[Congressional Record (Bound Edition), Volume 151 (2005), Part 1]
[Senate]
[Pages 16-19]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. WYDEN. Mr. President, before he leaves the Chamber, I commend the 
majority leader for his interest in health care, in particular. I have 
always thought it is far away the most important issue at home. I have 
come to the Senate to talk about some of the opportunities in this 
session to work in a bipartisan way on these critical issues. In fact, 
I was going to mention that the Senator and I have pursued legislation 
to tackle the problem of child obesity. I appreciate the majority 
leader's interest in health care and look forward to working with him 
in this session.
  Mr. President, colleagues, I have believed health care is the most 
important issue at home since my days as director of the Oregon Gray 
Panthers. I have thought health care was the most important issue 
because, in a sense, if our folks do not have their health, it is not 
possible to work, to learn, to raise children, or do much of anything 
the American people value.
  For me, this is the big priority at home. When we look at what is 
happening today with medical costs gobbling up everything in sight, the 
demographic revolution with so many more older people, the tremendous 
lifesaving technologies we have today which, of course, carry a big 
price tag, all of these forces come together to present an issue that 
just cannot be ducked any longer. To put it in perspective, David 
Walker, the Comptroller General of the Government Accountability 
Office, put it pretty well, saying that the Medicare problem is about 
seven times greater than the Social Security problem and it has gotten 
much worse. It is much bigger. It is more immediate. It is going to be 
much more difficult to effectively address.
  That is the view of the Comptroller General. He is talking about 
Medicare. But in my view, the concerns that David Walker talks about 
with respect to Medicare extend to the health care system as a whole.
  This afternoon for a few minutes I will chart a course as it relates 
to health care: first, a number of steps that could be taken right now 
that would significantly help the American people as we deal with this 
health care challenge. Then I will discuss, for the longer term, 
another bipartisan effort I have had a chance to team up with Senator 
Hatch on that will be implemented over the next few weeks.
  But if I might, I would like to start with Medicare. I think Senator 
Frist is right; these Medicare costs are soaring. For the prescription 
drug legislation alone, it is clear now the price tag will be in the 
vicinity of $100 billion more than Congress originally calculated. That 
is the current estimate. Many have said it will be much greater. I 
think it is critically important that steps be taken to contain costs, 
particularly as relates to this fast-growing area that we will be faced 
with, that is prescription drugs.
  We all hear about it from our constituents. Every time we are home, 
folks tell us about how skyrocketing prescription drug costs are such a 
hardship on them. They want to know what Congress is going to do to 
respond to it.
  One of the things I think has been so exacerbating about this issue 
of cost containment as it relates to prescription drugs is that the 
Medicare program is not even employing the kind of cost containment 
tools you see in the private sector. If you are talking, for example, 
about a big timber company, the Presiding Officer (the Senator from 
Idaho) and I know big timber firms and other natural resources firms 
use their bargaining power in order to try to hold down the cost of 
medicine and other essentials. The Medicare program is not doing that. 
The Medicare program is not using the kind of bargaining power that 
exists in the private sector today.
  In fact, if you are an older person, and you go off and purchase your 
medicine, either now or even in the future, under many of the plans 
that will be offered under the new program, you have no bargaining 
power, and in effect you are subsidizing those big private-sector 
buyers, whether they are steel firms, timber firms, auto companies, or 
various other kinds of concerns. I do not think that is right.
  (Mr. Talent assumed the chair.)
  Mr. WYDEN. I am very pleased I have had a chance over the last few 
years to team up with Senator Snowe of Maine on a bipartisan effort to 
contain those prescription drug costs, using essentially the model of 
more bargaining power the way private sector firms have.
  Part of the Medicare prescription drug bill that I think is very 
unfortunate is a statutory ban on Medicare using its bargaining power 
to hold down the cost of medicine the way big private-sector buyers 
would use their bargaining power. So Senator Snowe and I would like to 
change that. We would like to lift that bargaining power restriction so 
Medicare would be in a position to use marketplace forces to hold down 
the cost of prescription drugs.
