[Congressional Record (Bound Edition), Volume 155 (2009), Part 10]
[House]
[Pages 13856-13863]
[From the U.S. Government Publishing Office, www.gpo.gov]




                         HEALTH CARE IN AMERICA

  The SPEAKER pro tempore (Mr. Kissell). Under the Speaker's announced 
policy of January 6, 2009, the gentleman from Connecticut (Mr. Murphy) 
is recognized for 60 minutes as the designee of the majority leader.
  Mr. MURPHY of Connecticut. We are going to take the next 45 minutes 
to an hour, myself, Mr. Kagen, Mr. Langevin, and a few others that will 
likely join us over the course of the hour, to talk about a subject 
that's on the minds of more and more Americans every day, and that is 
the issue of getting health care for all Americans.
  President Obama was swept into office with a mandate to fix what has 
become an unjustifiably broken health care system here in this country. 
It costs way too much, outpacing all of our industrialized neighbors by 
almost twofold. It gets care that, compared to those same nations, 
ranks pitifully in the middle of the pack. And it has changed the very 
practice of medicine for far too many physicians who went into their 
profession for the love of treating people and making them better and 
now find themselves dedicating more and more of their time filling out 
paperwork, dealing with red tape, and arguing with insurance companies 
over whether or not they should get paid for their services.

                              {time}  1830

  We can make this health care system better for our society as a 
whole, for our government as a payer, for the patients who interact 
with it, and for the providers--the doctors and the nurses and 
practitioners--who perform miracles every day within that system 
despite the system.
  There are a lot of people who enter this debate from various sides, 
and we're, frankly, not going to have over the course of this next hour 
unanimity of opinion on the exact solution to this crisis going 
forward. What you will hear over the next hour is a group of 
individuals on the Democratic side of the aisle who are committed not 
just to reform for reform's sake, not just to a--pardon the pun--Band-
Aid fix, but to comprehensive health care reform. We're beyond making 
little incremental fixes here or there. We've got to strip this thing 
down and build it back up again. We've got to learn from our mistakes.
  On the Democratic side of the aisle, we've heard the American people 
loud and clear whether it was at the ballot box last November when they 
voted for a President, a President who made it clear that health care 
reform and getting coverage to every American was going to be at the 
top of his priority list, or whether it's every weekend when we go 
home, when we talk to individuals who are facing the reality of an 
economy that leaves them one paycheck away, one pink slip away, from 
losing their health care forever. That number is going up. More and 
more Americans are afraid that their breadwinners may lose their jobs 
over the next 6 months to a year. They realize that what comes along 
with that is the risk of having their entire lives turned over. Half of 
the bankruptcies in this country are not due to irresponsible spending 
decisions or due to houses that they bought that cost too much or due 
to a couple too many plasma TVs in the basement.
  No, it's medical costs. It's an unforeseen illness visited upon a 
family who didn't have the resources to pay for it. Half of the 
bankruptcies in this country are due to people who got sick but who 
didn't have the means to pay for it. Half of the bankruptcies are due 
to the people who played by all of the rules and who did everything we 
asked them to do but who just got sick.
  Now, in the richest country in the world, there is no justification 
for the fact that somebody who has the misfortune to be diagnosed with 
cancer or with an expensive illness has to lose everything--his house 
and his car--just because his fortune was a little bit different than 
someone else's fortune. There is no justification for the fact that 
millions of little kids in this country are going to bed, sick at 
night, just because their parents can't afford to get them to doctors. 
In this country, that can't be all right. People have come to the 
conclusion that this is the time--this year, right now, this summer, 
this fall--when we finally will wake up and will fix this thing for 
good.
  You're going to hear from a lot of us as to our ideas on how we 
should address this crisis. We're going to talk today about the role of 
consumers in this debate, whereby we can make our health care customers 
better purchasers of health care if we give them the right information 
and so that we can empower them in a new, reformed health care market.
  You're going to hear about the role of the Federal Government in this 
reform and, as part of that new purchasing power that we can give to 
individuals, that we can give them the option to buy the same health 
care that I have and that Mr. Langevin may have and that others in this 
Chamber may have. I know Mr. Kagen doesn't take the Federal employees' 
health care plan, but it doesn't seem like it's so revolutionary that 
we should not allow regular, everyday Americans to have the same kind 
of health care that Members of Congress have.
  We're going to talk about the role of people to have choices between 
public insurance and private insurance. We're going to talk about 
reforming the way that medicine is practiced so that physicians can get 
back to spending their time with patients rather than with filling out 
paperwork and with hiring more and more people to argue over whether 
they will get paid or not.
  We're going to talk about how we make this reform centered around 
improving quality. It still doesn't make sense that we spend 70 percent 
of our gross domestic product on health care, and yet we have infection 
rates, life expectancy numbers and infant mortality rates that should 
leave us pretty embarrassed given the amount of money

[[Page 13857]]

