[Congressional Record (Bound Edition), Volume 155 (2009), Part 10]
[Senate]
[Pages 13931-13933]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. SANDERS. Mr. President, I think the American people are aware 
that our country is in the midst of a major health care crisis. That is 
not a secret to anybody. Forty-six million Americans have no health 
insurance and, importantly, even more are underinsured, with high 
deductibles and copayments. Further, some 60 million Americans, 
including many with health insurance, do not have access to a medical 
home of their own. In fact, according to the Institute of Medicine, 
some 18,000 Americans die each year from preventable diseases because 
they lack health insurance and do not get to a doctor when they should.
  I can recall very vividly talking to several physicians in Vermont 
who told me how people walked into their office, quite sick, and when 
they asked why they hadn't come in earlier, they said: Well, we don't 
have a lot of money; we didn't have any health insurance. The result is 
that those patients died. That happens every single day in this great 
country.
  When we talk about health care, we have to understand that access to 
dental care is even worse. On top of that, in our Nation, we pay the 
highest prices in the world for prescription drugs. My State of Vermont 
borders on Canada, and it is not uncommon for people to go from Vermont 
to Canada to buy the prescription drugs they need at far lower cost 
than in America.
  In the midst of all of this--the 46 million Americans without health 
insurance, people being underinsured, and people paying outrageously 
high prices for prescription drugs--at the end of the day, our Nation 
pays far more for health care per person than any other country on 
Earth. Far more. It is not even close. Yet despite the enormous sum of 
money we spend, our health care outcomes--what we get for what we 
spend--lag behind many other countries in terms of life expectancy--how 
long our people live, in terms of infant mortality, and other health 
indices.
  According to a recent report from the National Center for Health 
Statistics--this is just one example--the United States ranks 29th in 
infant mortality in the world--29th in the world. We are tied with 
Poland and Slovakia for 29th in the world in terms of infant mortality. 
In all due respect to our friends in Poland and Slovakia, we should be 
doing a lot better than that because we spend a lot more on health care 
than they do in Poland and Slovakia.
  Further, according to a study published in the London School of 
Hygiene and Tropical Medicine, the United States has the highest rate 
of preventable deaths among 19 industrialized nations. Although our 
rate has declined over the past 5 years, it is doing so at a slower 
rate than other countries. According to that study, if the rate of 
preventable deaths in the United States improved to the average of the 
top three countries, which are France, Japan, and Australia, 
approximately 100,000 fewer residents of the United States would die 
annually.
  When we talk about health care, we are not just talking about 
individuals who suffer and die because they do not have health care. 
What we are talking about is that the high cost of health care--as 
President Obama makes clear all of the time--is a major economic issue 
as well. In our country today, we are now spending about 16 percent of 
our GNP on health care, and the cost of health care is continuing to 
rise at a very high rate, which becomes economically unsustainable. The 
fact is, General Motors, which recently declared bankruptcy, spends 
more money on health care per automobile than they do on steel, and 
that creates an economic climate in which America--our companies--
becomes noncompetitive with other countries around the world. But it is 
not just large corporations such as GM. Small business owners in 
Vermont and throughout this country are finding it harder and harder 
not only to provide health care for their workers but even for 
themselves.
  In addition, a recent study found that medical problems contributed 
to 62 percent of all bankruptcies in 2007 and that between 2001 and 
2007, the proportion of all bankruptcies attributable to medical 
problems rose by nearly 50 percent. Interestingly, 78 percent of those 
who experienced bankruptcy as a result of illness were insured. They 
were insured. These are not people who did not have any health 
insurance. But it speaks to the inadequacy and the lack of coverage, 
comprehensive coverage, in many health insurance programs.
  We as a Congress, for whatever reason--and I will suggest the reason 
in a moment--do not really spend a lot of time discussing why the 
American health care system is so expensive, why it is so inefficient, 
why it is so complicated. We do not talk about that very much. I fear 
that has a lot to do with the role private health insurance plays over 
the political process in this country. Let me be very clear. In my 
view, the evidence is overwhelming that the function of a private 
health insurance company is not to provide health care. The function of 
a private health insurance company is to make as much money as it 
possibly can. The truth is, the more health care a private health 
insurance company denies people, the more money it makes. If you submit 
a claim for coverage and they deny it, from their perspective that is a 
very good thing because they make more money.
