[Congressional Record Volume 155, Number 139 (Wednesday, September 30, 2009)]
[House]
[Pages H10402-H10406]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from New York (Mr. Weiner) is recognized 
for 60 minutes.
  Mr. WEINER. Mr. Speaker, before I proceed with the subject I want to 
talk about, I just want to summarize the last hour.
  Apparently ACORN is going to kidnap your children and drag them to 
Planned Parenthood where they're going to be forced to have national 
health care.
  That sounds pretty frightening. But if you were having trouble 
following that, Mr. Speaker, so were the rest of us.
  And for you, Mr. Speaker, and my colleagues and for anyone watching, 
if you're looking for a 1-hour screed about the ghosts that lurk in the 
closets of our government, I can't help you.
  But I would like to have a little bit of a conversation about the 
discussion that we're having around dining room tables and diners and 
church basements all throughout this country about the health care we 
provide Americans, how we pay for it, and what we should do to make it 
better. And to any of my Republican colleagues who are watching in 
their offices, who are watching off somewhere in the congressional 
campus, and this is kind of quiet at this hour, I am interested in 
having a real discussion and a real debate.
  There are things that we disagree with. There are philosophical 
schisms that have emerged in this. But, frankly, a lot of the debate, 
unfortunately, has been too much like the last hour, which is just 
something bordering on nonsense.
  But let me just start with the notion that we're really trying to 
solve with health care three problems, two of which are relatively easy 
to solve and one of which is very difficult to solve.
  The first problem we're trying to solve is that there are a lot of 
people that don't have health care. Well, I shouldn't say that. There 
are a lot of people that don't have health insurance. They get health 
care. Everyone in this country, everyone who's got insurance, not 
insurance, documented, undocumented, old, young get health care. And 
what I mean by that is if someone right now outside the steps of this 
Capitol falls down with a stroke, we're going to come and there's going 
to be an ambulance that's going to rush to get them. They're going to 
take them to an emergency room. A doctor is going to do everything 
medically possible to revive them and to make them healthy. The only 
question is, How do we pay for that service?
  If you have health insurance, you pay for it one way. If you have 
Medicare or Medicaid, you pay for it another way. If you pay for it out 
of your own pocket, you pay for it a third way. But if you have no 
health insurance at all, we the taxpayer by and large pay that bill. 
And it's a lot of money. It's a relatively small number of people who 
are uninsured, but the expenses that they have are very, very high 
because when you go into a hospital emergency room for care, that is 
usually pretty expensive care. And it might not come directly back to 
us in taxes, although a lot of it does.
  In New York City, for example, about $2 billion each and every year 
we pay for the uninsured that come into our emergency rooms. Some of it 
is paid for by everyone else that has health insurance paying higher 
premiums, but a lot of it is just passed along to the hospitals and 
doctors and saying, hey, you foot the bill. As a result, in my home 
county, there are three fewer hospitals than there were just a year 
ago. It's an unsustainable dynamic that the people who are not insured, 
frankly, if they can afford to pay, well, in some cases they do, but in 
a lot of cases, they pass along the expense to us.
  But that problem is pretty easy to solve. What do you do? You give 
them some money or you give them some tax benefit or you give them some 
tax credit and you say go out and go shopping for health insurance. Go 
buy some. We'll require you to do it. You go out and buy some.
  It gets a little bit complicated in how much you provide the subsidy, 
and it does get complicated when you're trying to figure out will they 
be able to afford that health insurance plan. And that's where the 
public option discussion comes in, but I will get to that in a moment. 
But that problem is a relatively easy one to solve. As some of my 
colleagues have pointed out, it's only 10 percent of the American 
public. How hard can it be?
  The second problem is also relatively easy to solve, but it's 
important: for all of us who have health insurance, making sure our 
health insurance company treats us relatively well. When we need care, 
do we get it? Do we get dropped because we have preexisting conditions? 
When they're deciding how to set a price for it, do they price it in an 
unfair way where effectively we're locked out of the market? That too 
is relatively easy to solve, and I think there is some agreement.
  Look, no one should be able to drop someone for preexisting 
conditions, and now that we in the Democratic Party are in charge of 
this Chamber, we're going to pass something to fix that. Those things 
are relatively easy. In fact, since insurance companies are regulated 
in all 50 States, a lot of States have tried to do those things, some 
with more effect than others.
  But the third problem, and it's the mother of all problems, is the 
overall cost to the system. The overall cost to those of us who have 
insurance, the overall cost to those of us who are taxpayers is getting 
so large that it's drowning everything else in the economy. And the 
question is, How do you solve that problem?
  Now, what has been suggested by the President and the majority party 
in Congress through the various committees is essentially what you try 
to do is if you require everyone to get insurance, meaning insurance 
companies will have more people to cover, that hopefully what that will 
mean is they'll have more money coming in from lower-cost people, 
meaning people that don't have a lot of illnesses, and that the 
insurance companies will be magnanimous and they'll lower their prices. 
That's basically what the argument is. Maybe it's right. Maybe that's 
what will happen here.
  Now, I believe, and what I would like to devote a little time to 
today, is I believe that we are using a bank shot when we should go 
directly at the problem. I say we are using a bank shot because we are 
basing all of this on private insurance companies to help us.

