[Congressional Record (Bound Edition), Volume 155 (2009), Part 12]
[Senate]
[Pages 15854-15858]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. SCHUMER. Mr. President, I rise to discuss the necessity of 
including a public option in the health care legislation Congress is 
currently drafting. One of our top priorities, as we undertake health 
care reform, must be increasing competition among health insurance 
companies in order to get costs under control and give consumers better 
choices. A recent New York Times/CBS poll clearly shows that a large 
majority of the American people, 72 percent in fact, want a government-
sponsored health care option that would compete with private health 
insurance companies--72 percent.
  What is even more incredible, 50 percent of all Republicans in this 
country want a public option. There seems to be a disconnect between my 
colleagues on the other side of the aisle and even their Republican 
constituents.
  Do you know why so many Americans want a public plan? Because, 
despite what many of my colleagues on the other side of the aisle would 
have you believe, they do not believe they have affordable choices. 
Fundamentally, this is what lies at the heart of our public plan 
proposal. We want to ensure all Americans have a guaranteed affordable 
choice when it comes to health insurance. Right now, too many of them 
do not.
  In many areas of the country, one or two insurers have a stranglehold 
on the entire market, which produces costly premiums and health care 
decisions that often serve the interests of the insurer, not the 
patient. In fact, according to a study of the American Medical 
Association, 94 percent of insurance markets are highly concentrated. 
This is why a public health insurance plan is absolutely critical, to 
ensure the greatest amount of choice possible for consumers and provide 
at least one option that is patient--not profit--focused.
  When you read what percentage one insurance company or two insurance 
companies have of a market in each State, you know that robust 
competition is missing from the health care market. That is why so many 
people

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are worried about the future of the plans that they now have.
  The public plan is not about government-controlled health care, 
socialism or any of the buzz words that have been tossed around as part 
of this debate.
  I ask my colleagues, do they consider Medicare socialism? Would they 
like to abolish Medicare? Probably some of them would. But Medicare--
hello, my friends--is a government-run plan. It is very popular with 
the American people. Very few propose eliminating Medicare. So let's be 
real here. The public option is about offering Americans a choice in 
the market that, far too often, offers them none.
  I will tell you the choices too many Americans face: whether to pay 
for health insurance or health care or to pay for other necessities of 
life, because health care has become so expensive. That is not a choice 
anyone should have to make, and maybe that explains why the American 
people do not agree with the critics of the public plan.
  Half of all Americans think the government plan will provide better 
health care coverage than private insurance companies, and a 
significantly lower percentage disagree with that statement.
  Let's be clear: A public plan may not have special built-in 
advantages. It would be a coverage option that would compete on an 
equal footing alongside private insurance plans in the market for 
individual and small business coverage. If a level playing field 
exists, then private insurers will have to compete based on quality of 
care and pricing instead of just competing for the healthiest 
consumers. In this way, a public plan will accomplish many of our most 
important goals. It will not waste money on costs incidental to 
providing health care. It will not focus on profits at the expense of 
the best health outcomes. Instead, it will spend money on improving 
health delivery and on trying innovative technologies and systems in 
order to save, save money. It will force many insurers that have been 
shielded and protected from competition for far too long to compete 
with a plan that provides comprehensive care at an affordable rate. It 
will, most importantly, give all Americans a choice. In fact, I think 
the thing that really scares opponents of the public option is choice, 
that Americans might actually choose the public plan over the plan of 
private insurance companies, because then the curtain might be pulled 
back on their friends at the insurance companies and Americans will 
finally see the hidden costs that have caused their premiums to 
skyrocket, the wasteful spending that does not improve health outcomes 
but fattens bottom lines, and the protection from competition that has 
been offered to private insurers over the last decade.
  To truly reform our health care system, Congress must pass 
legislation that includes a public option. A figleaf public plan is no 
plan at all, and I will not settle for such a figleaf.
  It is important to remember how we arrived here. For a long time, 
when thinking hypothetically about health care reform, many in this 
country suggested that we move to a single-payer option.
  The PRESIDING OFFICER (Mr. Udall of Colorado.) I would note that the 
Senator has used 10 minutes.
