[Congressional Record (Bound Edition), Volume 154 (2008), Part 5]
[House]
[Pages 6569-6574]
[From the U.S. Government Publishing Office, www.gpo.gov]




                         UNIVERSAL HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 18, 2007, the gentleman from Rhode Island (Mr. Langevin) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. LANGEVIN. Mr. Speaker, tonight I am honored to be able to speak 
this evening about the issue of universal health care, one of the 
biggest domestic challenges that is facing our country at the present 
time. I am also pleased to be joined this evening and who will be 
speaking in just a few minutes, by the gentleman from Connecticut (Mr. 
Shays) on the issue of universal health care.
  Mr. Speaker, again I am very pleased to have this time to speak on a 
topic that remains of paramount concern to individuals and families 
across the country, and that is again the issue of health care in 
America.
  Health care costs, Mr. Speaker, are rising in the United States at an 
alarming, alarming rate. Yet despite the fact that we spend more per 
capita on health care than any other industrialized country, we produce 
very disappointing outcomes by a number of important measures. One 
major attributable factor is the high level of uninsured in America.
  Furthermore, the U.S. remains the only developed nation that does not 
guarantee health coverage as a right to all of its citizens. Today, 
there are nearly 47 million Americans who lack health insurance 
coverage, leaving one in six without access to proper medical care. 
What makes these figures more shocking is that over 80 percent of the 
uninsured come from working families. As the cost of health care 
continues to rise, it is clearly burdening our families and placing 
American employers at more and more of a competitive disadvantage. 
Therefore, I believe it is our duty as policymakers to offer a new 
vision and new solutions to fix our ailing health care system.
  Providing quality, affordable health care to every American has been 
a long-time priority of mine. And it is in this spirit of furthering 
the national dialogue on this important issue that my colleague from 
Connecticut, Congressman Chris Shays and I have worked together to 
introduce H.R. 5348, the American Health Benefits Program Act of 2008.
  This bipartisan universal health care proposal is based on a tried-
and-true program that has stood the test of time, and that is the 
Federal Employees Health Benefits Program or FEHBP as it is called. 
Currently over 8 million Federal employees, retirees and their 
dependents receive health insurance coverage under FEHBP. This includes 
Members of Congress.
  This program uses a system of managed competition between private 
insurance carriers and provides enrollees with a large menu of coverage 
options. Its use of bulk purchasing power helps contain costs and 
brings stability to the system. In 2007, this resulted in an average 
premium increase of just 1.8 percent compared to the private market 
average of 6.1 percent. And by the way, I have yet to come across an 
employer, at least in my home district, or anywhere in the country, for 
that matter, who has only realized a 6.1 percent increase in their 
health care costs. Generally it is in the double digits and sometimes 
you can be talking about 20 or 30 percent or more increases to a given 
health care plan in any given year. Our proposal basically would use 
that successful model to provide similar benefits to all Americans, 
establishing the first ever American health benefits program or AHBP.
  Now the development of AHBP will be guided by eight fundamental 
principles, and they are on this chart to my right: choice, shared 
responsibility, affordability, portability, continuity, preventive 
care, and health care reinvestment. I believe these are the types of 
principles that we have to have in any type of system and they are 
certainly the core tenets of our universal health care proposal.
  Now under AHBP, employers who wish to continue negotiating with 
private insurance carriers may do so as long as the coverage they offer 
meets a basic standard set by AHBP. However, employer-sponsored 
coverage is proving to be more and more cost-prohibitive for businesses 
as health care costs continue to outpace inflation and insurance 
options drastically fluctuate from plan to plan. That's why AHBP allows 
companies to choose to pay a fixed predictable payroll tax according to 
their size and average employee earnings.
  We have a chart here which says that depending on the average number 
of employees that a company has, as well as according to their average 
salary, they would pay a certain percentage of their payroll tax. For 
example, on the very lower end where you have the small businesses that 
have the lowest average earnings, that company would only pay a maximum 
of 4 percent of payroll.
  On the higher end, you would have the companies that at the very 
highest end would pay no more than 10 percent of payroll. There would 
be a certain cap on the average earning itself.
  So my point is that there is a range of options here. There is a 
range of plans to choose from, but this is also an affordable way for 
employees to have health care coverage.
  Basically we are separating out the coverage from the workplace 
itself. We

