[Congressional Record (Bound Edition), Volume 155 (2009), Part 13]
[Senate]
[Pages 17388-17389]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. WYDEN. Mr. President, as the Congress focuses on health care 
reform, I wanted to take a few minutes to discuss one approach that has 
been documented by the Congressional Budget Office as producing 
significant cost savings in American health care. That approach is free 
choice and rewards for selecting health care wisely.
  Today, 85 percent of American businesses that offer health care 
coverage offer no choices. That is not because they would not like to. 
Quite the contrary; they would very much like to offer additional 
private sector choices. But for example, if you are a small 
businessperson--and I know the distinguished Senator from Alaska 
identifies with this--and you go out into that broken private insurance 
market, with huge administrative costs very often approaching 30 
percent, you can't offer choices. Without choices there can't be real 
competition and accountability in health care. As a result, costs go up 
and care for our workers and our employers and small businesses and 
others becomes less affordable.
  Some in America enjoy a better system, one where they have a full 
array of private sector health care choices. Everyone in this Chamber 
knows what that is all about because it is the system we have as 
Members of Congress. We get a menu--a menu of private health plan 
offerings. The plans that are offered to Members of Congress can't 
discriminate, for example, against someone with a preexisting illness.
  You go into a large group where you have a lot of bargaining power, 
which means you can hold down costs, and you don't face discrimination 
on the basis of age. That is particularly important because it looks as 
if under some of the approaches that are being discussed in the 
Congress there could be significant discrimination against older 
workers.
  I believe all Americans should have the opportunity to be part of a 
health care system where they have more choices, and they are in a 
position to benefit from the wise selection of those kinds of choices. 
I think that will lead to reduced costs, and I think it will lead to 
more affordable health care coverage.
  The legislation that is being developed in the Congress would not 
allow most people to have the free choice of insurance exchange plans. 
In fact, it wouldn't allow them to have free choice of health plans 
generally, whether they are in a private plan or a public plan. Without 
choice, there won't be competition to hold down costs.
  So I very much hope in the weeks ahead Democrats and Republicans 
alike will come to see what the Budget Office has documented, and that 
is free choice of an increased menu of private sector health care--
where the insurance companies can't cherry-pick, where they can't 
discriminate against someone with a preexisting illness, where people 
would go into a large group, and where you don't have older workers 
being discriminated against--will hold down skyrocketing health care 
costs and help keep quality health coverage affordable. I would hope 
Democrats and Republicans would see that kind of approach, with 
expanded choices, would help hold down health care costs and make 
health care more affordable for our people.
  The reason I have focused on this question of holding down costs, 
making coverage more affordable by expanding choices--free choice, as I 
call it--is in light of the discussion we have held this week in the 
Senate on the costs of health care reform.
  I note my friend from Utah, Senator Hatch, is here. He is someone who 
has, in my view, done so much good work on health care for children, 
for community health centers, for a variety of needs in our country. He 
and I participated in discussions, particularly in the Senate Finance 
Committee, about how to come up with additional money to expand 
coverage, particularly for the more than 45 million Americans who don't 
have coverage.
  The Finance Committee is going to continue to grapple with this 
issue, but I only wanted to talk about cost savings through free choice 
today because I believe that is what most Americans look at first.
  Most Americans feel very strongly that they want to get all our 
people covered. They know it is a disgrace