[[Page H10403]]

  I ask you, ladies and gentlemen, what is it that health insurance 
companies do? They don't provide checkups. They don't provide clinical 
services. They certainly don't operate on you. What do they do? We know 
they take your money. They take my money. We know they take the money 
from your employers. But then what do they do? Unlike any other 
insurance plan, they don't apportion risk because they don't cover 
anyone over 65. All of those people are on Medicare. They price a lot 
of people out of the market by saying to people like those who are of 
my father's age when he retired, we're going to charge you $15,000 or 
$16,000 for a policy. So the question becomes, What is it that 
insurance companies do?
  What they do is they make money. They take money out of your pocket, 
give it to doctors, and along the way they take some money for 
themselves. How much? Up to 30 percent. And the question that many of 
us are asking in the context of this debate is, Why do it that way? Why 
not try something different? Why not try to say if you're going to take 
your money and give it to your doctors and give it to your insurance 
companies, why not do it a little bit more directly? Why not do it the 
way we fund, I don't know, the fire department or the department of 
sanitation in your town? Why not treat it as if it's a service?
  Frankly, the fire department model is a pretty good one. If you think 
about it, it's very similar. You don't need the fire department every 
day. Day in and day out, you go without needing the fire department to 
be there. But when it's there, you really want it to be there for you. 
You need it. You can't put out the fire yourself. You need brave men 
and women of your local fire department, and maybe they're volunteers, 
to come to your home and put out your fire. So we all put in money into 
the fire department hoping that it won't be there; and when it does, we 
understand and it's a service that we willingly pay for.
  But you don't have to fantasize what it would be like in health care 
to have a government-run health care plan. And when I say ``government 
run,'' to some degree I am borrowing the language of our opponents 
because when I say ``government run,'' I mean really government running 
the reimbursement system. We do have some experience with that and it's 
called Medicare.
  Now, people have different views of Medicare. People either love it 
or they like it a lot or they think, oh, my goodness, it's never going 
to be there for me or it's unsustainable or it's growing broke. In a 
way both sides are right, both groups are right about that. Medicare 
has been an exquisite model of efficient government care and government 
services for 44 years. It didn't start out being all that much of a 
bipartisan program, but now it is, as you see from my Republican 
friends who thump their chests about how they are trying to defend 
Medicare. But the problem is at the very same time they say, But I'm 
against anything that's government run. I'm not quite sure I see the 
disconnect.