  Further, in pursuit of making as much money as they can, private 
health insurance companies have created a patchwork system which is the 
most complicated, the most bureaucratic, and the most wasteful in the 
world. According to a number of studies, we are wasting about $400 
billion a year in administrative costs, in profiteering, and in 
bureaucratic billing practices. That is enough money to provide health 
care to all of the uninsured.
  I know that is not an issue we are supposed to be talking about here 
on the floor of the Senate because we are not supposed to take on the 
insurance companies or the drug companies because of all of their 
power. But I believe, if we are serious about moving toward a 
universal, comprehensive, cost-effective health care system in this 
country, we have to talk about the very negative role private health 
insurance companies are playing in that process.
  Administrative costs for insurers, employers, and the providers of 
health care in the United States are about one out of every four health 
care dollars we spend. In other words, for every $1 we spend, one 
quarter of that dollar does not go to doctors, does not go to nurses, 
does not go to medicine, does not go to therapies; it goes to 
administration. That is at the root of the problem we have in terms of 
health care

[[Page 13932]]

costs in America. In California--one example--only 66 percent of total 
insurance premiums are used to cover hospital and physician services. 
One-third, $1 out of every $3, is spent on administration, billing, 
claims processing, sales and marketing, finance and underwriting.
  The American people want their health care dollars spent on health 
care. I know that is a radical idea, but when people spend money on 
health care, they assume it goes to the provision of health care, not 
profiteering, not administration, not hiring more bureaucrats to tell 
us we are not covered when we thought we were covered. What the 
American people want is close to 100 percent of that dollar to go to 
health care and not bureaucracy.
  While health care costs in America have soared, as everybody knows, 
from 2003 to 2007 the combined profits of the Nation's major health 
insurance companies increased by 170 percent. Health care costs are 
soaring, profits of the major health insurance companies have gone up 
by 170 percent from 2003 to 2007, and CEO compensation for the top 
seven health insurance companies averaged over $14 million per CEO. To 
add insult to injury, some of these health care profits are going 
directly into campaign contributions and into lobbying to make sure, in 
fact, the Congress does not move forward toward real health care 
reform, which, in my view, means a single-payer health care system.
  That is where we are right now. We have the most inefficient, 
wasteful, bureaucratic system of any major country on Earth. Our health 
care outcomes, despite all the money we spend, are way below many other 
countries in the world. And we are not discussing the most important 
issue with regard to health care spending; that is, the role private 
health insurance companies are playing.
  We are now in the beginning of the debate on health care. I am going 
to do my best to make sure that issue of the role private health 
insurance companies are playing in the system, the very negative role 
they are playing, is something that, in fact, we talk about.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio is recognized.
  Mr. BROWN. Mr. President, I commend my friend, the junior Senator 
from Vermont, for his words, this critique about the health insurance 
system--what is right about it and what is wrong with it. We know, for 
those with insurance, we can get good medical care in this country. We 
know many people do not have any insurance. We know many others have 
inadequate insurance. And we know that so many Americans are in a 
situation where they are anxious about the future of their health and 
the quality of health care they have. Too many Americans have seen 
their health care premiums go up, their deductibles go up, and their 
copays go up. They end up with a private insurance company that finds 
ways to delay paying them, to in many cases not reimburse them at all 
for their health care expenses. It is insurance that does not really 
deliver, and that is really no insurance at all.
  What Senator Sanders said is exactly right. The behavior of health 
insurance companies has meant we have huge administrative costs.
  More and more, we remember what the President of the United States 
said when he was a candidate for President. Senator Sanders mentioned 
that story at the White House the other day to President Obama, how 
moved people in this country were when they heard the President talk 
about his own mother who was dying, who was fighting with insurance 
companies over paying for her cancer treatment while she was dying. She 
had to advocate for herself. Her son was advocating for her, of course, 
too. But she went through the trauma and pain of cancer and the trauma 
and pain of dealing with insurance companies. We know that. Yet some in 
this body want to increase the role of private insurance and allow them 
to continue to game the system.