[[Page 6570]]

need to get away from the issue of just employer-sponsored coverage. I 
think it is the best way to go, and it is a sensible proposal.
  For many businesses this may cost less than they currently spend on 
premium contributions and health care and health plan administration. 
Payroll tax revenue under the system we are proposing will basically 
create a funding stream to allow for a fixed government contribution of 
72 percent toward health care premiums of every participating American.
  Individuals in AHBP will have the responsibility to pay for the 
remaining share of their premiums, to the extent that they can afford 
it, again with the lowest income earners receiving subsidies to ensure 
affordability.
  This new program is not a single-payer system. It is not one size 
fits all, and it does not reinvent the wheel. Medicare, Medicaid and 
veteran services and other public programs that are tailored to 
specific populations will remain intact. Additionally, no one will be 
denied coverage or discriminated against based on their health status 
or preexisting condition. That is a very important tenet of this 
proposal.
  AHBP will use basically an expanded system of managed competition to 
ensure that private insurance carriers compete for enrollees on the 
basis of benefits as well as efficiency, service and price. It will 
offer portable and continuous coverage and incentivize investment in 
disease preventive and long-term preventive care which decrease the 
costs of care over time.
  Investments in health information technology will also lower costs 
while increasing quality and efficiency.
  Mr. Speaker, instituting meaningful systemic reforms will require a 
fundamental shift in how we view employer-provided coverage and health 
care delivery. While it is critical that businesses maintain a role, I 
believe it is essential that we change our perspective of health 
insurance as a privilege or benefit tied to employment. Instead, we 
must look at it as a right and a responsibility to be shared by the 
community. Individuals and employers, health care providers and the 
government, all have key roles to play in reaching a truly inclusive 
and efficient health care model.
  The unsettling truth is that society already pays for the uninsured. 
Some think that there is no cost associated with the uninsured. That is 
completely not true. Society already pays for the uninsured, but it 
does so at tremendous cost and with staggering inefficiencies. 
Individuals without health insurance are most often forced to seek care 
from doctors and hospital emergency rooms only after their illnesses 
reach catastrophic levels, drastically increasing the risk of 
complications and the cost of treatment.
  Our most recent estimates place total uninsured medical expenses at 
nearly $125 billion a year. That is staggering. Approximately $41 
billion of this total comes in the form of uncompensated care which is 
predominantly borne by the government and financed by the taxpayer. 
Beyond this, the cost is also reflected in the form of higher health 
insurance premiums that everyone pays. This cost is only compounded by 
the lost income due to reduced employment and job productivity. 
However, Mr. Speaker, the most disturbing costs are not the monetary 
costs in nature, but the immeasurable price that we pay in human lives 
each year as a result of inequitable, inadequate care.
  A recently released analysis estimated that 22,000 deaths nationwide 
occurred last year resulting from adults not having health insurance, 
averaging one death every 24 minutes. This is simply an unacceptable 
price to pay for delaying necessary reforms to our health care system, 
and we need to change it.
  The challenges we face in fixing our ailing health care system are 
great. However, the costs of inaction are even greater.
  Mr. Speaker, the time has come for policymakers at all levels and 
across the ideological spectrum to take action toward developing a 
health care system that really works for our Nation, one that offers 
Americans choice, calls for shared responsibility, and is affordable to 
all.

