[Congressional Record (Bound Edition), Volume 153 (2007), Part 17]
[Senate]
[Pages 23884-23888]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. WYDEN. Mr. President, Senator Bennett of Utah and I have brought 
to the Senate the first bipartisan universal health care coverage 
legislation in more than 13 years. I thought today I would open my 
remarks on health care in something of a light fashion. There is a 
brand new study that has recently found Americans are no longer the 
tallest people in the world. Over the past 50 or so years, the U.S. 
population has lost that status and now ranks among the shortest among 
industrialized countries. The Netherlands now holds the honor for the 
tallest nation. The authors of this new study speculate this change may 
stem from the fact that most other affluent countries have health care 
systems that cover their entire population and that particularly 
healthy lifestyles and healthy diets are also significant factors.
  Senator Bennett is 6 foot 6. I am 6 foot 4. We would like our country 
to get its rightful position back as the leader among nations in the 
height department. We think part of what is going to be necessary to do 
that, in all seriousness, to make our health policies more health 
focused rather than just spending on health care, is to adopt some 
fresh policies. We have been particularly interested this week because 
the Wall Street Journal, which colleagues know displays a preference 
for private health care sector solutions, has written a fascinating 
front page article this week on the special accomplishments in Holland 
with respect to health care. I have long been of the view that as we 
look finally to accomplishing what this country has not been able to do 
for 70 years, which is to get all Americans good quality, affordable 
health care, we are going to have to devise our own system. It is not 
going to be possible to import some other country's system of health 
care to our Nation and pretty much plop it down on the United States 
and say: This is the way to go.

[[Page 23885]]

  But as the Wall Street Journal said in their article this week, there 
are some important lessons to learn as it relates to the experience of 
other countries.
  I ask unanimous consent to print in the Record this front page 
article from the Wall Street Journal with respect to health care.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

         In Holland, Some See Model for U.S. Health-Care System

                            (By Gautam Naik)

       The Hague.--The Netherlands is using competition and a 
     small dose of regulation to pursue what many in the U.S. 
     hunger to achieve: Health insurance for everyone, coupled 
     with a tighter lid on costs.
       Since a new system took effect here last year, cost growth 
     is projected to fall this year to about 3% after inflation 
     from 4.5% in 2006. Waiting lists are shrinking, and private 
     health insurers are coming up with innovative ways to care 
     for the sick.
       The Dutch system features 2 key rules: All adults must buy 
     insurance, and all insurers must offer a policy to anyone who 
     applies, no matter how old or how sick. Those who can't 
     afford to pay the premiums get help from the state, financed 
     by taxes on the well-off.
       The system hinges on competition among insurers. They are 
     expected to cut premiums, persuade consumers to live 
     healthier lives, and push hospitals to provide better and 
     lower-cost care.
       Some are already taking unusual steps. The insurance 
     company Menzis has opened 3 of its own primary-care centers 
     to serve the patients it insures, and plans to open dozens 
     more in a move to lower costs. Rival UVIT offers discount 
     vouchers to customers who buy low-cholesterol versions of 
     yogurt, butter and milk.
       To prevent insurers from seeking only young, healthy 
     customers, the government compensates insurers for taking on 
     higher-risk patients. Insurers get a ``risk-equalization'' 
     payment for covering the elderly and those with certain 
     conditions such as diabetes.
       Three years ago, Rianne Boel, who works in a store that 
     sells large-size clothes for women, weighted 293 pounds and 
     suffered from diabetes. She joined a new UVIT program that 
     promised to pay her back about $676 for gym membership--
     provided Ms. Boel lost 7.5% of her weight in 15 months.
       The 45-year-old, who lives in the town of Tilburg, says she 
     stopped eating french fries and pizza and took up an 
     intensive regimen of walking, cycling and rowing. She met her 
     weightloss target and used the gym-membership rebate to buy 
     some new clothes.
       Ms. Boel now hopes to manage her diabetes more efficiently 
     and lose more weight. ``I don't like exercising,'' she says, 
     ``but at least I can now walk without a stick.'' That's 
     welcome news to UVIT. Says spokesman Bert Rensen, ``Once she 
     stops using insulin, which we pay for, it will save us K900 
     [about $1,200] a year.''


