[Congressional Record Volume 168, Number 147 (Tuesday, September 13, 2022)]
[Senate]
[Pages S4553-S4556]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. SANDERS. Madam President, I understand that there is a lot that 
is going on in the world today. We are worried about climate change and 
what that is doing to our planet. We are worried about the terrible war 
in Ukraine and all of the destruction taking place there. We are 
worried about inflation and the fact that wages are not keeping up with 
the prices that people are paying. We are worried about the massive 
level of income and wealth inequality that exists in our country and 
the increased concentration of ownership that we see in the United 
States, among many, many other things that are on people's minds. But 
to my mind, Madam President, the American people remain and always are 
deeply concerned about an issue that, by definition, touches each and 
every one of us, and that is our collapsing and dysfunctional 
healthcare system.
  While it is not discussed much in the corporate media or here in the 
Halls of Congress, we have today in the United States the most 
inefficient, bureaucratic, and expensive healthcare system in the 
world. And that is not just what I believe; that is what the American 
people know to be true because of their lived experience with the 
healthcare system.
  Madam President, I would hope that all Members of Congress take a 
hard look at a poll that was published yesterday by the Associated 
Press-NORC Center for Public Affairs Research, and this is some of what 
the poll disclosed.
  At a time when I hear many of my colleagues tell us that we have the 
best healthcare system in the world, it turns out that, according to 
this poll, just 12 percent of the American people believe that 
healthcare in general is handled very well or extremely well in the 
United States. Twelve percent.
  At a time when we pay the highest prices in the world for 
prescription drugs, only 6 percent of the American people believe that 
prescription drug costs in the United States are being handled well or 
extremely well. Six percent.
  At a time when COVID has exacerbated the crisis, only 5 percent of 
the American people believe that the mental health care system in the 
United

[[Page S4554]]

States is being handled well or extremely well. Five percent.
  When so many older Americans have died unnecessarily in nursing homes 
and when so many cannot even find the nursing home bed that they need, 
just 6 percent of Americans believe that the quality of care at nursing 
homes in the United States is very good or exceptional. Six percent.
  Madam President, the American people increasingly understand, as I 
do, that healthcare is a human right, not a privilege, and that we must 
end the international embarrassment of the United States of America 
being the only major country on Earth that does not guarantee 
healthcare to all of its citizens. Again, that is not just Bernie 
Sanders talking; that is what the overwhelming majority of the American 
people believe.
  According to yesterday's AP poll, 66 percent of the American people 
believe it is the Federal Government's responsibility to make sure that 
all Americans have health insurance coverage. Sixty-six percent.
  Over 86 percent of the American people believe that it is absurd that 
millions of senior citizens lack dental care, hearing aids, and vision 
care, and they believe that Medicare should be expanded to cover these 
basic healthcare needs. It happens to be an issue I have been working 
on for several years. Eighty-six percent of the American people believe 
that Medicare should cover dental care, hearing aids, and vision care. 
Eighty-six percent.
  At a time when our long-term healthcare system is in shambles, 81 
percent of the American people believe that Medicare should cover the 
outrageous cost of long-term healthcare for senior citizens and people 
with disabilities. Eighty-one percent.
  Madam President, I ask unanimous consent to have printed in the 
Record this AP-NORC poll.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                            [Sept. 12, 2022]

      Americans Give Health Care System Failing Mark: AP-NORC Poll

                           (By Amanda Seitz)

