[Congressional Record (Bound Edition), Volume 155 (2009), Part 11]
[Senate]
[Pages 14273-14276]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. DURBIN. Mr. President, this morning we heard the Republican 
leader come to the floor again--this is not the first time--to address 
the health care situation in America. I have read his previous speech, 
and I listened to

[[Page 14274]]

his speech today. It is clear to me he does not believe we are facing a 
crisis when it comes to health care. I think we are. I think it is a 
serious crisis. It is a crisis where 47 million Americans have no 
health insurance. Imagine, if you will, being a parent and having 
children with no health insurance coverage. Imagine yourself in a 
position where an accident or a diagnosis at a doctor's office could 
literally mean you would lose every penny you have ever saved in your 
life for expensive medical care when you do not have health insurance. 
Imagine that as a crisis that affects Americans, too many of them 
today.
  Then imagine those who have health insurance and worry that tomorrow 
the costs will go up to the point where they cannot afford it, that 
there will be medical procedures necessary uncovered by their health 
insurance. Cost is an issue. It is an issue which is driving us to look 
at reform of the health care system.
  I heard Senator McConnell this morning, and what he is arguing about, 
frankly, is not even in the debate on Capitol Hill. He said 
repeatedly--said it yesterday, said it again today--that our debate 
over health care reform means Americans run the risk of losing the 
health insurance they want. Exactly the opposite is true. What 
President Obama has said and what we are saying is that if you have 
good health insurance, you can keep it. You like the health insurance 
you have? You can keep it. No one has ever argued the opposite 
position, which the Senator from Kentucky referred to this morning.
  He also spent a lot of time talking about government-run health care 
plans. It is interesting that he would raise that as an issue when we 
are not suggesting a government-centered health insurance reform. We 
think it should be a patient-centered health insurance reform.
  But we also know that when you ask Americans across the board--
families and patients--what do you think about the health care system 
in America, what are its greatest shortcomings in the current health 
care system, do you know what No. 1 is? Almost half, 48.9 percent, of 
the people say not having health insurance. The second, 43 percent say 
the greatest shortcoming of America's health care system is dealing 
with health insurance companies; 30.9 percent, inflexibility of health 
care plans; 30.9 percent, insurance companies' refusal to cover 
preexisting conditions.
  When the Senator from Kentucky comes to the floor and argues against 
changing the current situation, he is arguing for allowing these health 
insurance companies to continue to dominate. As long as they dominate, 
Americans and their families will be vulnerable--vulnerable to 
increases in costs they cannot manage, vulnerable to new policies with 
more exclusions, vulnerable to preexisting conditions not being 
covered. That is the vulnerability of Americans we have today that we 
have to seriously address.
  The Senator from Kentucky argues we do not want a Canadian plan, we 
do not want a British plan, we do not want a New Zealand plan. He is 
right. We want an American approach--an American approach that 
combines, yes, private health insurance companies when they are held to 
standards that are fair to American families but also holds open the 
option that we will have a plan which is run by the government--as an 
option, a voluntary option--for people to choose. If they like what 
they have in their current plan, they can keep it. If they want to move 
to another private health insurance plan, they can do so. If they want 
to choose a government plan, they can do that as well.
  According to the Senator from Kentucky, if the government is involved 
in it, it must be bad. Tell that to 40 million Americans under 
Medicare, many of whom never had health insurance in their life and now 