that we're spending. So I'm excited to be here on the floor for the 
next hour or so to talk about these things.
  I know Mr. Langevin has joined us here on the floor. I would be 
thrilled to turn it over in just a second to Mr. Kagen to give a couple 
of introductory remarks, and then I will turn it over to Mr. Langevin.
  So I'm glad to have you join us here, Mr. Kagen.
  Mr. KAGEN. Thank you, Mr. Murphy.
  If you could raise up that sign one more time, it does say ``Health 
Care for America.'' It doesn't say ``health insurance.'' It says 
``health care,'' which is our focus. We care about the people we're 
listening to--the people we have the honor of representing. It is about 
making certain that people can get to see their doctors when they need 
to at prices they can afford to pay. I'll share with you some of the 
stories that, perhaps, President Obama is going to hear when he comes 
to Green Bay, Wisconsin, on the 11th of June, just a few days from now.
  Here is someone from Green Bay who wrote to me. Her name is 
Stephanie: ``Insurance is number one on my list. My current employer 
can't afford to give us health insurance, and I can't get individual 
coverage. Help, please.''
  President Obama might hear from Jim, who is also from Green Bay: 
``Every human should have health care. Don't have insurance. 60 years 
old.'' He is between the cracks. He is not old enough for Medicare, and 
he is not poor enough for welfare or for Medicaid.
  In Sturgeon Bay, just outside of Green Bay, I got a card from Rhonda: 
``Our middle class income cannot support the increase in medical 
premiums, copays and deductibles. What will be done for the middle 
class?'' She is Rhonda in Sturgeon Bay.
  People are writing to their legislators, not just in the Federal 
House here in Washington but across the State houses. Every government 
at every level understands the pressure and that the cost for health 
care has risen astronomically. It is 17 percent of our GDP. It is that 
investment that we make in ourselves to guarantee that we have health. 
If you don't have your health, you may not have anything.
  Now, recently, I received a mailing from an insurance company that is 
in my district. It's a great company. I just want to read this into the 
Record because, if you have certain preexisting conditions, all the 
marketing in the world won't allow you to purchase their product, 
because they don't insure people with preexisting conditions:
  ``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 the coverage being offered.'' It 
reads: ``HIV/AIDS, alcohol, drug dependence, cancer, chronic 
obstructive pulmonary disease, connective tissue disease, Crohn's 
disease, diabetes, emphysema, heart attack, stroke, hepatitis, 
inpatient emotional and mental health care, organ or tissue transplant, 
ulcerative colitis.''
  It goes on to conclude: ``You should also be aware that we may not be 
able to provide coverage to individuals who are severely obese, who are 
severely underweight or who are undergoing or who are awaiting results 
of diagnostic tests. We cannot offer coverage to expectant parents or 
to children less than 2 months old.'' Finally, it reads: ``This list is 
not all-inclusive. Other conditions may apply.''
  I don't think it was a doctor who wrote this policy. I think it was 
someone who had his economic interests in mind and not the care of the 
people who are looking for the coverage they need in order to guarantee 
they get the care that they're going to require.
  We are prepared in this Congress, I believe on both sides of the 
aisle, to step up and to face and to confront this essential economic 
fiscal problem. It's not just about your money. It's about your life. 
This, after all, is the House of Representatives. Some people back home 
in Wisconsin think that we're trying to talk them out of their money 
and out of their lives.
  Tonight we're going to have a conversation with one another and with 
the American people about what is most important to you, and that is 
your health care. I'm hoping that, someday soon, we're going to come to 
a time when we'll have all prices openly disclosed everywhere in these 
United States for all of the products.
  Mr. Murphy, last week when I was home, I had a ``Congress on your 
Corner'' at a grocery store in Waupaca, Wisconsin. While there, I 
didn't get a headache, but if I had had a headache and had wanted to 
buy some aspirin--I took a picture of this. Now, some of my staff here 
in Washington think this is pretty cheap. You know, you can get Bayer's 
cherry- or orange-flavored aspirin for $2.55. Right there in the 
middle, you can buy a generic brand for $2.05, which is 20 percent 
less. What do you want to pay: more or less? It's the same medication. 
This price is openly disclosed.
  I think we have to have this type of health care available, not just 
at the grocery store for aspirin products but at the hospitals and at 
the doctors' offices and everywhere in health care across the country, 
most particularly for health insurance policies. If at the end of the 
day we're going to continue to allow companies to be in the 
marketplace, like the offering I just read to you, I believe very 
strongly they should be compelled to sell the same product to any 
willing customer with no discrimination due to preexisting medical 
conditions.
  If, after all, we have Federal standards in this country for almost 
everything, why don't we have the standard of a comprehensive health 
insurance coverage plan that each and every insurance company must 
offer to any citizen or legal resident anywhere in these United States?
  There is nothing wrong with having standards so long as we can meet 
those standards. So I think these are some of the issues that are 
important, one of which is transparency in health care purchases. We 
have to have no discrimination anywhere in health care. I think the 
President has accepted this as one of his most essential elements, as 
one of his eight principles for health care.
  One should not suffer in this country due to discrimination based on 
the color of one's skin. Well, what about the chemistry of one's skin? 
If we're not allowed to discriminate against anyone because of what 
they're thinking, what about how they're thinking? What about the 
chemistry of their minds?
  So I think it's time that we apply our civil rights that guarantee no 
discrimination to health care. When we do, we'll begin to guarantee 
access to affordable care for every single citizen and legal resident.
  I yield back.
  Mr. MURPHY of Connecticut. Thank you, Dr. Kagen.
  Dr. Kagen has been such a great voice on this. He highlights a 
growing issue that, I think, we can get bipartisan agreement on, which 
is that transparency of price, whether it be insurance products or 
physicians, is going to be so important, and empowering consumers to 
make these decisions can be part and parcel of what gets those costs 
down.
  With that, I am very happy to have my good friend from Rhode Island 
join us today. I would yield to him.
  Mr. LANGEVIN. I want to thank the gentleman for yielding, and I 
applaud his efforts, along with Mr. Kagen's and along with those of 
many of my other colleagues. I applaud them for their interest and for 
their concern about the health care crisis that is facing America and 
that has been facing this country for decades. I am proud to join in 
the effort to speak out and to demand that this Congress finally, once 
and for all, addresses the health care crisis in America and 
establishes universal health care.
  I particularly want to commend President Obama for making this such a 
strong priority for his young administration.
  I thank the gentleman for yielding and, again, for his efforts in 
organizing this Special Order.
  Mr. Speaker, our country has seen a significant rise in health care 
costs

[[Page 13858]]

over the past several years. Again, this is a national crisis, and it 
is probably one of the most pressing domestic public policy concerns of 
our time. We have witnessed a growing population with longer life 
spans, with higher incidence of chronic disease, with greater income 
disparities, and with increased levels of the uninsured, all of which 
put a tremendous strain on our health care system. Each of these 
elements has conspired to create an untenable situation that is being 
felt in hospitals, in doctors' offices, by individuals and families, 
and by businesses. It poses a threat to our long-term economic 
competitiveness and fiscal well-being.
  According to a recently released report by Families USA, 254,000 
individuals in my home State of Rhode Island were uninsured during some 
point during the last 2 years. Well, these numbers are unconscionable, 
but I have to say they come as no surprise. I have continuously heard 
from individuals and families who are struggling with rising premiums 
and copays and who are overwhelmed by medical debt.
  In fact, as my colleague mentioned, Mr. Murphy from Connecticut, the 
rising cost of care for unexpected illness is one of the leading causes 
for personal bankruptcy. It is outrageous in a country like America 
that being sick could put a family into bankruptcy. I think this is 
unconscionable.
  I have also heard from Rhode Island businesses that want to provide 
health coverage for their employees, but they simply can't afford the 
time or, most importantly, the expense of providing that coverage. Of 
course, workers who are fortunate enough to have access to health 
insurance face increasingly daunting costs while many people are afraid 
that they'll lose their benefits all together. This simply cannot 
continue. The time for comprehensive health care reform has come. This 
has to be the year that we fix health care in America, that we afford 
everyone universal health care coverage.
  I am pleased that, within the last few months, this Congress and 
President Obama have already taken significant steps to expand health 
coverage for children, to increase funding for community health centers 
and to invest in innovative technologies that will ensure better 
treatments and outcomes for our future.