       Washington (AP)--When Emmanuel Obeng-Dankwa is worried 
     about making rent on his New York City apartment, he 
     sometimes holds off on filling his blood pressure medication.
       ``If there's no money, I prefer to skip the medication to 
     being homeless,'' said Obeng-Dankwa, a 58-year-old security 
     guard.
       He is among a majority of adults in the U.S. who say that 
     health care is not handled well in the country, according to 
     a new poll from The Associated Press-NORC Center for Public 
     Affairs Research.
       The poll reveals that public satisfaction with the U.S. 
     health care system is remarkably low, with fewer than half of 
     Americans saying it is generally handled well. Only 12% say 
     it is handled extremely or very well. Americans have similar 
     views about health care for older adults.
       Overall, the public gives even lower marks for how 
     prescription drug costs, the quality of care at nursing homes 
     and mental health care are being handled, with just 6% or 
     less saying those health services are done very well in the 
     country.
       ``Navigating the American health care system is exceedingly 
     frustrating,'' said A. Mark Fendrick, the director of the 
     University of Michigan Center for Value-Based Insurance 
     Design. ``The COVID pandemic has only made it worse.''
       More than two years after the pandemic's start, health care 
     worker burnout and staffing shortages are plaguing hospitals 
     around the country. And Americans are still having trouble 
     getting in-person medical care after health centers 
     introduced restrictions as COVID-19 killed and sickened 
     millions of people around the country, Fendrick said.
       In fact, the poll shows an overwhelming majority of 
     Americans, nearly 8 in 10, say they are at least moderately 
     concerned about getting access to quality health care when 
     they need it.
       Black and Hispanic adults in particular are resoundingly 
     worried about health care access, with nearly 6 in 10 saying 
     they are very or extremely concerned about getting good care. 
     Fewer than half of white adults, 44%, expressed the same 
     level of worry.
       Racial disparities have long troubled America's health care 
     system. They have been abundantly clear during the COVID-19 
     pandemic, with Black and Hispanic people dying 
     disproportionately from the virus. Black and Hispanic men 
     also make up a disproportionately high rate of recent 
     monkeypox infections.
       Fifty-three percent of women said they are extremely or 
     very concerned about obtaining quality care, compared to 42% 
     of men.
       While Americans are united in their dissatisfaction with 
     the health care system, that agreement dissolves when it 
     comes to solutions to fix it.
       About two-thirds of adults think it is the federal 
     government's responsibility to make sure all Americans have 
     health care coverage, with adults ages 18 to 49 more likely 
     than those over 50 to hold that view. The percentage of 
     people who believe health care coverage is a government 
     responsibility has risen in recent years, ticking up from 57% 
     in 2019 and 62% in 2017.
       Still, there's not consensus on how that coverage might be 
     delivered.
       About 4 in 10 Americans say they support a single-payer 
     health care system that would require Americans to get their 
     health insurance from a government plan. More, 58%, say they 
     favor a government health insurance plan that anyone can 
     purchase.
       There also is broad support for policies that would help 
     Americans pay for the costs of long-term care, including a 
     government-administered insurance plan similar to Medicare, 
     the federal government's health insurance for people 65 or 
     older.

  Mr. SANDERS. Madam President, it is hard for me to imagine how anyone 
could defend a healthcare system in which over 70 million people today 
are either uninsured or underinsured. As we speak, this moment, there 
are millions of Americans who would like to go to a doctor, who need to 
go to a doctor, but cannot afford to go to a doctor because of the 
outrageous cost of medical care in this country.
  Frankly, I am tired of talking to physicians who tell me about the 
patients who died--who died--because they were uninsured or 
underinsured and who walked into the doctor's office when it was too 
late. Time and time again, I hear from doctors who tell me about a 
patient who walked in, and they said to the patient: Why didn't you 
come in when you first noticed your symptoms?
  The patient responded: I don't have the money; I can't afford the 
copayment; or I have no insurance at all.
  Madam President, we are talking about--and I know we don't talk about 
it much, and maybe we should--we are talking about some 68,000 
Americans who die every single year because they are uninsured or 
underinsured and don't get the medical care that they need. This is the 
United States, the wealthiest country in the history of the world; 
68,000 Americans should not die every year unnecessarily.
  I am tired of seeing working-class families and small businesses pay 
far more for healthcare than they can afford, which results in more 
than 500,000 Americans every year declaring bankruptcy because of 
medically related expenses. Half a million Americans declare bankruptcy 
because of outrageous healthcare bills they simply cannot afford to 
pay. Families in America should not be driven into financial ruin 
because someone in that family became seriously ill. Sickness should 
not be a cause of financial ruin.
  I am tired of hearing from Americans who lost loved ones because they 
could not afford the unbelievably high cost of prescription drugs, and 
I am tired of hearing from constituents who are forced to cut their 
pills in half due to the cost. Today, unbelievably, almost one out of 
four patients cannot afford the prescription drugs their doctors 
prescribe.
  When you want to talk about an irrational and dysfunctional 
healthcare system, think about a system in which people go to a doctor, 
they get diagnosed as to their healthcare problem, they get a 
prescription drug prescribed to them, but they can't afford to buy the 
drug the doctor prescribes. So what ends up happening? They end up 
getting sicker. Maybe they end up in the emergency room at an 
outrageous cost. Maybe because they couldn't afford the prescription 
drugs in the first place, they end up in the hospital at a very high 
cost. Maybe they die. That is an irrational and absurd healthcare 
system.
  I am tired of talking to people and families of people who are 
struggling with mental illness but cannot afford the mental health 
counseling they desperately need. Last year, as you know, a 
recordbreaking 100,000 Americans died of drug overdoses. And I will 
tell you that in my office--and I am sure that in every other Senate 
office--we get desperate calls from family members looking for 
affordable mental health counseling. Far too often, that care simply is 
not there in the community.
  People are struggling with husbands, wives, kids who are on the verge 
of doing something terrible to themselves, to others, and yet, in this 
country, despite spending far more for

