[Congressional Record (Bound Edition), Volume 155 (2009), Part 11]
[Senate]
[Pages 14303-14307]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. HATCH. Mr. President, I wish to take a few minutes now to talk 
about the perils of creating a government plan on American families and 
health care.
  I am very disappointed that the President and my friends on the other 
side of the aisle have chosen to pursue the creation of a new 
government-run plan--one of the most divisive issues in health care 
reform--rather than focusing on broad areas of compromise that can lead 
us toward bipartisan reform in health care legislation.
  Yesterday, I spearheaded a letter with my Republican Finance 
Committee colleagues urging the President to strike a more conciliatory 
tone on health care reform. Having played a profound role in almost 
every major health care legislation for the last three decades and 
having worked repetitively in a bipartisan manner with everyone from 
Senators Kennedy and Dodd to Congressman Waxman, I know something about 
getting things done for our families in a thoughtful manner. You 
advance legislation by focusing on areas of compromise, not strife.
  First and foremost, let me make this point again, even though I am 
starting to sound like a broken record: Reforming our health care 
system to ensure that every American has access to quality, affordable, 
and portable health care is not a Republican or Democratic issue; it is 
an American issue. When we are dealing with one-sixth of our economy, 
it is absolutely imperative that we address this challenge in a 
bipartisan manner. Anything less would be a huge disservice to our 
families and our Nation.
  Clearly, health care spending continues to grow too fast. This year 
will mark the biggest ever 1-year jump in health care's share of our 
GDP--a full percentage point to 17.6 percent. You can think of this as 
a horse race between costs and resources to cover these costs. The sad 
reality is that costs win year after year.
  Growing health care costs translate directly into higher coverage 
costs. Since the last decade, the cost of health coverage has increased 
by 120 percent--three times the growth of inflation and four times the 
growth of wages. It is not the only problem, but cost is one part of 
the reason more than 45 million Americans do not have health insurance.
  I believe we need to do more to ensure we achieve universal and 
affordable access to quality health care for every American. We can do 
this by reforming and improving the current system. However, the 
creation of a government plan is nothing more than a backdoor approach 
to a Washington-run health care system.
  At a time when major government programs such as Medicare and 
Medicaid are already on a path to fiscal insolvency, creating a brand 
new government program will not only worsen our long-term financial 
outlook but also negatively impact American families who enjoy the 
private coverage of their choice.
  To put this in perspective, as of this year, Medicare has a liability 
of almost $39 trillion, which in turn translates into a financial 
burden of more than $300,000 per American family.
  In our current fiscal environment, where the government will have to 
borrow nearly 50 cents of every dollar it spends this year, exploding 
our deficit by almost $1.8 trillion, let's think hard about what we are 
doing to our country and our future generations.
  The impact of a new government-run program on families who currently 
have private insurance of their choice is also alarming. A recent 
Milliman study estimated that cost-shifting from government payers, 
specifically Medicare and Medicaid, already costs families with private 
insurance nearly $1,800 more each year. Creating another government-run 
plan will further increase these costs on our families in Utah and 
across the country.
  Let me make a very important point. A new government plan is nothing 
more than a Trojan horse for a single-payer system, a one-size-fits-all 
government-mandated system, where we are going to put bureaucrats 
between you and your doctors. Washington-run programs undermine market-
based competition through their ability to impose price controls and 
shift costs to other purchasers.
  The nonpartisan Lewin Group has concluded that a government plan open 
to all, and offering Medicare-level reimbursement rates, would result 
in 119.1 million Americans losing their private coverage. This is 
almost three times the size of the entire Medicare Program, which is 
already in trouble. More important, this would run contrary to the 
President's own pledge to the American families about allowing them to 
keep the coverage of their choice. So far as I know, no one has 
disputed the Lewin Group. They are well known as one of the most 
nonpartisan groups in the country.
  Proponents of this government plan seem to count on the efficiency of 
the Federal Government in delivering care for American families, since 
it is already doing such a great job with our banking and automobile 
industry.