                              {time}  1930

  Now some of them argue, but, wait a minute. Isn't Medicare on an 
unsustainable financial track? No doubt about it. All health care is on 
an unsustainable financial track. I'm going to borrow some of the 
charts that have been used previously to give you a sense of what that 
means. This is the average health insurance premiums from 1999 to 2008. 
It went from about $5,800 to $13,000 from 1999 to 2008, in 7 years. It 
essentially doubled. That is unsustainable. And this is private 
insurance.
  Now, it is true that Medicare is also seeing that type of strain. 
Why? Well to some degree, it is a victim of its own success. Today the 
average life expectancy of someone is about 10 years longer than it was 
44 years ago when Medicare was created. And by the way, Mr. Speaker, 
you're not getting those 10 years when you're a teenager. You get them 
at the end of your life. So that is adding to a lot of expense. 
Technology has added to a lot of expense. And there's a lot of things 
that we do in Medicare that don't make a lot of sense that we could do 
to save money. A lot of them I hope we are going to do in our national 
health care fix that we are going to do. But one of the things you can 
absolutely say is that no money is going for profits. Very little money 
is going for overhead, only about 3.5 percent, according to a Rand 
study, compared to 30 percent for health care for health insurance 
companies.
  So the question has to be, what are the benefits that we are getting 
from those private insurance companies? Well, my colleagues frequently 
say, it gets you competition. Really. Competition? Explain to me how 
competition works in the health care business. If I fall down here, not 
to keep using morbid examples, but if I fall down and I have an 
appendicitis attack right now and I have to get my appendix replaced, 
tell me about competition. Do I get to shop around to see maybe I will 
have a liver or a spleen instead? Of course not. Do I get to say, I'm 
not going to get my appendix done right now, I'm going to wait and I'm 
going to get it done in December when I hear they go on sale? No. In 
fact, I also can't go out and say, wait a few years, don't operate on 
me. I'm going to go to medical school and learn how to do it myself in 
my garage to take out my appendix.
  The notion of competition is further folly in that for most people 
that have health insurance at their work, they don't have a choice of 
plans. The employer comes in and says, on the floor of the warehouse, 
they say, guys, gather around, you are going to get Oxford or you're 
going to get Aetna. That's our plan. I'm going to pay 60 percent, 
you're going to pay 40, that's it. You don't get to say, no, I'm going 
to do it different. I'm going to go to Blue Cross instead. There is not 
real effective competition in that context as well because most people 
get their insurance through their work.
  Remember something, the basic element of competition does exist 
within Medicare in a very important way. Patients have their choice of 
what doctor to go to. They have their choice of what hospital, what 
clinician to go to. They have absolute choice. So we are right back to 
where we started that both private insurance and Medicare both have 
financing problems. The private insurance, as I said, is worse. They 
both have some elements of choice, Medicare more choice than the 
private insurance companies. But the difference, and this is that third 
problem we are trying to solve, the difference is how much private 
insurance companies take out of the pot for their shareholders, for 
advertisements, for overhead. It's an enormous amount. And we should 
want it back.
  Now some have suggested, and I keep trying my best to do the other 
side of the argument, since none of my colleagues on the other side of 
this argument have taken me up on my offer to come down and discuss it 
with us tonight, but some have said, well, those insurance companies, 
the money that they are taking, they employ a lot of people, their 
shareholders have a right to take that money from the taxpayer, to take 
that money from patients. That might be an argument that you make at a 
shareholders' meeting, but it shouldn't be an argument you make on the 
floor of Congress. We shouldn't be standing up fighting for 
shareholders.
  I guess the equivalent would be in the 1980s when we discovered we 
were paying $700 for toilet seats in the Department of Defense, I guess 
I would have heard my colleagues stand up and say, yes, but there are 
many hardworking people making those toilet seats. You can't take that 
money away from them. Of course not. We said, you find a way to get a 
$10 toilet seat like everybody else because we are here fighting for 
the taxpayers' money, and we are here fighting to improve the lot of 
patients.
  So I believe that where we have to start is taking an example of 
something that worked, which is Medicare. Now Medicare, as you all 
know, begins when you turn 65. So the Speaker has about another 30 
years before he has to worry about it. But frankly, I don't understand 
what the magic is about the 65th birthday that makes it a plan that 
works. Ninety-six percent, every year we do a survey of people on 
Medicare. We ask them to grade the care that they get, the efficiency 
of the care, the quality of the care. They gave it a 96 this year, 96 
percent. By the way, we also asked the contractors. We always hear how 
terrible Medicare is for providers. We also ask each year, CMS

[[Page H10404]]

asks the providers, they call them contractors, the doctors and the 
hospitals, they gave them a 4.5 out of 6. So basically both elements 
are pretty happy with it. We started at age 65.