  Mr. SCHUMER. I ask unanimous consent that I be given 5 additional 
minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SCHUMER. The Republicans rejected the single-payer plan. So at 
the onset of this debate, we met them halfway with a framework that 
continues to largely rely on private insurers. So then we said: If we 
are going to continue to rely mostly on private insurance, can we at 
least introduce greater competition into the market by having a public 
plan as one option? The Republicans--most, at least; just about all, I 
think--rejected that too. We said: Well, what if we ensured that the 
public plan had to adhere to the same rules as private insurers, thus 
guaranteeing a level playing field? The Republicans here in the 
Senate--not in the country but the Republicans here in the Senate--
still said no to even a level playing field.
  So some Democrats came up with a new idea: What if we relied on a co-
op model that has served rural States well? In a good-faith attempt to 
consider this idea, I proposed some ideas for ensuring that co-ops 
could do the job of keeping private insurers honest. Yesterday, Senator 
Conrad indicated he could go along with many of these proposals. But 
Senator Conrad has never been the problem here. He has been well open 
to negotiating on how to make a co-op plan have the kind of clout to go 
up against private insurance companies, be available to all Americans, 
be able to bargain with the providers, and be ready to go on day one to 
compete with the large nationwide insurance companies. Senator Conrad 
has always been willing to entertain all of that. He has been a good-
faith negotiator with the best interests at heart. It has been those on 
the other side of the aisle who have not been willing to negotiate. So 
I am losing confidence that Senate Republicans will ever agree to the 
types of changes to a co-op to make it a viable alternative, a viable 
substitute to a traditional public plan that is nationwide and 
available to everybody, that can go up against the private insurers and 
go up against the suppliers in buying power, that is formulated so that 
it hits the ground running on day one of the insurance exchange.
  We can only bend so much to try to win over opponents of health care 
reform. We cannot bend so far that we break. We cannot say we are 
putting something else out there and not have it do the job because a 
public option is what really does the job. We must not let the 
scaremongering about the possible consequences of a public option deter 
us from doing what the American people overwhelmingly want and need. It 
is time to put the health needs of the American people, not the 
insurance companies, first. It is time to move past the partisan 
bickering and make sure the health care reform passed by Congress 
includes a real public option. It is the right thing, it is the smart 
thing, and it is what the American people want and what they deserve.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from South Carolina
  Mr. DeMINT. Mr. President, I ask unanimous consent to speak for 15 
minutes as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DeMINT. Mr. President, it seems that you are always stuck with 
listening to me. I apologize for that.
  I wish to respond to my colleagues' grand design of our new health 
care system in just a moment, but I would like to back up a little bit 
and discuss health care and some other things in context.
  There is no question in anyone's mind that these are difficult times 
for America. Millions are unemployed, and the unemployment rate 
continues to climb. Our economy has been in decline for a number of 
months. Our military is strained all around the world at a time when 
our enemies seem to be gaining strength and increasing in numbers. Back 
here at home, our spending and borrowing and debt are out of control, 
and this massive government spending plan we call the stimulus has yet 
to show any results. We see government intervention in many areas of 
our economy--in the banks, financial markets, the takeover of Fannie 
Mae and Freddie Mac, the takeover of large insurance companies, our 
auto industry. People back home and all around the country are alarmed. 
As I heard someone say last week as they tried to explain their alarm 
to me, they threw up their hands and they just said, ``I am outraged 
out.'' They could not speak anymore.
  My question for my colleagues today is, Is this a good time to create 
another government program? The answer on the other side has obviously 
been yes. Yesterday, they all voted, I believe, to get the Federal 
Government in the tourism business, to close off debate and pass a plan 
that would get the Federal Government to promote tourism in America all 
over the world. I think it is like $400 million--in today's terms, a 
small amount of money. But

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the tourism industry, while hurting because of the economy, is 
certainly not in collapse, in need of a government bailout. The tourism 
industry spent billions of dollars on advertising last year.
  It is not as if the rest of the world does not know we are here. The 
problem with tourism in America can be laid at the feet of an inept 
government. If you ask people abroad why they are not coming here in 
such numbers as they have in the past, we find the statistics show that 
we are the most unwelcoming at our Customs office, in the lines to get 
through to America. If you want to have a business convention or trade 
show in America, it is very likely you cannot get the visas for your 
customers to come here, so many of these conventions and trade shows 
have had to move overseas.