                           Likely Opposition

       What works in the Netherlands, a small country of 16.6 
     million people, may not readily apply to America. A Dutch-
     style scheme would likely raise opposition among U.S. doctors 
     and Republicans who are cautious about higher taxes. But many 
     U.S. states are similar in size, and one, Massachusetts, is 
     already experimenting with a universal-coverage scheme.
       ``The lesson for America is that this is what we ought to 
     do,'' says Alain Enthoven, a professor at Stanford 
     University.
       Three decades ago, Prof. Enthoven published a pioneering 
     proposal for what he called ``managed competition,'' a 
     version of which the Dutch have now adopted.
       The Enthoven plan partly inspired the Clinton 
     administration's failed health-care overhaul effort in the 
     1990s. It has now come full circle. Last October, an 
     economist from the Dutch health ministry was invited to 
     describe his country's new approach to about 50 Massachusetts 
     politicians and policy makers in Boston, as the state was 
     developing its own plan for mandatory health insurance.
       After being sidelined for more than a decade, health care 
     is once again a hot issue on the U.S. political agenda. Two 
     leading Democratic presidential candidates, Sen. Barack Obama 
     of Illinois and former Sen. John Edwards of North Carolina, 
     have backed the idea of universal coverage and suggested ways 
     to achieve it. California Gov. Arnold Schwarzenegger, a 
     Republican, has pushed a proposal to require all state 
     residents to obtain health insurance, but he hasn't been able 
     to strike a deal with state legislators to enact a plan.
       The notion of competition among insurers is nothing new to 
     Americans. Most Americans under 65 get insurance via their 
     employer, which can compare plans and pick the one that it 
     thinks offers the best coverage for the money. To cut costs, 
     U.S. insurers bargain with doctors for discounted rates and 
     try to weed out overbilling and frivolous treatments.
       The system has failed to stop U.S. health costs from 
     shooting up, and it has left many doctors complaining that 
     their medical judgment is being second-guessed by bean 
     counters. It isn't clear that a Dutch-style system, also 
     centered on insurer competition, could do any better. Dutch 
     doctors were among the most vociferous opponents of an 
     overhaul and many remain skeptical.
       Still, there are some differences in the Dutch way that may 
     work to its advantage. One is the emphasis on individuals 
     buying coverage. In the U.S., employers tend to be poor 
     buyers of health care. They're unfamiliar with the needs of 
     the people actually using the health care--their employees--
     and it is difficult for a large company to switch insurers.
       By putting the onus on consumers, Dutch officials hope that 
     more people will get the coverage they need. The ``risk 
     equalization'' that helps Dutch insurers cover sicker people 
     is also critical. In the U.S., competition among insurers 
     often means competition to find the healthiest customers, 
     especially in the individual market.
       The Netherlands began to overhaul its health system in 1987 
     after a government committee concluded that the best approach 
     was ``managed competition,'' the idea first proposed by Prof. 
     Enthoven of Stanford.
       The task was enormous. The country had four different 
     coverage schemes. The wealthiest third of the population was 
     required to get health insurance without government 
     assistance. Some in this group received help from employers 
     in paying premiums, while others paid the whole bill 
     themselves. The bulk of the Dutch population was covered 
     under a compulsory state-run health-insurance scheme financed 
     by deductions from wages. Civil servants and older people 
     were insured under two separate plans within this state-run 
     scheme.
       The government closely regulated hospital budgets and 
     doctors' fees, but provided few incentives to cut costs. When 
     hospitals lost money on a particular kind of care, they 
     rationed it. Many patients ended up on waiting lists.
       People in line for heart transplants were particularly 
     affected. In the mid-1990s, fewer than three Dutch people per 
     million received such transplants. By comparison, a study of 
     12 European countries showed that only Greece had a lower 
     rate of such operations. ln the U.S., there were about nine 
     heart transplants per million people.
       In 1999, waiting lists increased by 2%, despite a $54 
     million initiative to reduce them. ``Dead on the waiting 
     list,'' read one cover story of Vrij Nederland, a weekly 
     magazine that, like other Dutch media, relentlessly 
     criticized the country's health system.
       ``We felt frustrated,'' recalls Hans Hoogervorst, who was 
     the health minister from 2003 to early 2007 and a major force 
     in pushing through the overhaul.
       Though the Dutch still enjoyed better health than the 
     residents of many developed countries, standards were 
     slipping. Between 1960 and 2000, the increase in Dutch life 
     expectancy was 4.5 years, while its neighbors, Germany and 
     Belgium, showed far better increases of 8.1 and 7.1 years, 
     respectively, according to the Organization for Economic 
     Cooperation and Development. In the U.S., the increase was 
     nearly seven years.
       As in the U.S., medical costs began to increase, driven by 
     an aging population and the increased use of expensive new 
     technology. Between 2000 and 2004, Dutch health spending as a 
     share of gross domestic product shot up to 10% from 8%.
       In late 2004, the Dutch House of Representatives passed a 
     law to usher in mandatory health insurance and switch people 
     on state-run insurance to private carriers. But family 
     doctors fretted that it would allow insurers to interfere in 
     medical decisions, for example by pushing cheaper drugs.
       The following May, thousands of Dutch general practitioners 
     went on a three-day strike. Some tied their hands together 
     with rope to symbolize their helplessness. In response, Mr. 
     Hoogervorst promised to provide some protections for doctors 
     in the new legislation. One of them was that patients 
     wouldn't bear a big financial cost if they chose to go to a 
     doctor not under contract with their insurer. Soon after, the 
     senate approved the new plan.
       It took effect on Jan. 1, 2006. Despite predictions of 
     chaos, the changeover was surprisingly smooth. The government 
     set up a Web site where consumers could analyze insurers' 
     offerings. Consumers were allowed to switch insurers once a 
     year. As 2006 approached, the health ministry predicted that 
     only 5% would bother. Instead, nearly 20% of people switched, 
     either to get a better price or because they were 
     dissatisfied with their insurer.


