[Congressional Record Volume 165, Number 45 (Wednesday, March 13, 2019)]
[House]
[Pages H2709-H2711]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1500
                          MEDICARE FOR ALL ACT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2019, the gentlewoman from Michigan (Ms. Tlaib) is 
recognized for 60 minutes as the designee of the majority leader.


                             General Leave

  Ms. TLAIB. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and to include extraneous material on the subject of the Special Order 
today.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Michigan?
  There was no objection.
  Ms. TLAIB. Madam Speaker, I am honored to co-chair this Special Order 
for the Congressional Progressive Caucus with my amazing colleague from 
California, Katie Porter.
  This is a privilege for me to be able to work with so many of my 
colleagues on the issues that they are very passionate about, from 
healthcare to environmental justice to LGBTQ rights. It has been an 
honor to lead this and to be part of this.
  Today, we are talking about an important, important issue to one of 
my colleagues whom I have known for over 15 years as a community 
organizer and, later, as an immigration rights attorney working on 
civil rights issues. It is an honor to introduce my colleague from the 
State of Washington, the leader on healthcare for all, our wonderful, 
great colleague, Representative Pramila Jayapal.
  Madam Speaker, I yield to the gentlewoman from Washington (Ms. 
Jayapal).
  Ms. JAYAPAL. Madam Speaker, let me say how pleased I am to be with 
Ms. Tlaib today, leading the Special Order hour, and, Madam Speaker, 
how pleased I am to see you at the podium.
  This is a fantastic group of individuals who have joined us here in 
Congress, and I couldn't be prouder to serve with both of you and with 
others who are here as well.
  The topic of this Special Order hour is so important. It has been 
important to me, of course, but also to Members of Congress in general 
and to communities across the country, and that is the topic of 
healthcare.
  I wanted to break this down a little bit, in terms of where we are on 
this issue for people who are watching, because this is one of the 
beauties of the Special Order hour, that we get to talk about the 
issues that matter; we get to explain things; and we get to put forward 
our proposals and our ideas.
  I am so proud to say that, on February 27, I and my colleague, 
Representative Debbie Dingell, introduced the Medicare for All Act of 
2019, and we had 107 original cosponsors. Those are the folks who sign 
on right as it is getting introduced.
  Of course, a bill gets introduced, and we always add people on after 
that. But this is 107 original cosponsors for this act that would build 
upon, improve, and expand Medicare so that it covers every single 
person in this country--universal healthcare, the idea that healthcare 
is a right and not a privilege.
  Let me start by saying that we Democrats are absolutely united around 
the need to shore up the Affordable Care Act. There is no question that 
there is work to do immediately on some of the things that were done to 
take away access to those with preexisting conditions, to strip away 
the benefits of the Affordable Care Act. We are 100 percent united 
around continuing to do that.
  However, we have to have a bold vision that addresses the healthcare 
crisis in this country that leaves 30 million people uninsured and 40 
million people underinsured, without access to healthcare.
  We have to understand, in doing that, in the United States today, we 
spend, depending on what estimate you look at, about $32 trillion to 
$39 trillion on healthcare costs over 10 years. That is going up to 
about $50 trillion over the next 10 years on healthcare. That is about 
18\1/2\ percent of GDP.
  If you look at every other major industrialized country in the world, 
what you see is that they provide healthcare, comprehensive care, to 
everybody in their country, and they do it at about half the cost, or 
less, of what the United States spends.
  You might think that you could look at costs of healthcare in this 
country and you could say: Well, America has the best healthcare system 
in the world, and that is why we spend so much. We have the best 
healthcare outcomes.
  Well, let's talk about that for a second. In the United States, we 
spend 18\1/2\ percent of our GDP on healthcare costs, yet we have the 
worst health outcomes of any peer country in the world.
  Today in the United States, we have the highest maternal mortality 
rate. We know what that is; that is moms dying in childbirth.
  We have the highest infant mortality rate. That is kids dying at 
young ages.
  We have the lowest life expectancy rate of any of our peer countries. 
In fact, we are the only industrialized country in the world where life 
expectancy is going down and not up.
  So we don't even have good health outcomes to show for our healthcare 
system.
  That is why Representative Dingell and I and our 105 additional 
cosponsors of the bill, and Representative Tlaib and many others who 
are part of this effort, have introduced the improved Medicare for All 
Act of 2019.
  What this bill does is it offers, first of all, comprehensive 
coverage to everyone in the country. We say that that includes primary 
care; it includes vision, dental, hearing; it includes mental health 
and substance abuse; it includes long-term services and supports, 
maternal healthcare, and more.
  Everybody in the country will have access to healthcare when you get 
sick, not when you need an emergency room, not when you simply can't 
take your illness anymore, but when you actually get sick.
  This bill is the first time that we will actually have long-term care 
supports and services included in this coverage. This is very, very 
important because it covers seniors, obviously, our elderly, as they 
get toward the end of their life, and it includes people with 
disabilities who have, traditionally, been left out of this entire 
sphere.