  The problem with getting people here is in what the government is not 
doing well. We don't need to get the government in the tourism 
business. I have plants back home, such as BMW, that would like to 
bring people from their headquarters in Germany over here to train the 
American workforce, but they found it is easier just to send our people 
over there because it is so hard to get their people to come here. They 
could come here and stay in our hotels, eat at our restaurants, and 
improve our economy. But instead an inept government causes us to send 
Americans to stay in their hotels, eat in their restaurants, and rent 
their cars.
  It is illogical for us to create a Federal tourism agency, a la 
Fannie Mae, a new government-sponsored entity that is going to help 
promote tourism, but it is this same kind of logic we are now using for 
health care. We are saying we have a crisis in health care, so 
therefore the government needs to get more involved and to take over 
various aspects of the health care industry, such as was just described 
by my colleague from New York. But if we look at this situation a 
little more clearly, we will see that it is the government that is 
causing most of our problems and not allowing the free market health 
care system to work.
  Let's look at this a little bit closer because there was a whole lot 
of misinformation that was just shared on the floor here today. Let's 
look at health care coverage in America. You have about 60 percent now 
who are in employer-sponsored plans and almost another 10 percent who 
have purchased their own insurance on the individual market. So we have 
about 70 percent of people with private insurance. You have about 25 
percent Medicare-Medicaid and another 4 percent or so who are in 
military plans on the government side. So you have between 25 and 30 
percent of Americans who are now in a government health plan. And my 
colleague from New York was just bragging about how well the government 
health plans work in Medicare. Certainly, if you have Medicare and you 
can get a doctor to see you, it works just fine. But the problem is, 
every dollar that has come in from Medicare since its inception has 
been spent. The 2.5 precent that comes out of every paycheck has not 
been saved for our senior citizens, to pay for their health care; it 
has been spent and there is absolutely no money in the system to take 
care of America's baby boomers. This works like a government plan my 
colleague was just bragging about. It has trillions of dollars of 
unfunded debt that will fall on the heads of our children and 
grandchildren, trillions of dollars that we have no idea how we are 
going to pay for. And Medicare is hopelessly in debt at the State and 
the Federal level.
  But even worse is this problem. And let's keep looking at government 
versus the private plans. I think most people in America would believe 
the best situation now in health care is to have a health insurance 
policy so you can pick your own doctor and decide with your doctor what 
kind of health care you are going to get. No plan is perfect. There are 
always problems in health care. It is very complex. But you have here 
about 70 percent of people who are in that situation, but every year 
their insurance costs more money.
  My colleague was saying that is caused by private insurance, but 
let's find out the truth. Every year, these government plans pay 
physicians and hospitals less. They pay a physician less than their 
costs to see a patient. And I have doctors I know back in South 
Carolina and rural areas. They have to close their practice to new 
Medicare and Medicaid patients because once over 60 percent of their 
patients are Medicaid or Medicare, they can no longer make a living. 
That is happening all over the country. But you know how these costs 
are picked up. The hospitals and doctors who take Medicare and Medicaid 
have to charge private insurers more money every year because every 
year the government pays doctors less. That is why fewer and fewer of 
our best and brightest students are going to medical school and that is 
why we are headed for a real physician shortage in this country--not 
because of private health insurance but because of government plans.
  We have about 16 percent who have no coverage in our country today. 
Those are the ones whom we say we are concerned with right now. The 
government requires hospitals to provide them service whether they have 
any insurance or money anyway, and where do these costs go? They are 
transferred to those who have private insurance. So every year the 
inept government is transferring huge amounts of costs over to those 
employers and those individuals who are buying private health 
insurance.
  My colleagues are trying to say that the private market is what is 
failing us and we need to expand this part of the health care market--
the part that is not paying doctors and hospitals to see patients, the 
part that is trillions of dollars in debt, and the part that is already 
beginning to ration health care for those who are under those plans.