                              {time}  2015

  I believe our proposal introduces a practical model for universal 
health care while leaving room for further discussion on this very 
complex issue. And, Mr. Speaker, I believe this is not a Democratic or 
a Republican issue. It's not a conservative or a liberal issue. It's an 
issue that matters most to the American people.
  And on that note, I am pleased to yield this evening to the gentleman 
from Connecticut, my partner in this bipartisan universal health care 
bill and this effort to finally, once and for all, solve our Nation's 
health care crisis, the gentleman from Connecticut, Mr. Chris Shays.
  Mr. SHAYS. I thank the gentleman for yielding and I appreciate his 
launching this bill.
  Let me say, first and foremost, that you have worked on this 
legislation for over 4 years, and you have done what many of us in 
Congress said we wanted to do. We said we wanted Americans to have the 
same health care that Members of Congress have. And that's what I said, 
the same health care that Federal employees have, because that's the 
program that Members of Congress are a part of. It's a program that in 
my State, and in most States, we have, like, 18 different choices.
  And so what I'd like to do, I'd like to start out, if you wouldn't 
mind putting the American health benefit guiding principles back up on 
the chart there, because I think that's a good way to start out.
  And, again, let me say, Congressman Langevin, it's a privilege to 
work with you. You have done incredible work to bring forward a plan 
that Congress can consider seriously. And what you've done is what all 
of us said we wanted to do, and you've given me the privilege of not 
having to write it, but I got to edit it. And that's a lot of fun.
  So this is a partnership, and what a great partnership, to be able to 
first argue, as you have, that chart in front of you, universal 
coverage. So there's 85 percent of the Americans have coverage and 15 
percent don't. 90 percent have it in Connecticut. But there are about 
45 million Americans that don't have health coverage.
  What that does, as you've pointed out so well, it means that you have 
a distortion in the marketplace because those 45 million are going to 
get covered when they are really sick in a hospital, and it's going to 
be the uncompensated care.
  So you've written a bill that says, universal coverage. You've 
written a bill that says, Americans will have choice, which is really 
important to me. You've written a bill that said there'll be shared 
responsibility, that individuals, employers, the government, hospitals, 
insurers, all have a responsibility. That's what you've done.
  You and I are seeking to have this be affordable, so we are going to 
talk about a commission that we've established that would be 
established under this bill.
  But you want it to be portable. You want it to be that if an employee 
moves somewhere else they're going to have that same coverage. And if 
the employee wants to upgrade, they can upgrade every year, or reduce 
it, because Federal employees pay 28 percent of the cost. The 
government pays the employer, in this case, 72 percent. So 28 and 72 on 
the part of the government.
  The continuity concept, that if employers have worked out a really 
good program with their employees then they can keep it. But eventually 
I think they will ultimately want to be part of the American health 
benefit plan.
  And I particularly like the aspect that no insurer is going to be 
allowed to participate unless they have a strong preventative care 
program. And we can get into that.
  And then the health care re-investment. Insurers take 20 percent out 
and 80 percent goes to health care. The way you've drafted the bill, 
and we are promoting this bill, there's going to be, our expectation, 
and this is our goal, is that 90 percent be reinvested into health 
care.
  Now, it's pretty amazing when you look at the differences in cost. 
And maybe you want to comment on this. You have a pretty good view of 
it.

[[Page 6571]]

