[Congressional Record (Bound Edition), Volume 154 (2008), Part 2]
[House]
[Pages 2203-2206]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 18, 2007, the gentleman from Wisconsin (Mr. Kagen) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. KAGEN. Mr. Speaker, joining me this evening is Congressman 
Altmire from Pennsylvania.
  I think it's only fitting that on this Valentine's Day we begin to 
have a discussion about health care in America. It's a heartwarming 
day. It's a day of friendship, a day of conversation between one's 
loved ones.
  When I was sent here by the people of northeast Wisconsin, I was sent 
here to listen to their concerns. In my previous existence, I was a 
physician caring for many thousands of people across northeast 
Wisconsin. And I continue to listen to them while I'm here in the halls 
of Congress, and I want to share in the first few minutes of this hour 
some of their conversations with me.
  Tom and Sue Wright from New London, when I asked them what was 
important to them, 50 million people without health insurance is a 
disgrace. Tom and Sue are right, but they're not alone. Bob from Green 
Bay writes, ``If taxpayers can't get the same health insurance as 
Congress, at least get drug costs down so we can afford our pills.''
  What about from Casco, Russ writes, ``I'm 60 years old, and I have a 
$5,000 deductible on my health insurance per family member; all of my 
health expenses out of pocket. We need help desperately.'' That's Russ 
in Casco.
  In Greenville, it's the same story. This is from Al and Linda. ``As 
we near retirement, we know we can't afford health insurance premiums 
or drugs on our own. Please help. We're getting towards retirement. We 
don't have the money.''
  From De Pere, it's Kathleen. ``It's time for all Americans to have 
the same health care benefits as their Representatives in Washington.''
  And finally, from Crivitz, Al writes, ``Without a job that pays a 
fair wage, I won't have money to pay for health care, gas, a war, 
Social Security, or anything else.''
  My friends, my colleagues, it's time for us to have an open and 
honest discussion about what's important in America. And if it's not 
your health, I don't know what it is. Because if you don't have your 
health, you don't have anything.
  I yield to my colleague from Pennsylvania (Mr. Altmire).
  Mr. ALTMIRE. And I want to commend Dr. Kagen for his leadership on 
this issue. As all of our colleagues know, Dr. Kagen, right from the 
very start, has made health care his priority here in Congress using 
his expertise.
  I have a health care background as well, health care policy is my 
professional background, and the gentleman and I have spoken numerous 
times about the importance of health care. And I wanted to come down 
today to talk about the need for health care reform as we are currently 
discussing, but also just to commend the gentleman for his continued 
leadership on this at a time when clearly the political system is in 
unchartered waters, with a Presidential election that is going on 
around us, divided governments, we have a Congress with the House and 
the Senate that are having issues with other things going on.
  But we continue to see the health care system get worse and worse. 
And I think the gentleman and I agree on many things, but most 
importantly on the need to do something about the health care issue 
right now. It would be very easy to say let's kick the can down the 
road another year. We'll come back here in March of 2009 and everything 
will be different and we'll take up health care then. That's great. You 
know what? When next year comes along, we are going to take up health 
care. And there is a variety of differences of opinion on what the 
approach should be for health care reform, how expansive do you want it 
to be.
  But there are things that we can do now, this year, in this political 
environment, that are realistic. And that's what the gentleman and I 
have been discussing. We want to do things this year that would be 
considered, if not low-hanging fruit, at least issues that we can all 
agree on or most can agree on that we can pass and set the table for a 
further discussion next year on health care reform.

                              {time}  1645

  We have a country where there is over $2 trillion that gets spent 
every single year; 17 percent of our GDP goes to health care. And I 
don't think in my district there's an issue that I hear about more 
often than health care reform when I go around and visit my 
constituents, and the reason is this is an issue that affects 
everybody. It's not just your wallet. Obviously, a $5,000 premium, as 
Dr. Kagen was describing, something that we can all relate to, the 
exponential increases in health care costs. Small businesses every day 
in this country by the thousands have to make decisions on what to do 
about their health care costs for their employees. Do they shift the 
cost to an unmanageable level? Do they stop offering health care? But 
they know they can't afford it and it affects everything that we do.
  $1,500 of the price of your car, if you buy an American-made car, is 
due to the health insurance costs of the automaker. Your State taxes 
are higher because of exploding Medicaid costs. Health care is the last 
remaining item on the table in every labor dispute in the country. 
That's why those issues

