[Congressional Record Volume 155, Number 139 (Wednesday, September 30, 2009)]
[Senate]
[Pages S9949-S9952]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. DURBIN. Mr. President, I would like to debate the Republican plan 
for reforming health care. I would like to see the Republican plan for 
reforming health care. I would like to know what they stand for when it 
comes to reforming health care. They have been given adequate 
opportunity--
  Mr. ALEXANDER. Will the Democratic leader yield?
  Mr. DURBIN. Regular order, please.
  The ACTING PRESIDENT pro tempore. The Senator from Illinois has the 
floor.
  Mr. ALEXANDER. He asked me what our plan is. I would be glad to tell 
him.
  Mr. DURBIN. Mr. President, they have been given ample opportunity, to 
the point where they offered 160 amendments which were adopted in the 
HELP Committee when we were debating the bill, 160 Republican 
amendments. So they brought in their ideas, we put them in the bill, 
and then when the bill came up for final passage, not one Republican 
would vote for it. Over and over again, all they can do is criticize. 
They are just upset with the idea of changing the health care system.
  I am particularly amused with the defense of Medicare by Republicans. 
This is a historic change for a party that used to call it socialized 
medicine, a party that said: Keep the government out of health care, 
when we created Medicare. Now they are coming to the defense of 
Medicare. The reason they are is because 45 million Americans count on 
Medicare every single day; 45 million seniors know that without 
Medicare, their family savings would be in danger if they had a 
catastrophic illness after they have reached retirement; 45 million 
Americans who know the fact that for the last 40 years we have improved 
the longevity, the life expectancy of seniors because of Medicare.
  Let me tell the Senate what their real agenda is. When Republicans 
come here and talk about Medicare, it is all about health insurance 
companies. It is all about the health insurance companies that are 
turning down Americans when they want to have their basic coverage for 
medical care. It is all about health insurance companies that continue 
to raise the cost of their product and exclude people from coverage. It 
is all about health insurance companies that are seeing some of the 
greatest profits on Wall Street.
  So how do you link up these two, Medicare and health insurance 
companies? In a program called Medicare Advantage. Pay close attention 
to this program. Here is what the health insurance companies said to 
the Republicans several years ago. They said: The government doesn't 
know how to run health care. The government doesn't know how to run 
Medicare. We, the private health insurance companies, will show you how 
to do this. Let us offer Medicare benefits. We will call it Medicare 
Advantage and let the people decide, let seniors decide if they want to 
buy the private health insurance plan for Medicare or if they want to 
stay in the traditional government-administered Medicare.
  About one out of four seniors decided to buy into the private health 
insurance plans for Medicare called Medicare Advantage. In fact, across 
America, more than 10 million Americans have enrolled in Medicare 
Advantage. Since 2003, the number of Medicare beneficiaries enrolled in 
private plans has nearly doubled, from 5.3 million to the 10.2 million 
I mentioned earlier. It is higher in urban areas than it is in rural 
areas, higher in some parts of the country than in others.
  How did the experiment work? How did it work when the health 
insurance companies said: We can do it better than the government when 
it comes to Medicare? They failed. Not by my estimation, by MedPAC, a 
group that has stepped back and has said: Well, the premiums they are 
charging per Medicare recipient are higher than what people would be 
paying under Medicare--14 percent higher.
  So these private health insurance companies have a sweet deal: 10 
million Americans buying their private health plans instead of 
traditional Medicare, and they are overcharging them by 14 percent. Who 
pays the 14 percent? All the rest of Medicare recipients. The money is 
taken out of the Medicare Program. It means Medicare solvency is 
challenged because private health insurance companies have failed under 
Medicare Advantage.
  President Obama and Members of Congress have said: This subsidy to 
private health insurance companies to try to offer Medicare at a lower 
cost, which has failed, has to come to an end. If it comes to an end, 
what is it worth over 10 years? It is $180 billion. So when we say we 
are taking $180 billion in savings in Medicare, we are closing down the 
failed experiment by private health insurance companies to offer 
Medicare as a private health insurance plan.
  The Republicans are coming and complaining: Oh, they are taking money 
out of Medicare. Yes, we are. We are taking the subsidies to the 
private health insurance companies out of Medicare. So their complaints 
are basically complaints in defense of private health insurance 
companies. They can make all the case they want about private health 
insurance companies. I will take the case to the American people that 
private health insurance companies need to treat Americans a heck of a 
lot better than they are right now.