                              Premium War

       Consumers also benefited from a premium war as insurers 
     made a grab for market share. The Dutch health ministry had 
     predicted that insurers in 2006 would price the annual 
     mandatory premium at an average of K1,106, or about $1,500. 
     Instead, market forces set it at K1,028, 7.6% lower. This 
     year, it has risen to K1,103, partly because of an easing in 
     the price war. That's still less than the K1,134 the 
     government predicted for 2007.
       Included in the overhaul was a deal the government 
     negotiated with generic-drug makers to cut prices by about 
     40%. The generic-drug makers made up for some of their lost 
     revenue by reducing the rebates and bonuses they provided to 
     pharmacists to recommend their drugs to customers. From 2004

[[Page 23886]]

     through 2006, annual drug spending grew at an average annual 
     rate of 2.8%, down from 9% annual growth earlier in the 
     decade.
       Insurers have taken a hit, though. UVIT, which has more 
     than four million customers, was forced to open a 200-person 
     call center to help consumers switch between plans. In 2005, 
     UVIT had total revenue of about $7.6 billion and made a 
     profit of about $202 million from health insurance, which is 
     its main business. Last year, the company's health business 
     posted a loss of $30 million. UVIT expects to return to 
     profitability this year, partly by negotiating lower prices 
     with hospitals.
       In most European countries, consumers have no idea what 
     their health insurance costs because they are covered by 
     national health-insurance schemes financed by payroll taxes, 
     as used to be the case in the Netherlands. On a visit to 
     Germany last year, Mr. Hoogervorst boasted that thanks to his 
     country's switch to private insurance paid by individuals, 
     ``no other European country has a population so keenly aware 
     of the costs of their health-care insurance.''
       Now that they see the bills more clearly, some consumers 
     feel their payments have gone up. In one survey mainly of 
     labor-union members, about 70% said they were financially 
     worse off in some ways.
       Insurers get risk-equalization payments for patients with 
     about 30 major diseases. They can use these to offer 
     discounted premiums and programs tailored to those with heart 
     disease, diabetes and other ailments.
       One shortcoming is that many diseases aren't subject to 
     risk equalization. The excluded diseases--such as migraine 
     headaches--are harder to diagnose and their treatment costs 
     are harder to predict. ``Seen from the side of migraine 
     patients, this is highly unfair,'' says Peter Vriezen, 
     president of the Dutch Headache Patients Association.
       The real test of the Dutch approach is yet to come: Can 
     insurers push hospitals to lower their costs and improve 
     their quality? Insurers have clout because they can direct 
     large numbers of patients toward particular hospitals. But, 
     in a holdover from the old system, insurers can currently 
     negotiate prices * * *. The figure will rise to 20% by the 
     end of this year, and continue to go up.
       Because Dutch hospitals used to receive fixed prices for 
     their services, and got more money for more service 
     regardless of quality, they had little incentive to improve 
     their care. Under the new system, insurers should be 
     providing that incentive, but Mr. Hoogervorst acknowledges, 
     ``Thee's still a long way to go to increase competition among 
     hospitals.''