  Try this little experiment next time you go to the supermarket. Tap 
someone on the shoulder who looks like they are 55 or 60 and say, would 
you like to have Medicare now when you're 55 or 60? They will say, 
heck, yeah. Because those are the people for whom health insurance is 
the most expensive. Many of them have trouble getting it. Those are the 
people more likely to be laid off in this economy, that kind of in 
between group. Yet we don't offer it to them. Why? We have a system 
that works, Medicare, and yet instead of trying to figure out a way to 
take a system that works and expand it to more people, we say, no, it 
has got to be 65. Why don't we provide Medicare for those that are like 
21 to 25 who are just off their parents plan or just out of college? 
Those are people that we would like to have covered. Those are the so-
called invincibles. Those are the people who have trouble finding 
health care. Why don't we provide them with Medicare? Now, some have 
suggested oh, wait a minute, you're taking over health care, socialized 
medicine. Well, putting aside for a minute that socialism has a 
meaning, and it means that government controls the means of production 
and no one is suggesting that, the doctors are still going to be the 
doctors, the hospitals are still going to be the hospitals, if you take 
a look at that argument, you realize that, I don't know, what do you 
think, Mr. Speaker, 50 percent of this place has Medicare? Sixty? I 
don't see them complaining. They don't seem to mind socialized medicine 
when they are getting it. I don't hear anyone saying, we have heard a 
lot in this discussion, well, how come Members of Congress don't take 
the public plan? They already do have the public plan. They have got 
Medicare. And by the way, when I turn 65, sign me up. It's going to be 
a while, Mr. Speaker, so don't rush me. But look, the fact is we have a 
model of something that works.
  Now, as I said, and I want to stipulate to this, that it's expensive. 
And we need to contain that cost. But this brings us to the ideas about 
how you do it. And I will say this at the risk of antagonizing any of 
my colleagues or breaching the rules--I just wanted to see if the 
Parliamentarian would perk up at the suggestion I might be breaching 
the rules. But my Republican colleagues have not been honest in trying 
to deal with the cost of the argument. They have said a couple of 
things repeatedly. They say, oh, if only we had tort reform. We have 
tort caps in 46 of the 50 States. In some of the States that have the 
toughest cap, you have got the greatest rates of increases in health 
insurance and the malpractice insurance. Why? Well, it's obvious why. 
The health insurance companies lobby for the caps, and then they keep 
the money. They don't pass it along to us. And their shareholders 
cheer. Tort reform they say. Well, we asked them, by the way, we said 
to the Congressional Budget Office, the CBO, we said what would happen 
if you overnight can reduce 30 percent of all tort claims? What would 
happen? They said you get some savings, .4 percent. And we went back 
and said how can this be if you reduce 30 percent of all the tort 
claims, you don't do better than that? And they said to us--These are 
propeller heads. They are pencil pushers. They are not politicians. 
They said, yes, because we looked at the different States, and what did 
we find out? We find out that when you get caps, the insurance 
companies keep the money. So that's one thing they said about cost 
containment, and that clearly doesn't prove to be right.
  And then they said something else that's interesting. They said, why 
don't we let all health insurance companies compete in every other 
market, essentially adding to competition? Now this is an interesting 
one because it kind of argues for the public option in an odd way, but 
let's take it where it goes. Now, first of all, let me make it clear. 
There is a reason that a health insurance company in Maine doesn't come 
in and offer a health insurance policy in New York, because the first 
thing they have to do is develop their network of doctors in New York. 
That is very expensive and very difficult. But New York has made it 
very clear that they are willing, more than happy, there are no 
applications pending for someone who wants to come in and offer 
insurance. And that is true of most of the States. Now, why is it you 
need to apply to a State? This is where my Republican friends tie 
themselves into a little bit of an intellectual knot. Insurance is 
regulated by the 50 various States. And why is that? Because, and this 
is a place where as much as I'm critical of insurance companies, I kind 
of agree. Health insurance companies say, listen, we need to be able to 
do things that might be deemed anticompetitive under other laws. We 
need an exemption from the antitrust laws so that we can share 
information across State lines and across companies, essentially--it's 
too strong a word, but I'll use it anyway--essentially collude, share 
information about patients. You don't want somebody who gets into a car 
accident in New Mexico being able to hide it by going to New Jersey. So 
each and every State, since it's not regulated federally, it's not 
interstate commerce technically, each individual State has it, so each 
individual State has their own process for allowing insurance companies 
to come in. Do you know what? Nobody is saying no. You look at the 50 
State insurance commissioners, nobody is saying, oh, I'm getting 
overrun with applications to provide health care in Idaho. No. They are 
not doing that because insurance companies have no real interest in 
competing on price. So once all the customers are basically locked up, 
there is no interest in coming in. But I guess the logical extension of 
the argument for people who want to have that type of competition is to 
take away the antitrust exemption from insurance companies. You can do 
that. I don't think that your patrons, the insurance industry, who 
provide so much funding for campaigns and some of my colleagues, would 
be very happy about that though.