  We also know that private insurance companies in many ways are simply 
a step ahead of the sheriff. They do not mind insuring someone who is 
50 and healthy, but they would rather not insure someone who is 63 and 
unhealthy because they can make more money on someone who is healthy, 
but in somebody who has a preexisting condition, they will find a way 
not to insure them or not to pay off to them when they get sick. We 
know about the inefficiencies in the health care system, in private 
insurance. We know the difficulties with private insurance, the 
bureaucracy, and we know about the administrative costs of private 
insurance.
  Private insurance administrative costs run anywhere from 15 percent 
to 30 percent, depending on whether you are in a big group plan, a 
smaller group plan, or an individual plan. We also know Medicare, which 
has delivered for 44 years--it was signed by President Johnson in July 
of 1965--we know Medicare has delivered very well in the great majority 
of cases for the American people, for the elderly, but we also know 
Medicare has about a 2-percent or 3-percent administrative cost--again, 
contrasted with 15 to 30 percent with private insurance companies.
  We also know, interestingly, there is a statistic--there was a study 
several years ago of the richest industrial democracies--France, 
Germany, Japan, Israel, England, Spain, Italy, Canada, and the United 
States--and they rated all these countries according to several health 
care indices: life expectancy, infant mortality, maternal mortality, 
inoculation rates for children, all those things. Of the 13 countries 
they looked at, the United States ranked 12th. Even though we spent 
twice as much as any other country on Earth per capita, our outcomes 
were not as good. We were 12th out of 13. In one category, America 
ranked near the top, and that is life expectancy at 65.
  If you get to be 65 in this country, the chances are you are going to 
live a longer, healthier life than almost any other country in the 
world. Why? Because we have a health care system, Medicare, that 
provides health insurance for everybody over 65. There are holes and 
gaps in coverage in Medicare; the premiums can be pretty hard for some 
to reach; the copay and deductibles can be a problem.
  Overall people know when they have Medicare they are pretty darned 
well taken care of. That is not the case for people under 65. I came to 
the floor tonight for a few more moments, as I was listening to Senator 
Sanders talk so eloquently, to share a couple stories.
  Sherry, in Albany, OH, is not Medicare eligible. She is forced to 
consider borrowing from the equity in her home to pay her $1,070 
premium through COBRA. She had a job. She lost her job. She has to pay 
the employer and employee side to pay for her health insurance. That is 
the way COBRA works. It is a good program but a bit of a cruel hoax. If 
you lose your job, it is pretty hard to pay your premium and your 
employer's premium at the same time.
  She is considering borrowing against her house to pay for her health 
insurance for COBRA for 18 months. She will get a little bit of help 
now, because in the stimulus package, we took care of some of that. She 
has to find a way until she is 65 to cobble together insurance.
  Terry, a small business owner nearby in Columbus, expects to pay 35 
percent more this year to cover his employees. He wants to cover his 
employees, but he has a 30-percent increase. What is he supposed to do, 
especially when his business--I don't know a lot about his business, 
but so many small businesses are squeezed more and more because of the 
economy. So we know these stories, and that is why it is so important 
that we address health care reform this year.
  We want to do several things. First of all, anybody who is in a 
health care plan they are happy with, they are satisfied with now, they 
can stay in that plan. If they want to make that choice, they stay in 
the plan. Second, we need to do something on costs, to stop the huge 
increase in premiums, copays, deductibles. We have to do a better job 
to constrain costs in the health care plan than this government or the 
private sector has been able to do for decades.
  Third, we need to give people full choice. That means they can stay 
in

[[Page 13933]]

their plan, as I mentioned earlier, No. 1, but they also will have a 
choice of private insurance plans and a public plan, a public option. 
So they can choose a private plan with Aetna or a private plan with 
United Health or a private plan with BlueCross BlueShield or they can 
decide to join a public plan, a public plan that might look similar to 
Medicare, which they can decide, perhaps they would save money or have 
better preventive care or a plan with lower copays or deductibles.
  They can make the choice. A great majority of the Democratic caucus, 
and I hope Republicans will join us, an overwhelming sector wants that 
option, a public plan and a private plan they can choose, that might be 
similar to Medicare.