  Medicare is a perfect example. It is on a path to fiscal meltdown, 
with Part A already facing bankruptcy within the next decade, and we 
all know it. It underpays doctors by 20 percent and hospitals by 30 
percent, compared to the private sector, forcing increasing numbers of 
providers to simply stop seeing our Nation's seniors. According to the 
June 2008 MedPAC report, 9 out of 10 Medicare beneficiaries have to get 
additional benefits beyond their Medicare coverage--9 out of 10.
  We have a broken doctor payment system in Medicare that has to be 
fixed every year, so seniors can continue to get care. This year alone, 
this broken formula calls for a more than 20-percent cut. I can keep 
going, but the point is simple: Washington and a government-run plan is 
not the answer.
  Talk about creating problems. The supporters of the government plan 
know these facts. So they are trying a different approach by claiming 
that the government plan is simply competing with the private sector on 
a so-called level playing field. Give me a break.

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  History has shown us that forcing free market plans to compete with 
these government-run programs always creates an unlevel playing field 
and dooms true competition.
  The Medicare Program, once again, provides an important lesson. As a 
political compromise, Medicare was set up in 1965 to pay doctors and 
hospitals the same rates as the private sector. Faced with rising 
budget pressures, Congress quickly abandoned this level-playing-field 
approach and enacted price limits for doctors and hospitals. Today, as 
I have said, Medicare payments are 20 percent less for doctors and 30 
percent less for hospitals compared to the private sector. I have been 
told by doctors from Utah and across the country that if this 
continues, they will simply stop seeing patients altogether. A number 
of them are ready to quit the profession. I cannot tell you the 
problems that will arise if we go to a government-run program--a Trojan 
horse to lead us to a government-mandated, government-run, one-size-
fits-all massive program.
  In his March, 2009, testimony before the House Energy and Commerce 
Committee, Doug Elmendorf, the Director of the nonpartisan 
Congressional Budget Office, testified that it would be ``extremely 
difficult'' to create ``a system where a public plan [government plan, 
if you will] could compete on a level playing field'' against private 
coverage. The end result would be a Federal Government takeover of our 
health care system, taking decisions out of the hands of our doctors 
and our patients, placing them in the hands of a Washington 
bureaucracy, and inserting that bureaucracy right between them.
  Here is the bottom line: We are walking down a path where stories 
such as Jack Tagg's could become increasingly common in our great 
country. In 2006, Jack Tagg, a former World War II pilot, suffered from 
a severe case of macular degeneration. The regional government 
bureaucrats rejected his request for treatment, citing high costs, 
unless the disease hit his other eye also. It took 3 years to overturn 
that decision--3 years, while he had to suffer, when we could have done 
this in a better way.
  Let's remember that a family member with cancer in an intensive care 
unit would probably neither have the time nor the resources to appeal 
such an egregious bureaucratic decision. We need to remember the real 
implications of these policies--not simply in terms of political spin 
and special interests but in terms of its impact on real people, who 
are mothers, fathers, husbands, wives, brothers, sisters, and children.
  Similar to the ill-conceived stimulus legislation and flawed auto 
bailout plan, health care reform has the potential of simply becoming 
another example of the Democrats justifying the current economic 
turmoil to further expand the Federal Government.
  To enact true health care reform, we have to come together as one to 
write a reasonable and responsible bill for the American families who 
are faced with rising unemployment and out-of-control health care 
costs.
  I do look forward to working together to transform our sick-care 
system into a true health care system. I continue to hold deep in my 
heart that we will move beyond these beltway games and work together in 
a bipartisan way to fix Main Street. The time is now and I am ready.
  I am absolutely positive the way to go is not with a government-run, 
government-mandated health care program, which will bring the lowest 
common denominator in health care to everybody. I think you are going 
to find that the costs are so astronomical, the way it is being formed 
in the HELP Committee, in particular, that we are leaving a burden on 
our kids and grandkids and great grandkids that is going to be 
insurmountable.
  With that, I yield the floor.
  The PRESIDING OFFICER (Mr. Kaufman). The Senator from Oregon is 
recognized.