  But we're looking at statistics in 2004. And you can see that the 
Gross Domestic Product in the United States, in 2004, was 15 percent. 
And yet, it was 11 percent, and in 1980 it was 8.8. But the significant 
thing is Canada's is at 10, just slightly under 10, where ours is at 
15. The United Kingdom is at 8 percent of Gross Domestic Product. Japan 
is at 8. And Germany slightly over 10. There's a big difference in the 
cost here compared to our cost. I have a sense that part of that is 
just the uncompensated care, and that's, you know, we've had 
information that says that. But I think this is one that just gets you 
to have to wake up.
  If we do nothing, if we do nothing, we are going to be spending, by 
the year 2016, it's estimated, over $4 trillion a year in health care. 
And it still means that a good number of Americans don't get the 
coverage.
  So we have to do something. And let me just make this last point, and 
then I know that you'll have things that you want to say as well.
  But our bill, the bill that you wrote, and the bill that I'm now a 
part of, is going to give Americans choice. And there are going to be 
some other bills presented. There's a bill that says you have a single 
payer system. There's another bill that says the individual pays and 
not the employer in a tax to, and as you've designed the bill, pays 
into a tax, in which we have 300 million people in one pool. So you 
don't have this problem of a single employer.
  But, no, I just want to make this point before yielding back. The 
point I want to make is that we all know we're going to get to 
universal coverage. And the question is not if, but when.
  The other question is what is it going to look like? We have the 
perfect model, a system that the employer pays, that the individual 
pays, a system now where the hospitals, because they won't have such 
uncompensated care, will be contributing a bit, and where the insurers 
are going to be making sure that more goes into health care.
  And there's the other plan that will come out here, Mr. Wyden's bill, 
that deserves to be looked at, where the individual is going to pay. 
There's again, the single payer plan. And then there's the other groups 
that say, well, let's just kind of work on the edges and keep covering 
more and more of the uninsured and then see what it looks like when 
we're done.
  So maybe we could have more back and forth dialogue, but this is 
something I deeply believe in. And I appreciate the work that's gone in 
by you and your staff. And now, my staff as well.
  And this is a debate that Congress needs to say, let's begin it. 
Let's have a hearing in the House and in the Senate on this 
legislation, on the other legislation. Let's understand the impact on 
individuals and on employers.
  So this is a lot of fun for me to be out here with you.
  Mr. LANGEVIN. I thank the gentleman for his words and also his 
passion and support on this bipartisan universal health care bill. Your 
input has been invaluable in crafting this bipartisan bill and bringing 
it to where it is today, and we hope that this, now, continues, where 
we begin the process of fixing our health care system, bringing it to 
the top of the public policy agenda. It is clearly long overdue.
  The American people are asking, they're demanding that we fix our 
health care crisis, and that we cover the uninsured, not only cover the 
uninsured, but making health care affordable. This is something that's 
long overdue.
  I think it's a national disgrace that we have 47 million people in 
this country without health insurance. And as we have both pointed out, 
that because of that, it's a major contributing factor in that we have 
the highest cost and the worst outcomes in comparison to other 
industrialized nations. Again, the high number of uninsured is a major 
contributing factor to that statistic.
  So the fact that we have a bill now is exciting because it's based on 
a template, a tried and true program that's already working.
  When I first came to this debate, I said, this is one of the most, 
the biggest challenges facing our country right now. And I said, why 
can't we solve it? And is there anything out there that is working now 
that serves as an example of what we could base a universal health care 
system on?
  And after studying it and looking at it, I said it's really right 
before us, and that's the Federal employees health benefits program. 
Right now, we have, the Federal Government, as mentioned earlier, 
negotiates a variety of different health care plans for more than 8 
million Federal employees, dependents and retirees. You've got 
everything, and the choices of options that are available, from the 
very basic plan with the small premium and the small copay, up to the 
more classic comprehensive Blue Cross-type plans and everything in 
between.
  Mr. SHAYS. And if I could just jump in. The key that you make is that 
there are 8 million individuals, either actively working for the 
government or retired, who are part of the same pool, and so the 
purchasing power becomes more powerful.
  Mr. LANGEVIN. That's right. Using bulk purchasing power is the thing, 
by getting more people into one insurance pool, we spread risk around, 
and it achieves cost containment and stability in the system.
  Mr. SHAYS. And the exciting part, I think, or the very sensible part 
of what we have as Federal employees, because as Congressmen, we have 
that same plan that all Federal employees have, is that we can choose 
to upgrade our plan and spend 28 percent on the more expensive plan, or 
we can choose to lower it each year. But we never have a problem of 
there being a pre-existing condition.
  And thinking how it would work in the private sector, you move to 
another job and you will be able to keep the same plan. Or you are 
unemployed. You lost your job. And you have this huge fear of buying 
COBRA and having to pay all of the cost, and you can't. You're not 
working. In this case, you would be part of the government coverage, 
and it would be paid for almost entirely by the government, in that 
instance, until you were back working.
  And what's hugely important about that is to recognize though, that 
that individual wouldn't, then, be able to get the most expensive plan, 
they'd have the basic plan. But the basic plan is a good plan.
  Mr. LANGEVIN. That's right. Absolutely. And it's equally important to 
recognize that this is not a big government-run plan. We're not 
creating another big government bureaucracy. It's government negotiated 
but it's private competition. It's managed competition. Private 
insurers would be able to compete for now enrollees based on benefits, 
efficiency service and price. So the insurance companies have an 
incentive now to economize, find efficiencies. They would have to 
deliver on what has been negotiated in the various plans, and that 
would be clearly spelled out, but they would now be challenged to find 
ways to do things like invest in preventative and early care, which 
there really isn't necessarily the incentive, I believe, right now for 
insurers to do that, because, for example, when it's tied to 
employment, you know, we all, people change jobs several times 
throughout their careers. There's no guarantee that an enrollee that 
starts with an insurance company today is going it would be Insurance 
Company B, you know, wouldn't be with the Insurance Company A years 
down the road. They would be with potentially another insurance 
company, which means, you know, why should Insurance Company A invest 
in all this early preventative care, when, down the road, when someone 
gets older and we all become greater consumers of health care, that, 
why would they, that company wouldn't benefit from the investment that 
they made, where under this system they would. You may change plans 
within a particular company, but you may very well be with the same 
insurance company or plan throughout most of your life.