                              {time}  1845

  It is only with comprehensive health care reform that we will achieve 
substantive change that improves both our Nation's health care system 
and the health of our Nation's citizens. Fixing our health care system 
is also critical to ensuring that the U.S. remains competitive globally 
in this international market, making sure that our businesses can be 
competitive in the global economy and will improve our vital long-term 
economic growth.
  In the spirit of furthering this important dialogue on health care 
reform, I have reintroduced my own universal health care proposal. I'm 
calling it the American Health Benefits Program Act which is designed 
to guarantee every American access to the same health care coverage as 
Members of Congress. I think that this is the right thing to do for the 
American people. In introducing this legislation, I'm not trying to 
reinvent the wheel. I want to look to a template, something that is 
already working. This proposal is modeled after the Federal Employees 
Health Benefits Program, or FEHB. It uses basically a health insurance 
exchange template while leveraging the power of the Federal Government 
to negotiate with private insurance carriers so that competition for 
enrollees is based on quality, efficiency, service and price. Basically 
there is still a role for private health insurers, but it uses the bulk 
purchasing power of the Federal Government on behalf of the American 
people to get the best quality and the best price for health insurance.
  Under this program, no one will be denied coverage or discriminated 
against based on their health status or pre-existing condition. The 
goal is to offer portable continuous coverage that drives investment 
and disease prevention and long-term preventative care which decrease 
the cost of health care over time. But most especially, it ensures that 
when someone is sick, they can go to a doctor and not worry about 
whether or not they can pay for it.
  This proposal represents my own vision for health reform, one that 
contains cost, improves quality, increases efficiency, promotes 
wellness, guarantees universal coverage, and encourages the investment 
in treatments and cures for the 21st century. Each of these principles 
comprises a key element, an important goal within the national dialogue 
on health reform. Particularly it contains the key elements that 
President Obama has laid out as his requirements for fixing health care 
in America.
  It is clear that we are about to set the scene for the next chapter 
of health care in America. And it is my strong belief that by working 
together, we can create a truly inclusive and sustainable model for 
health care that meets the needs of our children, adults and seniors 
regardless of their income level, employment status, age or disability. 
We are all stakeholders in this important debate, and we will all have 
a role to play in health care reform. I look forward to working with my 
colleagues to offer fresh solutions and create a new vision for health 
care in America. The time has come. This is the year. We're going to 
get it done.
  I want to thank my colleague Mr. Murphy and all of my colleagues who 
have joined in this Special Order tonight in this effort to fix health 
care in America.
  Mr. MURPHY of Connecticut. I thank the gentleman from Rhode Island. 
You have been such a leader in this Congress for years on the issue of 
health care reform, especially, as the world knows, on the issue of 
stem cell investment. We know that one of the ways that we're going to 
get savings ultimately is by stimulating the next round of breakthrough 
treatments and cures that are going to save lives but also save money.
  With that, we'll turn to my very good friend and classmate from 
Florida (Mr. Klein) for some wise sage words.
  Mr. KLEIN of Florida. Thank you very much. I appreciate the gentleman 
from Connecticut and his characterization of ``wise sage words.'' I 
will try not to disappoint you.
  It is a pleasure to be here tonight with Members of the House to talk 
about health care. This is something that obviously touches every one 
of us, as 300 million Americans face health care issues every day. Some 
of us don't have to think about them from year to year other than maybe 
just a minor incident or you have to go to see a doctor from time to 
time. Others face literally chronic and life-threatening health 
situations every day, and it hangs over you. It hangs over you as just 
an emotional and physical thing as it relates to your body or your 
family, one of the members of your family. It relates to and hangs over 
you because of the costs and the threat of that overwhelming cost and 
impact on your family's wherewithal and to be able to do it. Certainly 
from the business community side, we hear from our small businesses. I 
know in South Florida, where I come from, we're a small business State, 
and so many small businesses with five employees, people who are self-
employed, 10 employees, 50 employees, they go through the same 
experience year after year, double-digit increases with no experiences, 
nothing that went on during the year that was a major cost factor that 
set off these double-digit increases. And what happens is, they then 
have to make a decision: What can I cut back? We are in difficult times 
right now. Do I increase the copayments? Do I increase the deductible? 
Do I cut back on the scope of care? Businesses want to provide health 
care. It creates loyalty from the employees to the business. It creates 
a healthy employee and someone who is able to come to work every day, 
someone who you've invested a lot in to train that employee. You also 
have large businesses that can compete internationally. They know that 
the costs of producing something with that added double-digit increase 
of health care cost impacts the cost of the product that they are 
selling worldwide and competing with other countries which somehow 
integrate the cost of their health care into their government 
operations or just in a lower cost way.

