a bipartisan plan, a plan which will reject partisanship, 
a plan which might even bring a little statesmanship to this body.
  When the three of us on the stimulus issue joined with the Democrats 
in providing the necessary votes, the indispensable 60 votes to invoke 
cloture and allow the stimulus package to move forward, the comment was 
made from the other side of the aisle: Three Senators don't make a 
bipartisan bill.
  So far, only three Republicans are negotiating on comprehensive 
health care reform. So let's see if we can't have in the intervening 
weeks between now and September a concerted effort made to move forward 
to answer some of these basic questions. If someone is opposed to 
covering the 47 million Americans, let's hear it. If someone is opposed 
to having a public option, as proposed by Senator Schumer, which 
maintains a level playing field, let's hear the specifics so that our 
constituents can judge us, so that the 700,000 people who are not 
covered by insurance in the home State of the Republican Senator who 
has spoken out to break the President, to promote the President's 
Waterloo--we will have a chance to evaluate that kind of an attitude.
  I thank the Chair, note the expiration of my time, 10 minutes, and 
yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Oregon.
  Mr. MERKLEY. Mr. President, we stand at a critical juncture today as 
we grapple with how to fix our broken health care system. Rapidly 
escalating health care costs are compounding the current economic 
crisis in America. Families and businesses across the country are 
struggling to afford increased premiums, copayments, and deductibles. 
Premium increases are taking an increasing portion of workers' wages, 
and more firms are under pressure to reduce or possibly eliminate 
health care coverage for their workers.
  Helping middle-class families and small businesses afford health care 
coverage is a critical component of improving the Nation's economy. 
Families and business owners in Oregon have told me at length how 
concerned they are about the rising costs of health care. Those 
families who have health care are concerned about losing it, and they 
are concerned about the rising cost of premiums and the copays. And 
those citizens without health care--nearly 47 million Americans are 
unable to afford the cost of health care--those citizens are worried 
about getting sick or they are sick and they are worried about how to 
pay for the drugs and treatments to get well. Under this system, our 
small businesses that are working hard to provide health care coverage 
for their employees are worried they will not be able to continue, that 
they will have to raise the share of the costs the workers carry or 
maybe they will have to eliminate the health care plan altogether.
  I wish to share with my colleagues the experience of one of my 
constituents, Jeanette Hall of Milwaukee, OR. She was employed, but she 
could not afford health insurance. Jeanette had a mole on her arm. It 
was a mole she thought should be looked at. Her friends and family 
urged her to have it looked at. Finally, she went to the emergency room 
to have it examined. The diagnosis was melanoma, but Jeanette could not 
afford to have the surgery to address it.
  Sometimes one gets a fortunate turn in life, and Jeanette just got 
such an example. She was interviewed by a local news station that was 
doing a story about the plight of the uninsured. Jeanette says she is 
only alive today because of that moment when a news station covered her 
story because after that story aired, she received a call from a local 
hospital that offered to help. They basically said that in exchange for 
being the subject of an observational surgery for medical students, the 
hospital would cover the cost of the surgery. Jeanette is now cancer 
free, and she feels very blessed about that. What is more, she now has 
a job where she has health insurance, and that certainly puts a 
brighter horizon in place for her. But while she is pleased about her 
personal health and her personal health insurance, she is worried about 
health insurance for families and friends and health insurance for all 
Americans in this broken health care system.
  Her brother is very ill. Her brother does not have health insurance. 
Her brother needs an operation to save his life, but he is not getting 
that operation. She anticipates that his life expectancy is very short 
now as a result. She sees it very personally, very directly.
  Just as she hopes for health care for her and her family and for 
American citizens, so do citizens across this Nation. Citizens such as 
Jeanette are not looking for a government handout. They don't expect 
something for free. But what they do want is access, choice, quality 
health coverage, affordable health coverage for their families and 
their workers.
  We need to offer citizens such as Jeanette a lifeline in these hard 
economic times. As a member of the Senate Health, Education, Labor, and 
Pensions Committee, I am very proud of the bill we passed 2 weeks ago 
which puts us a significant stride closer to providing affordable, 
quality health care for every American. It is a plan that will lower 
costs, provide consumers with more choices, and increase competition.
  That act, the Affordable Health Choices Act, is a landmark bill. It 
gives every American a full range of health insurance options, 
including a community health plan. It ensures that those who like their 
current health care coverage can keep it. And it guarantees that no 
American will be denied coverage because of preexisting conditions. 
That act makes sound investments in disease prevention, in health 
promotion, and it strengthens the health care workforce.
  The Affordable Health Choices Act gives small businesses better 
choices for high-value health insurance by creating a new health 
insurance marketplace, or gateway as it is called, which will help 
lower costs and increase competition. In fact, let me explain this a 
little bit more.
  Right now in America, if you are an individual trying to get health 
care, you have to pay an extraordinary premium because you don't bring 
any market share clout to the negotiating table. And right now in 
America, if you are a small business, you don't get a good deal because 
you don't bring any market clout to the negotiation. This health care 
bill at its heart addresses this problem. It creates an exchange where 
you would purchase health care, not as an individual but as a group of 
hundreds of thousands of fellow citizens. That health care plan would 
bring the combined negotiating clout of those hundreds of thousands or 
even millions of individuals, so you get a much better deal as an 
individual and you get a much better deal as a small business. I know 
that every individual and small business in America that has gone 
through this process of trying to get a fair, decent health care plan 
knows exactly what I am talking about. And that is the heart of this 
reform.