                              {time}  2030

  Mr. SHAYS. I love to talk about this and just delve into the 
preventative care part even more.
  The insurance company isn't guaranteed that that individual will be 
with

[[Page 6572]]

them for life. But they are aware that the insurance company's part of 
the American Health Benefit Plan and that all of the other insurers, as 
well, have to focus on preventative care. And that's going to be hugely 
important how people take care of themselves; are they having physical 
checkups, but more importantly, how do they take care of themselves? 
Are they smoking? Are they overweight?
  You are going to have insurance companies that are going to provide 
incentives for people, one, to not smoke; to provide incentives for 
them to lose weight; and this is going to also include a health savings 
account for those who want it. And the significance of that will be 
that it becomes a high deductible.
  So they would have to put in for the first few thousand dollars, but 
it comes out of what they put into a savings account. And if they don't 
spend it, then it stays in that savings account. And then there has 
been no cost to the insurer and, in this case, it will be a less 
expensive plan to the government as well.
  Mr. LANGEVIN. Right.
  Mr. SHAYS. I would love to, if you wouldn't mind, just point out that 
what we have done in this legislation is that when the bill passes, it 
will take 2 years to be implemented so that as we vote out the 
legislation with whatever changes are in there, it may be that the 
amount that an employer has to put into the system may be higher or 
lower in certain numbers of employees and so on; and we can go back to 
that chart in a second. But we want to have time to write the 
legislation but then to examine it during the course of the 2 years.
  And one of the things that we've done is that we require there to be 
a health benefits commission. And the significance of that is that we 
don't want the United States to be spending so much more than other 
countries. So much of our wealth and our income is going into health 
care, and we would like it to be less.
  Mr. LANGEVIN. Right.
  And I think that is an important point, if I could just interject. 
The high costs of health care now are putting not only a tremendous 
burden on our individuals and families, but it's putting our companies 
at a significant competitive disadvantage in terms of those companies 
overseas whose nations have universal health care. And so it is not 
particularly burdening in individual business itself in foreign 
countries where it is here where companies bear much of the costs of 
providing universal health care.
  So we're helping to change the dynamic, if you would, of how health 
care is provided in America. And, again, we're changing it from an 
employer kind of run system, a sponsor system, to now a universal 
health care model that everybody is participating in, and it's not 
necessarily tied to employment. Again, businesses still have an 
important role to play, we all do. Businesses, government, health care 
providers.
  Mr. SHAYS. But they won't have to negotiate a plan every year, and it 
won't be unique to that business. It will be a plan that will have been 
negotiated by the American Health Benefits Plan.
  You know, I look at this trend line, and I see that we're looking 
that in the year 2016, we would be spending $4 trillion. But what will 
we be spending in the year 2020? And this is without doing what we need 
to do, which is to reform the system.
  And so what we have done is we have established a commission, and the 
commission will be of nine members, the chair and vice chair, as well 
as two other members who will be chosen by the comptroller general. The 
President, the majority leader, the minority leaders of the Senate and 
Speaker, the minority leader of the House will choose one 
representative. And the commission shall examine and make 
recommendations regarding the major issues and cost drivers affecting 
the delivery of health services as it pertains to the American Health 
Benefit Program.
  Within the legislation, we specifically are directing the commission 
to examine a comparison of the American Health Benefit Plan to other 
public health insurance programs, the proper implementation and 
utilization of electronic medical records and other health information 
technologies, including privacy and interoperability issues. We're 
directing them to look at the effects of medical malpractice insurance 
and defensive medicine on the delivery and cost of health care, and 
that's something that needs to be looked at.
  The patterns and effects of overutilization. When do people 
overutilize care? Why do they overutilize it, and what steps can an 
overall plan do to encourage all of the insurance companies to have 
some of the basic same practices that would discourage overutilization?
  We are having them look at the cost and implementation factor of 
retiree health coverage under the American Health Benefit Plan. What is 
the impact of retirees? And candidly, what is the impact of the last 
few months of someone's life when we see a huge amount of money spent?
  A comparison of prescription drug prices under the American Health 
Benefit Plan to other public health programs, and the effects of 
insurance monopolies on health care costs and delivery, we need to look 
at that.
  Now, what this commission will do, it has 18 months to file its 
findings, which is 6 months before the law actually goes into effect. 
But we're asking them to give us a preliminary finding 12 months in, a 
final version 18 months, but one 12 months.
  So the legislation passes 2 years before it's implemented. The 
commission comes back in a year and says, You need to make these 
changes to help control costs, to help discourage overutilization, to 
help with preventative care. That would help save costs in the long 
run. We will come back 18 months later.
  Now, one of the last points I would make, and I know that you have 
comments that you need to make as well, we are willing to amend this 
legislation as we get data. And, for instance, I hope that sometime 
again we can look at the chart that you had where you talked about 
employer contributions because we're asking employers to say, okay, 
what do you pay now and how would this legislation impact you. And even 
if now they would be paying a little bit more, I suspect that in the 
long run, because their costs are going up significantly without a 
plan, but if I could just point out how this chart works. It's rather 
small. But we look at an average wage earner of $21,000 or less, and 
then we say okay, there's 10 employees to 25 employees. There are 200 
to 500 employees. That's on the left column. And in an average wage of 
$21,000 or less, even with 500 employees, they would only be paying 
about $1,000, slightly over $1,000 a year.
  Now, when you go and look at someone who is making $83,000-plus, the 
amount that they would be contributing would ultimately max out, 
potentially, at a much higher rate, more than $10,000. But the question 
is, what do they pay now?
  Did I get that right? Yeah.
  But the point is, employers are going to say, I have 26 employees, 
their average salary is $42,000. They will know that they're going to 
be paying approximately $6,600 an employee. So that's what they would 
pay under this plan. What do they pay now, and are there employees 
having the same choices that now--do they have the same choices under 
their private plan as they would under this plan?
  Mr. LANGEVIN. Right. And that's an important point to make.
  There are some employers that, though they offer health insurance, 
the company may only offer one plan, and it may not fit the needs of 
all of the employees. It may be good for some but, again, not everyone.
  Under this plan, there would be a variety of plans to choose from: 
again, a very basic plan with a small premium, a small copay, up to the 
more comprehensive-type programs, and several options in between. And 
it's basically bringing everyone into one insurance pool.
  So you're bringing a younger, healthier population into the program;

