[Congressional Record Volume 155, Number 168 (Tuesday, November 10, 2009)]
[Senate]
[Pages S11307-S11310]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. BROWN. Mr. President, I come to the floor, as I have many times, 
with Senator Whitehouse, my colleague from Rhode Island, Senator Udall 
of New Mexico, and others to talk about health care and, in many cases, 
to share letters I have received from people in my State. These letters 
have several things in common. Typically, they are letters from people 
who thought they had good health care, if you asked them a year ago. 
Then they had a child with a preexisting condition and they lost their 
health insurance or maybe they got sick themselves and found that their 
health insurance was canceled because of a policy insurance companies 
use called rescission. Often these are people who were middle class but 
because of health care expenses due to an illness, coupled with 
insurance policies that were far less than adequate, it meant they no 
longer were middle class.
  I have read letters from families who were consistently denied care 
because of a loved one's cancer or asthma. I have read letters from 
people who pointed out that if a woman is a victim of domestic 
violence, some insurance companies call that a preexisting condition 
and they literally can't get insurance because they are deemed to be 
more likely to again be a victim of domestic violence. I have read 
letters from small business owners who see double-digit premium 
increases year after year, especially if 1 of their 15 or 20 employees 
gets very sick, with very expensive care, and the insurance company 
raises the rate so much that the small business owner can no longer 
afford the insurance.
  Many of the letters I have read are from individuals in their late 
fifties or early sixties who have lost their jobs and, therefore, have 
also lost their insurance. They write of the anxiety they feel and the 
hope that they can--in their words--make it to 65 so I can get on 
Medicare because I know Medicare will not deny me for a preexisting 
condition. I know I can count on Medicare. I know Medicare will be 
stable.
  Last Saturday night, as we all know, a historic vote in the House of 
Representatives brought us one step closer to passing a law that will 
finally meet the promise of equality and affordable health care for the 
American people. We have been trying for 75 years--the last 100 years. 
Theodore Roosevelt first tried--a Republican--to pass health care. Then 
Franklin Roosevelt tried, then Harry Truman tried. They were Democrats. 
Lyndon Johnson was able to push Medicare through Congress, as we know. 
That was very difficult because of some of the same interest groups--
insurance companies and others--that oppose this legislation now. 
Richard Nixon tried to build a catastrophic health insurance that would 
have been a major step--a Republican. So we know how long this has been 
happening, and that makes Saturday night's vote even more important.
  Last week, I had the opportunity to be with Ohioans who oppose these 
health care changes and who wanted to share their thoughts and 
concerns. Some don't agree that article 1 of the Constitution permits 
health care reform. I spoke to a young man who said that all these 
health care reforms are unconstitutional because article 1 doesn't 
allow us to do that. I said: Does that mean we should eliminate 
Medicare? He said: Yes, because article 1 doesn't allow for Medicare. I 
am not a lawyer, but I certainly don't read the Constitution that way. 
I don't think many of my colleagues do and I think it is clear Medicare 
is constitutional and it is clear what we are doing today is equally 
so.
  But I wished to run through the four things that were said with 
probably the most frequency in my meetings last week with people who 
are opposed to

[[Page S11308]]

this health care reform. I know a majority of my State supports it. I 
know a strong majority in the State supports the public option--people 
from Findlay to Cleveland to Gallipolis to St. Clairsville to Vandalia 
support our efforts here. But I also note there is significant 
opposition.
  I will never question the sincerity and genuineness of people who 
talk to me in opposition, who take off from work to come on a bus to 
come and protest or who want to talk to me individually. But I do 
question those who make millions of dollars a year--whether they are 
insurance executives or radio and talk show people--and who are 
literally benefiting from trying to kill this health care reform. Their 
efforts are less sincere and less genuine.
  But let me run through several of these myths or the four things I 
have heard most frequently that simply aren't true about this health 
plan.
  First: If my employer drops my coverage, I will be forced into the 
public plan.
  As the Senator from Illinois knows and Senator Whitehouse and others 
know, no one is forced into the public plan. If your employer drops 
your coverage, you can choose private insurance or the public plan 
through the health insurance exchange. That is the whole point of the 
public option. The word is ``option.'' It is a total option--the public 
plan. It means that, whether you have lost your insurance, if you are 
uninsured or if you have lost your insurance or you are a small 
businessperson who is looking for a better insurance option, you take 
your employees or you go individually into the insurance exchange. You 
can choose Aetna, you can choose WellPoint, you can choose a plan from 
an Ohio company, Medical Mutual, or you can choose the public option. 
At no point is there anybody--anybody in this country--who is going to 
be forced to go into the public plan. As I said, it is an option, and 
it will remain an option.