  A few weeks ago, we got a big boost for our bipartisan legislation 
when the outgoing Secretary of Health and Human Services, Secretary 
Tommy Thompson, said he wished he had had the power the bipartisan 
Snowe-Wyden legislation would provide. Secretary Thompson gave a press 
conference, I believe on the day he announced his resignation, and 
specifically said he wished he had had the tools that the bipartisan 
legislation the Senator from Maine and I have authored would provide at 
the time of his service because he could have made those scarce 
Medicare dollars stretch further.
  So I think Secretary Thompson gave a pretty ringing bipartisan 
endorsement for the legislation Senator Snowe and I will be 
reintroducing very shortly. It seems to me to make sure that seniors 
get the best value in the marketplace, that taxpayers get their money's 
worth under the Medicare program, a program that is, of course, soaring 
in costs, we ought to make sure we use the kinds of tools the private 
sector uses.
  In the bipartisan legislation I have written with Senator Snowe--it 
is

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called the MEND bill, the Medicare Enhancement for Needed Drugs 
legislation--we would have a chance, in my view, to significantly rein 
in these costs using the power of the marketplace. But I bring this up 
first by way of saying this is just the beginning of what I think we 
could do in this session of Congress.
  I want to move now to the issue of catastrophic illness. The Senator 
from Missouri and I represent a lot of small businesses. We enjoyed our 
service on the Small Business Committee when we were in the House. I 
think we and our colleagues all understand if you have a small 
business, say a hardware store with six people, and one or two of them 
get particularly sick, that essentially blows the whole health care 
system for that small hardware store or furniture shop or what have 
you. In effect, if one or two of the people get sick at the small 
business, the premiums go through the roof for everybody, and they 
essentially can go so high that it is not possible for the firm to 
offer coverage at all.
  I was struck in the campaign by Senator Kerry's proposal because I 
thought it was a very innovative way to help those small businesses 
rein in their costs. In effect, he was going to use the concept of 
reinsurance for very large bills that would be faced by a small 
business. If you have the Government picking up the very large bills 
for the one or two people at the hardware store in Missouri who have 
these illnesses, that can stabilize the rate system for everybody.
  I thought the Kerry proposal was a good idea. I come to the floor to 
bring it up because I think if you compare the Kerry proposal to some 
of the ideas offered by the distinguished majority leader, Senator 
Frist, who was just on the floor, his Healthy Mae proposal, while 
different than the Kerry proposal, certainly in a number of respects 
both of them are looking at the same core concept, which is to use this 
idea of reinsurance to pick up the very large bills that would be faced 
by some of our small businesses.
  I think when you look at the Kerry proposal, when you look at the 
Frist proposal, there is a lot of common ground there to tackle a 
health care issue of enormous concern to millions of families. All 
across this country we have citizens who face the prospect of going to 
bed at night knowing that if the medical bills soar through the roof, 
they could lose everything. They could lose their home, the capacity to 
educate their kids. They could lose virtually everything.
  So I think it is important we enact a catastrophic illness program. 
This idea, by the way, has percolated around for decades. Democratic 
Presidents have talked about it. Republican Presidents have talked 
about it. Senator Kerry has authored an innovative proposal. Senator 
Frist has come up with ideas that I happen to think are attractive. 
What we ought to be doing as a body is looking for common ground and 
the opportunity to work together. As Senator Snowe and I have done with 
prescription drug cost containment, I would hope the Senate could come 
together for a bipartisan catastrophic illness proposal that I think 
would make a very meaningful dent in these huge expenses we so often 
face for catastrophic illness.