[[Page S9950]]

  You know what I am talking about. Preexisting conditions. If you are 
unfortunate and have a preexisting condition and turn in a claim to a 
health insurance company, get ready for a battle. First, you are going 
to battle some faceless clerk in Omaha, NE; and the next thing is going 
to be your doctor calling that office saying: For goodness sakes, you 
are not going to cover this procedure, this surgery this person needs 
under health insurance?
  That battle takes place every single day, thousands of times, when 
private health insurance companies say no or they wait until you are 
sick to cancel you or they will not let you take your health insurance 
from one job to another. Over and over again, people across America 
know what the private health insurance companies are up to.
  Because, unfortunately, the Republicans do not have a plan in terms 
of health care reform, because they will not join us in trying to put 
one together, President Obama has reached out to them, we have reached 
out to them. We have asked them to join us in this conversation: Join 
us in this debate. They have refused to do it. They will not be part of 
it.
  Only one Republican, a Senator from the State of Maine on the Senate 
Finance Committee, Senator Snowe, is keeping an open mind on this. I 
appreciate that. All Americans should. She said: I want to see this 
final product. I am not ruling out voting for it. Senator Baucus, the 
chairman of the Finance Committee, spent months, literally months, in a 
room with three of our colleagues--Senator Snowe was one, Senator Enzi 
of Wyoming, Senator Grassley of Iowa--trying to come up with a 
bipartisan approach, and eventually the Republicans walked out of the 
room but for Senator Snowe.
  It is not as if we have not tried to engage them. But for reasons I 
cannot explain, they do not want to be part of this conversation about 
the future of health care in America. They come down to one or two 
issues or one or two theories, and then they take a walk.
  Democrats want to protect consumers from health insurance companies 
and the abuses they have heaped on the American people. Unfortunately, 
whether it is Medicare Advantage or other health insurance reforms, the 
Republicans will not join us. They are on the side of the health 
insurance companies, not on the side of change to protect Americans 
from the abuses of health insurance companies.
  We want to strengthen Medicare. We want to maintain the benefits, 
even expand them, to the point where, for example, we close the 
doughnut hole in the Medicare prescription program. That is a term of 
art that has come about on Capitol Hill that basically reflects the 
fact that if you are under Medicare Part D, having your prescriptions 
paid for, and you have a lot of bills, you could reach a point during 
the course of the year where there is a gap, a percent where you have 
to put all the money in out of your own pocket, and then, after you 
spend up to another level, you get coverage again. They call it the 
doughnut hole. We would like to fill it. It is an uncertainty for 
seniors that needs to be taken care of.
  We also would like to make sure seniors have preventive care, so 
whether they need a mammogram or a colonoscopy or some sort of 
procedure to find out if there is an illness at an early point, they 
can get it to be able to deal with it effectively. That ought to be 
part of it as well. But instead, what did we run into?
  Senator Johnny Isakson is from Georgia. He is a conservative 
Republican and proud of it. He came into the HELP Committee, and here 
is what he said: We think we ought to provide, under our insurance 
plans, that patients can have a confidential meeting with their doctor 
to discuss one of the most delicate and difficult topics we can 
consider--end of life care--so the doctor would know: What is your 
wish, what do you want to have happen if you find yourself in a long-
term illness and some important decisions have to be made about 
extraordinary care.
  Senator Isakson of Georgia said: I think we ought to cover that under 
health insurance. We ought to at least give one appointment so the 
doctor and patient can discuss the possibilities and so the doctor 
knows what the patient feels will give peace of mind on both sides, 
should that terrible day ever come.
  Do you know what happened to Senator Isakson's idea of that meeting? 
It turned into a Republican diatribe against death panels: Somebody is 
going to pull the plug on grandma. In fact, one of the Republican 
Congressmen took to the floor of the House of Representatives and 
actually said: This is a death panel. Sarah Palin, former Governor of 
Alaska, used that phrase too.
  I can tell you Senator Isakson did not propose that. What he proposed 
is a sensible, commonsense approach. But it shows you the extremes in 
fear that are being spread by some who do not want to discuss health 
care in an honest and open way.
  We want to make sure people are happy with the insurance they have. 
If they are, they can keep it. Republicans would put people's insurance 
at risk by allowing insurance companies to drop people's coverage or 
put artificial limits on what they will be paid when someone gets sick. 
We want to make sure insurance is affordable and available for people 
who have no coverage or if you lose your job or change your job or have 
a preexisting condition.
  I am afraid the Republicans want to maintain the status quo. The 
status quo is unsustainable. We cannot continue the health care system 
we have today. Let me give you one statistic which tells the story 
about the cost and, I guess, the danger when it comes to health care. 
In the last few years, the percentage of Americans filing for personal 
bankruptcy because of medical bills has doubled from 31 percent to 62 
percent. That is almost 2 out of every 3 people filing for bankruptcy 
in America are filing for it because of medical bills.