  So what is it that the President proposes? And what is it that H.R. 
3200 proposes? It proposes that for some Americans, not many to be 
honest, some Americans, meaning those that don't have insurance through 
their work, are not working but are not eligible for Medicaid, who are 
individuals, who are just looking to get insurance but are not covered, 
that is a relatively small group of people, remember, 45 percent or so 
of all Americans have either Medicare, Medicaid, health care from the 
Department of Defense, the Department of Veterans Affairs, or the 
Bureau of Indian Affairs, you have got about 55 to 60 percent who have 
health care through private insurance, so you're talking 10 percent, 5 
percent, 8 percent, who are going to then be able to, we're going to 
give them a tax benefit, they're going to then go shopping. But in 
order to make sure that there is some competition so that the rate of 
health insurance that they're buying doesn't keep going up, we're going 
to have a public plan like Medicare that is going to be introduced for 
those people.
  Now, it's anticipated that maybe a third of all of those people at 
most would go into the public plan. So you have a tiny sliver if you 
are covered by insurance at your work. Theoretically you can say to 
your employer, keep your money, keep your money, I'm going to absorb 
all the costs and go try to shop for the public option. But that is not 
going to realistically happen according to CBO. If you have your own 
insurance policy, if you have Medicare, you're not going to be able to 
do it. But you're going to be able to get something resembling a choice 
if you're one of those people. And the argument that H.R. 3200, which 
is the bill we have all been discussing, and an argument that President 
Obama made when he spoke to us before Congress, is that if you have 
that element of choice, you will have low overhead, you won't be 
advertised, you won't be given bonuses, you won't be taking money out 
for shareholders, and that people, that company, that public option 
will hold down costs.
  Now in a strange way, both proponents of the public option and 
opponents of the public option argue for the Weiner plan, argue for 
single payer. And I will tell you why. People who argue for it say it's 
going to be an effective way to hold down costs because people are 
going to choose that public plan, because they are going to like the 
low prices, the low overhead and the

[[Page H10405]]

like. People who are opposed to it say, no, we are opposed to it 
because people are going to choose that plan. And if they do, private 
insurance companies won't be able to get those customers. They won't be 
able to compete. But in both cases, they are saying the same thing. 
They are saying that citizens are going to go to the public option. 
They are going to go to the Medicare for everyone else, whatever we are 
going to call it.
  So the question gets begged, why not just go there directly? Why give 
people tax benefits that they can go buy in the private market to take 
30 percent off the top? Why not just say let's expand a program like 
Medicare? Let's find ways to get cost savings for Medicare by doing 
things like not paying $900 for a slip and fall for a night in a 
hospital for a senior citizen, but maybe $30 to build a handrail next 
to their shower. Why spend an enormous amount of money in the very 
final days of life and do nothing in the early days to try to get 
people living a better life, living a healthier life?