[[Page 13859]]

  We now have a dynamic in place here that's been around, but I think 
it has finally hit the point where there is a coalition of people all 
across America that are saying, we need change. And we don't want 
nipping around the edges. We don't want some small little thing that 
isn't going to make a difference. We have fundamental problems. We have 
cost problems. We have coverage problems in some cases, pre-existing 
conditions. I know anybody this in this room I can speak to and people 
listening tonight, everyone could talk about a family member, a 
neighbor, a friend who has breast cancer or some other chronic 
condition that when you need that insurance the most is when it will be 
unavailable to you because if you change jobs or you are getting a new 
policy, they will be excluding coverage from that pre-existing 
condition when you need it the most. So the notion of insurance and 
spreading the risk among our whole population, which it's supposed to 
do, is what has somehow gotten away from the insurance system as we 
know it, and that's wrong.
  So where are we? We're at a place where I think Americans say and 
want and know that they want to have something that's stable, something 
that will be there for them. They're willing to pay a fair price for 
it. They want to be able to compete in their businesses. And the good 
news is our President, many Members of the United States House of 
Representatives and the Senate want to do something about it, and we're 
getting great support from across the country. We have got to get it 
right, but I think there's a tremendous amount of opportunity here.
  Let's talk just very briefly about what some of those notions are, 
those principles that we're going to create this plan. There are a lot 
of ideas out there right now. We can certainly invite Americans to talk 
to their Representatives and give us some input on what you think.
  Number one, I think one of the most important things is this notion 
of restoring the doctor-patient relationship. We have a lot of doctors. 
Dr. Kagen is a doctor. I see our friend from Pennsylvania who is going 
to speak in a few minutes. She has a doctor, I believe, as a husband 
and a son. There are a lot of doctors in the Schwartz family. And I 
think as patients we know the best thing we can do is have a long-term 
relationship with a doctor who knows my family history, knows my 
history. Not that I have to change jobs and change doctors, or my plan 
knocks this doctor off the panel, I have to find somebody else. So 
let's go back to the notion of having a doctor-patient relationship 
whose decisions are not dictated by people who are outside of the 
medical field, insurance companies, managed care, et cetera. Let's put 
that in place.
  Number two, let's make sure that as we go forward that people who 
like what they have in the insurance world can keep it. I mean, there 
are a lot of people who like what they have. I wasn't out here 
criticizing everybody. Some people are very comfortable with the plan 
that they have. They should be able to keep it. Nobody is saying you 
shouldn't be able to have it. Keep it. It's good. Let's stick with it. 
We want to provide tax credits to small businesses and individuals to 
make coverage affordable. In other words, again, it's not mandatory as 
we know it right now. So encourage businesses by doing it with tax 
credits to make it affordable. We want to certainly end this practice 
of eliminating pre-existing conditions from coverage. Spreading the 
risk is a very simple principle that could be done with a pen, and 
we're all set. So that's a principle that has to go in there.
  We want to make sure that whatever we put forward invests in 
preventive and well care medical coverage. I take Lipitor or I take 
something for cholesterol. It's a family history thing. A lot of people 
take it. It's just something that keeps me healthy. If I didn't take 
it, I would have cholesterol. Dr. Kagen could probably tell me how I 
should change my diet. I do run. I try to keep in shape. But the bottom 
line is, I take it as a preventive tool. There are lots of other tools 
and things that we can take, plus exercise programs and other things. 
But we should incentivize behavior through our health insurance 
scenario. Just the last couple of items before I turn it back to my 
colleagues, we want to ensure that we're using science-based 
information, that when decisions are made, it's based on science and 
not some of these nonscience-based concepts. I mean, science really 
relates to the best individualized treatment and care.
  Then, of course, we have to crack down on the waste, fraud and abuse. 
There's a lot of money in this current system here that is a lot of 
waste. We have to fix all that, you know, wring it tight so we can make 
sure that that money is being spent directly on health care. These are 
principles--and there are others that we're working on--that I think 
most Americans approve of and support. I think this is the construct by 
which the various ideas are being discussed here in Washington and are 
part of that discussion. There may be details which we may not all 
agree 100 percent on, but this is something that the time has come. The 
time has come for peace of mind for every American, for every business 
to know that we'll have a stable health care system that will support 
Medicaid, support Medicare, and on the private side, very important, 
most of us will get our care from the private side. We'll have that 
opportunity to know that it's cost-effective, and it will give us that 
necessary coverage.
  I thank the gentleman from Connecticut who brought us together 
tonight. I know being from South Florida and having a tremendous amount 
of senior citizens who depend on a good quality health care system and 
a whole lot of families that are very interested in making sure their 
families are covered as well, we're working to make sure that we take 
care of them the right way here.
  Mr. MURPHY of Connecticut. Listening to the gentleman from Florida, 
I'm reminded--you were down here with us the last time we were doing 
this. I got an e-mail not long after from a family member who comes 
from the other side, both the partisan and ideological side of the 
aisle. And he said, you know, be careful. You keep on talking about 
this. You know, it makes a lot more sense to me. I am struck by the 
principles that you have laid out because I think that a lot of our 
friends on the Republican side of the aisle, either here or out in the 
world, aren't going to find a lot of disagreement with a lot of things 
that we're talking about this system doing. I just think it's important 
for our constituents and for the American people out there to really do 
a little investigation when they hear the pundits on TV or the leaders 
of the Republican Party talking about President Obama and socialized 
medicine or the Democrats' plan for a government takeover because all 
you've got to do is scratch the surface there, and you will find out 
that really what we're talking about is some pretty important and I 
think broadly agreed upon reform and that the bogeyman and the straw 
man that gets thrown out there in terms of terminology that doesn't 
have any place in this debate can easily distract you from what is 
really a pretty unifying debate that's starting to happen here. I 
appreciate your words.
  One of the things you mentioned was the importance of getting at this 
issue of pre-existing conditions. Representative Courtney has been a 
great leader, offering his own legislation on that issue. I am glad to 
yield to the gentleman from Connecticut
  Mr. COURTNEY. I thank the gentleman for yielding.
  Again, like the others, I think this is an incredibly important 
moment right now not only this evening but this summer. The summer of 
2009 I think will go down in history really as one of the great 
movements forward by our country really at the level of when we passed 
Social Security, Medicare, Medicaid. And I, like you and the other 
speakers here, understand that; and getting this debate started and 
getting the facts out I think is the best way to make sure that we move 
forward and get this done.
  I wanted to just share briefly an experience I had at the Congress on 
the Corner that I think is important because there clearly will be, as 
we go further into the summer, forces out

[[Page 13860]]

there that are going to use misinformation and fear as a way of trying 
to stop the change that Mr. Klein described a few moments ago. At my 
Congress on the Corner, which was actually at a somewhat sort of off 
the beaten track or place, it was actually at a military PX, at the 
Navy base in Groton, Connecticut, where we set up our tables as active 
duty sailors, their families and retirees were going in to do their 
shopping. I had an experience which I just wanted to share with you, 
which was that many people, because of some urban myth that's out 
there, and whether it's talk radio or the Internet that is sort of 
propagating it, is spreading the claim that the Obama health care plan 
is going to take away TRICARE from our military and from retirees who 
are eligible for it. I just think it's important on this floor as 
clearly and as loudly to make the point that that is absolutely flatly 
untrue, that the veterans' health care system, the active duty health 
care system is going to be completely unaffected, as Mr. Klein said. It 
is an example of where the basic principles of this effort, which says 
that if you like the health care that you have right now, you can keep 
it. And that is clearly true for the people who wear the uniform of 
this country or who did and who now are eligible for VA benefits.