[[Page 2204]]

come up. And we have a system that in many ways is better than any 
other system in the world. It's why people from all over the world come 
here for their transplants and for their high-end, high-tech care. We 
have medical innovation and technology advances that far surpass 
anything happening anywhere in the world. That's if you can get in, if 
you can afford our system.
  The problem is when we are compared to other countries as a nation in 
life expectancy and infant mortality, we're not just in the middle of 
the pack; we're at the bottom of the pack when compared to other 
nations. We have tremendous issues. We're talking about 47 to 50 
million Americans that lack access to health care. They don't have 
insurance. There are tens of millions more that live in fear of losing 
their coverage. They are one accident or illness away from losing 
everything. So we have major issues to discuss.
  Most important, and I know the gentleman is going to deal with this 
issue at some length tonight, is the fact that if you're an individual 
or you're a small business owner and one of your employees gets sick or 
injured, you get a call from the insurance company, and they say guess 
what, we have to drop you because you've had this incident. And I think 
everyone can agree that your individual health status shouldn't be a 
factor in your health insurance rates.
  And something that the gentleman has taken a leadership role on, 
which I'm going to leave him with because I'm on a limited schedule 
myself, and I appreciate his giving me the time, is talking about ways 
that we can incentivize the 47 million Americans and others who have 
insurance to join large risk pools, community-rated risk pools, whether 
it be the 180 million people in the country that are privately insured, 
that would be everybody, or metropolitan statistical areas, regional 
groups, whatever we can agree on. And I realize that there are 
differences of opinion on how big the group should be. But we can all 
agree that your individual health status should not be a factor in 
setting your individual health rates. It should be a larger pool's 
health status, which would lower the costs for almost everybody.
  So at this point I am going to thank the gentleman for allowing me to 
say a few words and commend Dr. Kagen for his work.
  Mr. KAGEN. I appreciate your being here tonight, Mr. Altmire. Your 
contributions to Congress have already been exemplary, and I look 
forward to working with you in the future on health care issues. And 
it's not just you and I, it's not just the Members of the class of 
2006, a group I call America's hope for a real change and a positive 
change in the direction of our country, it's not just the people that 
call us up, not just the people who send us postcards, not just my 
patients back home; but it's the most trusted person in Washington, DC 
that understands the importance of health care costs today. And who is 
that person? That's our Comptroller General, David Walker, who, on 
January 28 before the Senate Budget Committee, had these words to say: 
``Under any plausible scenario, the Federal budget is on an imprudent 
and unsustainable path. Rapidly rising health care costs are not simply 
a Federal budget problem; they are our Nation's number one fiscal 
challenge. The growth in health-related spending is the primary driver 
of the fiscal challenges facing the State and local governments. 
Unsustainable growth in health care spending is a system-wide challenge 
that also threatens to erode the ability of employers to provide 
coverage for their workers and undercuts our ability to compete in a 
global marketplace.''
  And he went on to say that the key points in his presentation are: 
``Although recently declines in our annual budget deficit are good 
news, our longer-term fiscal outlook is worse, and absent meaningful 
action, we will face spiraling levels of debt. Our long-term fiscal 
challenge is primarily a health care challenge.''
  Well, I think the Comptroller General has it right. It's our health 
care challenge. And people every day in Wisconsin and across the 