  If you want to know how the public option is going to work, I 
encourage you to drop by a Social Security office, take a number, and 
sit down and wait for them to get to you, or maybe go to a veterans 
hospital or another government service. Do we really want the 
government involved with health care? Health care is the most personal 
and private service we have as Americans. Do we want to turn health 
care over to the most impersonal, the most bureaucratic, the most 
wasteful and, in many cases, the most corrupt aspect of our society?
  What we do need to do is look at how we can get these private plans 
in the hands of those who have no insurance. That is something we can 
do and we can do it for a lot less than the current administration is 
talking about. But before we talk about how we are going to get these 
people insured, let's look at who they are, because this is being 
misrepresented to exaggerate the problem, to create a crisis so we can 
justify another government takeover of another area of our economy.
  We say we have about 46 million uninsured in America. Here is how 
that breaks down. We have about 6.4 million who actually have Medicaid 
today, but they are undercounted in the census. This has been proven 
and we know it to be true. We have another 4.3 million who are eligible 
for Medicaid or SCHIP or another government program, but they haven't 
signed up for it. We need to make more of an effort to get people to 
sign up for the programs they are eligible for. We have about 9.3 
million who are noncitizens, many of whom are illegal in this country, 
and the taxpayer should not be paying for their health care. We have 
about 10 percent who have incomes of 300 percent or more over poverty 
and they are not buying health care. I have had some of those work for 
me when I was in business. I would offer to pay for most of their 
insurance. I would pay $500 a month, they would pay $50. Some people 
turn it down because they don't want to pay $50. There are some people 
who don't want to buy insurance. We have some people between 18 and 34 
years old without insurance, and we have 10.6 million who are 
uninsured. If we look at this, at least half of these should not be 
subsidized by any type of government plan who are not already eligible 
for a plan or not citizens of our country. We could look at 20 million 
to 25 million.
  I want to make clear that if there is one person in America who 
doesn't

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have access to good health care, that is a crisis to them, and we need 
to do everything we can to make sure we are fair and that affordable 
health care policies are available to every American. That is my goal. 
That is the goal of the Republican Party.
  This week--this afternoon, as a matter of fact--I am going to 
introduce a plan that will solve the problem at a fraction of the cost 
of what the Democrats and President Obama are proposing. In various 
ways, their plan is to expand the government option, whether it is a 
government health plan or a government-mandated plan on the private 
insurance market. One way or another, they want to expand government 
rather than expand private insurance. I know this for a fact.
  This is my fifth year in the Senate. I have introduced a lot of 
resolutions that would help these people get insurance, and every time 
my Democratic colleagues have voted it down. We have had proposals for 
association health plans that would allow small businesses to come 
together and buy insurance at a lower price to offer their employees. 
They voted it down. I had a proposal I introduced called Health Care 
Choice that would do what my colleague from New York was talking about, 
which is break up that single State monopoly of a few health care 
plans. My plan would allow Americans to buy health insurance from any 
State in the country. Wherever a plan is registered, certified by that 
State, someone in South Carolina could buy it from Arizona or Colorado, 
and that is how most industries work in America. If I want to go across 
the line and buy a car in North Carolina, I am not prohibited to do 
that, but I can't do it if it is a health insurance plan. So we allow 
these quasi-monopolies to develop in every State. I have introduced a 
plan that would allow Americans the freedom to buy health insurance 
from any State in the country, and to a person the Democrats voted it 
down.
  I have introduced a plan that would allow people to use what they 
have in a health savings account to pay for health insurance premiums. 
Common sense, right? They voted it down.
  The fact is this: The people who want to expand the government option 
do not want these people to have private insurance, because they 
believe in government and they do not believe the private market can 
keep itself accountable. But the problems we have with the private 
market now can be attributed, to a large degree, to the government not 
paying its share of the costs, to the government having policies that 
keep quasi-monopolies in every State.
  I have had a proposal that would allow individuals to deduct the cost 
of their health insurance, just as we allow employers. The Democrats to 
a person voted it down.
  Folks, we don't have to look far to understand what is going on. The 
people who like taking over General Motors and Fannie Mae and Freddie 
Mac want these government health plans to be expanded all the way 
around this circle. This is something we have to stop. We can do it 
very simply if we use fairness and freedom.
  My plea to all Americans, and particularly my colleagues, is before 
we give up on freedom in the health care area, let's let it work. That 
is what my proposal is.