                              {time}  1900

  In fact, between the stimulus package and the budget that has been 
presented by the administration, what we are seeing is an unprecedented 
new investment in military health care and in veterans' health care. We 
have great new leadership at the VA in General Shinseki and Tammy 
Duckworth, who are totally committed to making sure that this system is 
improved and, in fact, expanded to keep the promise for people who 
served in our military. And the efforts that we are going to be talking 
about over the next 2 months completely leave that system intact in 
toto.
  What is ironic, though, is that enemies of reform are using the 
argument that we are taking away a government-run system at the same 
time that they are attacking the reform effort as being too much 
government. Make up your mind. Either one doesn't work and we should 
get rid of it, or if it does work, well, maybe we should take some good 
ideas that exist in the military health care system and in the VA and 
apply them towards the populace at large. We know in terms of 
electronic medical records that probably the most highly developed and 
advanced system in American health care is military health care as far 
as electronic medical records. Doctors in Landstuhl hospital in Germany 
can track the charts of our soldiers who are recuperating at Walter 
Reed hospital or other military hospitals around the country. They can 
just pull it up in ways that in the civilian system don't exist today. 
Again, I would just argue that rather than using government as sort of 
an example of inefficiencies, the fact is that the military has shown 
that they can actually organize a sound, comprehensive system that 
provides high-quality care.
  Lastly, I just wanted to, because, again, some of you have already 
spoken very powerfully and eloquently about the fact that we have an 
insurance system that has run amok. We come from the insurance capital 
of the world, Connecticut. Your family and my family have people who 
worked in the insurance industry. In the good old days, insurance was 
about pooling risk and sharing risk and using it as a mechanism to help 
cover people in terms of dealing with accident, disease and chronic 
illness. Obviously, it has gone off in a different direction. It is 
about avoiding risk in terms of the way insurance markets are set up. 
We are not about dismantling the system in toto. But what we are trying 
to do is reestablish it and go back to its roots in terms of creating 
health care systems that pool risk and share it and do it in a way that 
actually gets back to the basic principles of when the insurance was 
first started. The whaling industry in Connecticut created a situation 
where the whale ship owners realized they had to do something about 
losing ships. And that was the birth of insurance in Connecticut.
  I will spare that history lesson and yield back. Again, my 
compliments for organizing this debate. And again, I do think this is a 
summer that historians will write about. And the discussion here is 
going to be an important part of it. So I yield back to Mr. Murphy.
  Mr. MURPHY of Connecticut. I thank you, Mr. Courtney.
  There is, and you can feel it, I hope, from the folks that are on the 
floor today, an enthusiasm and an optimism that we have that I don't 
think we have felt in this House for a long time. The forces are 
aligned in a way that they have not been in a long time to get this 
effort done. And I think your point about people wanting to stand up 
the public health care system as an example of what needs to remain and 
then also tear it down I think is a really good comment. I'm reminded 
of a point made by a political columnist who talked about one of the 
statistics that is very often used by the side backing up the status 
quo, which is that in the Canadian health care system, you have to wait 
weeks, if not months, for a hip replacement surgery, and here in the 
United States you can get it pretty immediately. What they fail to 
point out is that 70 percent of hip replacement surgeries in the United 
States are paid for by Medicare, are paid for by a government-run 
health care system. And so we, through our public payment system, 
already do a pretty good job of getting people the care that they need. 
The fact is they spend a lot less money on health care in Canada than 
we do here. And we are not even talking about cutting back the amount 
of money we are spending. We are simply talking about trying to 
restrain the rate of growth. By reordering the money that we already 
have in the most expensive health care system in the world, we are 
going to be able to get good care. We will have short waiting times and 
access to all the people that don't have it.
  So with that, I'm so glad that Representative Schwartz has joined us 
on the floor. Whether it is standing up for primary care physicians or 
being a leader in this Congress on the issue of health care IT, I'm so 
glad to have you joining us here.
  Ms. SCHWARTZ. Thank you very much. I'm very pleased to join you. I 
want to acknowledge the really good work, Mr. Murphy, you have done in 
having these kind of dialogues on the floor and talking about health 
care and how important and how possible it is for us to actually find a 
uniquely American solution to the problems that are facing us, and to 
just reiterate a little bit, which is why we are here, why we are 
talking about this. It isn't only because it is a moral imperative; I 
know many of us have worked particularly on making sure Medicare works 
very well or extending health care coverage for children, the CHIP 
program which we all really worked so hard on, I know some of us in our 
States, certainly I did, back in Pennsylvania in 1992, but even here on 
the floor, making sure that children of working families had access in 
most cases to private health insurance, to affordable private health 
insurance.
  But the fact is that we are here because it is also an economic 
imperative. And we know that from hearing it from our businesses, small 
businesses and large businesses, saying that they cannot be 
economically competitive because of double-digit inflation and 
inflationary costs of health premiums for their employees. A business 
owner just told me the other day that their rates went up 40 percent 
from one year to the next. That is just not sustainable.
  So we need to address that because if they are going to be 
economically competitive and continue private health benefits where the 
cost-sharing is reasonable with employees, we have to do something 
about the escalation in costs in health care.
  And third, of course, is as a government we are spending money that 
is growing again in unsustainable rates under Medicare, and we need to 
contain the growth of those costs. And again I think I would reiterate 
what was said before is that we believe that Americans should have 
access to quality health care. They should have access to

