[Congressional Record Volume 155, Number 117 (Thursday, July 30, 2009)]
[Pages S8506-S8508]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

                           HEALTH CARE REFORM

  Mr. DURBIN. Madam President, the Senator from Nevada has just 
expressed his views on health care, and I would perhaps like to give a 
little different view on where we are and where we should go. We are 
wrapping up this end-of-July session. We will be taking a recess for a 
few weeks. It is one of the few chances during the year for us to be 
back home, get a little time with our families before school starts. We 
are all looking forward to it, as everyone does each year. But we have 
had important work we have done this year, and more important work is 
to follow.
  This year we hope to take up before the end of the year, and pass, 
health care reform for America. The House of Representatives is moving 
a bill, a matter that will be considered in September by the House. We 
are counting on the Finance Committee to work with us to develop a bill 
for consideration on the floor of the Senate about the same period of 
  These bills and the concepts they contain are going to be there 
throughout the month of August for everyone to take a close look at and 
review. This is not going to be done in haste because it is too 
important. It is going to be there, and the critics will have a chance 
to look at it, people will be able to come up with suggestions--
constructive suggestions, I hope--that will lead us to the passage of 
health care reform in this country.
  I listened earlier to my colleague and friend from Nevada, Senator 
Ensign, talk about government-run health care. In my hometown of 
Springfield, IL, a doctor wrote a letter to the editor warning us about 
government-run health care. I would like to put it in perspective.
  There are about 300 million people living in our great Nation. Of 
those 300 million people, 45 million of them are currently covered by 
Medicare. Medicare, for seniors and disabled people in America, is a 
government-run health care plan. For many of these people it is the 
first health insurance plan they have ever been covered by.
  A realtor in southern Illinois came up to me, a woman 63 years old. 
She said: Senator I want you to meet somebody who has never had health 
insurance protection one day of her life. I never could afford it. I 
was a realtor. I didn't have enough money. Knock on wood, lucky for me, 
I have been pretty healthy. I didn't need it. I was able to pay my 
medical bills. But, she said, thank God in 2 years I will be under 
Medicare so the savings I put aside for my retirement are not going to 
be wiped out by one illness or one surgery. I will have Medicare.
  She will join the ranks of 45 million people on a government health 
insurance plan called Medicare that we have had for 45 years in America 
and is wildly popular. Not one single critic on the other side of the 
aisle who stands up and shakes their fist and rails against government 
health care has said eliminate Medicare. Of course they would not. That 
is not a position the American people are going to support.
  Some people are a little confused though. One of my colleagues went 
back home over the weekend and somebody said: Senator, listen; whatever 
you do, don't let the government start meddling in my Medicare plan.
  He said: Pardon me, ma'am, but the government runs your Medicare 
  She didn't understand that. Some people don't, but that is a fact.
  So there are 45 million people under Medicare. There are another 65 
million Americans, maybe as high as 70 million, who are covered by 
Medicaid. Medicaid is the health insurance plan for the poorest people 
in America. We said: If you are poor in America, you are still going to 
get health care, and we are going to provide it, working with the 
States. So more than one-

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third of the people who live in America today are covered by government 
health insurance.
  I have never heard a person on the other side of the aisle say 
eliminate Medicaid. They don't. They understand we are a caring, 
compassionate country, and we are going to provide this health 
insurance coverage, as we have for decades, as we should.
  Here we have one-third of America currently under a government health 
plan, and on the other side of the aisle people are waving their fists 
saying: Whatever you do, don't have a government health plan.
  It does not work. It is inconsistent. Many people say: I like my 
health insurance right now. I don't want to change. I don't want to go 
into Medicare or Medicaid. I like what I have. Would you please leave 
people alone.
  The answer is yes. In fact, we guarantee it. We are going to put in 
any legislation considered by the House and Senate the protection of 
you, as an individual, to keep the health insurance you have, if that 
is what you want. What we are trying to create are voluntary choices 
and opportunities. These are critically important because, let's face 
it, the cost of health care is going out of sight. We know it. We sense 
  Some people say: Senator, easy for you to say, you have that famous 
Senator health care plan.
  We have heard all about that one. Let me set the record straight. 
Members of Congress, if they choose--and I have chosen on behalf of my 
family--can sign up for the Federal Employees Health Benefits Plan. It 
is not a special program for Senators or Congressmen. We sign up for 
the same program that covers Federal employees across the United 
States, 8 million Federal employees and their families. It is a great 
program. That is why I signed up for it for my wife and myself.
  Open enrollment is once every year. How about that. We get to go 
shopping once every year for the best health insurance for our 
  What do we choose from? In my case, in Illinois, nine different 
private health insurance plans. We pick the one best for our families. 
If we want a lot of coverage, they take more out of our paychecks; less 
coverage, less out of our paychecks. But it is a voluntary choice, and 
I think that is what the bottom line should be for Americans.
  We are trying to move toward that model, create pools of people 
similar to Federal employees so they can bargain with the private 
insurance companies, have good coverage at a reasonable cost. We want 
to build into this as well health insurance reform. What good is it to 
have a health insurance plan that says they offer coverage for 
everything except our sickness? That happens. People who may have 
turned in a claim last year for an aching back can find this year it is 
a preexisting condition; it is not covered.
  People who, 2 or 3 years ago, may have survived prostate cancer or 
breast cancer may find no coverage for cancer illness in the future. 
That is unacceptable. That is not really health insurance. Health 
insurance isn't worth much if it is not going to cover your illness.

