[Congressional Record Volume 155, Number 171 (Wednesday, November 18, 2009)]
[Senate]
[Pages S11465-S11467]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. SANDERS. Mr. President, I do disagree with my friend from 
Oklahoma very much, but that disagreement will have to wait for another 
day because today I want to deal with another crisis, and that is the 
situation regarding health care.
  I come to the floor to urge my fellow Senators to go forward in 
passing the strongest possible piece of health care reform 
legislation--legislation which is comprehensive, covering all basic 
health care needs; legislation that is universal, covering every man, 
woman, and child in our country; and legislation, importantly, that is 
cost effective both for individuals and for our Nation.
  I think all of us understand the United States today is in the midst 
of a major health care crisis. Mr. President, 46 million Americans have 
no health insurance and, importantly, even more are underinsured with 
large copayments and deductibles. We have heard some of our rightwing 
friends talk about death panels. Let me tell you about the reality of a 
real death panel, not a phony death panel, and that is, this year in 
the United States, according to Harvard University, some 45,000 
Americans will die because they lack health insurance and they do not 
get to a doctor when they should.
  Mr. President, 45,000 will die this year. And if we do not take 
action, 45,000 or more will die next year. This is the United States of 
America. To see tens of thousands of our fellow country people dying 
because they do not have access to a doctor is an abomination, it is 
not acceptable, and that needs to change.
  Among many other reforms we need to bring about as we go forward with 
health care reform is a revolution in terms of primary health care. 
Today, 60 million Americans, including many with health insurance, do 
not have access to a doctor. The result of that is, when they get sick, 
they go to the emergency room, at great cost, or they delay getting 
health care, and they end up in the hospital being treated for a far 
more serious illness than they would have had if they were treated 
initially. Clearly, this is an absurdity. It costs us lives. It costs 
us money. We have to change that.
  I am very happy to say that in that regard I have introduced 
legislation that has 25 cosponsors in the Senate and which has been 
incorporated into the Health, Education, Labor, and Pensions bill, 
which would quadruple--quadruple--the number of federally qualified 
community health centers in our country over a 6-year period, which 
would mean there would be a community health center providing excellent 
quality health care, dental care, mental health counseling, low-cost 
prescription drugs in every underserved area in the country. We go from 
about 1,300 centers to 5,200 centers.
  Also in this bill, we would increase by 10 times the amount of money 
for the National Health Service Corps so we can provide debt 
forgiveness for those people in medical school who want to practice 
primary health care, which in Vermont and around this country is a 
desperate, desperate need. We absolutely need to increase the number of 
primary health care physicians we have.
  When we talk about health care reform, we also have to include dental 
care. Dental care is often sometimes pushed aside. But I can tell you, 
in many regions of this country, people are finding it virtually 
impossible to gain access to a dentist and, oftentimes, they simply 
cannot afford the dental care they need. So when we talk about health 
care, we have to include dental care in that.
  Furthermore, when we are talking about health care reform, it is 
absolutely imperative we begin to address the fact that in the United 
States of America we spend far more on prescription drugs than do 
people of any other country. This is not just a financial issue for the 
individual; this is a health care issue. I have talked to physicians 
who tell me--and I think this is common not just in Vermont but all 
over the country--that some 25 to 35 percent of their patients do not 
fill the prescription the doctor writes because they cannot afford to 
do that. So what sense is it when somebody goes to the doctor that the 
doctor writes out a prescription but that individual cannot afford to 
fill that prescription? We need to deal with the high cost of 
prescription drugs, and we can do that in several ways.
  No. 1, when I was in the House, I was the first Member of Congress to 
take American citizens over the Canadian border to purchase 
prescription drugs there that cost a fraction of what they cost in the 
United States. So we need to pass what is called reimportation--the 
right of Americans and the right of people who manage prescription 
drugs, who are in that business, to be able to purchase safe, FDA-
approved medicine from abroad at a fraction of the price the drug 
companies are selling those products to them in this country. That will 
lower the cost of prescription drugs for all Americans.
  Second of all, we, obviously, have to negotiate prescription drug 
prices under Medicare Part D. When we do that--and we lower the cost 
that Medicare is paying--we can end the doughnut hole which is now 
causing so many problems for senior citizens today who go above the 
first part, where Medicare is paying about $2,500, and then they have 
to pay 100 percent of the cost, which is hurting a whole lot of 
seniors.
  Thirdly, we must deal with the biologics issue. My colleague Senator 
Sherrod Brown of Ohio has been strong on this issue, so that we stop 
drug companies from having exclusivity for 12 years, preventing generic 
companies from getting into the market and lowering the cost of 
biologics. That is a very important issue.
  Any serious health care reform legislation must include strong cost 
containment. Insurers have increased premiums 87 percent over the past 
6 years, while premiums have doubled over the last 9 years--increasing 
four times faster than wages. If present trends continue, health 
insurance premiums will double over the next 8 years, which will be a 
disaster for millions of Americans and, in fact, for our entire 
economy.
  Today, the United States spends far more per capita for health care 
than any other country on Earth. That is a very important point for us 
to understand. We are now spending over $7,000 per person, and yet 
despite spending almost twice as much as any other industrialized 
country, our outcome in terms of infant mortality, in terms of life 
expectancy, in terms of immunization and preventable deaths, is often