  There are other areas that lend themselves to immediate action as 
well. In this regard, I particularly commend the distinguished senior 
Senator from New Mexico, Mr. Domenici, and the senior Senator from 
Massachusetts, Mr. Kennedy, for their outstanding work on mental 
health. We have been working for some time to try to ensure that there 
would be mental health parity. Having had my late brother, Jeff, suffer 
from schizophrenia, I have watched these families jostled around in the 
health care system for years. I know colleagues of both political 
parties have as well. There is no reason why we cannot get a bipartisan 
mental health parity effort, a Domenici-Kennedy bill, working with the 
other body, get that enacted into law, and get it sent to the 
President--again, a chance for immediate action.
  Finally, I mentioned briefly the issue of childhood obesity. It is 
obvious that we now have literally an epidemic of childhood obesity 
problems occurring early on in life that produce other deadly and 
costly illnesses such as diabetes and heart disease. Senator Frist and 
I, working with a group of health advocates for children and 
independent scientists, have put together a bipartisan bill. I hope we 
can use that legislation as an opportunity for the Senate to come 
together.
  Our proposal essentially involves a modest Government role, 
particularly at the outset of the program. Then we use a foundation 
approach to generate additional funds in the private sector. But at the 
end of the day, under that legislation, we would have a grassroots 
juggernaut all across the country focused on our schools, on our 
families, tackling this issue of childhood obesity. Again, there is no 
reason why we could not act immediately.
  On these kinds of issues--and I have outlined four of them now--I 
believe Congress is on the cusp of success. Bipartisan efforts are 
underway. Certainly they need some tweaking and some changes, going 
through the committee process and the negotiations that are essential 
to pass legislation, but for all practical purposes, in each of these 
areas--prescription drug cost containment, a program to deal with 
catastrophic illness, mental health parity, and fighting childhood 
obesity--we have legislation that is camera-ready to tackle these very 
serious health care concerns. We ought to have it.
  As the Congress moves on these initiatives, we have to also move to 
address the health care system of tomorrow. In this regard, Senator 
Hatch and I have worked for several years on the Health Care That Works 
for All Americans Act. We got it funded finally last year as part of 
the appropriations legislation. Now the Government Accountability 
Office is moving to set in place the first stage of the legislation, 
which would involve naming the 14 individuals who would be part of the 
Citizens' Health Care Working Group.
  The bipartisan effort Senator Hatch and I have pursued for several 
years is built on the proposition that it is time for the country and 
the Congress to try something different and to look at this in a 
dramatically altered way. This may be of some interest to the Presiding 
Officer because essentially Harry Truman, in the 81st Congress in 1945, 
tried on the health care issue what Bill Clinton tried back in 1993 and 
1994, and essentially all Presidents have tried in between the 1940s 
and the 1990s. That was to write legislation in Washington, DC. The 
American people would find these big Federal health reform bills 
incomprehensible. The various powerful interest groups would attack 
each other. And essentially nothing would happen. It was essentially 
driven in the confines of the beltway in Washington. Literally for more 
than five decades in the debate about creating a health care system 
that works for everybody, we would essentially have paralysis.
  What Senator Hatch and I have sought to do is to try something 
different; that is, to essentially start this debate outside the 
beltway, to try to involve the American people in the most important 
questions, not the various arcane issues about what every single 
payroll tax level ought to be, but the big kinds of questions--I will 
outline a couple of those in a moment--and then use that kind of 
effort, where citizens could be involved in community meetings, 
citizens could weigh in online, citizens could participate in a variety 
of ways, to try to build a consensus for the kinds of reforms that 
would be needed to create a health care system that works for everyone.
  Under our legislation, after the Citizens' Working Group is named by 
Mr. Walker, the head of the Government Accountability Office, what 
happens next is the working group essentially would put out for the 
American people, in simple, straightforward English, information--it 
could be available online, in booklets, senior centers, other places 
where folks gather--about where the health care dollar goes today. This 
year we are going to spend in the vicinity of about $1.8 trillion on 
health care. That is what we are spending on health care, yet it is 
clear that as far as the

[[Page 18]]

country is concerned, there really is no sense where that $1.8 trillion 
goes now and what the alternatives are for perhaps spending it in a 
different fashion.