  I think an even more troubling statistic: 78 percent of those filing 
for bankruptcy because of medical bills have health insurance, health 
insurance that failed them, health insurance that was not there when 
they needed catastrophic protection, health insurance that was denied 
them because of a preexisting condition, health insurance that was not 
there at the moment when they needed it the most.
  That is the reality. To ignore that and say, as some have said on the 
Republican side of the aisle: We have to go slow, we have to take this 
slowly and decide whether we need change. We need change. We have asked 
the Republicans to join us in this conversation about change. They have 
not done it.
  Senator Bennett from Utah is on the floor. He and Senator Wyden are 
exploring an approach to health care which has a few sponsors on both 
sides of the aisle. It is the only effort I know of on his side to put 
up a constructive alternative. At least they have come forward with 
one. It is not one I think most Americans would immediately come to 
because it eliminates employer-based health insurance. It basically 
says we, as individuals, would be in a market for health insurance, 
trying to find the best policies and, under their plan, hope for the 
competition of that pool of people who would bring costs down.
  But, unfortunately, when it comes to the Republican side of the 
aisle, that is the only offering. The Bennett-Wyden bill is the only 
offering. Unfortunately, as well, the Republicans have not engaged us 
and have not agreed to be part of the conversation that leads to a 
final bill.
  Well, we have to deal with this in an honest and open way. We 
understand that doing absolutely nothing at all is unacceptable because 
every American, including those on Medicare, will be far worse off if 
we do nothing at all. Doing nothing at all for many Republicans is the 
answer. They have created these arguments.
  Yesterday, there was an argument in the Finance Committee about 
government health care and the question of the public option. Should 
there be, in the choices available to Americans, one not-for-profit 
option that is trying to bring down costs? Well, I think there should 
be. Many of the Republicans do not. Some Democrats do not.
  In the course of the debate yesterday, a question was asked of 
Senator Grassley, who opposed the public option: Well, what do you 
think of Medicare? Isn't that a government-run health care program?
  Yes, it is.
  Would you eliminate Medicare?
  He said: No. That has become part of the social fabric of America.