[[Page S11466]]

behind other countries. So we are spending huge amounts of money; we 
are not getting value for what we are spending.
  The cost of health care in this country is now 16 percent of our GDP, 
and it continues to soar at a rate that is basically unsustainable. So 
this is not, again, just an issue for individuals. This is an issue for 
our economy and our Nation.
  If you look at a company such as General Motors--General Motors which 
went bankrupt--they were spending more money on health care per 
automobile than they were on steel. Small business owners in Vermont 
and across this country are finding it harder and harder not only to 
provide decent health care coverage for their workers, but in many 
instances they cannot even provide health care to themselves. What ends 
up happening is, instead of investing their profits into expanding 
their businesses and creating more jobs, all of that money is going 
into the soaring health care costs.
  But when we talk about the personal impact of our disastrous health 
care system on individuals, there is no better example than looking at 
bankruptcy. In this country today, we have approximately 1 million 
Americans who are going bankrupt because of medically related costs. It 
is not hard to understand why: You lose your job in the midst of a 
severe recession. Somebody in your family becomes very ill. Well, how 
do you come up with the money if you do not have any health insurance, 
or even if you do have an inadequate health insurance program? The 
answer is, you go bankrupt. So, incredible as it may sound, close to a 
million people in this country this year are going bankrupt because of 
medically related illnesses.
  I have talked a little bit about some of the problems that are out 
there--and there are many more. What is the answer? I do not think 
anyone has a perfect answer. But I do think the United States should be 
looking at other countries around the world. Why do we end up spending 
so much and get relatively poor value for what we are spending? When we 
do that, when we look at countries throughout Europe, Scandinavia, 
Canada, and so forth, I think it leads one to the conclusion that if we 
are serious about providing quality, affordable care to all Americans, 
in a cost-effective way, then we must move toward what many of us call 
a Medicare-for-all single-payer program.

  I understand, as I think many people do, that because of the power of 
the insurance companies and the drug companies and the medical 
equipment suppliers, because of their campaign contributions, because 
of their lobbying, the truth is, a single-payer program has never been 
on the table from day one since this whole discussion began. I think 
that is very unfortunate. It is doubly unfortunate because we have many 
thousands of physicians in this country, including the 16,000 members 
of Physicians for a National Health Program, and other health care 
providers, the largest nurses union in this country, in support of a 
single-payer system. Millions of Americans want us to move that way. 
But because of big money interests, that discussion does not even begin 
to get to the floor.
  Well, I intend during the course of the debate to offer an amendment 
on a national single-payer system. We will see how many votes we get. 
But what I am also trying to do is give States flexibility so that, if 
they so choose, they can move forward with a single-payer approach. My 
guess is that if one State does it--whether it is Vermont, California, 
Pennsylvania--whichever that State may be, if it works well, if 
everybody in that State has good quality health care, in a cost-
effective way, it will spread all over the country. I intend to do my 
best to see that language is in the bill, which will allow States to do 
just that.
  A single-payer national health insurance program is a system in which 
a single public or quasi-public agency organizes health financing, but 
delivery of care remains largely private. This is not a government 
health care program. It is not what they do in the United Kingdom. It 
is public insurance privately delivered.
  The reason we spend more--and this is an issue that has gotten 
amazingly little discussion--why do we end up spending almost twice as 
much as any other country? Well, I think that is a good question to 
ask. I do not hear a whole lot of answers. The reason is we have a 
patchwork system of for-profit payers. We have private insurance. What 
is the function of a private insurance company?
  Everybody in America understands the function of a private insurance 
company is not to provide health care, it is to make money. What we end 
up with are 1,300 private insurance companies, with thousands of 
separate systems, each geared to a different group, each geared to make 
as much money as it possibly can. The result is we as a nation are 
spending about 30 cents of every $1 not on doctors and medicine and 
nurses; we are spending it on administration and bureaucracy, huge 
profits, advertising, billing, sales, marketing--you name it; we spend 
it--rather than spending it actually on trying to keep people healthy 
or make them well.
  Single-payer financing is the most significant way I know to end the 
waste and bureaucracy of the current system. What the studies suggest 
is if we move toward a single-payer system, we would save over $350 
billion every single year, getting rid of all of that bureaucracy, that 
waste--the paper shuffling that has nothing to do with making people 
well.
  Under a single-payer system, all Americans would be covered for all 
medically necessary services, including doctor, hospital, long-term 
care, mental health, dental, vision, prescription drug, and medical 
supply costs. In other words, unlike anything else I have been hearing, 
it would be comprehensive: all of your basic health care needs. 
Patients, of course, would remain free to choose the doctor and 
hospital they would want, and doctors would retain autonomy over 
patient care, which often is not happening today as they have to argue 
with insurance companies as to what kind of therapies they can 
prescribe. Physicians would be paid fee-for-service according to a 
negotiated formulary or receive salary from a hospital or nonprofit HMO 
group practice. Hospitals would receive a global budget for operating 
expenses. Health facilities and expensive equipment purchases would be 
managed by regional health planning boards. A single-payer system would 
be financed by eliminating private insurers and recapturing their 
administrative waste. Modest new taxes would replace premiums and out-
of-pocket payments currently paid by individuals and businesses. Costs 
will be controlled through negotiated fees, global budgeting, and bulk 
purchasing.