                              {time}  1945

  Mr. Speaker, so that the question comes back to how you get the 
savings, and it also comes back to who's accountable for those savings.
  Now, I believe we've got to get savings in Medicaid. We've got to get 
savings in Medicare. We've got to get savings. Frankly, this is not 
just something that has to be done by the private insurance companies. 
We have to find savings because, frankly, as the President said when he 
stood here, virtually our entire deficit right now is health care 
costs, and the health care costs that are paid for by the taxpayer are 
going up.
  And people say, well, why is that happening? Well, everyone watching 
this broadcast tonight is not only paying their premiums, not only 
paying their copayments, but they're paying taxes that are supporting 
the city workers in your town for health care. You're supporting the 
State workers, the Federal workers, all of the retirees. You're paying 
an increasing amount because that health care inflation is coming back 
to you in a lot of ways.
  I had someone stand up at a town hall meeting--and I had 13 of them I 
think over the August recess--come up to me and he says, well, 
Congressman, why can't you give all of the uninsured the same plan you 
have? I don't think the person who made that suggestion realizes he's 
my employer. He's putting in the 70 percent I think for the health care 
plan that I and every other Federal employee gets. So you might not see 
that you're paying it, but you're paying it, and we need to turn that 
cost down.
  But before I yield back the time, I do want to try to address some of 
the kind of visceral concerns that the opponents to this health care 
plan have had. One I've already touched upon but I'll do a little bit 
more now, and that is the notion, you know, that it's going to be a 
government-run program, and by definition, government-run programs are 
not good programs. You know, there are some good government programs, 
and there are some not-so-good government programs.
  I think Social Security is a program that worked. You know, people 
talk how we're falling off a demographic cliff that's unsustainable. 
Baloney. It's got giant surpluses. It's the only part of the budget 
right now that does have giant surplus.
  I think Medicare has worked. I think that people haven't gotten rich 
off it, but it took a group of people, seniors, who had about a 28 
percent poverty rate and lifted them to the point now that we have 
single digits, that it's so popular now that the Chair of the 
Republican national party put out a couple of weeks ago the Republican 
plan to protect Medicare, which I thought was unintentionally ironic 
because at the same time he was lamenting the growth of government-
funded health care.
  There are some maybe government programs that aren't so good. This 
one works. And there's a certain level of phoniness about going home to 
our districts, as I know opponents of this legislation do, and they 
rail against government-funded plans, the government-administered 
plans, and then embrace Medicare.
  But listen to what the choice is. The choice is health insurance 
companies. Now, some of my colleagues have come to the floor with 
clever and creative boxes showing different where your money goes, 
where you go to try to show how bureaucratic health care is. Well, this 
is the present. This is the way private insurance operates today. You 
think it's not bureaucratic?
  You know, you've got consumers, and then they're passing through 
their costs to employers who then have copayments. Then they have to go 
out and try to figure up--by the way, don't forget about this. This 
system that we right now, it's employers have to go out and get health 
insurance. Actually, let me spend a moment on this.
  You know, why is it that we have health care that's provided by our 
employer? Where did that come from? Why should a shoe store on one side 
of Queens Boulevard in my district have a different obligation to its 
workers than one on the other side? Why should they compete based on 
what health care plan they have? I mean, that's what happened. If Joe's 
shoe store on one side decides, you know what, I want to do the right 
thing and cover my employees; I'm going to put, let's say, $7,000 an 
employee into the till--yet, he's competing against the guy across the 
street who says, wait a minute, let me see about this; no, I'm going to 
provide no insurance; I'm going to send them to the neighborhood 
emergency room for their health care, but since I'm saying $7,000 an 
employee, I'm going to cut the cost of my shoes by 15 percent. How is 
that fair?
  Medicare says we're not going to do it based on employers, and that's 
what, frankly, I think we should do with all health care. Ask your 
neighborhood employer who's wrestling with trying to keep a business 
afloat whether having to provide health care is a bureaucratic headache 
for them. It ain't for Medicare. Medicare's a 4 percent overhead. The 
doctors say it's efficient; patients say it's efficient.

  Getting back to this, this is the way private insurance is modeled 
right now because they've got to go through all the rigamarole. They've 
got to go negotiate with hospitals and communities and doctors. They 
deal with drug companies. They take a couple of dollars off the top 
there as well. Then they're dealing with the sellers of goods, and 
you've got administration of costs, then there's profit.
  Well, here's what Medicare looks like on a chart. Patients get health 
care, the patients pay taxes, and then administrators, Medicare pays 
the doctors. That's it, over and done with, pretty simple. The only 
thing simpler is taking money out of your own pocket and giving it to 
your doctors which, frankly, Medicare being able to take this pool of 
people together has been able to do much more efficiently than you or I 
could do.
  You know, another thing to keep in mind as we take a look at this is 
that there's a lot of money being spent on health care that we don't 
see. If you do a single payer plan like I have suggested here, no 
longer will you have cities and States being left holding the bag for 
unreimbursed expenses? What happened to my colleagues lamenting the 
unfunded mandate? Health care is the mother of all unfunded mandates 
because our States and our cities and our businesses all have to pay 
because you're doing nothing. That's the ultimate unfunded mandate.
  So, hopefully, what we are going to do here as I conclude, hopefully 
what we are going to do here is try to come up with a plan that does 
provide additional choices for people that don't have choices right 
now: the uninsured. We're going to try to improve the circumstances 
that people that have private insurance find themselves under, and 
we're going to try to do something to introduce some element of 
competition to hold down costs.
  But I tell you, I don't think that that's the right way to go, and 
I'm going to offer a different plan when we're on this debate in the 
next month or so. And I'm going to offer legislation, a modified 
version of H.R. 676 offered by Congressman Conyers with many 
cosponsors, that says, you know what, we're going to take a plan like 
Medicare and we're going to offer it to all America. We're going to 
take their payroll taxes and the taxes they pay, and we're going to 
fund the system. We're not going to do a backdoor way. You're not going 
to have to dump all your city and State taxes. We're going to say, you 
know what, we're going to

