[Congressional Record (Bound Edition), Volume 155 (2009), Part 11]
[Senate]
[Pages 14487-14489]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. MERKLEY. Mr. President, in the coming weeks we are going to be 
taking up what is probably one of the most vexing policy challenges of 
the last 50 years: how to reform our health care system and provide 
affordable, accessible health care to every single American. The goal 
could not be more straightforward: to guarantee access for every 
American--and the stakes could not be higher.
  Our small businesses are collapsing under the weight of health 
insurance premiums. Last month, Oregon's largest insurer announced that 
the small business premium was going up 14.7 percent. That is on top of 
a 26-percent increase the previous year.
  Large employers have the challenge as well. In a global economy, our 
broken health care system is a major competitive disadvantage. A 
greater share of the price of each car in the United States goes to 
health care than goes to steel. Mr. President, $1,500 of the cost of a 
car goes to health care, while across the border in Canada that price 
is zero. If we are going to compete in the world, we need a 
competitive, cost-effective health care system.
  Of course, the biggest impact of our expensive, ineffective health 
care is most acutely felt around the kitchen table by our working 
families. With unemployment skyrocketing, virtually every family is 
reminded of how tenuous its connection is to health care--just one pink 
slip away from losing health care for their family.
  Even those with insurance find health costs out of reach. Nearly half 
of the personal bankruptcies are by folks who have health insurance but 
who still could not manage all the health care costs because of when 
they became ill.
  So this is what it boils down to: Working families in America, if 
they have health care, are concerned about the copays, they are 
concerned about being underinsured, and they are concerned about losing 
their insurance