[[Page S9951]]

  Why has it become part of it? Because it is reliable, it is 
affordable, and it changes lives for the better. Why wouldn't you want 
that option? If you do not want to take the public option under health 
insurance because you think it is socialism or communism or just plain 
wrong or you do not trust the government to run health insurance, you 
do not choose the option. But if you believe in keeping costs down in a 
program you can rely on that is administered by the government--a 
program such as, incidentally, the health insurance Members of Congress 
have--then you can make that choice. That, to me, is what we should be 
coming down to. But, unfortunately, that option is not open.
  We want to hold down health care costs for Americans by attacking 
waste and fraud. Medicare Advantage, in my mind, is wasteful. Mr. 
President, 14 percent more the health insurance companies are charging 
for the same basic Medicare Program. Why in the world would we continue 
that subsidy to these profitable health insurance companies? Some want 
to. They argue that any change in Medicare or Medicare Advantage is 
going to cut basic Medicare benefits. That is just plain wrong.
  This do-nothing approach we have heard from the other side of the 
aisle is going to mean costs are going to continue to skyrocket. As 
they do, we are going to find fewer and fewer Americans with coverage. 
We know what is happening with premiums across America. They are going 
up sky-high, and the wages of American workers are not, so workers are 
falling behind. Fewer companies are offering health insurance. Smaller 
businesses even have a more difficult time offering health insurance.
  I put together a bill with Senator Lincoln of Arkansas, Senator 
Snowe, and Senator Collins of Maine that was supported by the National 
Federation of Independent Businesses and the realtors to give small 
businesses a chance to get into a pool to reduce their cost and their 
administrative overhead and to have health insurance available. I could 
not draw any more Republican support for that idea. Too much 
government, they said. Well, for a lot of small businesses that 
intervention in the marketplace could make a big difference.
  I had a hearing back in my hometown of Springfield, IL, on Monday. It 
was not exactly a hearing. It was more of a roundtable. I wanted it to 
be informal because I wanted to hear stories. I heard quite a bit.
  I heard from Sandy Hill. Sandy is an interesting woman. She and her 
husband own an excavating company, a small business in central 
Illinois. They are proud of it. They work hard at it. She said: My 
husband is going to die on the job. He is the kind of guy who will 
never retire. He is a hard-working guy, proud of his business.
  Sandy, unfortunately, has diabetes. As a result of that, they cannot 
afford health insurance. No health insurance for her or her husband, 
and Sandy is in a position in life where she needs it. Her doctor was 
there with us. Sandy talked about the fact--because she does not have 
health insurance, and can spend up to $900 a month on insulin and other 
care for her diabetic condition--that sometimes she has had to make the 
decision to cut back on her medication. I looked over at her doctor, 
Dr. Albers, who was sitting next to me, and she winced when Sandy said 
that and thought that is the wrong thing to do. It is the wrong thing 
to do. But Sandy Hill has no choice. She does not have health 
insurance. She gets up and goes to work every single day, proud of the 
little business she and her husband have put together, and she cannot 
get health insurance.
  In 2009, in the United States of America, a hard-working woman and 
her husband with no health insurance, with a medical condition that 
could be life-threatening if she does not receive basic care and 
protection. We have said to our Republican friends, and we have said to 
all the critics and detractors: Join us in solving this problem. Let us 
get costs under control. Let's start reducing the increase in the costs 
of health care. We have to do this. Let's also make sure health 
insurance companies treat people fairly, that they do not deny coverage 
to them when they need it the very most. Let's make sure as well that 
people like Sandy Hill who have no health insurance will have a choice, 
an option to turn to. That is only sensible. I think it should include 
a public option. She can decide whether she wants it. If she doesn't 
want it, she doesn't have to take it. She will have private health 
insurance companies and the public option--her choice to take one or 
the other.