country are challenged when they receive in the mail a solicitation 
from an insurance company, one such as this: with happy smiling faces 
on the front, they invite you to call an 800 number to see if you 
qualify. But here's the list, and it reads: ``Important information 
about preexisting conditions. Although we make every effort to extend 
coverage to all applicants, not everyone will qualify. If you have had 
treatment for any of the following conditions, you may not qualify for 
coverage.'' And it lists a long list of conditions that many millions 
of people have. And at the very end there is a real teaser, and it 
says: ``This list is not all-inclusive. Other conditions may apply.''
  My friends and my fellow Americans, I believe it's time on this 
Valentine's Day, February 14 of 2008, to bring an end to the 
discriminatory actions that insurance companies now enjoy. We have to 
bring an end to the discrimination against any citizen in this country 
based on their preexisting medical conditions.
  Before I highlight the bill that I am putting in for submission today 
called No Discrimination in Health Insurance Act, I'd like to review 
with you what we have today in our health care system, and it's here to 
my right.
  Our health care system is simply unsustainable. There are three tiers 
to health care. In tier one, in red and orange, we have Medicaid, which 
is 61 million Americans; and Medicare, 43 million. These people, in 
general, don't pay for the bill. They don't feel the economic costs 
because government is providing for their needs in most cases.
  So in tier one, you have a group of people that aren't paying the 
bill. In tier two you will pay a portion of your bill, and this has to 
do with the 149 million Americans that have health insurance. But 
increasingly today, the health insurance premium is skyrocketing, and 
the cost for care averages $14,000 each year for a household of four. 
This price and this cost is beyond what the normal hardworking family 
in Wisconsin and elsewhere in the country can afford to pay.
  In tier three, this is the 47 million American citizens who have no 
health care coverage at all, and I am one of them as the only Member of 
Congress who has not signed on for health care benefits. For I didn't 
come here for a benefit; I came here to guarantee access to affordable 
care for everyone. But 47 million Americans who choose not to purchase 
insurance either because they don't have the money in their pocket or 
they can't afford it. So our system, as it exists today, is 
unsustainable, unbalanced, and is tipping over rapidly.
  That is why I submitted for passage a bill called the No 
Discrimination in Health Insurance Act. This bill seeks to do three 
things: first, it guarantees that if you're a citizen, you're in 
because no insurance company in group or individual health should be 
allowed to sell you a policy that excludes you from the community. We 
have to begin again to ensure communities rather than individuals 
because what's happening amongst the insurance world today is you will 
be cherry-picked away from your mate. A husband will qualify but not 
his wife. A mother may be separated from her family. And what's worse, 
your neighbor may have a completely different health care coverage only 
because we're being cherry-picked and divided.
  I believe we have to get back to community ratings. It's not just my 
opinion. Many millions of Americans agree with me. The SEIU agrees with 
this idea, families USA as well. And our Constitution, in fact, 
guarantees any citizen and every citizen has protections against 
discrimination. This is the result of very long and hard-won gains by 
ordinary people who for decades showed extraordinary courage fighting 
for positive change and the rule of law to protect each and every 
citizen. Now I believe is the time to apply this fundamental principle 
of anti-discrimination to our health care system, because my patients, 
quite frankly, cannot hold their breath any longer. And that's why I 
have introduced this bill, the No Discrimination in Health Insurance 
Act. This essential