  So we say as part of health care reform they can no longer exclude 
people for preexisting conditions. They can no longer exclude people 
who live in certain parts of the country over those who live in other 
parts of the country. They cannot discriminate based on age or 
geography except within certain limitations. This gets health insurance 
to where it ought to be, not a game where the health insurance 
companies try to pick and choose the healthiest people in America and 
push everybody else over the cliff.
  We want everybody under the tent. We want folks to understand if they 
buy health insurance in America, it really will protect them.
  I was interviewed this morning on WMAY, a station in my hometown. Jim 
Leach asked me a question: Senator, if you don't allow insurance 
companies to discriminate against people with previous conditions, 
won't all our premiums go up?
  The honest answer is, if everybody has health insurance in America, 
premiums can go down. We are not just paying for our care, we are 
paying for the care of the uninsured. Uninsured people in America are 
not going to die on the street, thank God. They are going to show up in 
an emergency room and they are going to be cared for. When they can't 
pay their bills, that hospital, that doctor, will pass their medical 
charges through the system on to those of us who are paying for health 
  So if we bring everybody in with health insurance protection, this 
cost transfer is not going to happen. It is going to reduce the upward 
push for health insurance premiums in our country.
  Second, if we don't have basic rules about health insurance as to 
what they will cover, hold on tight. We found out in Illinois not too 
long ago there were actually health insurance companies--I remember 
this, as a person working in the Illinois General Assembly--there were 
actually health insurance companies that were selling maternity 
coverage to new mothers and their children but excluding the newborn 
baby for the first 30 days of life. Do you know why? Because if you 
have a premature infant or an infant with a real problem, those first 
30 days of medical care can be very expensive. So they just wrote it 
out of the policy.
  We said no way. As a matter of policy in Illinois, if they want to 
sell health insurance to cover a family or maternity benefits or cover 
children, they do it from the moment that child is born. We put it in 
the law.
  We can argue that is going to raise the cost of insurance. Maybe it 
did. But if health insurance is not there when we need it, frankly, it 
is not worth the cost. That is why we are doing this health care 
  There is one other aspect I want to mention, and that is small 
business. I guess small businesspeople know better than any other group 
what is happening because these businesses are struggling to survive in 
a recession. The men and women who own these businesses in good 
conscience are trying to provide for their employees. Yesterday we had 
a gentleman from Aberdeen, MD, who came to speak at a press conference. 
He owns a moving and storage company. His last name is Derbyshire. Mr. 
Derbyshire inherited this business from his father. He brought his son 
Garrett with him in the hopes his son would carry it on, I am sure. He 
always felt a special kinship and connection with his employees. He 
wants them to do good work and he wants them to be loyal and he wants 
them to know they are appreciated. So Mr. Derbyshire pays, as an 
employer, 85 percent of each individual employee's health care 
premiums--85 percent, and 75 percent of the family's. That is pretty 
good. I give him an A+ for caring and trying. But he told us he can't 
keep up with it. Health insurance premiums are going up so fast he 
doesn't know how long he can do it.
  I heard the same thing again. I heard it from the man who owns 
Starbucks--which, incidentally, offers health insurance to its 
employees--who told us not that long ago: We want Congress to do this. 
We think it is the right thing to do, even for part-time employees. But 
if the costs keep going up we will not be able to continue.
  That is the reality small businesses face. When we take a look at 
what they are facing, last year, only 49 percent of small businesses, 
three to nine workers, offered health insurance; 78 percent of 
businesses with 10 to 24 workers offered some type of health insurance. 
In contrast, 99 percent of businesses with more than 200 employees 
offer health insurance. It shows if you are operating close to the 
margin in a small business, and a little added expense pushes you over 
the edge, one of the first casualties is health insurance protection. 
It means, incidentally, the employees have no protection. It also means 
the openers of the business have to go out on the private market.
  What happens when they go out on the private market? For small 
businesses, their choices are limited. The overhead costs, 
administrative costs are dramatically higher than they are for the 
larger companies, and many of them cannot afford to do it.
  What we are trying to do is offer, through health care reform, a way 
for every person working, for a business, large and small, to have 
health insurance. Look at the uninsured people in America and we are 
going to find that most of them are not the poorest people in our 
country. They have Medicaid. Of course, they are not the luckiest 
people in the world like myself and other families who already