                           Market Incentives

       One concern is the potential for overconcentration among 
     insurers. UVIT, for example, is the result of a merger 
     between four insurers. ``If eventually you have only three or 
     five insurers, you might wonder how many market incentives 
     will remain,'' says Niek Klazinga, professor of social 
     medicine at the University of Amsterdam.
       Last fall, Prof. Enthoven delivered a speech to health 
     economists in Rotterdam. He congratulated the Dutch for being 
     ``in the lead'' in health-care change. However, he cautioned, 
     ``you still have considerable work ahead of you to transform 
     your present success with insurance'' into a system that 
     delivers improving care.
       Some insurers are taking unusual steps to get there. Menzis 
     rewards doctors with bonuses if they prescribe generics 
     instead of more expensive branded drugs. UVIT ranks hospitals 
     based on the quality of care.
       To put pressure on Dutch hospitals, some insurers let 
     patients go to other countries where high-level care for 
     certain ailments costs less. Thea Gerits, 71, went to Germany 
     for a hip replacement and spent four weeks in a 
     rehabilitation center there, receiving physical therapy and 
     enjoying yoga, massages and mud baths.
       UVIT paid the $19,000 bill. It says the same amount in the 
     Netherlands would buy only the surgery and basic therapy. Ms. 
     Gerits came home happy, and soon was riding her bicycle 
     again. ``I got lots of attention,'' she says. * * *.
  Mr. WYDEN. I am going to read one paragraph at the outset of the 
article:

       Since a new system took effect here last year, cost growth 
     is projected to fall this year to about 3 [percent] after 
     inflation from 4.5 [percent] in 2006. Waiting lists are 
     shrinking, and private health insurers are coming up with 
     innovative ways to care for the sick.

  What struck Senator Bennett and I is, there is an awful lot of 
comparison between our bipartisan legislation and the experience of the 
Dutch. For example, both in Holland and in the United States under our 
proposal, there would be a requirement that individuals would have to 
purchase their own health insurance. Insurers under our proposal, as in 
Holland, would not be able to discriminate against individuals who have 
had illnesses. We saw in the movie ``Sicko'' that wonderful scene with 
the ``Star Wars'' music describing all the various conditions that 
individuals might have that would exclude them from insurance coverage. 
That would be illegal under what Senator Bennett and I are advocating. 
It is illegal, according to the Wall Street Journal, in the 
Netherlands.
  Finally, in the Netherlands and under our legislation, there is a 
sharp and specific focus on prevention and wellness. The tragedy in our 
country is, we don't have health care at all. What we largely have is 
sick care. Medicare shows this probably more clearly than anything 
else. Medicare Part A will pay huge expenses for senior citizens' 
hospital bills. The check goes from the Government to the hospital. But 
Medicare Part B, on the other hand, will pay for virtually nothing for 
prevention and keeping people well. Senator Bennett and I seek to 
change that. For the first time under our legislation, Medicare would 
be authorized to discount the premiums for seniors who lower their 
blood pressure, lower their cholesterol, practice good health in their 
individual lives. I am struck by this Wall Street Journal article, 
where insurers in Holland are adopting much the same kind of approach. 
The article states on the front page that insurers now are offering 
discounts to customers who buy low cholesterol versions of yogurt, 
butter, and milk.
  The point is, worldwide the message is getting out. Prevention works. 
Wellness, a new focus on personal responsibility, and keeping our 
citizens healthy makes sense. They are doing it in Holland. The Wall 
Street Journal describes the positive benefits there. I and Senator 
Bennett, along with our cosponsors, Senators Bill Nelson, Lamar 
Alexander, and Judd Gregg, are trying to build a bipartisan coalition 
in the Senate to do exactly the same.
  Our legislation, the Healthy Americans Act, would require that 
everyone not on Medicare or in the military would have to purchase 
private health insurance. But to make sure that is doable, we fix the 
broken marketplace. Under our legislation, private insurance companies 
wouldn't be able to cherry-pick. They wouldn't be able to take just 
healthy people and send sick people over to Government programs more 
fragile than they are. They couldn't discriminate against those with 
illnesses. They would have to spread risks through large groups of 
people. Right now essentially much of the private insurance business is 
about filtering out those people who have illnesses and finding a way 
to cover just those who are healthy. Our legislation would change that.
  We also take critical steps to make sure that if you are going to 
require that people purchase coverage, you have generous subsidies for 
folks with modest incomes. What Senator Bennett and I propose--and 
apparently they are doing something along these lines in Holland--is to 
subsidize those up to 100 percent of poverty completely and for those 
between 100 percent of poverty and 400 percent of poverty, there would 
be a partial subsidy. The most generous subsidies of any program 
anywhere in our country would be offered under this legislation that we 
are offering, with Senators Alexander, Gregg, and Nelson of Florida.
  How do we pay for it? The Lewin Group, which is kind of the gold 
standard for looking at health policies, scored the administration's 
approaches, many of the States and ours and said we can find a lot of 
the savings under our legislation through an administrative process 
that establishes that once you sign up in Ohio, once you sign up in 
Oregon or anywhere else in the country, you are in for life. You don't 
have to sign up again and again and again. In my State, my guess is it 
is very similar to the situation in Ohio, if you are on Medicaid, there 
is something like 31 or 32 categories of coverage. A poor person has to 
try to squeeze themselves into one of those boxes in order to get 
coverage. It is degrading to the poor and a big waste of money.
  What Senator Bennett and I have offered is a one-stop process so you 
sign up once, and everything else from that point on is essentially 
accomplished through the magical world of electronic transfers. An 
individual's contribution would be taken out of their paycheck while 
they are working. Ours is fully funded.