  Mr. WYDEN. Before the Senator leaves the floor, I wish to tell the 
Senator from Utah how much I am looking forward, on a personal level, 
to working with him in this 5-month sprint to figure out a way to fix 
American health care in a bipartisan fashion. Some of the moments I am 
proudest of have been those when the two of us have been able to team 
up on health reform. Without getting into it this afternoon, let me say 
that millions of poor young people who use community health centers are 
getting services there at no extra cost to our taxpayers, because 
Senator Hatch was willing to work with this Senator and a group of 
others, including public interest groups and a wide variety of health 
care advocates, in order to change malpractice rules. This was done to 
make sure not only that those who had a legitimate claim got served but 
also that the bulk of the money went to patients in need. Thousands of 
low-income Americans get care because Senator Hatch was willing to take 
a stand for low-income folks. I wish to tell him I am very much looking 
forward to working with him and our colleagues on a bipartisan basis 
over the next 5 months to get this job done.
  Mr. HATCH. If the Senator will yield, I am very appreciative of the 
Senator's remarks. I have spent 33 years working on virtually every 
health care bill that has come up. We have always done it in a 
bipartisan way. I certainly enjoy working with the distinguished 
Senator from Oregon. He is one of the more thoughtful people in health 
care on the Finance Committee and in this whole body. I am grateful to 
him for wanting to work together and in a bipartisan manner. We need to 
do that. You cannot work on a partisan basis on issues regarding the 
American economy. There are some in the White House and on the 
Democratic side who want to do that. I am grateful the Senator from 
Oregon is not one of them. I, personally, will do everything in my 
power to try to put together a bipartisan approach to this that would 
work and would put the best of the private sector in with the best of 
the government sector and work for our folks in this country. When you 
are talking about one-sixth of the American economy, if we do that, it 
will be for the betterment of the country and for everybody. If we go 
in a partisan, one-size-fits-all way--especially, in my opinion, with a 
government-run plan--we are going to be anything but good as far as 
health care is concerned. I am grateful for the Senator's kind remarks.
  Mr. WYDEN. Mr. President, I share the Senator's interests. There are 
a lot of Senators of good will on both sides of the aisle who want to 
get this done right.
  Mr. HATCH. I thank the Senator.
  Mr. WYDEN. Mr. President, I ask unanimous consent to speak in morning 
business for up to 20 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WYDEN. When I was a young man, I got involved working with senior 
citizens as codirector of the Oregon Gray Panthers. Every day back 
then, we got up and said we are going to make a difference. We are 
going to help people and, particularly, for senior citizens we are 
going to make it possible for them to have a better quality of life.
  The distinguished occupant of the chair is, I think, close to my age. 
We can both recall that in those days if a town had a lunch program for 
senior citizens, that was considered a big deal. There weren't a whole 
lot of discount programs. People didn't even talk about home and 
community-based health care services. In most of the country, back 
then, if a town had a lunch program for senior citizens, that was 
considered a full-fledged program for older people.
  In those early days with the Oregon Gray Panthers I started thinking 
about the importance of good-quality, affordable health care. I spent 
hours and hours back then watching what happened when seniors and their 
families got exploited in the health care system. The first issue I was 
involved with concerning senior citizens was a real tragedy. At that 
time, there were a lot of older people who needed insurance to 
supplement their Medicare. It was very common for senior citizens then, 
every time some fast-talking salesman came through, to buy another 
policy. When I

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was running the legal aid office for senior citizens I would go to 
visit older people in their homes, and very often they could take out a 
shoe box full of health insurance policies--15 or 20 policies. A lot of 
them weren't worth the paper they were written on. In fact, they had 
what were known as subrogation clauses, so that if you had another 
policy, the first one would not pay off. It was tragic to watch senior 
citizens walking on an economic tightrope every week, balancing food 
against fuel and fuel against medical bills, and getting sold all this 
junk health insurance, and as I said earlier, most of it wasn't worth a 
lot more than the paper it was written on. I starting saying to people, 
I want to do something about this. In a few years, I got elected to the 
House of Representatives, and I had a chance to work with both 
Democrats and Republicans, a number of them in the Senate today. 
Chairman Baucus was very involved in the effort.