[[Page 13861]]

doctors, to be able to continue to have relationships with their 
doctors, ongoing relationships. But we also think that we can do three 
things. We have to be able to contain costs. And we can be smarter and 
more efficient and more effective in the way we provide health care in 
this country. And I will talk about that in a minute.
  But secondly, we have to improve the quality of health care. We 
actually provide a lot of health care. And not all of it is exactly 
what you need and maybe more than you need, sometimes less than you 
need. We have to get that right. And we can.
  And then we have to extend coverage to all Americans because 
Americans do put off health care that they ought to get. They go to 
emergency rooms because there isn't a doctor for them to see. And they 
often don't fill a prescription because they simply can't afford to. 
They don't follow the recommendations of health care providers.
  I agree with Mr. Courtney. We are here in a moment when we can find a 
way, where we can, in fact, contain the growth of costs, extend 
coverage and improve quality for all Americans. And that is what we 
want to do. We are going to do it in a uniquely American way, which 
means it will be very much a public-private partnership. And we will 
build on what works in the system, which is that most Americans get 
their health coverage through their employers, 55 percent of the 
insured get it through their employers. They will be able to keep that. 
Hopefully it will be less expensive for the employers. And for the 
group in particular that is so hard to access health coverage, these 
small businesses, individuals, they are going to be able to find a way 
to find affordable, meaningful coverage. Mr. Courtney didn't even talk 
about his preexisting condition bill, which is really very important in 
making sure that when you buy insurance to find out maybe years later 
that you don't have coverage for a condition because, in fact, they 
found some reason that this was a preexisting condition, is really just 
not acceptable anymore in this country. We should make sure that 
coverage is meaningful.
  I do want to just say on the delivery system, we have already taken a 
very major step forward in putting some real dollars into the system 
and under Medicare to incentivize our hospitals and our doctors to use 
electronic medical records. Interoperable--that means different doctors 
and hospitals can see what is going on, patients can see what is going 
on to them, go and check their own records potentially, which is a very 
exciting way to empower patients. Under Medicare, we are going to say 
that physicians and doctors in this country are going to use electronic 
medical records. And this way they won't duplicate unnecessarily tests. 
They will actually be able to find out if a patient filled the 
prescription and if they are taking the medication, and if not, give 
them a call and say, you haven't been back in 2 months, you're early 
diabetes and you really need to be taking this medication. You really 
need to be monitoring what you eat. And if you don't, you're going to 
get a lot sicker. Why don't you come in and we will talk about that? 
Wouldn't that be something if a doctor gave you a call and said that?
  One of the ways we can do that is making sure that we have adequate 
primary care in this country. And we don't. We don't have enough 
primary care providers. I just had a conversation with another Member 
representing a rural area. And he said, I represent a small town. There 
are not enough primary care doctors. I You know what, I represent a 
suburban/urban district and we don't have enough primary care doctors. 
This is a problem across this country.
  In 1998, half of the medical students were choosing primary care. 
Well, just now, we are actually looking at 20 percent choosing primary 
care, and they expect that number is going down. And so there is a 
reason why we can't find a primary care physician. They aren't out 
there. And while we all want to have our specialists when we need them, 
having the access to primary care is extremely important to making sure 
you get the kind of care that you need and that you get it in a timely 
fashion and that you have somebody help you figure out what specialist 
to go to and figure out what kind of care you need and hopefully help 
you stay healthy and help those, particularly with serious chronic 
diseases, have ongoing care.
  I see you all nodding. You're probably ready for me to conclude. But 
this is something I think people do as part of health care reform. As 
we move forward, there are a lot of different pieces. It is 
complicated. It is not going to be easy to do. We have to believe in 
each other that we can do this right and that we can get it right. And 
that is what we are trying to do. The next 8 weeks will be very 
important to the American people, to American businesses, to the 
sustainability of providing quality health care to Americans.
  I look forward to working with all of you to get it done.
  Mr. KAGEN. You have got me all excited now. It has taken so long to 
get to this point. It is very frustrating. Back when we first got here, 
the class of '06, we got to initiate bills in '07 in the first few 
months. And as they say here, I dropped a bill called ``no 
discrimination'' to apply our constitutional rights to prevent us from 
being discriminated against, to prevent the insurance companies from 
cherry-picking people out.
  I don't know how it is in Pennsylvania, but in Wisconsin, in my 
neighborhood, I grew up in a neighborhood. But that neighborhood has 
been chopped apart by the insurance industry. The insurance industry 
was allowed to separate Mrs. Koss or Mr. Romer out of the risk pool 
because they had some condition they didn't want to touch or insure. 
And it has gotten to the point now where even some mothers may be split 
from their family because they have a condition, and their children can 
be insured but they can't. So I like the idea that we are going to get 
primary care and access to primary care. But as you know, we don't have 
enough doctors and nurses right now. So we have to invest in a 
possibility to make sure that our students can go to school and perhaps 
have their funding paid for through medical school and in return give 
us those years back in terms of service in primary care where that need 
most exists. My district is a rural district. I would point you to the 
rural district of northern Wisconsin.
  As Mr. Courtney has brought out so elegantly about the VA system, I 
would ask this question not only to him but to everybody in the 
country: Is there any reason why a soldier served only for himself or 
herself to get that benefit at the VA at the pharmacy? If a soldier has 
a VA benefit and has a discount, a medication available at a lower 
price, is there any reason not to provide his or her entire family with 
that same medication at that price? And what about his neighborhood? 
What about his community? In fact, what about the whole United States?
  No soldier today is serving in Iraq and Afghanistan for him or 
herself. They are there for our Nation. And if the VA was successful in 
negotiating a steep discount for a given medication, I think that price 
ought to be available to anyone who is willing and in need of that 
medication. And Mr. Klein from Florida mentioned that he might be 
taking a medication. Is there any reason that it continues to exist 
today that if I go into a pharmacy anywhere in the country, if all four 
of us are in line to get the same exact prescription, the same number 
of pills, we are going to pay four`` different prices for the same 
thing? I think not. I think we have to have complete transparency, and 
the price that one should pay for medication is the lowest price 
available within that community, and that price should be openly 
disclosed.
  And no one put it better than one of my constituents. Kaukauna is 
another city that Barack Obama has visited in my district. I tell you, 
this guy, Obama, is everywhere. Sally from Kaukauna said, ``Our 
prescriptions cost $1,000 a month. This is a very big issue for us.'' 
Well, heck, yeah. If you don't have the money, you're not going to get 
the medication you require just to survive. So I would submit to you 
that it is time to end discrimination in

[[Page 13862]]

health care. And when we do, that form of discrimination that takes 
place at the pharmacy where Mr. Klein might get charged three times 
what the person in line next to him is charged for the same medication, 
to me that is a form of discrimination. I think it is time that that 
form of discrimination came to an end. We have to have openness and 
transparency for prescription drugs and be allowed to negotiate for a 
lower price.