[[Page 2205]]

piece of legislation will guarantee access to affordable care for every 
citizen in America by bringing an end to the discriminatory practices 
employed by insurance companies today who deny lifesaving coverage to 
millions of Americans only because of a preexisting medical condition.
  Look, the grim reality is that our Constitution protects us from 
discrimination unless and until we become sick. I believe our 
legislation here that I am putting forward will put discrimination 
where it belongs: in the past.
  Ending all forms of discrimination is essential, I believe; but it's 
also time we pull back the veil of secrecy because today the real price 
of health insurance, the real price of a pill, the real price of a 
hospital service is hidden. And that's why the second thing that this 
bill will do is to show us the price, openly disclose the price, and 
then allow every citizen to purchase that product, that health 
insurance policy at that same lowest price within the region. Ending 
all forms of discrimination is paramount and tantamount to why we are 
here as a Congress.
  If you go to your favorite restaurant, you'll find the solution to 
our health care crisis right in front of you. They'll hand you a menu, 
and when you open the menu and see that your ice cream for dessert 
might cost $5 for you, what's the price that the person sitting next to 
you or across the table will pay? $5. Show us the price, and everyone 
gets to pay the same price.
  If you go today to a pharmacy anywhere in the country and you're 
standing in line with five people to buy the same prescription drug, 
you may all pay five different prices for the same product because the 
price is not openly disclosed and there isn't a free and open medical 
marketplace.
  As a physician for the past 30 years and now as a Congressman for the 
past 13 months, I understand how difficult it is for families to pay 
not just their health care bills but their insurance premiums. People 
today all across the country are choosing between taking their next 
pill and skipping a meal or vice versa.
  But you don't have to be a doctor to know our system is broken 
because ordinary people cannot afford to pay for their health 
insurance. These skyrocketing costs are excessive. They're simply out 
of reach for small businesses. They're out of reach for families across 
America.
  We need to do more. We need to do more now. We need to pass 
legislation that contains the essential elements of openly disclosing 
the price, guaranteeing if you're a citizen, you're in and you will not 
be discriminated against, and that everyone in your region, every 
citizen or legal resident can pay the lowest price possible.
  The reality is our Nation's insurance industry has been successful. 
It has been successful beyond all measure. And it's been successful by 
dividing and conquering. Dividing you by your neighbor, dividing up 
families, and individually insuring people based upon their preexisting 
condition. We have to put the letters ``unity'' back into community and 
restore community-based ratings. We can begin to heal our Nation by 
doing this, by becoming a community once again.
  My No Discrimination in Health Insurance Act requires companies to 
openly disclose their price, to charge every citizen the same fee for 
the same service within the region, and allows all citizens to find a 
benefit by paying the lowest available price. It will end 
discrimination in health insurance. It's the right thing to do, and it 
will reduce the cost for everyone across the country for health care. 
Simply put, if you're a citizen, you're in, without any discrimination 
against you due to a previous medical condition.
  I ask all of you to join me in this effort because it will be a big 
battle. There are some very strong forces in the insurance industry 
that don't want to compete for our business. This legislation is 
essential not just for you and your family; it is essential for small 
business to survive.
  The greatest expense everywhere in Wisconsin, as I went around the 
district to listen to different employers, whether you're in 
agriculture and a family farmer or a small businessman trying to run a 
photography shop, the greatest expense in their overhead is their 
health care cost. We can and we must do better. And we can do better by 
forming an openly disclosed marketplace where people begin to compete 
once again for each other's business. This is important. It is 
essential not because I say so, but because the people that I represent 
say so and, as I mentioned earlier, the Comptroller General agrees.
  Everyone in this House, every Member of Congress in the Senate and 
the House has a health care story to tell. I can share that with you 
nonconfidentially because they come up to me on the floor and ask me 
about their health.

                              {time}  1700

  They ask me about the pills they are taking. And I am here, I am 
available, and I can't bill them because, well, I have taken an oath. I 
only get paid by the people I represent.
  The fact is everybody has a health care story to tell. We have to 
make certain that we don't discriminate against people based on their 
political affiliation, be they independent, Democrat, or Republican, 
but by the condition that they are a citizen and they ought to be 
involved in the risk pool.
  Mr. Speaker, I will close my remarks on health care by suggesting 
very strongly that every Member of Congress consider this. Either you 
are for discrimination and on the side of the insurance industry or you 
are against it and you are on the side of the consumer, the patients, 
and the millions and millions of Americans who need health insurance at 
prices they can afford to pay.
  It was said first in the White House several years ago, either you 
are with us or you are against us. But this bill allows everybody in 
the House to decide whose side are you on. Whose side are you on? Are 
you sitting in the boardroom with the CEOs of the insurance company or 
are you sitting at home at the kitchen table with mothers and fathers 
who are struggling to pay their bills every month?
  In my State of Wisconsin, and it is true across the United States, 
the most common reason that people go bankrupt today is they go 
bankrupt because they cannot afford their health care bills. They 
cannot afford this. In Shawano County several months ago when I stopped 
into the county courthouse, I was told that 19 out of 20 families who 
had come through an education policy after going bankrupt did so only 
because they couldn't afford their health care bills. We can and we 
must do better in America. And it starts by reforming our health care 
system. When we drive down the cost of health care, we are going to cut 
taxes for everyone. Now this sounds like it is voodoo economics, but if 
I lower the cost of doing business for every city, every county, every 
town, every State in the country by lowering health care costs, I can 
reduce your taxes. This is not just a health care issue. It is a 
business issue. It is a tax issue.
  And, Mr. Speaker, I would like to share with you some words I was 
privileged to listen to in a small town in the northern part of 
Wisconsin, a district I have the honor and privilege of representing. 
It is a city called Niagara, Wisconsin. And as Niagara goes, so goes 
our Nation. Niagara is a small town of 1,880 people. And the major 
employer there is a paper mill, which was recently purchased and then 
closed. Three hundred twenty jobs in this small town are about to 
disappear in April. And I went to Niagara to interview some people and 
listen to their concerns to see what government can do to help them. I 
spoke with George. George is nearly 80 years old. I would like to share 
with you his words for our country. They will be available, if not 
today, then tomorrow at my congressional Web site, Kagan.house.gov, as 
a video clip.
  I asked George, ``Are you still working?'' And George responded, 
``Nope, I'm retired 19 years. Put 41-plus years in there. But what I 
want to say is that Congress should have been aware of this happening 
because it has been in all the union papers.'' And he is referring to 
the closing of the mill, the one