[[Page 23887]]

  There is an opportunity for bipartisan cooperation, particularly 
should the Bush administration want to assist in this effort. For 
example, every single economist who has come before the Finance 
Committee, before the Budget Committee, has talked about the Tax Code 
as it relates to health care disproportionately favoring the most 
affluent and rewarding inefficiency at the same time. To put it another 
way, if you are a high-flying CEO in the United States, if you want to 
go out and get a designer smile put on your face, you can write off the 
cost of that service on your taxes. But if you are a hard-working woman 
without any health plan and a local furniture store, you get nothing. 
So I and Senator Bennett redirect the current tax expenditures. They 
are the biggest part of private health care spending.
  The Lewin Group establishes in their analysis of our report that 
would ensure we could expand coverage over the next few years without 
any additional cost to taxpayers. The Lewin Group has said the proposal 
now being sponsored by five Members of the Senate would slow the rate 
of growth in health care spending by $1.5 trillion.
  I know the distinguished Presiding Officer has a great interest in 
health. We are so pleased he is here because we have worked together on 
these issues often. It is clear this is the premier domestic issue of 
our time. A combination of today's demographics with a rapidly aging 
population, escalating costs, the huge increase in chronic illness, our 
current health care system is not sustainable. It is not one we can put 
on automatic pilot and say: Let us run it this way for years and years 
in the future.
  The tragedy is with all the wonderful doctors and hospitals and 
nurses in Ohio and Oregon, all across the country, we are spending 
enough money on health care to do this job. We are simply not spending 
it in the right places.
  To give an idea of how out of whack American health care spending is, 
for the amount of money we are spending today, $2.3 trillion, 300 
million of us in the country, you divide 300 million into $2.3 
trillion, and you could go out and hire a doctor for every seven 
families in the United States and say: Doctor, your job will be for 
this year to take care of seven families, and we will pay you $200,000 
a year.
  My experience, I say to the Acting President pro tempore, is that 
when I bring this up to physicians at home in Oregon, they say: Ron, 
where do I go to get my seven families? It sounds pretty good to be 
able to get back into the business of practicing medicine again and 
advocating for my patients rather than going through all this paperwork 
and bureaucracy and redtape.
  So we are spending enough on health care today. We are not spending 
it in the right places. That is what they have begun to change in 
Holland, according to the Wall Street Journal this week. That is what I 
and Senator Bennett and our colleagues on both sides of the aisle are 
seeking to do in the Senate.
  One last comment, Mr. President. I know there is a hectic schedule 
for all Senators, and certainly the Senator from Ohio.
  The question is whether there should be action now or the Congress 
should simply wait for another Presidential election. Here are the 
consequences of waiting for several more years. The Census Bureau 
reported last week that 2.2 million additional Americans were without 
health insurance between 2005 and 2006. If this Congress waits a couple 
of years more, we can expect that number to increase and the number 
without coverage in this country to hemorrhage further.
  That is a moral abomination, No. 1; and it is going to be costly to 
taxpayers, No. 2, because those people very often will have to go to 
hospital emergency rooms to get their coverage. Of course, those bills 
will be passed on to businesses in Ohio and Oregon and across the 
country and to our taxpayers. So the costs of delay are very direct and 
immediate.
  Second, with respect to employer-based coverage, the new numbers 
indicate the number of employers offering coverage has now fallen below 
60 percent. It is pretty easy to see why, with these double-digit 
premium hikes, Price Waterhouse says health costs are going to average, 
this year, a little over 11 percent. A lot of our employers want to do 
the right thing by their workers and simply cannot offer coverage.
  If this Congress decides to stand down on the question of overhauling 