                              {time}  1915

  Mr. MURPHY of Connecticut. You know, Mr. Kagen, the discrimination 
finds itself in a lot of different corners. It's not just you, as an 
individual, who may not be able to get that insurance. But it prevents 
you from going out and getting employed or reemployed, because that 
discrimination is against you individually, but also against your 
employer, that if you have a small employer who's looking to go out and 
get health care for his five or six employees, that insurance could 
potentially be double for your pool of five or six employees if one of 
them happens to have a preexisting condition.
  So, you know, it's really a triple whammy for somebody that gets sick 
and has expensive care: one, you have to deal with the limitations on 
yourself through that disease; two, you may not be able to get 
insurance to cover it. You may have to pay for it out of your pocket; 
and three, you may not even be able to be employed because employers 
today are going to say, Forget it. Even though that guy might be the 
perfect person for this job, I might need that person to fill that 
slot. It's going to break my bank if I have to put that person on the 
insurance rolls. And that's another reason why we have to make sure 
that the elimination of preexisting discrimination is part of this 
bill.
  Ms. SCHWARTZ. I just want to mention a couple of answers. I was also 
going to say it prevents people sometimes from leaving a job. Sometimes 
they say, you know, I don't know if my next job's going to have the 
same health benefits. Can I risk taking another job? And you have sort 
of a job lock in that situation. And, of course, as we know, because of 
the high cost, a lot of employers are passing it along, there's more 
cost sharing.
  But there are several answers to this. There's a bill that's been 
introduced, we hope to get done, that requires transparency in the 
language that's used in insurance policies. All of us are supposed to 
read that fine print. Well, I don't know how many of us really read the 
fine print. And the fact is that even if you do, you may not really 
know what it means until you're faced with the situation.
  So there's a bill I worked on with Congresswoman Rosa DeLauro, and it 
says about language, if it says, I'm going to cover hospitalization, 
well, it means the same thing whichever insurance company is selling 
it. So if you're going to look at that, you will know what's covered 
and what isn't and then be able to decide whether that's the kind of 
policy you want or not.
  The others we also--there's legislation that I also actively support 
that says that small businesses should be able to band together to use 
their purchasing power to buy insurance in the private marketplace.
  And third, something that we can do to help individuals as well as 
small businesses is to do something called community rating. So you say 
it's not this small business that has five employees, somebody gets 
cancer, well, they're rated on that experience. Their rates can go 
skyrocket the next year.
  What you can do instead is say we're going to tell the insurance 
companies sell insurance, but the records have to be set not on the 
experience of that small group but on the experience of the broader 
community. We're going to really spread that risk. That's how insurance 
is supposed to work. Share the risk more broadly, come up with a 
community rating system that's fair, that the businesses or individuals 
would pay but isn't, one by one, based on your conditions, your gender, 
your age, and to be able to go forward on that.
  We can do those things. Those are just changing the rules of the 
marketplace, and that will make it more affordable, more accessible for 
more Americans to be able to buy health insurance.
  Mr. KLEIN of Florida. Will the gentlewoman yield?
  Ms. SCHWARTZ. Please.
  Mr. KLEIN of Florida. I think that's an excellent point. And again, 
if we think about what insurance is supposed to do, it is supposed to 
spread the risk. Yet the experiences that small businesses have with 8 
employees or 1 self- employed or 10 is they get a different pricing 
than somebody who's negotiating for 10,000 people. A major corporation 
that negotiates for 10,000 or 100,000 lives has a much--we call it the 
economy of scale, but it is also the insurance company saying, All 
right, we have a large group. We can spread the risk.
  Well, why should that be any different than you take your small 
business and your small business, and in Fort Lauderdale where I'm from 
or Delray Beach or wherever, you've got all these small businesses, 8 
and 20 and 110, and let them combine together and purchase policies. 
And that is just a basic right of free enterprise to be able to do 
that.
  I'm going to toss out another idea because, again, a lot of this 
thinking that we're talking about is common sense. It's not out-of-the-
box thinking; it's just common sense.
  When I was in the Florida legislature a number of years ago, we were 
looking at various ways to fix the health system, because, 
unfortunately, despite your good efforts and others for the last number 
of years, nothing was really happening of any major consequence. And we 
said, Well, what if we allow people to purchase into the State of 
Florida health insurance plan?
  Or let's use the Federal system. We have hundreds and hundreds of 
thousands of people in our Federal system. Okay? Members of Congress 
and everybody else gets to buy this, and it's a typical plan. The 
government pays a piece of the premium and we pay a piece of the 
premium. Okay? What if we allow people to buy into the Federal plan? 
Okay. Not on the Federal Government's dime. No subsidy whatsoever. 
Whatever the cost is, the administration and the policy and everything 
else, purchase into that.
  Well, we did some research on this to the State of Florida plan, 
which is not that much different than the Federal plan, and we found 
that if you take a small business that was trying to buy a policy, the 
same policy, apples and apples, the price was almost twice what it 
would cost if they paid the full out-of-pocket cost in the State of 
Florida plan.
  Now, of course, our friends in the insurance industry were not 
interested in supporting that because they like the idea of the small 
groups buying individually. And they said, Well, it's going to change 
the risk assessment.
  You know, where there's a will, there's a way. That's my attitude 
about this whole thing. So again, I think as we're going through this 
discussion, maybe we can talk. I know some of the Members of the Senate 
and some House Members. I think that just may be another way of 
offering alternatives, options to people. Let them purchase into a 
large plan like the Federal Government plan.
  Again, the U.S. taxpayer is not subsidizing it. Whatever the cost is, 
it is. But you get the benefit of a large plan that lots of people are 
in and you can spread the risk.
  So, again, to me the excitement right now is lots of good ideas are 
coming forward, and I think we're going to be able to get there, and 
let's just engage the American people in the right answers.
  Mr. MURPHY of Connecticut. And, Mr. Klein, when you talk about it 
like that, it is common sense. When you talk to a small business out 
there and you tell them, Listen, what do you think about having the 
option, up to you, to purchase into a plan that is run or administered 
by the State of Florida? The State of Connecticut, we're looking at 
doing the same thing, or the Federal Government. If it costs you less, 
you know, people are going to raise their hands by the droves because