  In the early nineties, we finally drained that swamp of paper. Today 
it is possible for a senior to have just one of these policies, not 15 
or 20, and have the extra money to spend on other essentials. The 
coverage is standardized so you don't need to be some kind of Houdini 
in order to figure it out.
  That effort resulted in the only tough law on the books today that 
really has teeth in it to regulate and stop some of these private 
insurance ripoffs. I am very proud to have taken a role along with some 
of my colleagues in the Senate in changing it.
  Democrats and Republicans, as part of health reform, are going to 
have to fix the insurance market for the nonelderly population. The 
insurance market today for those who are not in Medicare or in the 
veterans system, but who instead have private coverage, is inhumane. It 
is all about cherry-picking. It is about trying to find healthy people 
and send sick people over to government programs more fragile than they 
are. That is today's insurance market.
  Fortunately, a big group of Democratic Senators and Republican 
Senators are now on record saying they want to change that. They want 
to make sure, for example, that people cannot be discriminated against 
if they have a preexisting condition. These Senators want to make sure, 
for example, that instead of being sent off to the individual insurance 
market, where people don't really have any clout or any bargaining 
power, people will be able to be part of a bigger group so they get 
more value for their health care dollar. In this larger group market, 
insurance companies pay out a bigger portion of the premium dollar in 
terms of benefits.
  Democrats and Republicans are prepared to, in effect, turn the 
current system of private insurance around completely and say: Instead 
of basing it on cherry-picking, which is what it is about today, in the 
future, private insurers should have to take all comers. They should 
not discriminate. People should pool into large groups, and the 
companies should compete on price, benefits, and quality. There will 
have to be prevention and wellness so it is not just sick care, as 
Senator Hatch touched on very eloquently.
  That is something Democrats and Republicans already are on record as 
coming together to support. Fixing the private insurance marketplace is 
a fundamental part of health reform.
  There are other areas where Democrats and Republicans can join 
forces. One that I care most about is making health care coverage 
portable so that you do not lose your coverage when either you leave 
your job or your job leaves you.
  This is an especially serious problem for the millions of folks who 
are laid off today. They go to a program called COBRA, which, I might 
note, is the only Federal program named after a poisonous snake. 
Colleagues have improved it, certainly, in the stimulus to try to 
provide additional assistance. But it is still part of a dysfunctional 
system that has not changed a whole lot since the 1940s. Much of the 
rules with respect to coverage--and certainly, in my opinion, that have 
led to the lack of portability--were made in the 1940s, when there were 
wage and price controls, and when big decisions got made that affect 
health care today.
  Back in the 1940s, the rules made some sense for those times. People 
would usually go to work somewhere and pretty much stay put for 20 or 
25 years until you gave them a gold watch and a 20,000-calorie 
retirement dinner. That is not what the workforce is about today.
  Today the typical worker changes their job 11 times by the time they 
are 40. So what workers need is portable health care coverage, coverage 
they can take from place to place. People do not need to find that when 
they lose their jobs, they go out and face discrimination in the 
insurance marketplace where they are not able to afford insurance, even 
with the COBRA subsidies which, of course, run out often before they 
get their next position.
  The current system is also anti-entrepreneur because very often 
somebody who works for a business has a good idea and they would like 
to go into the marketplace and try it out, but if they have an illness, 
they cannot leave their job because they are not going to be able to 
get coverage at their next job.
  Once again, Democrats and Republicans in the Senate are on record as 
being willing to make a fundamental change in the way the system works 
today. They are on record in favor of portability and guaranteeing to 
Americans who lose their job or want to go somewhere else the ability 
to take their coverage with them. This system would be administered in 
a seamless kind of way so you wouldn't have to go out and reapply and 
have physicals and incur excessive costs.
  Which leads me to my next point where Democrats and Republicans are 
in agreement, and that is lowering the crushing costs of health care 
administration. This Senate has begun to move in the right direction, 
with the leadership of the Obama administration, to promote electronic 
medical records. As far as I am concerned, we ought to send these paper 
medical records off to the Museum of American History and put them next 
to the typewriter and telegraph.
  The Obama administration has made good progress in moving in that 
direction. But much more needs to be done to lower administrative costs 
in health care.