[[Page 6573]]

you're spreading risk, which leads to more stable costs; and we talked 
about the fact that the Federal Employees Health Benefit Program under 
last year only had a 1.8 percent increase in its health care plans on 
average and the private sector had about a 6.1 percent increase. And I 
think that's even modest.
  So, again, a good model here.
  I'm glad that you raised the issue of the commission because it is 
important to look at the reasons for the rising costs of health care 
and then look at what options we can employ to achieve cost containment 
and bring stability to the system. Things like employing health 
information technology, the electronic medical records that we're 
talking more and more about these days, the cost of prescription drugs 
and how that system is run, and how we pay for prescription drugs. I'm 
looking at performance-based outcomes that the commission would look 
at. Again, all important tenets of achieving cost containment.
  And you rightly pointed out that employers, in determining whether 
they like the system or not, are going to look at the range of costs or 
percentage of payroll that they would contribute based on the size of 
their company. Employers, I suspect right now, hopefully this will 
encourage them to ask, what are we paying as a percentage of payroll 
right now, and that figure will determine, in many ways, whether this 
system works better or worse for them. I suspect that in many cases it 
will be better.
  And we pointed out that the smaller companies with the lowest average 
salaries would pay no more than 4 percent of their payroll toward this 
payroll tax. And the larger companies with the highest salaries would 
pay no more than 10 percent of payroll and not to exceed more than 
$12,000 per employee.
  Mr. SHAYS. Right. Because what we do is we cap the payroll at 
$120,000. And so it ends up being $12,000 an employer would pay.
  But when I was speaking of someone with 500 employees, they would pay 
$21,000 salary, they pay 5.25, 5\1/4\ percent of payroll. It gets up 
to, if they're making $83,000 on average, and that would be quite a 
company, then they would be paying the 10 percent rate. And the key is 
that when we drafted this legislation, we had the input of private 
foundations and experts. But in the end, this still is an estimate of 
what we think brings in the revenue needed to provide the services.
  And the challenges you just don't know until you get more into it. 
That's why the hearings are so necessary.
  Mr. LANGEVIN. Absolutely.
  Mr. SHAYS. We have to draft legislation that we think is as accurate 
as can be, and then we present it to those who would be impacted: 
Employers, government individuals, and say tell us how it impacts your 
life. I have committee meetings, and I had individuals say, well, for a 
period of time I lost my job. This plan would have meant I would have 
had health care.