  What we do is we say that, instead of the current system where you 
have to get so poor that you have to be on Medicaid--you have to have a 
low level of income, be on Medicaid--if you want long-term supports and 
services, and the automatic default is institutional care instead of 
home care, we flip that on its head and we say you get to stay at home 
with the people you love. You get to be in your home as you are dealing 
with these incredible challenges that you may have.
  Our bill says no premiums, copays, and deductibles. We don't want you 
to have to think about that as you go to the doctor.
  This is very important, because you will hear this is a government 
takeover of healthcare. That is what opponents of my bill are already 
trying to tell you.
  I want you to hear this really clearly, if you are listening: We use 
the same network of doctors and hospitals that is already here.
  In fact, I bet, if we had a roomful here and I were to ask people how 
many of you have been told, or have a family member or a relative who 
has been told, that you can't go to a certain hospital or doctor 
because it is out of network, or you only get a certain coverage if you 
go, I bet everybody would raise their hands. I see people raising their 
hands right now. Good for you. I feel like I have an audience here.
  What our plan says is that you can go to any doctor or hospital. The 
government isn't taking over those services. It is not going to be a 
different government service. It is just the same as what you have 
right now.
  The only thing that changes is, instead of having to argue with five 
insurance companies--because maybe you have Medicare and you have 
Medicare Advantage; maybe you don't have anything at all; maybe you 
have a combination of things put together. Instead of having to argue 
with five insurance companies, you get to just say:

[[Page H2710]]

This is a government insurance program. This is covered by one 
insurance program, a single payer.
  If you have heard that statement, that is what that means. This is 
the way that almost every industrialized country in the world does it.
  I think that we have to think about what the problem is here, why 
have we not been able to do this. We have, increasingly, seen our 
healthcare system, unfortunately, being moved more and more to a for-
profit system that puts those profits over patients.
  If you look at, for example, the cost of pharmaceutical drugs in our 
country today, it is so much more expensive to get insulin treatment or 
cancer treatments or even an MRI in the United States. I have clients 
and constituents who drive to Canada, who go to other places, because 
they can't afford the drugs here, and they can buy the exact same thing 
across the border for significantly cheaper.
  We are having a crisis, Madam Speaker, where people are going to bed 
at night thinking about how they are going to pay their rent and pay 
for their cancer treatment, how they are going to afford to get the 
insulin treatments that they want. People are foreclosing on homes.
  In fact, two-thirds of all the bankruptcies today in the United 
States are due to medical issues, medical costs. GoFundMe has become 
one of the most popular insurance plans around, where people are just 
banking on the goodness of people to take care of their healthcare 
costs. That is simply not acceptable.
  If we want to take on this question of universal healthcare coverage, 
which, by the way, Teddy Roosevelt talked about in 1910, Harry Truman 
in 1945, President Johnson--this is not a radical idea. It is actually 
something that has been tried and tested.
  But here in the United States, the idea that we could provide 
universal healthcare for everybody, make sure that people get the 
healthcare access that they need, this is the time for it. Seventy 
percent of the American people actually agree with us. You might hear 
that that support goes down if you say some other things, but let's be 
really clear that the fearmongering out there is driven by for-profit 
industries that, unfortunately, have a lot to lose if a plan like this 
were to pass, because we would actually make sure that we are not only 
providing universal coverage but that we also have cost containment 
built into our system.
  That is what my bill does. We build in cost containment measures so 
that we can actually bring down the overall cost of healthcare in this 
country to what is standard in other countries around the world.
  This is incredibly important to us, and as we think about who gains 
and who loses in this, I believe that it is actually a win-win for 
everybody who is concerned about putting patients over profits.
  It is a win-win for doctors who have been trained to take care of 
patients but, instead, spend 25 to 30 percent of their time dealing 
with insurance companies and trying to do all the paperwork that needs 
to be there, trying to argue for a patient of theirs to be able to get 
the care they need.
  It is a win for hospitals that want to make sure that they know what 
kind of budgets they are going to have and that they can work within 
that. We have something built into our plan called global budgeting, 
which is actually the standard in other countries but is being tested 
in Maryland to great effect, where hospitals get an overall amount of 
money, and they get a global budget. We have that built in as well.
  It is a win for patients. This is the thing that is so important to 
emphasize again and again.
  Actually, before I get to the patients, let me say it is also a win 
for our businesses, particularly our small- and medium-sized 
businesses. I have a lot of business owners who might disagree with me 
on a few other issues, many of them are across the aisle--they are 
Republicans; they are independents. They come up to me and they say: 
Representative, I don't agree with you on this or this or this, but 
please, can you get the Medicare for All bill passed, because we 
cannot, as small businesses and even medium-sized businesses and, by 
the way, even large-sized businesses, deal with the growing cost of 
these insurance premiums that we are paying that are really just going 
to line the pockets of top CEOs.