  This afternoon I am going to introduce a plan that tells every 
American: If you like the plan you have, whether it be Medicare or 
Medicaid or an employer plan or a military plan, you keep it; we are 
not going to mess with it. But if you have no coverage at all, or if 
you are buying your policy on your own on the open market, we are going 
to, for the first time, treat you fairly and give you the same tax 
break we give the people in the employer-sponsored plan.
  This plan does this: If you are a family, we are going to give you a 
certificate for $5,000 to buy health insurance. If you are an 
individual, we will give you $2,000 a year to buy health insurance. 
Some will scream and say, Oh, you can't get a good policy for that, and 
you can, because I have bought it for my adult children who aged out of 
my plan.
  My plan also includes the option for an individual to buy health 
insurance in any State so we will increase competition and lower the 
prices. The plan also allows an employer to put money in a health 
savings account for you that you can use to pay for your health care or 
to pay the premium to support you to buy additional coverage with your 
health insurance. We have a provision that deals with lawsuit abuse, 
and we have a provision that funds high-risk pools for States so people 
who have high-risk conditions, uninsurable conditions, preexisting 
conditions, can buy insurance they can afford at the State level.
  The estimates are by the Heritage Foundation that within 5 years, 
more than 20 million of these uninsured--most of them--will have 
private insurance plans, because they can't use their health care 
certificate unless they use it to buy health insurance.
  I would ask my colleagues this: If we had the option to get everyone 
in an individual or employer plan or expand these government plans, 
which aren't paying their way, which are transferring costs to other 
people, and which are hopelessly in debt, which way do we go? But we 
can fund my plan without one additional dollar of taxpayer money. The 
estimates are over the next 10 years, getting these people insured with 
private policies, giving them a $5,000 a year health care certificate, 
will cost about $700 billion. If that number sounds familiar, that is 
about how much money we have outstanding with the bailout money we call 
TARP here in this Congress. Instead of them bringing this money back 
and spending it on something else, my proposal pays for my plan by 
recapturing this TARP money. So as this bailout money comes back over 
the next 5 years, it can pay to give every American access to a plan 
they can afford and own and keep. It is basically no additional cost to 
the taxpayer at this point over what we are already committed for, for 
the bailout.
  The choice belongs to Americans. Are we going to buy this idea that a 
government option is going to give us more choice, more quality, more 
personal attention? Will it attract more physicians into the 
profession? Any thinking American knows that isn't going to happen. The 
ideal plans now are those when individuals have a plan they own and can 
keep, they pick their own doctor, and the doctor and the patient decide 
what health care they are going to get. This is within our reach. We 
don't need a massive government takeover of health care in order to 
make health care accessible to every American. Let's not buy this idea 
that we are in such a crisis that we have to rush over the next couple 
of months to create another government program, another government 
takeover, when we see what happens to government-run health plans right 
in front of our eyes. It won't work. We can't afford it. They are going 
to end up rationing care. They are going to take employer plans, 
irrespective of what they say--if you have a low-cost government option 
that doesn't pay doctors enough to see you, you are going to see 
insurers dropping their health plans and you are going to end up in the 
lap of government whether you like it or not.
  Let's not give up on freedom. Let's look at the facts. Have we seen 
any government program, over your lifetime or mine, that has actually 
done what it said it was going to do at the cost it said it would be 
done at? My colleagues know that is not true.
  Social Security is so important to seniors, and a promise we must 
keep. It is hopelessly in debt, because this government has spent every 
dime Americans have put in it, and there is not a dime in the Social 
Security account to pay future benefits. The same with Medicare--
trillions of dollars. This is a commonsense solution that every 
American can see, if we don't listen to the misrepresentations we are 
starting to hear in this body. Every American with a policy they can 
afford and own and keep is available to us, within our reach, without 
any government takeover of health care. We just have to believe that 
what made America great can make health care work, and that is freedom.
  Mr. President, I yield the floor and note the absence of a quorum.

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  Mr. CORNYN. Mr. President, would the Senator withhold the quorum 
call?
  Mr. DeMINT. I withhold.
  The PRESIDING OFFICER. The Senator from Texas.

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