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with the loss of a job. Those working families without health care are 
worried about getting sick and how they are going to get well if they 
are already sick.
  This does not have to be the case. Health care is already devouring a 
large portion of our economy--18 percent of our gross domestic 
product--driving long-term Federal deficits and crowding out important 
State investments in education, in infrastructure, in social services, 
and pretty much everything else, and it is only projected to get worse 
as our population ages and health care inflation runs rampant year 
after year.
  Put simply, if we do not reform our health care system, our economy 
will not thrive. That is a stark choice. Our economy and health care 
are tied together.
  I know none of this is news to the Presiding Officer or to any 
Members of this esteemed Chamber. In fact, since President Truman, 60 
years ago, called for health care for every working American as a 
national priority, we have been struggling to achieve that goal, and we 
have not yet gotten there. We have been periodically trying to fix up a 
fragmented, expensive, unfair system. But the fear of change has always 
overtaken the sense of possibility.
  Those stakes and that history make it all the more critical that we 
seize this moment to meet the challenge President Obama has laid out 
for us and that we deliver on health care reform. This is the year--
2009 is the year. This is the year to deliver on the promise to give 
every American access to affordable health coverage, to ensure that our 
economy has the same potential to be the engine of prosperity and 
opportunity and employment in this century that it was in the last 
century.
  To make this happen, we have to find ways to make our health care 
system more affordable. We need to spend our health care dollar in 
smarter ways so we can put money back in the pockets of Americans and 
make our businesses more competitive.
  The good news is we have lots of examples of how to do this right 
now. Extensive research has documented that the regions of our country 
which spend the most per person on Medicare, that is, 60 percent more 
than the regions with the lowest expenditures on health care, do not 
end up with better health care. The lowest spending regions actually 
have the same or better health care outcomes after adjusting for health 
histories, ages, and occupations. Plus, the beneficiaries are more 
satisfied.
  So if we could take the practices and change them in the high-cost 
regions to match the low-cost regions, we would save, in Medicare 
alone, hundreds of billions of dollars.
  Our job in this health care reform effort is to change some of the 
rules of the road so they encourage and enable all providers to act 
more like the high performers, those providing and delivering high 
quality, lower cost health care.
  That is why this legislation needs to get us to start spending our 
health care dollars more wisely, investing more in prevention, 
investing in chronic disease management, building a research base about 
what works and what financial incentives are necessary to utilize those 
practices, rewarding care delivery built around coordination and 
efficiency rather than fragmentation and volume. We know these things 
work, and we need to make them the norm, not the exception.
  We cannot stop the bleeding in our health care system costs without 
also doing something about the convoluted and broken health insurance 
marketplace. The first thing we need to do is to end the insurance 
company practices that penalize you if you are old or you are sick or 
you have ever been sick.
  I am outraged when I hear stories from Oregonians about being turned 
away because of their preexisting conditions or their potential 
propensity toward certain diseases. The folks who need health care the 
most are being turned away the most, and that is not a health care 
system.
  We have 50 million Americans without health care. That is what this 
conversation is about: taking that 18 percent of our gross domestic 
product we spend currently and finding a way to provide good quality 
coverage to every single American--not leaving out 50 million 
Americans.
  Those are reforms that anyone can get behind. But I understand as we 
talk about other changes to how people get insurance, folks can get 
nervous. They can worry about the system changing in ways that are not 
beneficial to them. That is why I keep coming back to this point: We 
are going to provide the health care system we have for the people who 
have it, but we are going to improve it, we are going to improve it by 
making it more cost effective, so we can also provide health care to 
the 50 million who do not have coverage.
  With these reforms, our citizens will have more choices. And choice 
in health care options is good. Instead of leaving individuals and 
small groups at the mercy of insurance companies providing expensive 
plans with very high administrative costs, those individuals and those 
small businesses will be able to participate in a marketplace that 
groups them together with millions of other Americans so they can 
benefit from the larger pool of health care participants.
  This marketplace will resemble something very close to the list of 
options Federal employees have. When you become a Federal employee, you 
have an option of this plan or this plan or this plan. Well, that is 
what we are going to do. We are going to provide a list of plans 
citizens can choose from, being part of a larger pool. We are going to 
provide a list of plans small businesses can choose from and benefit 
from, being a part of a larger pool of the insured.
  This is a structure we are familiar with as Members of Congress. What 
works for Members of Congress, what works for Senators will work for 
working Americans. These plans give apples-to-apples comparisons so 
citizens can pick the plan that fits their family the best. It will 
ensure minimum standards so our workers are not ripped off, and the 
access to the marketplace will come with premium assistance so strapped 
consumers can get help affording the premiums to obtain health care.
  Given the track record of inefficiencies and cherry-picking by 
private insurers, I think it is imperative that consumers have multiple 
choices, including a public option. Public option is simply a way to 
describe what we are already providing to our seniors throughout this 
Nation: A public, organized plan, a very efficient plan.
  Administrative costs of Medicare are around 2 percent, while the 
administrative costs for the individual applicants to the health care 
system for our small businesses is 30 percent. Why not let our 
individuals, why not let our small businesses benefit from a 30-percent 
improvement in the use of the health care dollar? This public option 
would compete on a level playing field with private plans, it would 
further expand choices for consumers, it would be a tool for keeping 
costs low, and it should be a part of any package we put forward.
  One would think all of us in this room, hearing from our constituents 
in every corner of our States, would understand this whole conversation 
is about addressing one of the highest stress factors for working 
families in every part of this Nation, but there are opponents of this 
reform. My colleagues across the aisle hired a consultant, Frank Luntz, 
to prepare a plan to torpedo health care. This plan came out in April. 
This 25-page document is about how to kill any plan that is put 
forward. This goes on to say it doesn't matter what the specifics of 
the plan are, adopt language that attacks it and present it as the 
opposite of what it is. Because what this document says is that 
Americans want this health care reform, so you can't fight it head-on, 
you have to recharacterize it, reframe it.
  What does this plan that has been put out to kill health care say? It 
says: Time is on our side. If we can slow the process down, we can kill 
it. Well, all windows of opportunity are open for a certain period of 
time and then they close, so I suppose that is smart advice

