[Congressional Record (Bound Edition), Volume 155 (2009), Part 11]
[Senate]
[Pages 14276-14278]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. KYL. I thank the Chair.
  Mr. President, I would like to address two subjects. The first is the 
subject my colleague from New York was just discussing, and that is 
what to do about health care issues we have in the United States. 
Specifically, I would like to refer to some comments that both he made 
and the assistant majority leader made this morning.
  The first point I wish to make is that when the assistant majority 
leader came to the floor this morning and in effect said: Unless you 
agree with our solution, you don't believe there is a problem, that is 
a fallacy, of course. I think everybody agrees there are lots of 
problems. The question is, What is the right solution? So we can all 
agree there are problems, but let's don't suggest that unless you agree 
with my solution or your solution, somehow or other we don't appreciate 
that there are problems.
  We are frustrated and a lot of Americans are frustrated because they 
may work for a small business or they are

[[Page 14277]]

unemployed and therefore they don't have insurance. It is not easy to 
take your insurance with you. It is hard to find quality, low-cost 
health care. This has to be a big priority for a lot of Americans. We 
all understand that.
  Health care needs to be portable. It needs to be accessible. It needs 
to be affordable. I think all Americans want it to be quality care as 
well. The question is, How do you accomplish these goals?
  One of the problems is, what if you have insurance and you like it? 
The President says, in that case you get to keep it. The problem is, 
under the bill that is being discussed in the Finance Committee, you do 
not get to keep it. If you are an employee of a small business, for 
example, or you are an individual with your own insurance, when your 
insurance contract runs out--and those contracts are usually 1 year, 2 
years, sometimes as long as 3 years; let's say it is 2 years, and you 
are through the first year of it--the bottom line is, even though you 
may like it, at the end of next year when the contract runs out, you 
don't get to keep it.
  Under the bill being discussed there is a new regime of regulation 
for the insurance companies about who they have to cover, how they 
cover them, what they can charge, and a whole variety of other 
regulations that mean that the policy you used to have, that you liked, 
does not exist anymore.
  It may be you will be able to find coverage that you like, but it is 
simply untrue to say that one of the mainstays of the legislation being 
proposed is that if you like your current plan, you get to keep it. 
When your current plan expires, it expires, and you don't get to keep 
it because it cannot be renewed in its current form. That is point No. 
1.
  Point No. 2. We just had a discussion about government-run insurance. 
I find it interesting that some on the other side like to call this a 
public option, as if the public somehow or other is operating its own 
insurance company. Let's be clear about who would operate this 
insurance company. It is the U.S. Government. It is not the public; it 
is the U.S. Government. That is why Senator McConnell has referred to 
it properly as government-run insurance.
  The Senator from New York just got through saying: Who else is going 
to provide a check on the private insurance companies to make sure they 
do things right? The President himself has spoken about the need for a 
government-run plan to keep the other insurance companies ``honest.''
  Insurance is one of the most highly regulated enterprises in the 
United States. Every State in fact regulates health insurance. This is 
an area that not only has some Federal regulation, but every State 
regulates health insurance. In fact, one of the reasons you cannot buy 
a health insurance policy from the State you do not live in--you can't 
go across State lines and buy a policy in another State--is because we 
are so jealous of the State regulation of insurance. So to the question 
of my friend from New York, who is going to provide a check, the answer 
is, your State. If you do not trust your State to properly regulate 
health insurance, then I don't know where we are. But you are not going 
to provide better regulation by commissioning a government insurance 
company to exist and compete right alongside the private insurance 
companies. How does that provide a check on the private insurance 
companies?
  It is not as if there are not enough private insurance companies or 
they are not providing enough different kinds of plans, so that can't 
be the problem. It is not a matter of a lack of competition in most 
places. If the question is, who is going to regulate, the answer is, 
the State is going to regulate. To the extent it does not, the Federal 
Government is going to regulate. That is why, A, it should not be 
called a public option if what they are talking about is creating a 
government-run health insurance company, which is exactly what is being 
proposed in the only legislation put out there so far, the so-called 
Kennedy legislation in the HELP Committee. That is precisely what he 
proposes. Republicans say: No, thank you. We are not for that.
  My final point is that the assistant majority leader said there are 
lots of other government-run plans, and we are not afraid of them. He 
mentioned Medicare and the Veterans' Administration. First of all, 
these are not government insurance companies, these are government-run 
programs. But, second, the President himself said, and everybody I know 
of who has studied the issue agrees, Medicare is in deep trouble. The 
President has said its commitments are unsustainable, meaning we cannot 
keep the promises we have made in Medicare to future generations 
because it is far too expensive. We have to find a way to get those 
expenses under control.
  How is adding another 15, 20 or 30 million Americans to an existing 
program that is not sustainable going to make it any better?
  My colleague talked about waiting lines. It may well be true we can 
find an example or two of people who have to wait in line in the United 
States. That is something we should not permit in the United States. We 
know that is what exists in other countries, and I will get to that in 
just a moment. Why does that justify having an expansion of a 
government program? If we have a government program which causes 
waiting lines today, does it solve the problem by adding a whole lot 
more people to the rolls?
  What is likely to happen? The waiting lines are going to get longer 
because more people are going to have to be waiting for care. Is that 
what we want in the United States of America? I submit not. So far from 
being a justification for a government-run program, I believe that 
argues for not having a government-run program, or at least not 
expanding the government programs we already have. A government 
takeover is not the answer. No country, even the United States, the 
most prosperous country on Earth, has unlimited resources to spend on 
health care.
  That brings up the third problem, which is the rationing, the 
inevitable delay in getting treatment or tests and frequently the 
denial of care that results from that. When a government takes over 
health care, as it has, for example, in Britain and Canada and many 
places in Europe and other places, care inevitably is rationed. We all 
have heard the stories.
  One of the most direct ways we can ration care is one that the White 
House has already embraced, and it is part of the Kennedy bill that I 
spoke of earlier.
  The White House has said comparative effectiveness research, which 
would study clinical evidence to decide what works best, will help them 
eliminate wasteful treatments. Wasteful to whom? A recent National 
Institutes of Health project has a description of part of their plan 
that states, and I will quote:

       Cost-effectiveness research will provide active and 
     objective information to guide future policies that support 
     the allocation of health resources for the treatment of acute 
     and chronic conditions.

  Allocation of health resources is a euphemism for rationing. 
Allocation means to allocate, and inevitably there will be denial based 
upon those things which are deemed to be too costly.
  As discussions about health care reform have dominated the news 
recently, stories have trickled out from individuals living in 
countries that ration care whose medical treatment has been delayed or 
denied due to rationing, and we are beginning to hear some of those 
stories. One that I came across was reported in the Wall Street 
Journal.
  It was the story of one Shona Holmes of Ontario, Canada. When Miss 
Holmes began losing her vision and experiencing headaches, panic 
attacks, extreme fatigue, and other symptoms, she went to the doctor. 
An MRI scan revealed a brain tumor, but she was told she would have to 
wait months to see a specialist.
  Think about this. She goes home and tells her family: The MRI said I 
have a brain tumor. I have all of these symptoms, including losing 
vision and the rest of it. But I have to wait months to see a 
specialist--I gather, to confirm the diagnosis. I don't know. As her 
symptoms worsened, she decided to

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visit the Mayo Clinic in Arizona. So she left her home country, paid 
her way down to Arizona and paid for the diagnosis and treatment that 
was called for in her case to prevent the permanent vision loss and 
potentially death that could have ensued had she not been treated in a 
timely fashion.
  A Lindsey McCreith, also of Ontario, was profiled in the same article 
to which I referred. Mr. McCreith suffered from recurring headaches and 
seizures. When he went to the doctor, he was told the wait time for an 
MRI was 4\1/2\ months. Think about this. You are having seizures and 
the test that will reveal what if anything is wrong is going to be 
delayed 4\1/2\ months. One of the reasons, I am told, by the way, is 
that there are very few places in Canada where MRIs are located, where 
you can actually get the test. In any event, he decided to visit a 
clinic in Buffalo, NY--fairly nearby--in order to get the MRI. He did 
and it, too, revealed a brain tumor. Now Mr. McCreith is suing the 
Canadian Government's health care monopoly for jeopardizing his life.
  I wonder if we want lawsuits to be the answer. When you can't get the 
care you want, you have to file a lawsuit to get it? Is that what we 
want in America? I don't think so.
  There are also people whose care has been flatout denied. Britain's 
National Health Service has denied smokers treatment for heart disease, 
and it has denied hip and knee replacements for people who are deemed 
to be obese. The British Health Secretary, Patricia Hewitt, has said it 
is fine to deny treatment on the basis of lifestyle.