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do it Federally. We're not going to do it based on employer. It's not 
going to be just based on the luck of the draw; hey, I got lucky, I 
didn't get born with asthma. That's not the way we're going to choose 
who's going to get health care.
  We're going to take hospitals and we're going to fund them globally. 
We're not going to incentivize them to run up the bill. We're going to 
say here is your area, this is the number of people you have in it, 
this is the number of uninsured people you have in it, this is the 
number of seniors you have in it, this is the number of people who have 
higher needs; here's your budget. You come in under budget, you keep 
the extra money.
  Doctors are going to be the same way Medicare is. Patient gets to 
choose, you come in, you provide the service. And if you think we can't 
afford to pay for it, this is an old chart from a couple of years ago. 
$2.2 trillion we're paying for health care in this country, $2.2 
trillion. It's actually $2.5 trillion today. This is the dreaded 
socialized part: Medicare, Medicaid, DOD. So essentially this is what 
it would like for more Americans. By the way, you're paying this out-
of-pocket number, and you're paying about, let's say, let's round it, 
$200 billion in profits of this guy, for your private insurance 
companies.
  And what we're saying is don't do it that way anymore. Other 
countries don't do it that way, but put aside other countries. When you 
hear people come to the floor of this Congress and say, oh, you want to 
make a system like England, you want to make a system like Canada? No, 
I want to make a system like United States of America where we tried 
something 44 years ago that has been an abiding success and that's 
Medicare.
  I want to try that. I want to try that plan that--I don't know, I 
really do have to get the exact number. It would be a good thing to 
get--that half my colleagues have. A third of my colleagues have 
Medicare. If it's good enough for Congress, why isn't it good enough if 
you're 55 or if you're 60 or if you're 45?
  That's the kind of plan that we should have, and if you think we 
can't afford to do it for less than $2.5 trillion, you're wrong. We 
can, because the present system is completely unsustainable.
  And so the question is not whether we're going to do something. It's 
kind of like Buddhism. It's not whether you're going to have change but 
what type of change it's going to be. We can continue along this arc--
it's funny, the 30 Something Group's charts aren't nearly as good as 
mine--but this arc here that says our national health expenditures are 
going to keep going up and up, they actually have a better one here. 
Here it is. Share of our GDP, are we going to let it get to 20 percent 
of our GDP? How about 50 percent? Sixty percent? How far are we going 
to let it continue to grow?

  The answer isn't whether we're going to do something; it's what we're 
going to do and when. Well, the what we should do is take a system like 
Medicare that is efficient, that is well-liked, that is understood, 
that is simple, and extend it to more Americans.
  What we're not going to do, what we're not going to do is follow the 
advice and counsel of my friends on the other side who for the hour 
preceding mine went on some screed about ACORN, you know, kidnapping, 
Planned Parenthood, babies, and bringing them into Obama-funded death 
camps or something. We're not going to have a conversation like that. I 
mean, you can keep doing it. It didn't stop you for the last 6 years. I 
guess you've got to do it and you've got to feed the beast of the talk 
radio and everything else, but the adults of this institution and 
President Obama and the Senate, we're going to try to solve this 
problem because that's what we get paid to do.
  And we have the luxury in this body of laying down our head tonight 
with pretty good insurance, Medicare many of my colleagues have, and I 
see no reason why all Americans shouldn't have that, they shouldn't 
have what so many Members of Congress have.

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