  Anything we tried in health care, every time that health care reform 
was introduced, the cries of ``government takeover'' and ``socialized 
medicine'' were heard from by conservatives who do not think government 
should have a role in health care.
  We are the only country in the world that thinks that, it seems like, 
because every other country has a major part of their health care plan, 
a major part is involved with the government, if not the whole plan.
  We are not asking for a government takeover, we are not doing 
socialized medicine. That is what they always say. We heard it in 1948, 
when Harry Truman tried to push through Medicare. We heard it in 1965, 
when Lyndon Johnson and the overwhelmingly Democratic House and Senate 
passed the Medicare law. We heard it in 1993, my first term in the 
House, Senator Sanders' second term in the House. And that is what 
insurers are claiming today. They are saying: Government takeover of 
medicine. That is not true. We want a government option plan. We want 
the government to provide a Medicare plan that people can choose from. 
You can choose a private plan or public plan.
  Americans deserve no less. Our country can afford no less. The 
President asked us to move on this as quickly as we can and to do it 
right. This is our chance, and I think we are going to do it.
  Mr. SANDERS. Would the Senator from Ohio yield?
  Mr. BROWN. Yes.
  Mr. SANDERS. I wish to thank him for his cogent remarks, talking 
about one of the most basic issues facing this country and that is 
health care. We are on the Veterans' Committee as well, and I know you 
spend a lot of time talking to veterans in Ohio. Has the Senator heard 
a veteran in Ohio tell you they want to privatize the VA?
  Mr. BROWN. I have heard mostly conservative Republicans say they want 
to privatize the VA.
  Mr. SANDERS. Every time that issue is raised, the veterans say no.
  Mr. BROWN. One of the things we noticed about the Veterans' 
Administration is that the VA has found a way to buy, at the lowest 
cost possible, some of the least-expensive but good-quality 
prescription drugs. Because what the VA does--there are millions of 
veterans--they negotiate on behalf of veterans with individual drug 
companies for individual prescription drugs, individual 
pharmaceuticals, and they get a rate at about one-half of what you 
would pay if you went to Drug Mart or Rite Aid or any of the other 
stores.
  The Medicare bill, when it came through the House and Senate--
President Bush pushed that bill--they did not allow us to negotiate 
drug prices. We know what this is about. We know if we follow the lead 
of the drug industry and the insurance industry, which this Congress 
did through most of the first part of this decade with President Bush, 
we end up with special interest laws that protect the drug companies or 
insurance companies.
  Or we can now pass health care with a public option plan, give the 
public the option of going to a Medicare-like plan instead of a private 
insurance company plan, if they want to, or stay in the plan they are 
in and then they decide on what kind of care they would like.
  Mr. SANDERS. My friend from Ohio is exactly right. If you talk to the 
people of this country, if you talk to the veterans and say: Do you 
want VA health care to be privatized? Overwhelmingly, no.
  In recent years, the Senator from Ohio, I, and others, have worked to 
substantially increase funding for federally qualified community health 
care centers all over this country. These are the most cost-effective 
ways of providing quality health care, dental care, low-cost 
prescription drugs, mental health counseling.
  The people of this country want those. I hope we have success in 
expanding that program. But I get a little bit tired of hearing from 
some of our friends on the other side who tell us: Oh, people do not 
want government involved in health care. Well, you tell that to 
seniors. Tell them you want to privatize Medicare. Tell that to the 
veterans, that you want to privatize the VA.
  The fact is, as the Senator from Ohio indicated, we are wasting tens 
and tens of billions of dollars every year in bureaucracy, in billing, 
in excessive CEO salaries through private health insurance companies. 
At the very least, the people of this country are demanding, and we 
must bring forth, a strong--underline ``strong''--public option within 
any health care reform program we develop.
  Mr. BROWN. I thank the Senator from Vermont. It is pretty clear, and 
I think this Congress is going to do the right thing. The President, 
when he met with us last week, as he promised in his campaign, was 
strongly in favor of purchasing insurance from the Medicare look-alike 
plan or private plans or either one or keeping what they already have.
  The President has spoken strongly on it for months. The majority of 
this Congress wants to do the same. I am hopeful that is what we will 
do in the months ahead.

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