[[Page 2206]]

major employer in town. ``People been talking about it. They put one or 
two paper machines out of there. They pulled the machines out. And what 
do they do? They ship the machine to India. That machine was 100 years 
old, and now it is operating in India. So why was Congress so lax? All 
these jobs been deteriorating right along.''
  And I asked him, ``How long have you lived here?'' He responded, 
``All my life.''
  ``You were born right here?''
  ``Yup. I will be 80 years in April. And I have 5 brothers who worked 
in the paper mill also, 41, 42, 45, they all worked there that long. 
And my children during the summer months worked in that mill.''
  I asked him, ``What did you do in the mill?''
  ``I worked on the paper machines.''
  ``Which one?''
  ``I worked on them all, all machines. Started off in the old mill, 
number one, went to number two, and then went to number three, and then 
to number four''
  ``And do they have any retirements,'' I asked him, ``at the mill?''
  ``I have very good benefits, and I am thankful for that. That is what 
I am worried about now, though. I was told that at the end of 2008, 
things are going to change. I am going to have to get something else. I 
don't know that. Nobody told me that. But that is just the rumor. So we 
have to start looking into something else.'' He is referring to health 
care benefits and the prescription pills.
  ``What makes me mad is that we found out we can get medication in 
Minnesota and in Canada. And what happens? They tell me I can't do it 
no more because we would get sued, the company would get sued. They 
would save the mill about $300 every 3 months, and we would save 
ourselves $250 every 3 months. And they said, `No, we can't do it,' so 
now we have to buy them at Wal-Mart.''
  And I asked him, ``So you think there is a better way of doing 
things?''
  ``You better believe it.'' I asked him then at the end of my 
conversation if there is anything else he would like Congress to hear? 
If he were talking then with Congress and with President Bush, what 
would he have to say, what would you ask him to do.
  And George responded, ``Get on the ball. Take care of the United 
States, not foreign countries. They always said foreign countries are 
going to take us from within. They don't have to fight a war with us. 
Well, that is what is happening right now. They are buying up all the 
United States.''
  George had it right. We have to be able to take care of our own 
people. I represent people in Wisconsin, not foreign nations. And 
taking care of people in Wisconsin means, first of all, guarantying 
them access to health care that they can afford, high-quality care that 
is delivered right close to home. And how can we do that? How can we 
afford to continue to pay for those costs when our jobs are being 
shipped overseas?
  So, Mr. Speaker, as a close this evening, I would like everyone to 
begin to think differently in America. Health care is intimately tied 
up with our employment opportunities, with our jobs. We need higher 
wage jobs that will sustain America and provide living wages, a living 
wage that can afford health care. Health care is intimately involved 
with our jobs and also with our environment and the education of our 
children. You can't unwrap all of these problems. They are all stuck 
together. But the single greatest problem we face today is our health 
care crisis. And by submitting this bill for passage today, the No 
Discrimination Health in Insurance Act, I hope to lay the first brick 
in the new wall for the foundation of the House of Health Care. We have 
to begin to think differently in America, and hopefully that starts 
today.

                          ____________________