health care and say, ``Let's just wait until 2009,'' you are going to 
see more businesses in Ohio, in Oregon, and across this country lose 
coverage. I do not think we ought to sit by and just let our coverage 
continue to melt away along the lines of these statistics that I 
mentioned.
  Finally, on the question of prevention and what Holland is doing, and 
what we are seeking to do in the Healthy Americans Act, there is a very 
significant cost with respect to chronic illness as it relates to doing 
nothing to change our policies. The new numbers with respect to chronic 
illness indicate that in 31 States over the last year obesity has risen 
once again; of course, there is a direct link here between heart and 
stroke and diabetes and so many illnesses. Not one State--not one--
experienced a decline.
  So if the Congress says: Well, we will pass on overhauling American 
health care until 2009, we can expect to have missed another 
opportunity--yet another opportunity--for doing something about 
enacting health care policies that put a new focus on prevention and 
wellness.
  So this question of waiting for 2 more years and saying: Let's just 
spend our time looking at what the various candidates for President 
from both political parties are saying about health care--certainly it 
is getting a lot of attention in terms of debates on TV and all of us 
trying to look at the various merits of the candidates' proposals; and 
they are good people; and they have good suggestions--but I want to 
make it clear to the Senate there are very real costs of waiting to fix 
health care.
  I think the question of fixing health care is so urgent we ought to 
get on with it, and we ought to get on with it in a bipartisan way, 
which is what I and Senator Bennett are trying to do. We are very proud 
to have been able to get the support of business and labor leaders.
  When we offered the initial proposal, Andy Stern, the president of 
the Service Employees International Union, stood on one side of me, and 
Steve Burd, the CEO of the Safeway company, a very large Fortune 500 
company, stood on the other side. We had individuals such as Ron 
Pollack, of Families USA, and advocates for compassionate end-of-life 
health care with us as well.
  The last time Congress looked at this--and the Acting President pro 
tempore, I think, remembers this--during a period in the early 1990s, 
the people who stood with me for the kickoff of the Healthy Americans 
Act were spending millions to pretty much beat each other's brains out. 
That was the last time the Congress and the President, during the 
Clinton years, debated health care.
  So this is a different climate, certainly a different climate for 
businesses in Ohio and Oregon. What I hear from businesses at home--
unlike in 1993, the Clinton years, when they said: We cannot afford 
fixing health care--they are now saying: We cannot afford the status 
quo. That is why they are joining Senator Bennett and I and others on 
these proposals.
  My hope is as Congress looks at the evidence, whether it is the Wall 
Street Journal reporting on promising developments--very often people 
think of Europe and socialized countries--the Wall Street Journal is 
putting on the front page of the paper--a publication that clearly 
favors private health care coverage--an example of a country in Europe 
where they seem to be making great progress.
  So as we devise our own system, one that is uniquely American, I and 
Senator Bennett want to work with every Member of the Senate--I think I 
can speak for Senators Bill Nelson, Lamar Alexander, Judd Gregg, and 
the others we have been talking to--that we think this is the premier 
domestic issue of our time. Certainly, the

[[Page 23888]]

conflict in Iraq is the premier national security issue. But the 
premier domestic issue at home is fixing American health care.
  I think based on the evidence that comes in every day, we know what 
needs to be done. Now the question is making sure there is the 
political will to go forward. I look forward to working with the Acting 
President pro tempore, who has a great interest in these matters, and 
all our colleagues.
  Mr. President, I yield the floor.
  Mr. President, I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BROWN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Casey). Without objection, it is so 
ordered.

                          ____________________