  Well, that is where, in my view, we should be going. That is not 
where we will go. As I said earlier, that approach is anathema to the 
insurance companies, the drug companies, the medical equipment 
suppliers, all of the big money interests, and they have, 
unfortunately, enormous power over what goes on in Congress, so we are 
not going to go there.
  Let me say a few words about where we are going. Obviously, we are in 
the middle of that right now. Last week the House came forward with 
their bill. Majority Leader Reid is now trying to meld the two bills in 
the Senate from the HELP Committee and from the Finance Committee, and 
we expect that new legislation will be out very shortly. I have not 
seen it; I don't know if anybody has. Let me express a few words of 
concern about what I have seen in the discussion and the legislation 
that has been passed in the House.
  First of all, the average American is saying--I get this in Vermont 
every day, and I am sure the Presiding Officer gets it in Maryland 
every day--all right, hey, good, health care reform. That is great. 
What is it going to cost me? What do I get? How much am I going to have 
to pay, and what do I get for what I pay? That is the question on the 
minds of millions of Americans.
  The answer is, at this point--and, again, we have not seen Senator 
Reid's bill which will be out almost momentarily, but let me just tell 
my colleagues about what was in the Senate Finance Committee bill so 
everybody has a sense of what we are talking about.
  Under the Finance Committee bill--and that is going to change; 
whether it goes up or down, I don't know, but it will change--a family 
of four in Vermont earning $44,000 a year, which is not an unusual sum 
in my State, would pay about $3,087 in annual premiums, while the 
Federal Government

[[Page S11467]]