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if you want to kill health care, but if you want to do something for 
the 50 million Americans without health care, then we need to move 
forward quickly with health care reform.
  This Republican document about how to kill health care says: Say the 
plan is centered around politicians. Say it is about bureaucrats. Say 
it is about Washington, DC.
  Well, I am not sure what there is about providing health care options 
to 50 million working Americans who struggle every day to address the 
cost of health care, and often end up in personal bankruptcy, and forgo 
all kinds of other opportunities so their child can go to the doctor. 
That has nothing to do with bureaucrats. That has nothing to do with 
Washington. That has everything to do with family values and 
strengthening the foundation of our families.
  This document about how to kill health care says: Bring in denial and 
horror stories from Canada or other parts of the world to suggest to 
people they will lose their relationship with their doctor; that 
somehow they will be jerked out of the arrangement they have found to 
be so satisfactory. Scare them. Scare the citizens of the United 
States.
  Well, I can tell my colleagues that what is scaring the citizens of 
the United States is they can't afford their health care, and they want 
us to do something about it. Bringing up false horror stories that have 
no bearing on the plan before us to scare our citizens and make them 
worry even more is not responsible. What is responsible is to do 
something about a broken health care system.
  This document has lots more about how to kill health care. It says: 
Take this and say this will destroy the personalized doctor-patient 
relationship. Take this and say this will create waste, fraud and 
abuse, and so on and so forth; every poll-tested set of words designed 
to decrease support and scare people into forgoing this once-in-a-
decade opportunity or pass this once-in-a-generation opportunity we 
have to change the health care system.
  One may think I am raising this document before my colleagues--this 
plan for how to kill health care--and that maybe it doesn't have any 
bearing on the real debate, but it absolutely does. These talking 
points are being echoed in this very Chamber--in this very Chamber--in 
order to kill health care.
  Let's see. Here we go: Frank Luntz's memo--that is this memo on how 
to kill health care that came out in April--it says: Talking point No. 
5: Health care denial horror stories from Canada and other countries do 
resonate, but you have to humanize them. You will notice we recommend 
the phrase ``government takeover'' rather than ``government-run'' or 
``government-controlled.'' Why? Because government takeover sounds even 
scarier.
  So what do we hear on the floor of this Chamber from our minority 
leader recently? I quote: ``Americans are concerned about a government 
takeover of health care, and for good reason.'' It goes on.
  So recognize that is a point that is coming from a document about how 
to kill health care, not a responsible debate about the plan we have in 
front of us.
  Let's take a look at another example in Frank Luntz's memo. His memo, 
talking points Nos. 3 and 4: Time is a government health care killer. 
Nothing else turns people against a government takeover of health care 
than the expectation that this plan will result in delayed and denied 
treatment. The arguments against the plan--now, note that this is about 
a plan that wasn't written; it is about any plan put forward. The 
arguments against this plan must also center around politicians, 
bureaucrats, and Washington. Note the emphasis on saying the plan will 
result in delays and denied treatment.
  What have we heard on the floor of this Chamber from the minority 
leader? We have heard recently:

       Americans don't want to be forced by bureaucrats--

  That comes right out of these talking points--

     to give up their private health care plan to be pushed into a 
     Washington-run government plan.

  Right out of those talking points. They don't want to wait 2 years 
for surgery, and they don't want to be told they are too old for 
surgery.
  All of this straight out of this roadmap.
  My friends, in the face of 50 million Americans without health care 
and with working Americans in every one of our States going bankrupt as 
they struggle with health care expenses, it is irresponsible to utilize 
a roadmap of rhetoric that comes from polling about how to scare 
people. That is irresponsible. What we need to do is lay out a plan on 
how we can create affordable, accessible health care for every single 
American, addressing one of the biggest factors that degrades the 
quality of life for our citizens across this Nation.
  We have a unique opportunity. We have an opportunity because small 
business wants help with those 26-percent increases and those 14.7-
percent increases in premiums they are having to pay and they are not 
able to continue paying them. Large businesses are asking for help to 
become cost competitive so we can restore manufacturing in our Nation 
and put people to work and rebuild the middle class and have successful 
international corporations operating out of America. Families around 
the kitchen table are asking for help today. They know how they have 
struggled. They know if they have health care they might lose it next 
week when they lose their job. They know if they have health care, they 
might not be able to make the copays if they have something serious 
happen with their child. They know if they don't have health care, they 
are going to have to forgo virtually everything else or perhaps forgo 
the treatment itself because they won't be able to afford to make those 
payments to the doctor or to the hospital.
  This is the moment when families and small businesses and large 
businesses are coming together to paint a new vision to improve the 
quality of life and to strengthen the foundation of our families. Let 
us seize this moment.
  I thank the Chair. I yield the floor.

                          ____________________