have the protection of Medicare. Medicare has worked for senior 
citizens and the disabled for a long period of time.
  The Senator from Kentucky should also tell the people in the 
Veterans' Administration that when the government is involved, it does 
not work. They know better. Veterans and their families across America 
know our veterans health care system provides quality care for them. We 
entrust to them, the men and women who risk their life for America and 
come home injured--we know they are going to get quality care. To argue 
that if there is any government involvement at all in health care it is 
to the detriment of America argues against Medicare, argues against the 
Veterans' Administration.
  The Senator went on to say, if the government gets involved, the 
delays will be intolerable. We do not want delays. We want timely 
treatment of people. If a doctor believes either I or my family members 
need to have a surgical procedure, some help, some diagnostic test, we 
want it done in a timely fashion.
  What the Senator from Kentucky, the Republican leader, ignores is 
that there are delays within the current system. An article in 
BusinessWeek highlights a case of a woman in New York, Susan, who 
called for an annual mammogram appointment in April, knowing she would 
have to wait 6 weeks. In 2007, her first scan at the end of May was not 
clear. A followup scan detected an abnormality which the doctor wanted 
to address with a needle biopsy and outpatient procedure. The first 
available date was mid-August, more than 2 months later. This lady who 
had an abnormality in her mammogram was forced to wait months under the 
current private health insurance system.
  We have a similar problem in Chicago, Cook County, IL. At the local 
public hospital, wait times for speciality services can range from 6 
months to 1 or 2 years under the current system.
  We know that when it comes to delays, unfortunately, they are 
occurring in the current system. We also know that for a lot of people, 
this current system has become unaffordable and intolerable.
  I think back to one of my friends in Springfield, Doug Mayol. Here is 
a fellow who tells a story. He owns a small business in my hometown of 
Springfield, a shop that sells cards and gifts. His only worker has 
Medicare coverage, so she is taken care of. But Doug has to buy private 
health insurance. Unfortunately, Doug has a problem. He was diagnosed 
many years ago--30 years ago, in fact--with a congenital heart valve 
defect. He has no symptoms. Without regular health care, he runs the 
risk of developing serious problems.
  In the year 2001, Doug, in Springfield, IL, paid $200 a month for 
health insurance. By 2005, even though he had not turned in any claims, 
his cost of health insurance was up to $400 a month. The next year, 
when he turned 50, the rate nearly doubled to $750 a month. He made 
some changes in coverage so he would pay more out of pocket, choose a 
small network of providers, and have a higher deductible. He got his 
premium down to $650 a month.
  This man owns a small shop. He sells greeting cards. He was up to 
$650 a month. Two years later, his premium jumped to over $1,000 a 
month. Again, he made some changes. By opting for the highest possible 
deductible, he was able to bring his premiums down to $888 a month. 
Think about that: He is paying 300 percent more than he paid for health 
coverage 8 years ago and getting a lot less for it.
  He isn't a costly patient. His valve condition is asymptomatic. He 
has never made a claim for illness or injury. He receives routine 
medical care. His high deductible rarely kicks in. Here is the problem. 
Because of his high deductible and expense of health insurance, he is 
afraid to go to a doctor, that it will create another red flag for the 
health insurance company to raise his premiums even more.
  It is unfair to him, Doug Mayol, working in Springfield, IL, as a 
small business owner, a man whose insurance company has never paid a 
claim, to watch his costs explode from $200 a month to $1,000 a month 
in just a few years. Sadly, if we follow the advice of the Senator from 
Kentucky, it will get worse.
  President Obama has challenged us to take on this reform. This is not