  The second myth I hear a good deal about, of these four myths, is: 
After 5 years, I would not be allowed to purchase private insurance.
  Mr. WHITEHOUSE. Will the Senator yield for a question?
  Mr. BROWN. Sure, I yield to the Senator from Rhode Island.
  The ACTING PRESIDENT pro tempore. The Senator from Rhode Island.
  Mr. WHITEHOUSE. To go back to the first point about the public 
option, in fact, being an option, I think everybody here understands 
the government is going to help pay the costs of health care, 
particularly for low-income families who can't work to get the funds 
together to pay for the cost of health care. As the Senator from Ohio 
knows so well, wages have increased just a tiny bit and health 
insurance costs have gone through the roof. The result has been that 
families are getting clobbered, so they need some help.
  So the health care reform bill we have before us will help those 
families who are having such trouble affording their insurance. I think 
it is worth confirming the help that will come to American families 
does not require them to join the public option. They will get the same 
benefit based on their income and their family's health care needs 
whether they choose the public option or a private insurance carrier 
that is offering a program through the exchange.
  As long as you show up at the exchange, as I understand it--and I 
would like to have the Senator from Ohio confirm this--you can take 
that government subsidy that is yours and your family's and you can 
spend it at the public option, you can spend it with Blue Cross, you 
can spend it with Aetna, you can spend it with any insurance company--
private, for profit, nonprofit, public option--that is doing business 
in the exchange. You can take your subsidy and you can go there and 
spend it there. You are not tied to the public option by your subsidy.
  Mr. BROWN. That is exactly right. Senator Whitehouse and I, his 
staffers and mine, wrote the language in the Health, Education, Labor, 
and Pensions Committee on the public option, and the whole point was to 
create a level playing field.
  As Senator Whitehouse said, if you are low income, if you are lower 
or medium income, making $30,000 or $40,000 a year, with a couple 
children, you and your spouse are required, under this bill, to buy 
health insurance or, if you obviously choose to, you will get a subsidy 
from the taxpayers--from the government--to help pay for this 
insurance. You then take those subsidies, as Senator Whitehouse says, 
and you have a choice. You can go to WellPoint, you can go to Aetna or 
you can go to the public option. The public dollars will follow you 
into any one of these.
  The public option gets no special treatment. The public option gets 
no special taxpayer subsidies. The public option gets no special 
government infusion of dollars. The public option gets what any one of 
the private companies do. As Senator Whitehouse said, it could be a 
private company, it could be a for profit, a not for profit, it could 
be a co-op of some sort or it could be a public option. But it is all a 
level playing field, so people can decide which one of these they want 
to go into.
  I thank Senator Whitehouse for his question.
  The second myth: After 5 years I won't be allowed to purchase private 
insurance.
  This is not too different from the first myth we see out there that 
there is going to be some forcing of people into public insurance and 
into the public option. When Senator Whitehouse and I and our staffs 
wrote this language for the Health, Education, Labor and Pensions 
Committee, it was written in a way not just today for people going into 
the insurance exchange but 5 years from now, 10 years from now, people 
will have the option. You can choose a private for-profit or not-for-
profit insurance company or you can choose the public option. That is 
the way this language will continue to be. That is another one of those 
myths out there that has scared people.
  Some people are very distrustful of government in this country. I 
understand. But I think the experience of Medicare has shown that, in 
terms of health care, government has been a pretty good delivery 
vehicle for people getting insurance. In 1965, half of American seniors 
had no insurance. In health insurance today, 99 percent plus of 
Americans have health insurance and it is because of Medicare.
  We know government can deliver these plans efficiently but we also 
are not telling people they have to have the public option. In the 
public plan they continue to have an option.
  Mr. WHITEHOUSE. If the Senator will yield again, we are approaching 
Veterans Day, a time when the Nation takes a moment from our busy lives 
to pay our respect and our honor to those who wear the uniform of the 
United States and are willing to put themselves in harm's way. I think 
there is not a person in this body who does not feel a great loyalty 
and pride in our Armed Services. We want them to get nothing but the 
best. What do we give them for health care? If they are active, they 
get a government plan called TRICARE. Once they retire from active 
service and become veterans, they go into the Veterans' Administration. 
So at least one measure of the quality of government health care, in 
addition to the success of Medicare in reaching a population that had 
been deprived of adequate care for generations until Medicare came 
along, our seniors, is that those very people whom we are about to 
spend the week honoring, and for whom we insist on the very best, one 
of the ways we pay them honor and respect is by giving them among the 
very best health care in the world, government health care, TRICARE and 
Veterans' Administration care.
  Mr. BROWN. That is exactly right. TRICARE you rarely hear a complaint 
about. The VA is a huge operation. Of course there are sometimes 
complaints about people having to wait or something that doesn't quite 
go right all the time, but obviously by and large veterans in this 
country, soldiers and sailors and marines and active duty, understand 
their medical needs are taken care of, as they should be. It is one of 
the things to be proud of in our country, that we have done a decent 
job of taking care of people who serve the country with TRICARE.
  I sit on the Veterans' Committee and all the time we are wrestling 
with problems in the VA. There has been a problem with people going 
from active duty in TRICARE into retired status, as Senator Whitehouse 
said, the VA. To make that transition is not always as smooth as it 
should be, but it is clear people's medical care works and