would pick up the rest of the total of $14,700 in premiums. In a year 
with high medical expenses--in other words, somebody gets ill, somebody 
has an accident and ends up in the hospital for 3 weeks--that family 
would pay up to $5,800 out of pocket. So you have premiums of $3,087, 
out-of-pocket costs of $5,800. That is a total potential payment in 
premiums and out-of-pocket expenses of $8,887 for health care under the 
Finance Committee's bill. This would be about 31 percent of the net 
income, aftertax income, of a family in Vermont, and I don't know that 
Vermont is any different than Maryland or any other State earning 
$44,000--31 percent.
  Somebody could tell us that is health care reform, but I really don't 
see it. Asking people in this country who, admittedly, have had a tough 
year with illness to pay 31 percent, and then say, hey, we passed 
health care reform, that, frankly, is not good enough for me, and I am 
going to do everything I can to make sure the final product out of the 
Senate is a lot better than that for ordinary middle-class families.
  The second issue that concerns me as we proceed down the line in 
terms of this health care debate is the issue of public option. I think 
there is a lot of confusion about what a public option is, but let me 
say this: My belief is the vast majority of the American people want to 
have a choice as to whether they stay in a private insurance company or 
whether they go into a Medicare-type public option which is funded by 
premiums. It is not Medicare; it is funded by premiums. But there are 
large numbers of Americans, for right reasons--I agree with them--who 
do not trust private insurance companies because they understand that a 
private insurance company wants to make as much money as possible off 
of their premiums. They would like the choice of looking at and maybe 
going into a public option. My view is we should make that choice 
available to as many people as possible.
  I have the sad thought that many folks out there are hearing us 
talking about a public option saying: Hey, that is great. I am going to 
have a choice. I don't like my employer-based health care. Now I am 
going to have a public option. That is great.
  Let me break the bad news to you if that is what you believe. That is 
not the case as it now stands. Relatively few people--people who are 
currently uninsured; small, very small, businesses; people who today 
get their insurance companies privately for themselves or their 
families; the self-employed, those are the people for whom a public 
option is currently available based on what has been passed. I think 
that is wrong. I think we need to expand it. Frankly, I think virtually 
every American should have that choice.
  There is the great debate: Should Members of Congress have the public 
option as our rightwing friends talk about? Yes, we should. And if the 
public option is better than Blue Cross Blue Shield or private 
insurance companies, many of us would take it. But as does everybody 
else, we deserve the option. That is what it is, an option. If you like 
private insurance, it is working well for you, stay with it. If you 
like the public option because it is better for you, you go with it. 
Let's give as many Americans the choice, not 2 or 3 percent but the 
vast majority of the people in our country who are now in private 
insurance.
  That takes us to another issue because, in the midst of a bill which 
is very complicated--and I am not a great fan of complicated. I think 
when you have a bill that is 1,900 pages, that just begs for the big 
money interests and the special interests to get their little things in 
it, and I worry about that a whole lot. This is much too complicated, 
but there it is. I think the House bill is 1,900 pages. But when we 
talk about opening the public option for more Americans, it means to 
say you have to open the exchange, the gateway for more Americans. The 
gateway means if you choose either your private insurance company or a 
public option, you are going to get subsidized by the Federal 
Government. Right now, as this bill stands, there are many people stuck 
in bad private insurance plans.
  Maybe you work for Wal-Mart, maybe you work for Dunkin' Donuts, maybe 
you work for McDonald's, and they are offering you some kind of 
insurance program which either costs a fortune or doesn't cover very 
much. Well, under the current legislation, up to now at least, you are 
stuck with that. That is what you have. That is not health care reform, 
to be stuck in a bad Wal-Mart plan. We have to do better than that. So 
we want to expand that gateway for more people.
  The other question is--I don't know what Majority Leader Reid's bill 
is going to end up costing, but the estimates are that we are looking 
at about, over a 10-year period, $800 billion to $1 trillion. Well, the 
simple question is, Where is the money coming from? Where is the money 
coming from?
  There are some people who have said: Well, maybe we want to tax good, 
strong insurance programs out there. That is the way to go. Well, not 
for this Senator, it is not, and I will do everything I can to oppose 
any movement in that direction. Workers have fought, in many cases, 
long and hard--given up wage increases--in order to get decent health 
insurance programs for their families, and now we are going to tax 
them? Not me. I am not going to do that. This country has the most 
unequal distribution of income and wealth. The rich are getting much 
richer while the middle class is shrinking.
  I think it is fair as we move forward in health care reform to ask 
the wealthiest people in this country to start paying their fair share 
of taxes.
  There is another issue which is kind of a local issue, I admit, and 
that is on the impact on early-acting States in terms of Medicaid 
reimbursements. It was just in the newspapers today--and I am very 
proud of this--that for whatever it is worth, according to some group, 
the State of Vermont is now the healthiest State in the country. What 
that tells me and what I know for a fact is that Vermont, which is not 
a wealthy State, has said we are going to take care of our kids. We are 
going to make sure that as many kids as possible are involved in what 
we call our SCHIP program. It is called Dr. Dinosaur. It is a very 
good, popular program. We are going to have other public health 
insurance programs. We are going to do the best we can.

  I am proud that today Vermont was acknowledged to be perhaps the 
healthiest State in the country. I am not going to sit by idly while 
Vermont and Massachusetts--another State that has taken major steps 
forward--are penalized because we have made reimbursement rates. 
Because we have done the right thing is not a reason to penalize us. I 
am all for helping out States that have not done the right thing, but 
we should not and will not penalize States that have done the right 
thing.
  So let me conclude by saying this: This country faces a major crisis 
in health care. Because of the power of big money, we are not going to 
do the right thing and pass a Medicare-for-all, single-payer approach, 
which is the only way to provide quality, affordable, cost-effective 
health care for all Americans. What we are now looking at is a 1,900-
page bill which is enormously complicated which clearly has been 
heavily influenced by the drug companies, by the insurance companies, 
and by every other special interest that is making billions off of 
health care.
  I think it is very important as we proceed down this path to take a 
very hard look at the end of the day as to what this bill will mean for 
middle-class families, for working-class families, and for the 
financial stability of our country as a whole. I am going to do 
everything I can to make sure this bill is something worth voting for--
worth voting for.
  So with that, I thank the Chair for the indulgence, and I yield the 
floor.
  Mr. COBURN. Mr. President, I seek recognition to speak on the 
nomination of Judge Hamilton.
  The PRESIDING OFFICER (Mr. Merkley). Without objection, it is so 
ordered.

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