  Once again, Democrats and Republicans have teamed up. They've said, 
let's use the withholding system. We already do that for administering 
much of the human services benefits on which our people rely. We will 
make sure people sign up once so they don't have to go through it again 
and again. We will pool people into these larger groups so they don't 
have to experience the excessive administrative costs that are 
associated with smaller groups, and they will have portable coverage so 
our people do not have to apply time and again, every time they change 
their job.
  For each one of these issues--insurance reform, portability, lower 
administrative costs--already there exists a significant group of 
Democrats and Republicans in the Senate willing to join forces.
  My own view is these are not partisan issues, and I think there are 
other areas that can also be tackled together by Democrats and 
Republicans.
  One of the most contentious of those upcoming issues involves the tax 
rules for American health care. The reason these are so important is, 
of course, they are vital to Americans who are trying to pay for their 
health care and other essentials. These tax rules, which are upwards of 
$250 billion a year, amount to the biggest federal health care program.
  Prominent Democrats and prominent Republicans, just in the last few 
weeks, have said these rules do not make sense. Let me give some 
examples for colleagues on our side of the aisle of some of the 
progressives who have called for reforms just in the last couple of 
weeks. Robert Reich, the former Secretary of Labor, certainly one of 
the leading progressive thinkers in our country, has talked about the 
regressivity of these rules, how they disproportionately favor the most 
affluent. Bob Greenstein, the head of the Center on Budget and Policy 
Priorities,

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is on record with the same views. Both of those reflect the comments of 
individuals who are progressive.
  Suffice it to say, a number of conservatives have spoken out against 
these rules as well. Milton Friedman, going back to a legendary 
conservative, began to speak out against these rules some time ago.
  We ought to deal with these issues on a bipartisan basis. I know of 
no Senator--not a single one--who is going to support taxes on middle-
class people on their health care. It is off the table. It is not going 
to happen. There are 100 of us. Not a single one of us is going to 
support taxing those individuals. But I do think Democrats and 
Republicans, just like Robert Reich and Bob Greenstein on the 
Democratic side and conservatives going back to Milton Friedman on the 
Republican side, have said we can come together and find a way to make 
sure in the future these rules do not subsidize inefficiency and also 
disproportionately favor the most affluent.
  What is tragic in the State of Delaware, the State of Oregon, the 
State of Georgia, is, if somebody does not have health care coverage 
and works in a furniture store outside Atlanta, they, in effect, have 
their Federal tax dollar subsidize somebody who is particularly well 
off who decides they want to get a designer smile in their health care 
plan.
  Can we not all say in the interest of protecting taxpayers and 
fairness that we want that person who is interested in their designer 
smile to be able to buy as many of them as they want; but can we not 
agree, Democrats and Republicans, that if they are going to get a 
designer smile, they are going to pay for it with their own money 
rather than with subsidized dollars?
  In each of these areas I mentioned there is an opportunity for 
Democrats and Republicans to come together. What each of the areas I 
have touched on deals with is making health care more affordable--more 
affordable for individuals, more affordable for families, and more 
affordable for taxpayers who are getting pretty darned worried about 
the debts that are being incurred and the prospect that their kids and 
their grandkids are going to have to pick up some of these bills.
  I believe one of the keys to making health care more affordable is to 
make it possible for the individual, largely as part of a group where 
they can have some clout, to be rewarded for making a financially sound 
decision for herself and her family and to have a choice to go to the 
kind of program that makes sense for her and her family.
  The current statistics show 85 percent of our people who are lucky 
enough to have employer coverage get no choice. Let me repeat that. 
Eighty-five percent of those who are lucky enough to have employer 
coverage get no choice.
  Every one of us is going to require that a final bill protect 
somebody's right to keep the coverage they have. Mr. President, 100 
Senators are going to vote for the requirement that you can keep the 
coverage you have. But can we not agree, as Democrats and Republicans, 
that we are also going to say you ought to have some other choices? I 
would like those choices to be in the private sector. If you can find a 
plan that is financially in your interest, you can keep the difference 
between what your health care costs today and what this new health 
package you buy costs. You can keep the difference. We will have a 
functioning market. If you save $600, $800 on the health care you buy, 
you have $800 to go fishing in Oregon, and I suspect the Senators from 
Delaware and Georgia may have some other ideas for where people can use 
their savings.