  Let's also start dealing with some fundamentals here. We need to 
focus more on prevention and wellness in America. Keeping people 
healthy and well is not only good for them and their families, it is 
good for the cost of health care in our country. I believe it is 
important that we focus more on that.
  If you have a $5,000 deductible--and a lot of people do because they 
have health insurance policies with expensive premiums, so they put a 
big deductible on it--let's assume you have a $5,000 deductible or 
copay. I just ran into a man with that. What does that do to you? Some 
people say: Well, it is an incentive not to overuse the system. That is 
true, but you have to watch out that it isn't a perverse incentive.
  The man I met had been told by his doctor that he needed a 
colonoscopy. There were some worrisome signs that indicated he needed 
that procedure to find out if he, unfortunately, had polyps or colon 
cancer, and he needed to be treated right away. Because he had a $5,000 
copay, he asked: What does it cost?
  They said: It is $3,000.
  He said: I can't afford it. I will try to get back to that later.
  People with copays and deductibles that are very high turn down some 
very basic procedures, preventive procedures, that can catch something 
in an early stage and deal with it in an effective way. That is what we 
are trying to achieve here. We are trying to achieve this quickly so we 
can turn this around and move this forward and so we have real health 
care reform.
  I agree with those who say the bill should be in writing and Members 
should have a chance to read it. That just makes sense, and it will be. 
But those who want to slow it down for weeks or months--maybe let's 
wait until next year; maybe it will take a few years--don't understand 
the pressing urgency of our dealing with this problem.
  The President has committed himself to this like no other President 
since maybe President Clinton or President Lyndon Johnson. It has been 
years. Under the previous Republican President, there were no proposals 
when it came to health care reform--none. None that I can recall. The 
closest thing I can remember is the Medicare prescription drug plan 
which I mentioned earlier. An extension of the Children's Health 
Insurance Program, which we had to fight with the administration over, 
is one that I think has been good, to extend health care, with the help 
of the government, to a lot of kids who otherwise wouldn't be 
protected.
  The Republican leader came to the floor today and talked about his 
concerns, and there were many.
  He said it was going to raise taxes. Well, let's make it clear. When 
we talk about health care reform, first, President Obama has said he 
will not sign any health care reform bill that adds to the deficit. So, 
unlike the Medicare prescription drug program which added to the 
deficit dramatically, this approach cannot add to the deficit. We have 
to pay for it.
  He said it would include tax hikes. Well, I don't know what is going 
to be included in the health care reform bill in terms of increases in 
revenue. If we are talking about taking the subsidy back from the 
health insurance companies under the Medicare Advantage Program and the 
Republicans are objecting to that, they can, but I think most Americans 
would agree that the subsidy is something that shouldn't be sustained.
  He argues that the bill is 1,000 pages long. It might be. We are 
talking about a change in our basic economy that affects $1 of every $6 
spent. It, of course, is going to have a lot of sections to it to 
consider all of the possibilities.
  He talks about the cost of $1 trillion over 10 years. The Republican 
leader objects to that. This year, we will spend $2.5 trillion on 
medical care and health care in America. Over the next 10 years, I am 
sure the total figure will be over $35 trillion. So addressing it with 
a $1 trillion program over 10 years is less than 3 percent of what we 
anticipate spending on health care if we do

[[Page S9952]]

nothing. So $1 trillion is a staggering figure until it is put into 
context.
  He says it will impact a sixth of the economy. He is right.
  He says it will impact every American. He is right about that. It is 
the biggest challenge we have faced. It is one that is going to be 
tough, politically difficult, but we have to do it. As the President 
said, if it were easy, some other President would have done it a long 
time ago, but we have to do it now.
  I believe most people understand that the bottom line here is that 
failing to do this--do nothing, as some on the other side of the aisle 
would suggest--isn't going to solve this problem, it is going to make 
it much worse. It is going to reach a point where we are going to face 
even grimmer choices in the future. The American people will stand up 
and work together on a bipartisan basis for something that is truly 
good for the common good. There will be dissenters. There are people 
standing outside now with signs against the public option. That is part 
of the American way. But the fact is, if we do nothing, this situation 
will get dramatically worse.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Begich). The Senator from Ohio.
  Mr. BROWN. Mr. President, I appreciate the words of Senator Durbin, 
especially his story about Sandy Hill from Illinois and what he said 
about her situation.
  I come to the floor often to share letters I have received from 
people all over my State who oftentimes were very happy with their 
health insurance and then found out their health insurance, once they 
got sick, wasn't so good. Let me share a couple of these letters, and 
then I have some other comments I wish to make.
  Susan from Stark County, in the Canton area, writes:

       The cost of having health insurance is coming to a point 
     where I may have to drop it because of the cost. I have three 
     years until I can qualify for Medicare, but in that, how high 
     will my premiums increase? Right now my insurance costs 
     almost $500 a month and as of this November will increase 
     another $60 a month. The insurance companies dictate to the 
     doctors what they can charge and to the patients how long 
     hospital stays can be. This is not fair to those of us who 
     have to try to pay our own way.