[[Page 14275]]

easy, believe me. There are health insurance companies that are going 
to fight us every step of the way. Anytime we step in to try to protect 
Doug and other families to make insurance affordable and to make sure 
it is quality, they are going to argue it is too much government, such 
as we heard from the Senator from Kentucky this morning. What he had to 
say is what we hear from the health insurance companies: Leave it 
alone, leave the system alone.
  Can we afford for Doug Mayol and millions of Americans to leave this 
alone? We have to make sure we move toward a situation that recognizes 
we face a crisis. It is a crisis of cost and a crisis when it comes to 
availability of health insurance. We have to hold the health insurance 
companies accountable to provide us affordable quality care. We have to 
change the system so we have early detection of problems--preventive 
care. We have to ring some of the costs out of the system.
  One of the persons who has made a comment on this regularly whom I 
respect very much is a doctor in Boston named Atul Gawande. He 
recently, in a June 1 article in the New Yorker, talked about the 
disparity in cost around the United States for Medicare. It is clear 
that in some parts of the country--and he was speaking of McAllen, TX, 
at this point--the cost for Medicare patients is dramatically higher 
than they are in other places. We can bring costs down to a reasonable 
level and try to take control of a system that is currently out of 
control, but we cannot do it if every day we are reminded of problems 
that do not exist. That is what we have heard from the other side of 
the aisle.
  They are arguing that we want to take away people's health insurance. 
Absolutely false. We said: If you like your health insurance, you can 
keep it. They argue the government will take over the health care 
system. I have not run into anybody who has suggested that. What we 
want to do is have public health insurance and have a private option, 
which the Senator from New York is going to address in a moment when I 
close.
  This is an important debate for every single American. It is time to 
put together reform that assures quality and affordable health care for 
all Americans.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from New York.
  Mr. SCHUMER. Mr. President, I thank my friend and colleague from 
Illinois for his strong and forceful words, meaningful, bringing it 
home, as he always does, in a very strong and good way about 
individuals and how they are affected.
  I would like to talk a little bit about where we are in health care 
and where we have to go. Let me say that about 10 years ago--I cannot 
remember the exact time--one of the major issues we faced was called 
the Patients' Bill of Rights. Doctors and patients felt--everyone 
felt--that HMOs were taking undue advantage of them. Doctors, if a 
patient desperately needed a prescription, would call some accountant 
in a faraway city and could not get approval and the patient would not 
get the medicine. It sort of hit home.
  There was a movie called ``As Good As It Gets,'' with Jack Nicholson, 
and I cannot remember the name of the woman who starred in it. The 
family could not get the health care they needed because the HMO turned 
them down. I believe it was her child who was hurting. When she and 
Jack Nicholson made remarks about how somebody has to keep an eye on 
these HMOs, in theaters across America, the audience got up and 
cheered.
  That is, again, what we are talking about when we talk about public 
option. Every one of us has a friend, a family member--maybe it is 
ourselves--who has experienced the basic intransigence of insurance 
companies in providing--even when you have a package of benefits--the 
kind of care you or a loved one, a member of your family, needs.
  It is clear in America the insurance companies--and they are doing 
their job maximizing their profit to their shareholders. Of course, our 
capitalist system says they have to maximize it by trying to sell as 
many policies as possible. So there is some check on them. But it is 
clear America is not happy with insurance companies.
  My good friend from Kentucky, the minority leader, keeps saying we do 
not want the government involved. Well, let me ask him: Who is going to 
protect the individual and even some of the individual providers--the 
doctor in a small town or in an inner city--from an insurance company 
when the insurance company either charges too much or tries to get rid 
of the small businessman--such as in the case of the gentleman from 
Springfield whom my friend Dick Durbin talked about--or when they deny 
coverage or when they tell you because you have a preexisting condition 
that you can't get coverage or they are not renewing your proposal or 
whatever?
  We understand there needs to be a check on the insurance companies. 
Left alone, they will not provide the kind of low-cost, full health 
care many Americans need. And when we propose a public option, we are 
proposing someone to keep a check on them. That is the only point. If 
we had complete faith in the insurance companies, we wouldn't be 
debating a public option. If we had complete faith that, left on their 
own, when an individual had the situation of an illness and their costs 
went way up, they would say: Sure, we are going to take care of you, 
you signed the contract when you were healthy and now you are sick--and 
sometimes that happens. I am not saying it never happens, not for sure. 
But what about all the instances when it doesn't? What about the worry 
the rest of us have? And praise God, we are healthy, but it might 
happen. There has to be a check on the insurance companies, and that is 
what the so-called public option does.
  Insurance companies are part of the free enterprise system, and it is 
a great system, but the goal of the insurance company--it is probably 
in their charters, but it is how our system works--is to maximize 
profits to their shareholders by producing a good product. But we all 
know, particularly when it comes to health, that system has major 
flaws. It sometimes works and it sometimes doesn't work.
  If we thought only the private sector should provide health care, we 
wouldn't have Medicare. And I know there are some--way over on the 
right side--who would like to get rid of Medicare. If we thought 
private insurance on its own worked just fine, we wouldn't have fought 
for years for a patients' bill of rights. So this idea coming from the 
minority leader that we should have no check on the insurance 
companies, which is what we would have if we had no form of public 
option, isn't where the American people are, and it is certainly not 
where I am.
  Some bring up--and I think it is a valid argument--well, if the 
government is involved--and by the way, what we are proposing here is 
not that the government take over health care. We are proposing that in 
this exchange where all kinds of insurances companies compete, there be 
at least one that doesn't put the profit motive above all else but has 
to put patients above all, a public option. It doesn't make a profit. 
And what we are saying is, if you believe in competition, why not let 
the public option compete? We do this in State governments. In State 
governments, if you are a State worker in some States, you can 
sometimes get a public plan or a private plan. The consumer chooses. 
And that is how it should be. We are simply saying that, just as there 
are some who might say: I don't think there should be any private 
sector involved in health care, it should all be public--and many 
people think that is not the right view, as I know my friend from 
Kentucky does--many of us think it is just as wrong to say it should 
only be the private sector. Let's see who does a better job. Let them 
compete in the marketplace.
  My view is this: There has to be a level playing field. You cannot 
give the public option such advantages that it overwhelms the private 
sector. The proposal that I have made and that others are looking at--
Senator Bingaman is one; my friends in the House, Congressmen Welch and 
Brady and Murphy--is to try to make the playing

[[Page 14276]]