                              {time}  2045

  I had someone else who said, you know, I had a condition. I was 
insured. I couldn't hold my COBRA. I couldn't keep my insurance for a 
while. It stopped. And then I got insurance later and they said, you 
had a preexisting condition, and they weren't covered.
  I had business men and women who said, I only have five people in my 
office, and we're paying an exorbitant amount. I mean, under our 
legislation, someone who had less than 10 would be paying, if their 
salary was $21,000, 4 percent of payroll. If their salary was 83, they 
would be paying 6 percent of payroll, far less than what they're paying 
now, far less. And so, it's a debate that we need to have. Now, I'm 
waiting for the employer who comes to me and says, guess what? Under 
your plan, I'm going to have to pay more. I want him or her to tell us 
why and how much. So we need to make sure that people get on your web 
page or our web page and take a look at this legislation and give us 
feedback.
  We're going to literally tour the country to argue that we need to 
begin, first, a debate on health care that our bill, the bill presented 
by Mr. Wyden, the bill of the single payer, all of that should be 
brought forward for really a terrific debate.
  Mr. LANGEVIN. I couldn't agree more. This is one of the most 
challenging issues facing us in our time right now. It's going to take 
time and effort to get the message out and hopefully encourage support 
for our plan.
  I'm glad that you and I have made a commitment to travel the country 
so that we can help to bring the plan before people, hopefully to 
educate the American people about what we're proposing, and offering 
this as a viable solution to our Nation's health care crisis. It's 
clearly long overdue. And in my home State of Rhode Island, it's the 
number one domestic issue that I hear most about. It is directly tied 
in many ways to the health of our economy and making sure that our 
companies can be competitive in this global market. It's important to 
individuals and families.
  And no person should have to worry if they're going to lose their 
home because they come down with a catastrophic illness or a family 
member comes down with a catastrophic illness, but that happens every 
day across this country right now because of the present health care 
system. And again, it's not that there is no cost associated with the 
uninsured. If someone is that sick and they need to be treated, they're 
going to go, very often, to the hospital, to the emergency room where 
they're going to be seen. But usually by then it's at the end stage of 
an illness where a person is so sick that they have to be likely 
hospitalized, or the cost of treating them is far more expensive than 
it otherwise would have been at the earlier stages when early 
intervention, early care would have made all the difference if it were 
with a prescription or some other treatment. Now we're offering a 
system to change that.
  Mr. SHAYS. See, that's, I think, one of the key points. You could 
make an assumption that 15 percent are not covered and you're now going 
to cover them, that it means it's going to be more expensive for 
everyone. And there are arguments that we might have to phase the 
legislation in to make sure that we get more doctors and nurses and so 
on because we're looking at potential shortages. But the key thing is 
that those that don't have insurance have extreme measures taken, and 
by extreme, more services, more costly services. And so we have this 
artificially inflated cost, and that clearly will have an impact if 
everyone is, in fact, covered.
  Before we end, I'd love to make sure we just go right through the 
simple parts of this legislation. If I could just start by saying 
you've written a bill that says all Americans should have the same 
health care benefits and opportunities that Federal employees have. 
Federal employees, Members of Congress who are Federal employees, we 
pay 28 percent of the cost, the government pays 72 percent of the cost. 
We can get a more expensive plan or we can get a less expensive plan.
  What your plan does is it puts everyone in a pool, one pool, 300 
million people. It spreads out the cost. It gives all Americans at 
least, probably--we have now 18 choices, there will probably be more, 
and they have choice. Your plan says that you will never lose your 
insurance, ever. Your plan says it doesn't matter if you're an employer 
with five employees or one with a thousand. Your plan recognizes 
whether you're one person or 500, you're going to get covered and be 
part of the same pool.
  And ultimately it means that we're going to do something that we've 
talked about for 50 years, and that is, this great country of ours, the 
United States of America, will have a universal plan, all Americans. 
And when we do it, I think you're going to find that we're going to 
say, what took us so long?
  So it's just a real pleasure and an honor to work with you and your 
staff. And I look forward to our having some impact on this hugely 
important issue.
  Mr. LANGEVIN. I thank the gentleman from Connecticut again for his 
words and his support in helping to craft this bipartisan universal 
health care bill.
  Like you, I believe that the American people deserve the same kind of