  That is exactly what we are addressing in this bill. Many people have 
insurance. Many people are generally satisfied with their insurance, 
but they are seeing several things happen: The costs continue to go up; 
small businesses continue to be more burdened with the expense of 
covering their employees; and in too many cases, people who had decent 
insurance get denied care, perhaps because of a cap or a lifetime cap 
where they get very sick, they take biologic drugs, they go to the 
hospital for a long hospital stay, and all of a sudden they have busted 
their cap. In other words, the fine print in their insurance policy 
says: We are not covering you after we spend X number of dollars. They 
have lost their insurance, and bankruptcy is too often around the 
corner.

  Jeanne from Dayton writes:

       Last November I was laid off from my job and lost my 
     benefits at the same time. My husband has health insurance 
     through his employer, but he might lose his job soon. We're 
     both in our mid 50s and have more than 10 years to go before 
     we can get on Medicare. We've been frugal all our lives. 
     We've got enough money in savings to pay off our mortgage, if 
     necessary. We could even live on the pensions we've 
     accumulated starting today if we had to. But that's assuming 
     we have no health problems in the next 10 years. Please don't 
     let greed take away what we have worked so hard for.

  The assistant majority leader, Senator Durbin, just spoke about 
insurance subsidies and how this legislation is going to be good for 
insurance companies. It is going to get a good bit of money to the 
insurance industry so they can cover people and bring their rates down. 
That is why the public option Senator Durbin spoke about is so 
important.
  The public option will make sure the insurance companies play by the 
rules. We are going to have insurance reform in this bill. We are going 
to outlaw preexisting conditions, the game of community rating. We are 
going to outlaw those insurance companies putting a cap on costs for 
any individual patient, either an annual cap or a lifetime cap. We are 
going to outlaw discrimination based on geography or gender or 
disability or age in this legislation. We are going to enforce these 
rules because we have all seen the insurance companies game the system 
even when the rules were thought to be strong and tight and ironclad. 
We know the insurance companies will still try to game the system. That 
is why the public option is so important.
  The public option is an option. You can choose CIGNA or Aetna; you 
can choose, in my State, Medical Mutual, a not-for-profit headquartered 
in Cleveland; or you can choose the public option. The public option 
will make sure CIGNA and Aetna and those other for-profit insurance 
companies play by the rules. That is why it is so important.
  Randolph is from Summit County. He says:

       I have operated a small business in Ohio for 25 years. We 
     have provided all of our employees health insurance from day 
     one. It does hurt, it's the only area we can count on going 
     up every single year--and not three or five percent, but 
     double digit increases nearly every year for the past 27 
     years. These increases stop us from what we could do: Add 
     more employees. This country needs health insurance reform 
     now.

  Randolph is exactly right. Almost every small businessperson I know 
wants to cover his or her employees. Those small businesses are getting 
so oppressed by these health insurance costs that it stops--in many 
cases, it means they have had to scale back the benefits they provide 
their employees, force their employees to pick up more of the cost. It 
also means, as Randolph points out, he would like to hire more people, 
grow his business more, expand, but he can't do it because of health 
care costs. That is why this legislation is so important.
  The public option is important to keep the insurance companies 
honest. The assistance we are going to provide for small businesses 
with tax credits will allow them to pool their resources, with the 
opportunity, if they choose, to go into the public option. All of that 
will help those smaller employers in Mansfield and Gallipolis, in 
Fremont and all over my State, will help those small employers, those 
small businesses prosper, be able to provide insurance for their 
employees, and allow them to grow and do what they want to do as 
businesspeople.

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