  That would be the first task of the Citizens' Working Group, to put 
out online, in booklets available throughout our communities, 
information about where the health care dollar goes today and what the 
various options are for where it might be targeted as an alternative so 
Americans would have a chance to say: Look, what I am interested in is 
this kind of approach. Let's say a health savings account or the 
Associated Health Plan concept, the health plan concept the Senator 
from Missouri has advocated.
  Other citizens might say: I am interested in a single payer kind of 
system, perhaps in a small community. They think that is the approach 
that makes sense for them. The point is, until you tell the American 
people where the health care dollar is going now, it is hard to have a 
debate with respect to changes that might be necessary so the Congress, 
on a bipartisan basis, could in effect move forward with legislation 
that would create a system that works for everybody.
  When Senator Hatch and I began this effort, we made a systematic 
effort to make it as inclusive as we possibly could. The legislation 
early on won the support of the Chamber of Commerce, the AFL-CIO, and 
the American Association of Retired Persons--certainly a coalition that 
doesn't agree all the time on health care or other kinds of issues. We 
have had many groups endorse the effort since. The reason they have is 
they believe it is critical that something new be tried.
  What happens under our legislation, after the Citizens' Working Group 
has made it possible for folks to see where the $1.8 trillion we are 
spending on health care goes now, is that our citizens will have a 
chance to participate in open community meetings, online, and other 
kinds of sessions so that they would have a chance to be heard on the 
second stage of this very different approach with respect to health 
care reform.
  After our citizens have had a chance to be heard, then the Citizens' 
Working Group in effect takes that kind of sentiment they have heard 
from all corners of the Nation and tries to synthesize it into a set of 
recommendations to the Congress. And under our legislation, within 60 
days after the Citizens' Working Group has provided the recommendations 
to the Congress with respect to what the American people have said, 
each committee of jurisdiction has to begin hearings on what has come 
from the Citizens' Working Group in terms of the recommendations of the 
American people.
  I want to close by giving a few examples of the kind of areas where I 
think we have to have the input of the American people where they have 
never been asked. For example, the issue of end-of-life care is 
absolutely essential in terms of a new focus for health care reform. We 
know that many of our health care dollars are spent in the last few 
months of an individual's life. We are told by many medical experts--
doctors, hospitals, and others--that in many of those instances there 
is nothing they can do that is medically effective, and there is 
nothing they can do to enhance the quality of life for the individual. 
So the question for the country and for courageous political leadership 
is: What should we do with respect to end-of-life care?
  If we are being told by our best doctors and hospitals that they 
cannot do anything that is medically effective, cannot do anything to 
promote a better quality of life for individuals, do we want to refocus 
the health care dollars to make sure, for example, that there are 
better hospice programs and better end-of-life care programs for 
individuals facing those kinds of health challenges? I personally think 
that is where the American people are going to end up. Let's ask them, 
for the first time, how they want to deal with these very difficult 
social and ethical issues with respect to American health care. I 
submit that financial issues with respect to health care are very 
difficult, no question about that. I think the social and ethical 
issues, with respect to end-of-life care, where much of the health care 
dollar gets spent today, are even more challenging, but we have to act. 
That is the kind of question that would be posed by the Citizens' 
Working Group. I think other issues are important.
  I am particularly interested in the issue of personal responsibility. 
I think that has been part of what has been driving the debate with 
respect to health savings accounts and other such approaches. I have 
been discussing with my constituents in town hall meetings the idea 
that if we are to have a system that works for everybody in terms of 
affordable quality health care, I am prepared to say that an individual 
should, every time they use a medical service, if they are not 
destitute, have to make a payment on the spot so as to ensure that 
there is a clear requirement of personal responsibility. Certainly, 
that will be controversial, but that is the kind of issue that has to 
be discussed with respect to health reform.