  But even as we make historic progress on guaranteeing affordable 
quality health care for all, there are powerful forces underway to halt 
this effort. There are those who favor the status quo, and they are 
working on their talking points, they are rallying their special 
interests, they are doing polls to see what phrase will most scare 
Americans from changing. They want to defeat this historic march toward 
quality, affordable health care for every single citizen.
  One thing is clear: We cannot afford to fail. Maintaining the status 
quo is not an option. The last time we attempted to tackle the problem 
in 1992, health care spending was $849 billion. Today, health care 
spending in America is $2.2 trillion and growing by over 10 percent a 
year. March it forward next year, and it will be over $2.4 trillion; 
the year after that, $2.7 trillion; the year after that, $3 trillion, 
and so forth. We will be spending nearly $40 trillion under the status 
quo over the next 10 years.

[[Page S8155]]

  Premiums in the early 1990s were 7 percent of a family's income. 
Today, premiums eat up 17 percent of a family's budget. In 1996, 
employers paid about $3,700 toward a family plan. Now that is well over 
$10,000 and growing, and workers are picking up an increasing share of 
the costs.
  Today, under the status quo, 60 percent of bankruptcies are due to 
health care costs--more than half. More than half of personal 
bankruptcies are due to health care. What is more, more than half those 
personal bankruptcies due to health care are with folks who have health 
care insurance, but their health care insurance simply was not adequate 
to cover the extraordinary costs of a medical emergency. Indeed, 75 
percent of those individuals who are going through bankruptcy due to 
health care costs had health insurance.
  If we look to the future, the consequences of inaction are even more 
dire. But, despite all that, every day we hear from special interests, 
we hear from their allies who are standing up, using their poll-tested 
phrase such as ``government takeover'' in order to scare the American 
people into rejecting health reform.
  Here are citizens who know firsthand the challenge and the stress of 
health care. But they are being manipulated. There is an effort to 
manipulate them by powerful special interests that want to scare them, 
to turn them against reform and change. The opponents of reform have a 
health strategy. Their strategy is the status quo. Why do they like the 
status quo so much? Because the special interests are making so much 
money with the current health care system--huge profits for insurance 
companies, huge profit for other health care players. But here is the 
problem. Soaring profits for health care companies equate to out-of-
control, unaffordable premiums for America's working families.
  Let's examine the status quo plan put forward by the opponents of 
reform. Under the opponents' status quo strategy, the premiums that are 
paid by a family would go from about $13,000 a year now to, just 8 
years into the future, $24,000--nearly double in a short period of 
time. If you want out-of-control premiums, then support the opponents' 
status quo efforts.
  Second, under the opponents' status quo plan, the cost of health care 
for a small business would more than double. The cumulative costs are 
extraordinary. We see the costs here, in billions of dollars, start in 
2009 at $156 billion--the cost imposed on small businesses--and soaring 
to $2.4 trillion by 2018--cumulative costs. So over a 10-year period, 
small businesses carrying a multitrillion-dollar burden under the 
status quo.
  Third, under the opponents' status quo plan, the number of uninsured 
Americans increases. Why is that? It is very simple: Families cannot 
afford these premiums, small businesses can't afford these premiums, 
even large businesses may not be able to afford this more than 10-
percent-a-year increase in premiums. Indeed, under one study, the 
number of uninsured Americans, under the status quo, the opponents' 
plan, would reach 66 million Americans over the next 10 years, up from 
about 47 million right now. That is a huge increase.
  Fourth, under the opponents' status quo plan, our community hospitals 
would see uncompensated care go through the roof. Why is that? Because 
we have more uninsured. They have to go to the emergency room to get 
their care. So the hospitals end up carrying that burden. What does 
that do? That results in a cost shift from those who do not have 
insurance and go to the emergency room--those costs get shifted to 
those with insurance. It continues the death spiral in soaring 
insurance premiums that we have right now in America.
  What is more, under the opponents' status-quo approach, we get the 
same failure to invest in prevention and disease management. Insurance 
companies do not have an incentive to invest in disease management that 
might make you healthier 10 years from now or 20 years from now because 
they assume you probably will not be their customer 10 or 20 years from 
now. We get the same investment in a fee system, in a cost-plus system, 
that is driving up the cost of health care.
  Let me make this very clear. If you have any form of expense in which 
the compensation is cost-plus, the person providing those services is 