[[Page 13863]]

you're giving them more choice. Right now they may be, you know, if 
you're in some States in this Nation and you are looking to purchase an 
individual policy or a group policy, you don't have a lot of choice out 
there. It's Blue Cross/Blue Shield or--
  Mr. KLEIN of Florida. Would the gentleman yield for 1 second?
  Mr. MURPHY of Connecticut. Of course.
  Mr. KLEIN of Florida. I want to make it perfectly clear, if I didn't 
make this, when I say State of Florida or Federal Government, the State 
of Florida doesn't own an insurance company. It could be Blue Cross or 
United, any combination of private companies. So it's the Federal 
Government through our Blue Cross or whatever it may be. It's private 
companies offering the insurance. But the beauty, of course, is the 
spreading of the risk.
  Mr. MURPHY of Connecticut. And giving people choice. I mean, I think 
that this really gets back to the fact that if consumers--and Mr. Kagen 
was talking about this at the beginning. If consumers know what they're 
buying, if they can really compare the cost of A to B, and as Ms. 
Schwartz said, they know the terms of what they're buying, they're 
going to make smart choices.
  And many of us here in Congress who would like for individuals to 
simply have the option to buy into even the plan that as Federal 
employees and Members of Congress we have the benefit of getting, we 
want them to have the option of doing that. If it costs less in their 
particular region of the country, great, they'll buy it. If it costs 
more somewhere else then maybe they won't. But no subsidy from 
taxpayers, no check from the general treasury, just the cost of 
providing that plan.
  And the fact is that the plan that is run or sponsored by the Federal 
Government, it might be cheaper for people because maybe it doesn't 
have the same profit motive that the private insurers have. Maybe it's 
found a way to get administrative or marketing costs down. Maybe it 
doesn't have to return money to shareholders like private plans do.
  But all we think is that individuals and businesses out there should 
have that choice, like I have the choice to buy private health care in 
the market or join the Federal employees health care plan.
  Ms. SCHWARTZ. Just to reiterate, I think what we want to really be 
very clear with our constituents and with all Americans is that we are 
looking for creative ways to increase the choices and increase access. 
And again, it should be affordable. It has to be meaningful coverage. 
We have to make sure we have the delivery system that works.
  We also think that this is a shared responsibility. I certainly do. 
This is something that we're asking individuals to take some 
responsibility, employers to take some responsibility, we're asking 
insurance companies, and many of them are stepping up to the plate 
saying, We can do this. Many big companies are also saying, We're doing 
some really innovative work on prevention and health care for our own 
employees. We're encouraging them to walk and to eat right. And, 
obviously, I think we should do that for school kids and all of that as 
well.
  So there's not really a single answer here. The issue is how can we 
improve the delivery system, the health care system you encounter so 
you get the best kind of care you might, that we make sure we have the 
right kind of providers working at their scope of practice, as we call 
it, and really providing you with the right kind of care. But all of 
this has to work together.
  One of the reasons we're looking at all of these issues at once is 
because we know it makes a difference if we can contain costs, if we 
can get everyone coverage, if we can actually improve the delivery 
system, then all of us will be better off. But it takes--it's not 
really the government doing this alone by any means. We're hoping to be 
a trigger for some of this, and we have asked all of the stakeholders 
to participate.
  Yes, the insurance industry, the pharmaceutical industry, the 
hospitals, the physicians, and they've really been at the table, a lot 
of advocates for the different groups as well, and so have we. We all 
bring our personal experiences, some of them good, some of them not so 
good in the health care arena, but we all recognize that we could be 
without health care coverage. We could be without access to the health 
care providers that we need, and we never, none of us, want to be in 
that situation. And, unfortunately, it's true for too many of our 
neighbors, too many of our constituents. And it's about time for us to 
step up and say we again are going to find a uniquely American way to 
address these issues for our constituents and for our country, and 
we're all going to be better off for it.
  Mr. KAGEN. Thank you for yielding. I'm just reassured, I'm more 
reassured tonight, I'm more optimistic tonight than ever before that by 
working together, not just as Democrats and Republicans or Libertarians 
or Independents, but as Americans we're going to come up with the 
solutions we need, as you say, to find this uniquely American solution 
to our health care crisis. It's going to happen. And, as we said 
tonight, in part it's going to be by leveraging the marketplace, using 
the marketplace to leverage down prices for everyone.
  After all, for those of you who are listening tonight, do you want to 
pay the higher price or the lowest price for the medical care that you 
need? Today the price is whatever they can get.
  So I look forward to working with all my colleagues on the floor in 
the House and working with the Senate to bring about the solutions that 
we need.
  Mr. MURPHY of Connecticut. Mr. Kagen, as a closing comment I will 
just say that, as much agreement as we've had over the last hour, 
there's going to be disagreement. There are going to be people that try 
to stand in the way of this change happening. And there's a memo 
circulated by a Newt Gingrich pollster going around Washington now and 
around the circles that want to stop reform from happening, and it sort 
of lays out the case for how you can stop health care reform. But it's 
interesting because one of the underlying points of that memo, based on 
the polling that this pollster had done around the country, was that 
this year you can't be for nothing. This year you have to be for 
something.
  Now, he undergoes a very cynical analysis of how, in the end, you 
stop reform from happening. But the message, even through this 
conservative Republican pollster, is clear: People want change. And I 
think they're going to get it this year.
  I thank the Speaker for giving us this time, and we yield back our 
balance.

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