[[Page S8508]]

have health insurance. They are smack dab in the middle. They are the 
people working for small businesses, and their children and they are 
the ones who are uninsured.
  If we are going to fill the gaps in America and provide for coverage, 
that is the way we have to go. What are our goals? Our goals are simply 
stated. We want to have health care reform which helps the middle class 
in America. We want to make sure at the end of the day we have stable 
costs so people know what they can anticipate, so the costs will not 
run them out of health insurance coverage even if they lose a job. We 
want to provide a helping hand, for example, to lower income people so 
they can buy health insurance, giving them a tax break and giving them 
an incentive. We want to provide incentives and opportunities for 
businesses so they have the right to shop for the right health 
insurance coverage. We want to make sure they have stable coverage so 
these health insurance companies cannot waive the magic wand and all of 
a sudden they are not covered by health insurance anymore.
  Stable costs, stable coverage, and make sure at the end of the day we 
have quality care available for all Americans.
  One element we should be rewarding that the current system does not 
reward is preventive care.
  There are a lot of things we can do to reduce the cost of health care 
in America and improve the health of individuals and families. We need 
to create incentives for that to happen. There are ways to do that.
  Steve Burd is the CEO of Safeway and of Dominick's. He has a plan for 
his management employees where they can voluntarily sign up. They go 
through a health screening, they identify any risk that person might 
have: being overweight or diabetic or high blood pressure, high 
cholesterol, things of that nature, smoking. Then they create a little 
profile and say: What we would like you to do is move toward more 
fitness, better diet, monitoring your diabetes, monitoring your 
cholesterol and your blood pressure.
  As they show improvement, they earn cash incentives. In other words, 
they pay them extra money if they get healthier. What has happened to 
the health insurance costs at Safeway in the last 3 years? It has been 
flat. It has not increased. Across the board in other companies across 
America on average it is has gone up 38 percent. So they are on to 
  By incentivizing employees to get healthier, they not only have 
better lives but better health outcomes and lower costs for their 
company. Why is that not a national model? Why are we not doing that 
across the board saying we are going to move toward a healthier country 
so we have fewer health care costs?
  Second, we have to eliminate the incentives for piling on medical 
bills. Ever had a member of your family go to the hospital for a day or 
two or a week, then a month later they send you the bill? Were you 
amazed at how thick it was? You turn it page after page and say: My 
goodness, thank goodness I have health insurance--if you do.
  But if you do not, you look at the bottom line and say: I do not know 
how I am going to pay for these things. We reward doctors and hospitals 
for piling on every single line on the page. Every single line is a 
profitmaker, instead of saying the real goal is wellness and making 
certain people get well from diseases and illnesses. So we need to 
create a new incentive in the way we have health care in America, to 
take the best and brightest women and men who serve as our medical 
professionals working at these hospitals and give them the incentive 
for the best outcome.
  Senator Klobuchar from Minnesota was here a few moments ago, and she 
talked about the Mayo Clinic for which I have the highest regard and 
highest respect. This is a clinic which gets some of the best results 
in medicine in America at the lowest cost. How do they do it? What is 
so miraculous or magic up there in Rochester, MN?
  Well, they pay their physicians a salary. The physician does not make 
an extra buck if he orders an extra test. The physician, instead, looks 
at that patient and says: I think we need three specialists in this 
room right now, and let's see if we can work out a plan for wellness. 
They come together and they work it out. It is not a matter of how many 
lines there are on a page and final billing. It is a matter of that 
person going home well, and it works. They have reduced cost, and it 
happens across America. We have seen it many places such as the 
Cleveland Clinic, and so many other places have been noted as examples 
of centers of excellence. That is what I want to see in my State of 
Illinois. That is what every State and every Senator should be working 
  I will close by saying, let's not fall into the trap of this health 
care reform debate and let the buzzwords and the words that infuriate 
people stop us from a meaningful, honest debate. This has to be 
patient-centered health care not government-centered health care.
  We are not talking about rationing. We are talking about a rational 
health care system that is geared toward wellness and disease 
prevention. We have to make certain that at the end of the day we allow 
people to choose their own doctors and their own hospitals and their 
own health insurance plans and to keep the health insurance plan they 
have if they want to.
  We have to help small business provide the kind of health insurance 
coverage they want to have for themselves as owners and for their 
employees as well. At the end of the day, we can improve this system. 
It is the biggest single issue challenge Congress has faced in at least 
40 years, maybe in a much longer period of time, because it affects 
every single person in this country.
  We can do it. With the President's leadership and his commitment, we 
can get this right.
  I yield the floor, and I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Begich). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mrs. BOXER. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.