[[Page 17389]]

that, in a country as rich and strong and good as ours, that close to 
50 million people do not have coverage.
  But they are also very concerned about the idea that, when you are 
already spending $2.5 trillion annually on health care, before you go 
out and spend a trillion dollars or more to pay for expanding coverage, 
you better have a plan to save money through choice, through the kinds 
of approaches I have been talking about in order to be credible. It is 
not credible to go to the American people and say we need $1 trillion 
or more to expand coverage, expand coverage and pay this huge sum on 
top of the $2.5 trillion being spent today, unless you have an actual 
plan to hold down costs and generate savings.
  That is why I hope the Democrats and Republicans will look at how the 
Congressional Budget Office has documented that, through choice, you 
can generate significant cost savings and make health care more 
affordable.
  I am concerned that the point I have made this morning has gotten a 
bit lost as the focus this week has been on the question of paying this 
very large additional sum to finance coverage expansion. There is no 
question that at a time of soaring deficits, the Congress must pay 
attention to what it costs to pay for health reform.
  It would be fiscally irresponsible to pass health reform that is not 
paid for. But it would be equally irresponsible to pass a bill that is 
labeled health reform that fails to put a lid on the skyrocketing costs 
of our health care system. The two go hand in hand.
  So what will provide significant savings? All the experts agree that 
we need to change incentives and behavior to change how people buy and 
use their health care.
  First, show that you can generate cost savings for all Americans 
through increasing choice and rewarding those who make a wise selection 
of their coverage. That, in my view, ought to be built around what the 
Congressional Budget Office has documented, which is savings through an 
approach very much like what Members of Congress have. If you do that 
first, then you have the credibility to go back and say to the American 
people: Here are the choices in front of us for expanding coverage to 
the close to 50 million people who do not have it today.
  What I have tried to describe this morning is a way to keep faith 
with the small business owners who are across this country, from Coos 
Bay, OR, to Oyster Bay, Long Island. Let's keep faith with them by 
showing we are going to hold down costs and then also, in a bipartisan 
way, come together and grapple with the question Senator Hatch and I 
were discussing with our colleagues this week, which is how to best and 
most responsibly finance coverage for the close to 50 million Americans 
who do not have it. I believe we can do it. I believe the approach I 
have outlined this morning is one path to do it.
  I have never said, in the course of health reform debates, that it is 
my way or the highway. But I think we certainly ought to learn from the 
constructive analyses done by the Congressional Budget Office that show 
it is possible to get hard cost savings, not within a decade but within 
a matter of years, by expanding choices for our people and rewarding 
those who make a wise selection from that menu of choices.
  I yield the floor.
  Mr. HATCH. Mr. President, I note the Senator from Oregon has to read 
some things, but I have a brief additional comment to make and then I 
ask unanimous consent I be given the floor thereafter.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HATCH. Mr. President, the distinguished Senator from Oregon is 
one of the leading figures on health care in this Congress and has been 
in the past. He is thoughtful. He works very hard. He is one of the 
most contributing members of the Senate Finance Committee and I, 
personally, respect him very much and we have a very dear friendship. I 
appreciate the kind remarks he has expressed about me here today.
  Mr. WYDEN. Mr. President, I have unanimous consent requests to make. 
Before I do that, I wish to say, again, how much I appreciate the 
Senator from Utah and his involvement and particularly his leadership 
on health care issues. When you look at the array of important 
legislation that has clearly improved American health care, Senator 
Hatch's name is all over that legislation.
  Think about landmark legislation for children. It could not have 
happened without Senator Hatch. He and I have written legislation 
together. One of the accomplishments of which I am most proud is that 
we found a bipartisan way to increase coverage for community health 
centers by lowering their malpractice costs. I think it was an example 
of the way Senator Hatch approaches that kind of legislation. He 
brought together advocates of low-income people, trial lawyers, 
community health centers. Everybody said you could not find common 
ground among those kinds of organizations, and with Senator Hatch's 
leadership we were able to do it.
  I am going to make a unanimous consent request, but I wish to tell 
the Senator from Utah I am convinced this year we are going to be able 
to pass health reform. One of the reasons we are going to be able to do 
it is because of both the good will and the expertise of the Senator 
from Utah. I am very much looking forward to working with him on that.
  Mr. HATCH. I thank the distinguished Senator from Oregon and 
appreciate his remarks.
  The PRESIDING OFFICER. The Senator from Utah.

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