field level. The government won't just keep pouring money into the 
public option. It sets it up and then it has to compete. If the private 
sector needs reserves--God forbid there is catastrophic illness 
everywhere--then so will the public option. I am certain those of us 
who are interested in a public option are very interested in 
suggestions as to how to make the playing field level. But make no 
mistake about it, the public option is a different model. The public 
option will not have to make a profit. That is about 10, 12 percent. 
That money will go to health care for the patients. The public option 
will not have to merchandise and advertise. That is often 20 percent. 
So right off the bat, the public option has the same level playing 
field but has 30 percent of its revenues that can go to patient health 
care.
  My friends on the other side say: Well, the public option isn't very 
efficient; it doesn't give enough direction, and direction to the right 
person, to cure this disease but lets people go all over. Well, if it 
is not, it is not going to work.
  You know, if I were designing a health care system, I would even look 
carefully at single payer. I believe we do need control mechanisms, and 
I think the insurance companies themselves, no matter how we try to 
regulate them, will figure out ways around them. That is almost their 
mandate because their goal is to maximize profit. There is nothing 
wrong with that. But we are not going to get single payer here. We know 
that. And we are probably not even going to get something called 
Medicare For All, which would be a much more pure system that would not 
be, frankly, a level playing field. But just as we have to compromise 
and move to the center a little bit to get something done, so do my 
colleagues on the other side of the aisle. Again, when they say no 
public option, it is the inverse of saying no private insurance 
companies. Let's see who does better in this exchange.
  My view is this: The public option will have certain advantages. It 
won't have to make a profit, it won't have to advertise and 
merchandise. But on the other hand, it is going to have certain 
responsibilities. When Dick Durbin's friend from Springfield can't get 
insurance from a private company, the public option will be there, and 
that may be somewhat more expensive for them. Admittedly, we are going 
to try to pass laws to say the private insurance company has to keep 
Dick Durbin's friend, the small businessman who is paying for his own 
insurance, without a huge increase in cost. But if you believe, as I 
do, and I think most Americans do, that the private insurance company 
is not going to embrace this and say: Gee, this is great, this is 
costing us a ton of money and we have to report earnings for our 
shareholders, and we will try to find ways--there will be an intention 
of not covering people like that, and the public option will step into 
the lurch.
  So this is a different model, no question about it. It is not just 
another insurance company that happens to be public. But it will be a 
level playing field. There will be a playing field where the private 
insurance companies will be under certain rules and the public option 
plan will be under certain rules. If the private company has to leave 
reserves, the public company will have to leave reserves. No one is 
seeking to unlevel the playing field, but we are seeking to keep the 
insurance companies honest. A public option will bring in transparency. 
When we know what the public option has to pay, we will say: Why isn't 
the private insurer paying the same? A public option will keep the 
insurance company's feet to the fire.
  That is why President Obama feels so strongly about it. He said so in 
his letter. My friend from Iowa, Senator Grassley, said he is just 
being political. I don't think so. He knows the public option will work 
well. Maybe after 3 years, the public option fails and isn't needed. 
Fine. Fine. But I don't believe that will happen. But we are not going 
to, in the public option, just keep putting more and more government 
money in until it wipes out the insurance companies. That is not the 
intent. The intent is to have a robust market, such as we have in other 
States and some of the Federal systems, where many different plans 
compete, and one is a public option. There might also be co-ops, such 
as my friend from North Dakota has been advocating, but there will be 
plenty of private insurance companies.
  I would say one other thing. My friends on the other side of the 
aisle say: Well, why can't we just have the private insurers compete 
and offer a whole lot of plans? We don't have that in the vast majority 
of States right now. We have a system where any private company can 
sell insurance. But in more than half our States--and I believe this 
statistic is right, but I will correct the record if it is not--the top 
two companies have more than 50 percent of the market. There is usually 
not unvarnished competition when you just leave it up to the private 
insurance companies but, rather, an oligopoly. And we all know what 
happens when there is not real competition: Price setting occurs. Price 
leadership is what the economists call it. Nobody tries to undercut on 
price. We have seen this with the oil industry, for instance, with our 
five big oil companies, and you don't get the kind of competition you 
would from a public option, even if there were only one or two 
insurance companies competing.
  In conclusion, I would ask my colleagues on the other side of the 
aisle to, A, be openminded. We haven't said no this or no that. When 
you say no public option, you are saying we want to let the private 
insurance companies, under the guise of competition, run the show. And 
if you believe that will work, fine, but then you also should believe 
the public option won't be a threat to them. Some of us who are worried 
that, left to their own devices, the private insurance companies will 
not serve all or even most of the public as well as they should be 
served, are saying let there be the competitive advantage or the 
competition of a public option in a level playing field that has no 
particular built-in advantage but has a different model--no profit, no 
merchandising, no advertising, serve the patient first.
  This debate will continue, but I would just say to my fellow 
Americans out there who might be listening to this, when you hear the 
other side say no public option, ask them: Then who is going to provide 
a check on the insurance companies? And do you believe the insurance 
companies, even with some government regulation, won't find their way 
out of the regulations or avoid the regulations or walk around them?
  The ACTING PRESIDENT pro tempore. The Senator's time has expired.
  Mr. SCHUMER. The debate will continue, Mr. President, and I 
appreciate the opportunity to address my colleagues.
  The ACTING PRESIDENT pro tempore. The Republican whip.
  Mr. KYL. Mr. President, I understand the time for morning business 
has now reverted to the Republican side; is that correct?
  The ACTING PRESIDENT pro tempore. The Senator is correct.

                          ____________________