       [Doctors] will say to patients: ``You should not have this 
     operation until you have lost a bit of weight,'' she said in 
     2007.

  That is easier said than done for some people. In any event, if they 
need a health treatment and they need it now, there is a real question 
whether they can accomplish the ``losing a little bit of weight,'' as 
Ms. Hewitt said. All Americans deserve access to quality care, but 
government-run insurance does not equate with access. Rationing will 
hinder access.
  As I said, my colleague from Illinois, the distinguished majority 
assistant leader, says you can actually find some examples in the 
United States where there are long wait times. If that is true--and I 
don't doubt what he said--that is not good; it is bad. We should try to 
fix that so we don't have wait times. We should not justify having more 
wait times on the fact that we already have some. We should not say 
because there are some people in America who have to wait, therefore we 
should make it possible for everybody in America to have to wait; we 
should be like Canada or Great Britain.
  That is not the answer. If we have wait times here, we should stop 
it, not say that we, therefore, might as well be like Canada or Great 
Britain. Americans do not deserve or want health care that forces them 
into a government bureaucracy with its labyrinth of complex rules or 
regulations.
  Think about the hassles of dealing with the IRS or Department of 
Motor Vehicles or Social Security Administration when you have a 
problem there and then imagine dealing with the same issues when it 
comes to getting health care. We can't enable a panel of bureaucrats, 
through rules and regulations, to put the politicians in charge of 
deciding who is eligible for a particular treatment or deciding when or 
where they can get it. It is wrong for America, wrong for the patients 
in America, and it is the wrong approach to health care reform.
  Republicans believe there is a better way for health care reform. 
Rather than empowering the government, empower patients. Rather than 
putting bureaucrats in between your doctor and yourself, try to remove 
the constraints that physicians have and hospitals have for treating 
people. Try to remove constraints on insurance companies.
  One of the things I have asked for, for example, with all of these 
wonderful ideas about more government regulation of insurance is, how 
about repealing some laws that currently prevent insurance companies 
from competing? I mentioned before you can't compete across State 
lines.
  We all know if you want to incorporate as a corporation--why are all 
the corporations incorporated in Delaware, ``a Delaware corporation''? 
It doesn't matter whether you are in Illinois or Arizona, corporations 
are incorporated in Delaware. At least that is the way it used to be. 
One of the reasons is Delaware had very benign laws regulating the 
incorporation of businesses. It was cheaper to do it, and there was 
less regulatory hassle. But if the distinguished Presiding Officer, for 
example, looked across the river to the west and saw an insurance 
company in Iowa that could provide him with better coverage at less 
cost than the company that insures him in Illinois, why should he be 
restrained from buying the policy from the company in Iowa? You could 
buy your automobile insurance that way. You could buy your home 
insurance that way. Why should you not be able to buy your health 
insurance that way? Well, you can't.
  I am going to conclude this discussion, but just one idea is to 
remove some of the barriers to competition that would make it more 
likely that insurance companies could expand their coverage by 
competing, be required to compete with lower premiums and/or provide 
better access to care. It seems logical, and in this country, where 
people move around all the time--my family just drove all the way 
across the country from Washington, DC, out to Arizona to visit friends 
and family and go on to California. We travel all around this country 
all the time. We move families, unlike back in the old days. Why can't 
we have an insurance regime that enables you to buy insurance from 
another State? It does not make sense; it inhibits competition; it 
makes prices higher; and it can have the effect of restricting care. 
Those are the kinds of things we need to do to reform our system, not 
put more government in charge and not put government between you and 
what your physician says you need, or even put some time delay between 
the opportunity to visit your physician when you know you have 
something wrong with you.
  We are going to have more discussion about this in the future, but I 
want to back up what Senator McConnell from Kentucky has said. 
Americans don't want government-run insurance companies any more than 
they want government-run car companies. It seems as though the 
government is starting to run everything now--from the banks, to the 
insurance companies, to the car companies. Now we are going to run 
insurance companies as well for health care. I do not think that is 
what the American people want.
  I think the Senator from Kentucky is exactly right. I think he is 
right when he says no government-run care and that we should not be 
rationing care. Those are two of the most critical aspects of the 
legislation Senator Kennedy has come forth with and among the things 
being discussed in the Senate Finance Committee as well. We need to 
draw a line: Put patients first, not put the government first.
  (Mrs. Gillibrand assumed the Chair.)

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