[[Page S11309]]

that is another argument for the option.
  Mr. WHITEHOUSE. I suggest to the distinguished Senator from Ohio, who 
has come to this floor so often to share the stories of Ohioans in our 
health care system, which are heartbreaking, which are tragic; which 
involve people being thrown completely out of the program when they 
have the temerity to get sick, which involve families going broke who 
had insurance, when they find out the insurance policy had holes in it 
that they have fallen through, when they find out when they become sick 
they not only have as their adversary the illness they are fighting but 
also the insurance company they have to fight on the other side--over 
and over again you have come here with those stories.
  If Senator Brown's experience is anything like mine in Rhode Island, 
I don't get those letters about the VA system. I don't get those 
letters about TRICARE. Sure, there are glitches now and then; any big 
system has its problems. But the massive cascade of human tragedy the 
Senator represents so effectively on this floor with the letters he 
brings from home--that is not coming out of these systems. That is 
coming out of the private health care system.
  Mr. BROWN. That is exactly right. We don't see veterans or we don't 
see active-duty soldiers or people on Medicare denied because of a 
preexisting condition. Soldiers who are injured in the line of duty, 
imagine if they have a preexisting condition if we don't take care of 
them in Bethesda or Cleveland or Dayton or in Chillicothe in my State, 
in the Senator's State the same. It is absurd to think that would be 
the case. But it is clear these endemic massive problems with people 
fighting their insurance companies, denied care, come out of the 
private insurance system.
  One of these other myths was one Senator Whitehouse has talked about, 
that health reform will lead to rationing of health care. It is such a 
peculiar charge to say about this bill, that health reform will lead to 
rationing of health care, because we see rationing of health care every 
day.
  Senator Whitehouse pointed out on the floor several times, the model 
of the health insurance business is this: They hire a lot of 
bureaucrats to keep people from buying insurance if they are too sick. 
A large insurance company will have a bunch of employees, a bunch of 
bureaucrats. When people apply for health insurance, they will check 
and see is this person going to cost our company too much, so they will 
deny them, they won't even get insurance with this company--a 
preexisting condition or something. Then they have bureaucrats on the 
other end to challenge the claims once one of their insured customers 
gets sick. So they have bureaucrats on both ends of this health 
insurance model, stopping people from getting insurance at the 
beginning and stopping them from receiving coverage. In fact, 30 
percent of the claims on the first go-around are denied. Sometimes when 
you appeal them you can win. But just the idea, when you are sick or 
you are taking care of a very sick child or spouse or parent or sister 
or whatever, and you are fighting with the insurance companies to pay 
the bill--we remember the President, President Obama, talking about 
that with his mother, the fights she had with the insurance companies 
to pay for her cancer care as she was dying. We don't hear about that 
in the public plans. We don't hear about that in TRICARE or in 
Medicare.
  Mr. WHITEHOUSE. It has happened in my family as well. A member of my 
family whom I loved very much went to the National Institutes of Health 
to get the best recommendations he could for a very terrible diagnosis 
he had received. When he went back to New York, where he lived, and 
filed his claim and began the treatment that the National Institutes of 
Health top expert on his diagnosis had recommended, his insurance 
company came back and said I am sorry, no, that is not the indicated 
treatment. They dropped--tried to, anyway--dropped a bureaucrat between 
his doctor, a world expert, and the care he was entitled to.
  The Senator and I hear these stories all the time. People are not 
making them up. They happen to us. They happen to people we know. 
Unfortunately, unlike my family member who fought back and was able to 