  The point is, we will have created a market where there is none now. 
I consider the current health care system today, for all practical 
purposes, a money-laundering operation. What we have done largely since 
World War II is set it up so that third parties call the shots, and 
there are not any opportunities for individuals who want to make a 
cost-conscious choice to buy a good quality health care package. In 
effect, the individual has been divorced from the process completely.
  I am not calling for individuals to go off into the health insurance 
marketplace by themselves. What I am saying is they ought to have the 
opportunity, as we have as Members of Congress, to be part of a large 
group where they can have clout, where they aren't discriminated 
against, where they do have power in the marketplace to make a sensible 
choice for themselves and their family.
  So in each of these areas, Mr. President--and this is why I wanted to 
come to the floor of the Senate today, because I know emotions are 
starting to run hot on this health issue--I have outlined ways in which 
Democrats and Republicans can come together. The Congressional Budget 
Office, which is the independent arbiter of all of this, has largely 
scored the proposals I have outlined in the legislation that 14 
Senators are in support of as being budget neutral over a 2-year phase-
in period. The CBO has said that in the third year the proposals would 
actually start bending the cost curve downward.
  I close with this--and I thank my colleague and friend from Georgia 
for his patience--I think we have five of our most dedicated 
legislators working now on a bipartisan basis in two committees to 
bring Democrats and Republicans together. The leaders on the Finance 
Committee on which I serve--Chairman Baucus and Senator Grassley have 
been extremely fair and gracious. They have put untold hours into this 
issue. Both of them have spent an exceptional amount of time with me, 
and they have extended that offer to literally any Member of the 
Senate, to sit down and spend time with them to try to address this 
bill in a bipartisan way. In the HELP Committee, Senator Kennedy, 
Senator Dodd, and Senator Enzi who serves on both committees, are 
extending the same kind of goodwill. I have told the leaders of both of 
these committees I am going to do everything I can to bring to them the 
ideas I have outlined today that have strong bipartisan support and 
have been scored by the Congressional Budget Office as saving money and 
pushing the cost curve downward. I have great confidence in the leaders 
of those two committees, because they are showing they want to spend 
the time to bring the Senate together.
  I see the distinguished Senator from Maine on the floor, and I know 
that for a lot of us who have worked together on health care over a lot 
of years, this is a historic opportunity. This is the place--the 
Senate--and this is the time to get it done. I believe Democrats and 
Republicans coming together can make it happen.
  Mr. President, with that I yield the floor.
  The PRESIDING OFFICER. The Senator from Maine.
  Ms. SNOWE. Mr. President, I ask unanimous consent to speak for 15 
minutes as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. SNOWE. Mr. President, I rise to speak about the Family Smoking 
Prevention and Tobacco Control Act, but before I do I want to 
compliment the Senator from Oregon for his passion and his eloquent 
statement on behalf of renovating and reforming our health care system. 
That certainly will be a historic occasion. I have worked with him on 
so many instances in the past, in a bipartisan fashion, on key issues, 
such as prescription drugs and adding the critical Part D benefit to 
the Medicare Program. That also was a historic event in the Medicare 
Program--the first major expansion of Medicare since its inception. I 
look forward to working with him in a genuine bipartisan way to build a 
consensus for this historic occasion that is so essential and so 
important to all Americans.
  It is important to get it right. It is important that we work 
together in a concerted fashion, as we have in the past. And certainly 
on the Senate Finance Committee, as we begin to proceed to mark up 
legislation in the future, I certainly am looking forward to working 
with him.
  Mr. REED. Madam President, would the Senator yield for a 
parliamentary request?
  Madam President, at the conclusion of the remarks of the Senator from 
Maine, I ask unanimous consent to be

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recognized for 5 minutes, and then following me that Senator Isakson be 
recognized for 10 minutes.
  The PRESIDING OFFICER (Mrs. Shaheen). Is there objection?
  Without objection, it is so ordered.
  Mr. REED. I thank the Senator and the Chair.

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