  The CEO of UnitedHealth took home $82 million, even as people are not 
able to afford treatments and are dying. The other CEOs have taken in 
$52 million, $29 million.
  We have to make sure that the balance of something like healthcare, 
which is an essential, I believe, a common good in this country, that 
we are able to provide that to people.
  There are lots of other places where markets can work, but in this 
marketplace where you need to make sure that healthcare is provided to 
everybody regardless of whether you are rich or poor, regardless of 
where you live, regardless of the color of your skin, this is where the 
government comes in to try to help make sure that that is actually 
possible.
  This is a really important bill for us, and I am absolutely honored 
to have so many of my colleagues who are so smart on these issues, not 
only in liberal districts like mine but also in frontline districts, 
places that were held by Republicans for a very long time.
  My Democratic colleagues flipped those districts, and they ran on 
this issue. They ran on this issue, and they won on this issue, because 
they know, and their constituents know, that it is time to take profit 
out of this system and make sure that it once again gets focused on the 
healthcare of people.
  We also have an incredible coalition of labor unions that have come 
on board for the first time ever. Our teachers are on board, our 
machinists, our steelworkers. We have so many different unions that are 
on board this time.
  Our disability rights community is on board.
  Our women's organizations are on board, because for the first time, 
we make sure that everybody gets the care they need, whether they are a 
woman or a man, and we make sure that people have control over their 
reproductive choices.
  We are absolutely thrilled about this.
  I want to be clear about one thing, as I turn this back over to my 
incredible colleague from Michigan. This is not a messaging bill. I 
want to be clear about that.
  For the first time in the House of Representatives, this bill is over 
120 pages long. It is a detailed analysis and layout of exactly how 
this would work. It ensures that everybody gets healthcare. It keeps 
the existing system of delivery that we have. We are not changing the 
system of delivery.
  It does not in any way say that insurance companies can't continue to 
operate. They just can't provide the same benefits that we are 
providing through the government insurance plan. That is actually the 
way Medicare works right now.

                              {time}  1515

  You can't provide the same benefits because we don't want a two-
tiered system.
  Now, if they want to provide benefits outside of what we provide, 
they are welcome to do so. That is how Medicare Advantage originally 
came in to being. Medicare Advantage plans, the benefits that are 
offered under those, would be included in our plan, so we wouldn't need 
those plans. But insurance companies are free to continue to innovate 
as they need to; and we have built in 1 percent of the cost of the bill 
for the first 5 years actually goes to a fund that ensures transition 
and appropriate support for workers in the insurance industries who may 
actually end up having to lose their jobs or to eventually transition 
into this new system that we have.
  We will, for the first time, thanks to Speaker Pelosi's support, and 
others' support, we will have hearings on this bill. And whether you 
agree or you disagree with the premise, what I would ask is that you 
understand how critical it is to address and finally get to universal 
healthcare in this country.
  This is a debate that should have been had on the House floor and in 
our committees a long time ago. We are finally going to have that with 
a number of different committees; and I am looking forward to 
continuing to help lead with all of my colleagues on ensuring that 
healthcare is a right and not a privilege; that you don't have to be 
wealthy to get basic healthcare; and