convince the insurance company to honor what the expert at the National 
Institutes of Health indicated was the standard and approved treatment 
for that type of condition, many people are overwhelmed by the illness, 
they are overwhelmed by the paperwork, they are overwhelmed by the 
battle with the insurance company. They believe what they are told and 
they allow themselves to get rolled over.
  If an insurance company only gets 1 in 10, it still saves them money 
when they deny people that care. It is in their business model to deny 
their insureds the care that they paid for, once they have the nerve to 
get sick. That is a recurring and consistent problem that just plain 
never comes up in the government programs. It is unique to our very 
unique position as being the one country in the world that turns over 
our health care to the profit-making private sector for things we 
cannot negotiate on, for things that are not elective.
  If you do not want to buy a bicycle, you don't have to buy a bicycle. 
They have to come to you on price. But if you need a heart transplant, 
there is not a lot of negotiation. We turn that over to the profit 
sector and as a result we have higher costs and worse results than any 
country.
  Mr. BROWN. I would point out when the Senator said the only country 
in the world--not every country in the world has a government health 
care system; not that every country has, or even many of them that have 
successful health care systems are necessarily socialized medicine or 
public health care plans. But what they have, when they use private 
insurance in other countries, they are private but they are not-for-
profit private insurance. So they don't have all the bureaucrats in 
this business model at the beginning keeping people from getting 
coverage and at the end denying payment for those plans.
  The fourth myth we hear so much is related to rationing of care, the 
myth about rationing of care, and that is that health reform will 
interfere with decisions that should be between doctors and patients. 
That is exactly what we are saying again with private insurance now. 
You don't see that with Medicare.
  The ACTING PRESIDENT pro tempore. The time of the majority for 
morning business has expired.
  Mr. BROWN. I ask unanimous consent for 2 more minutes.
  Mr. ALEXANDER. Reserving the right to object, I ask to add an equal 
amount of time, 2 minutes, to the Republican time.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. BROWN. That is the fourth myth, that health reform will interfere 
between doctors and patients. That is what we are seeing now. We are 
seeing so many cases where the doctor and the patient--the doctor puts 
his or her secretary or nurse on the line or the doctor herself calls 
the insurance company to beg them for coverage. I have heard doctors 
say to a patient: I will pay it out of my own pocket if I can't get 
this covered with the insurance company.
  All these resources of the system, the patient's time, the family 
time, the doctor time, the doctor hiring all these people, the 
insurance companies hiring all these people to prevent you from getting 
coverage, the insurance companies hiring all these people to prevent 
you from getting reimbursed for your expenses--all this goes into what? 
It is waste. Executive salaries, profits, but certainly doesn't go into 
patient care.
  I ask Senator Whitehouse, why don't you wrap up.
  Mr. WHITEHOUSE. It provides no health care value at all and it is 
going in the wrong direction. Insurance company administrative expense 
is up over 100 percent. I go to Rhode Island and I talk to doctors and 
community health centers, for whom 50 percent of their personnel are 
devoted not to providing any health care but to fighting with the 
insurance company. So the notion that it is the Government that will 
get between you and your doctor is truly the big lie. It is the 
insurance companies that are the ones that, day after day--a manner of 
their business model--get between Americans and their doctors. We are 
trying to cure that and we will.

[[Page S11310]]

  I thank the Senator from Ohio.
  The ACTING PRESIDENT pro tempore. The Senator from Tennessee is 
recognized.

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