[[Page S4555]]

healthcare than any other country, we don't have the capability of 
helping those people. It is not there. The mental health counseling, 
the help that people need is not there because in this system, geared 
toward the profits of the insurance companies rather than the needs of 
the American people, we don't have enough psychologists, counselors, or 
social workers.
  Unbelievably, despite spending far more per capita on healthcare than 
any other nation, we don't even have enough doctors. We are facing a 
major doctor shortage in America now, which will only get worse in the 
years to come if we don't address it. We don't have enough nurses. We 
don't have enough dentists. We don't have enough medical providers in 
general. We have, however, more than enough people who bill us and more 
than enough debt collectors who hound us to pay for a bill we cannot 
afford, but we just don't have enough people to provide the healthcare 
that we desperately need.
  By the way, the crisis of lack of healthcare providers is only going 
to get worse as our society continues to age.
  At a time of declining life expectancy in the wealthiest country on 
Earth, your health and your longevity should not be dependent on the 
amount of money you have. It is an absolute outrage and grossly un-
American that the number of years we live in this country is dependent 
upon our income. Studies have shown that the top 1 percent of Americans 
live 15 years longer than the poorest people in our society. It is not 
only the very top as opposed to the very bottom; it is wealthy people 
in general versus working-class people. If you got the money, you are 
going to live longer in this country than if you do not have the money.
  In my view, healthcare is a human right that all Americans, 
regardless of income, are entitled to, and all Americans deserve the 
best quality healthcare that our country can provide.
  Further, as chairman of the Senate Budget Committee, it is not 
acceptable to me that we end up spending over twice as much as 
virtually every other major country on Earth per capita--twice as much 
per capita--while our life expectancy and other healthcare outcomes lag 
behind most other countries. This is really quite an amazing thing. We 
spend more; yet our results are worse than in other countries, 
unbelievably.