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health care coverage as Members of Congress. And this is a bill that 
achieves that goal. It's something that is long overdue. It's something 
that is vitally important to every family across America, making sure 
that our families are taken care of, our businesses can stay 
competitive, and that we're offering something that is affordable, not 
only for the short term, but for the long term.
  In closing, for individuals, the American Health Benefits Program 
offers choice, affordability, and portability. You can take the 
coverage with you if you change jobs. And on the side of how we provide 
this coverage, it's managed competition whereby insurers would now have 
to compete for enrollees based on benefits, efficiency, service and 
price; again, a good model for guaranteeing coverage, but making sure 
that it's affordable, with an important component of cost containment, 
making sure that we're looking at using the most innovative 
technologies out there, such as health IT records, and other things 
that would make sure that we're providing the most efficient and 
affordable care possible, but comprehensive care.
  I think my friend has some other comments that you would like to make 
as we close?
  Mr. SHAYS. We just have to insert different names here, but our web 
page is www.house.gov/shays. If someone goes to www.house.gov/shays, 
they will see this plan, as we've been talking about, on our main page. 
And I'm assuming that your web page would be www.house.gov/langevin. So 
they can go on either of our web pages and see the plan.
  We would love for people to respond, tell us what they like about it, 
how they would benefit. And then we would like their help in contacting 
their Member of Congress and saying we would like you to support the 
Langevin bill, and get on it. We need to start getting cosponsors. We 
need to encourage Congress to have hearings on this legislation, begin 
that process.
  So again, that's www.house.gov/langevin or www.house.gov/shays.
  Mr. LANGEVIN. I thank my colleague. And I couldn't agree more. We 
want people to look at this plan, tell us what part of it they like, 
what they don't, what works, what doesn't, so that we can improve upon 
it. And certainly it's important for people to get educated because 
this is an issue that is clearly confronting our country. It is 
serious, it is challenging, but the time to solve it is now.
  We're beginning the process. We invite the American people to be 
partners with us in this effort. I look forward to traveling the 
country with you as we talk to groups across the country and hopefully 
enlisting their support, and ultimately the support of all the Members 
of this House and the Senate.
  I look forward to the day where we can pass this bill in both 
Chambers and put it on the President's desk for the President's 
signature, and again, truly make a difference for the people that we 
serve. I think it's the right thing to do.
  With that, I thank my colleague from Connecticut for his friendship, 
his valuable input and support on this bipartisan universal health care 
bill. And I also want to take a minute just to thank the Speaker for 
giving us time to discuss this very important issue.
  Mr. SHAYS. If I could thank the Speaker as well. And thank you again 
and your staff, and my staff as well. It's a great opportunity to work 
on this legislation with you. Thank you.
  Mr. LANGEVIN. Thank you. I thank my staff as well. It is something 
that often gets overlooked, and I want to make sure that it's not 
because your staff and my staff have worked so closely on this, as well 
as the effort that you and I have put in. A lot of great work has come 
from this collaborative effort. And I thank you again for your support 
and your input.

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