[[Page H2711]]

that we improve the ultimate competitiveness of our businesses, our 
families, our communities, and the health, the basic health, the right 
to live with dignity and respect for all of our people.
  Ms. TLAIB. Madam Speaker, that was incredible. And obviously, many of 
us in the Congressional Progressive Caucus have fully supported so much 
of what Medicare for All stands for. I thank the gentlewoman from 
Washington for her leadership and courage for taking on such a bold 
move.
  Madam Speaker, I am very honored to be here representing the 
community that raised me. I was raised in Southwest Detroit, in the 
13th Congressional District. Growing up in Southwest Detroit, I 
actually thought that smell was normal, all the pollution that I kind 
of grew up in, all the truck traffic. As I got older, I realized it 
wasn't normal. It wasn't normal that so many of my neighbors were 
getting cancer or had respiratory issues. It wasn't normal that one of 
five children have asthma.
  We have one of the highest--one of the worst air qualities in the 
State of Michigan in the 13th Congressional District; and it is the 
third poorest Congressional District in the country.
  So the deadly consequences of being uninsured is real for my 
constituents at home; through no fault of their own, but for the fact 
that they live in communities that are polluted and communities that 
lack so much opportunity to be able to thrive.
  So this is an important issue, not only to millions of Americans 
today, but to my residents; this need for universal healthcare. It is a 
topic that most, if not all of us in this Chamber were sent here to 
work on. It is a topic that is always on the minds of our residents 
every single day. It is a topic that is literally a life or death 
situation, and an issue that has bankrupted many of our families; an 
issue that we should not be worried about in this country.
  We are the richest country on the planet, but the United States is 
the only industrialized country without universal healthcare.
  Fifty thousand residents in my district are uninsured. This is why I 
am thrilled and excited that over 100 of my colleagues have signed on 
to sponsor the Medicare for All Act.
  More than 30 million Americans are without access to healthcare right 
now without insurance, with an additional 40 million who cannot afford 
co-pays and the deductible.
  Pharmaceutical companies make billions, Madam Speaker, in profits, 
while working Americans are forced to go through extraordinary measures 
to pay for care.
  Just the other day, I heard a mother talk about losing her 6-year-old 
child, her little girl, because she couldn't afford insulin. This is 
why we need something bold, courageous, transformational, and that is 
supporting Medicare for All.
  We spend the highest amount per capita in the world on healthcare. We 
need a better system for our constituents. We need Medicare for All.
  This system is one that many more of my colleagues should get behind. 
It provides a system where our constituents will know that they are 
secure and getting healthcare that they need today. This is a system 
that will take away the worry of our constituents who have constant, 
day-in, day-out thinking about the cost of healthcare, and whether or 
not their current insurance even covers it.
  It is really important to be clear about Medicare for All. One, it 
includes comprehensive coverage for primary care, for hospital, 
outpatient services, prescription drugs, reproductive health services, 
newborn care, long-term care services. This is so critical for my 
residents.
  Constantly do I hear, day-in, day-out of families that are taking 
care of their parents and not having access to long-term care coverage.
  It supports mental health and substance abuse treatment, laboratory 
and diagnostic services, and so much more.
  Patients will have complete freedom to choose their doctors. I am 
going to say this again. Patients will have complete freedom, under the 
Medicare for All Act, to choose their doctors, hospitals, and other 
providers that they wish to see.
  Long-term care, again, in support for our older Americans, our 
neighbors, and those with disabilities, will be covered.
  Medicare for All will decrease the costs by reducing inefficiency; 
preventing healthcare corporations from overcharging; and increasing 
transparency in our system.
  Medicare for All will also decrease prescription drug costs by 
allowing Medicare to finally negotiate our prices.

  The legislation also preserves healthcare programs for our veterans 
and our Native Americans.
  Healthcare is a right, Madam Speaker, not a privilege for the 
wealthy.
  And not only is this the most incredible class, and not because I am 
part of it, but it really is, it is the largest incoming class since 
Watergate but, more importantly, it is the most diverse.
  We not only ran because we wanted to be first, or we wanted to be 
diverse, we ran because we speak differently; we serve differently; and 
we are much more courageous than, I think, previous classes ever have 
been.
  So, I am asking our colleagues to please stand up and support 
Medicare for All. Give it a chance. See the possibility of finally 
being able to provide for our constituents' universal healthcare.
  Madam Speaker, I yield back the balance of my time.

                          ____________________