  Finally, I think the question of addressing health care--and 
particularly Senator Hatch and I have tried to do it in a bipartisan 
way--means you have to get beyond the blame game. Sometimes when you 
have a discussion about health care, the topic comes up that 
Republicans say it is the trial lawyers' fault; nail the trial lawyers 
and everything is going to be fine. Then you go meet with Democrats and 
Democrats say, yes, we have to have health reform. Go nail the 
insurance companies; do that and everything will be fine. I think--and 
Senator Hatch and I have talked about this--if we are going to have a 
health care program that works for all Americans, we are going to have 
to get beyond the blame game. You bet changes need to be made in the 
insurance sector, because they do skim the cream and take the healthy 
people, and they do send sick people to Government programs that are 
sicker than they are. There do need to be changes in those insurance 
practices. I think we also understand that there are frivolous cases 
and abuses in the legal sector, and changes would be necessary there if 
we are to have meaningful reform and a health care program that works 
for all Americans.
  It seems to me this is an issue that we cannot duck because come 
2010, 2011, 2012, medical costs will clearly consume just about 
everything in sight. I submit that the problems we are seeing today in 
terms of small business premium hikes, folks falling between the 
cracks--they are not old enough for Medicare or not poor enough for 
Medicaid; our Medicare providers are understandably frustrated by the 
reimbursement system--if we keep nibbling at the Medicare health care 
system, the problems we are seeing today are going to seem like small 
potatoes compared to what happens in 2010, 2011, and 2012. On New 
Year's Day in 2008, this demographic influx, in effect, of 7 million-
plus retirees we will see over the next few years is going to start to 
retire. That happens New Year's Day 2008. So the reason I have come to 
the floor this afternoon is I wanted to outline a number of steps--
four, specifically--that I thought Congress could tackle in a 
bipartisan way that would make a meaningful difference right now: the 
legislation Senator Snowe and I have authored in terms of prescription 
drug cost containment, using marketplace forces to hold down 
prescription drug costs; catastrophic illness, and looking particularly 
at ideas that Senators Kerry and Frist have talked about; the question 
of mental health parity; childhood obesity. Again, we can build where 
there is a bipartisan foundation for congressional action. These are 
steps we ought to take now. Then we ought to use the next couple of 
years--as Senator Hatch and I have tried to do in a bipartisan kind of 
way--to build a health care system that works for all Americans. Our 
legislation is moving ahead.
  The Government Accountability Office is appointing the Citizens' 
Health Care Working Group right now. The $3 million appropriated for 
the legislation--and I am grateful to Senators Specter and Harkin for 
that particular work--is going to allow us, in our Health Care That 
Works For All Americans Act, to take a very different

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approach to break this spiral which dates back to 1945, tried by Harry 
Truman in the 81st Congress, and continued literally up through the 
time of President Clinton. Making sure the public has the facts is the 
first task of the Citizens' Health Care Working Group established in 
the legislation I have authored with Senator Hatch. Second is to make 
sure the public gets a chance to weigh in. Finally, to ensure public 
accountability, the Congress is under a requirement to move forward 
with hearings after the Citizens' Working Group has reported.
  So I think it is appropriate on this first day of the new session to 
zero in on the health care issue. I have been very closely following 
the discussions colleagues on both sides of the aisle have made with 
respect to the tragedy that has taken place overseas. I am very pleased 
to hear that Majority Leader Frist is leading a trip to the area and 
will come back with ideas for bipartisan action on that terrible 
tragedy. I wanted to talk about what I think is the most pressing issue 
at home, the health care challenge, and particularly to outline 
bipartisan steps that could be taken now. I also look forward to 
working with my colleagues as the legislation I have authored with 
Senator Hatch is implemented in the weeks ahead.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Chafee). The Senator from Oklahoma.
  Mr. INHOFE. Mr. President, I ask unanimous consent that I be 
recognized for up to 45 minutes as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. INHOFE. Mr. President, first let me say to my friend, Senator 
Wyden, he has always been a champion of that cause. A lot of us with 
different political philosophies rely on his judgment, his experience, 
his background, and those things he has accomplished in the field of 
health care. I look forward to working with him in this coming year.

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