going to provide as many services as possible. If you are building a 
fighter and you say: We will pay your costs plus 10 percent, you are 
going to make sure that fighter plane is as expensive as possible. The 
same is true in health care. Yet that model of compensation is the 
dominant model in health care today.
  We need to invest in an integrated approach, such as the Mayo Clinic 
does, where the doctors are not motivated by profits but by providing 
health care to their patients. They have no incentive to run you 
through that MRI machine four or five times. Their only incentive is to 
help you get well. That is a very different approach, an approach we 
need to expand on in America, an approach that says we need an 
integrated health care system, not a cost-plus fee system.
  When the opponents of reform try to scare you and say we don't need 
to change anything, remember how scary their plan is. I know you 
understand what I am talking about because you see it every day. The 
opponents are saying it is OK if insurance companies routinely deny 
necessary medical care and cancel policies in order to increase their 
profits. The opponents are saying they prefer an America where parents 
will lie awake at night, worried if they can afford health care their 
children need because they do not have health insurance for their 
children. The opponents want an America where workers are just one pink 
slip away from losing their job and their health care. That is a double 
calamity that strikes millions of families in America every year.
  The opponents are arguing for an America where a would-be 
entrepreneur who works hard and wants to start a business may not do so 
because he or she cannot afford health coverage in a volatile, 
expensive small business market. The opponents want an America where 
small businesses that do offer insurance are faced with double-digit, 
budget-straining premiums that threaten the economic viability of that 
small business.
  I wish to see our small businesses thrive. Our small businesses are 
incredibly creative, with far more patents per capita than large 
businesses. Our small businesses expand and grow and absorb more 
workers. We want them to expand and thrive, and a major challenge they 
have today to their thriving is our broken health care system.
  I do not accept that vision for America, the vision put forward by 
opponents of health care reform. We need to create a simple health care 
exchange, where individuals and small businesses can go and be part of 
a large pool so they can negotiate a fair deal. Today we do not have 
that fair deal. Tomorrow we will.
  We need a health care system that invests in prevention and disease 
management. We need a health care system that works to expand the 
health care workforce, because we have a big challenge. Many of our 
health care workers in America, our doctors and our nurses, are 
retiring. They are baby boomers. They are reaching retirement age. We 
will have increasing demand for more of their services as baby boomers 
retire. The bill we put forward works to address that discrepancy; 
otherwise, greater demand and lower supply will drive up the cost of 
health care.
  We need to create a system that eliminates insurance that doesn't 
cover preconditions. What kind of health care do you have if you have a 
bad back but your bad back is not covered? What kind of health care 
system do we have if you have melanoma, such as Jeanette did before her 
operation, and you cannot get it covered because it is a preexisting 
condition?
  This bill changes that. I believe we need to create a health care 
system that expands citizens' choices instead of constraining them as 
in our current system. We have many markets in America that only have a 
single dominant provider. We need to create a Community Health Care 
Plan to hold the feet of insurance companies to the fire. Competition 
in the marketplace--a 100-percent apple pie, American concept--is 
needed in health care to help control costs.
  Americans across the country are counting on us to work together to 
find a solution, to help ease the burden of health care costs on family 
and business budgets and create more affordable health care options. I 
urge my colleagues to set their partisanship aside,

[[Page S8156]]

set aside the goal of trying to torpedo America's future because you 
want to torpedo the Presidency of Barack Obama. Think about the quality 
of health care for our working families and what we in this Chamber 
could do to make that quality of life far better. The costs of 
inaction, the costs of our broken status quo system, are too great to 
allow their solution to fall to petty, bitter partisan bickering.
  Let's come together. Let's fight for a brighter future for America's 
families.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mrs. Gillibrand). The clerk will call the 
roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. ALEXANDER. Madam President, I ask unanimous consent that the 
order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ALEXANDER. Madam President, I ask unanimous consent to speak for 
up to 10 minutes as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ALEXANDER. Would the Chair please let me know when I have 1 
minute remaining.
  The PRESIDING OFFICER. The Chair will.

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