  According to the Centers for Medicare and Medicaid Services, we are 
now spending $12,530 per capita on healthcare. Imagine that--over 
$12,000 for every man, woman, and child in this country. This is, 
frankly, an outrageous and unsustainable sum of money. In comparison, 
the United Kingdom spends just $5,300; France spends $5,400; Canada, 
$5,900; Germany, $7,300. We spend over $12,000 per year.
  The question that everyone should be asking is, How does it happen 
that we spend so much money for healthcare, but we get so little in 
return?
  Let's be clear. The current debate over healthcare in the United 
States really has nothing to do with healthcare. Frankly, it is hard to 
defend this dysfunctional system. The healthcare debate has everything 
to do with the unquenchable greed of the healthcare industry and their 
desire to maintain a system which fails the average American but which 
makes the industry huge profits every single year. While ordinary 
Americans struggled to pay for healthcare during this pandemic, the six 
largest health insurance companies in our country made over $60 billion 
in profits last year, led by UnitedHealth Group, which made $24 billion 
in 2021.
  While millions of Americans cannot afford soaring healthcare costs, 
the top executives in the insurance industry receive huge amounts of 
compensation. In 2020--remember, 70 million uninsured and underinsured 
and 68,000 dying every year because they don't get to a doctor on 
time--the CEOs of 178 major healthcare companies collectively made $3.2 
billion in total compensation--up 31 percent from the previous year--
all in the midst of the pandemic. People were dying every single day, 
and the cost of healthcare was soaring; yet the CEOs saw a 31-percent 
increase in their compensation. According to Axios, in 2020, the CEO of 
Cigna, David Cordani, took home $79 million in compensation. The CEO of 
Centene, Mr. Neidorff, made $59 million. The CEO of UnitedHealth Group, 
Mr. Wichmann, received $42 million in total compensation.
  But it is not just the health insurance companies that are ripping 
off the American people; it is the drug companies as well. In terms of 
the pharmaceutical industry, last year, Pfizer, Johnson & Johnson, and 
AbbVie--three giant pharmaceutical companies--increased their profits 
by over 90 percent to $54 billion. How is it that, in the midst of a 
pandemic, during which we lost over a million people and millions and 
millions of people have become sick, the profits of the major drug 
companies went up by over 90 percent?
  The CEO of Moderna got a $926 million golden parachute after his 
company received $2.5 billion in taxpayer dollars to develop the 
vaccine. We all appreciate the development of the vaccine, which is 
saving lives every day. But, really, does the CEO of the company that 
received $2.5 billion of taxpayer money deserve a $926 million golden 
parachute? That is an indication, a manifestation, of a sick and broken 
healthcare system. And while over 330,000 Americans died during the 
pandemic because they could not afford to go to a doctor on time, the 
CEO of Regeneron Pharmaceuticals made over $450 million in total 
compensation.
  The current system is failing the American people, and the American 
people want change--real change.
  In March, a few months ago, I was pleased to introduce Medicare for 
All legislation, with 15 Senate cosponsors. Companion legislation in 
the House now has 122 cosponsors. This legislation would improve and 
expand Medicare to cover, over a 4-year period, healthcare to every 
man, woman, and child in this country. In other words, what this 
legislation finally does is make sure that the United States joins 
every other major country and that we guarantee healthcare to all of 
our people.
  This legislation is comprehensive, and it would end out-of-pocket 
expenses. Unlike the current system, it would provide full freedom of 
choice regarding healthcare providers. In other words, under Medicare 
for All, there would no longer be insurance premiums, deductibles, or 
copayments, and no more networks which deny you your choice of doctors. 
And, when I talk about Medicare for All being comprehensive, it would 
cover dental care, vision, hearing aids, prescription drugs, and home- 
and community-based care. In other words, it would do precisely what 
the American people want us to do.
  Would a Medicare for All system be expensive? Yes, but while 
providing comprehensive care for all, it would be significantly less 
expensive than our current dysfunctional system because it would 
eliminate an enormous amount of the bureaucracy, profiteering, 
administrative costs, and misplaced priorities inherent in our current 
for-profit system.
  Remember, we currently pay twice as much for healthcare as do the 
people of virtually any other country, and all of those countries 
manage to provide universal healthcare. So, yes, we can provide quality 
care for all at a much, much lower cost per person.
  Under Medicare for All, there would no longer be armies of people 
billing us, telling us what is covered and what is not covered, and 
hounding us to pay our hospital bills. This not only saves substantial 
sums of money but will make life a lot easier for the American people, 
who would never again have to fight their way through the nightmare of 
insurance company bureaucracy. In fact, the Congressional Budget 
Office, the CBO, estimated that Medicare for All would save Americans 
$650 billion a year.
  Now, trust me. I do know the 30-second ads from the insurance and 
drug companies that have told us that if Medicare for All becomes law, 
your taxes will go up. What they forgot to tell you is that, under 
Medicare for All, you will no longer be paying premiums, deductibles, 
copayments, and out-of-pocket expenses to private health insurance 
companies. What they certainly won't tell you is that Medicare for All 
will save--save--the average American family thousands of dollars a 
year. In fact, a study by RAND found that moving to a Medicare for All 
system would save a family with an income of less than $185,000 about 
$3,000 a year on average.

[[Page S4556]]

  Now, one might ask, fair enough: If Medicare for All is so good, if 
it has so many advantages, if it is what the American people want, why 
hasn't it been enacted by now? Why hasn't the United States joined 
every other major country in guaranteeing healthcare for all?
  That takes us to our corrupt political system and the outrageous way 
we fund campaigns. So I would suggest if you want to know why we are 
stuck with a dysfunctional healthcare system that fails the American 
people but that makes the drug companies and the insurance companies 
wildly profitable, follow the money. Follow the money.
  Since 1998, in our corrupt political system, the private healthcare 
sector has spent more than $10 billion on lobbying. Got that? More than 
$10 billion on lobbying since 1998. Over the last 30 years, it has 
spent more than $1.7 billion on campaign contributions to maintain the 
status quo.
  In terms of their lobbying efforts, let's be clear. They are very, 
very bipartisan. There are former Democratic Party leaders and former 
Republican Party leaders who are working together to represent the 
insurance companies and the drug companies.
  And, by the way, of course, in terms of the campaign contributions, 
the insurance companies and the drug companies are also very 
bipartisan. In fact, their contributions go to many Members of both the 
Democratic and Republican Parties. It doesn't really matter if you are 
a Democrat or a Republican; what matters is you protect the interests 
of the drug companies and the insurance companies.
  But, you know, what I believe is that maybe, just maybe, now is the 
time for Congress to do what the American people want--not what the 
lobbyists want, not what the drug companies want, not what the 
insurance companies want. And maybe, just maybe, we should have the 
courage to take on the powerful special interests that dominate 
healthcare in the United States. And maybe, just maybe, now is the time 
to provide healthcare to every man, woman, and child as a human right 
by passing a Medicare for All, single-payer program.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Nebraska.