[Congressional Record (Bound Edition), Volume 155 (2009), Part 13]
[House]
[Pages 17901-17908]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   URGENT NEED FOR HEALTH CARE REFORM

  The SPEAKER pro tempore (Mr. Donnelly of Indiana). Under the 
Speaker's announced policy of January 6, 2009, the gentleman from 
Connecticut (Mr. Murphy) is recognized for 60 minutes as the designee 
of the majority leader.
  Mr. MURPHY of Connecticut. I thank Speaker Pelosi and my colleagues 
for allowing us to come down for the next hour or so and speak to you. 
We're doing a joint hour. Occasionally, those of us who are pushing for 
health care reform to happen for our constituents this year have come 
down to the floor to share our thoughts about the urgent need for 
reform.
  We're sharing this hour with the 30-something Working Group, which 
I'm honored to be a part of. And I know our hope is that, at the very 
least, Representative Ryan will be able to join us later this evening 
as part of this hour.
  But we are here to focus our thoughts and our energies and to talk to 
our colleagues about the need to pass real comprehensive health care 
reform for this country and for our constituents. We know what the 
problem is out there because when we're out there at our town halls, 
when we're setting up our office hours at the supermarket or the 
grocery store, it's our constituents that are coming to us and telling 
us about the fact that they just can't afford this health care system 
any longer.
  If you're lucky enough to have insurance, you've seen your family 
have to pick up more and more of the share. As the cost of health care 
goes up for businesses, they're passing more of it along to individual 
consumers.
  So now, if you're a family of four out there, you're likely to be 
spending $3,000 to $5,000, at least, on health care, even when you have 
insurance. Your deductible now is in the thousands of dollars rather 
than in the hundreds of dollars.
  That copay that you have to bring with you to the doctor's office now 
isn't $5 or $10; it's $100 or $150. Those drugs that used to only cost 
you $5 or $10 when you showed up, well, if it's in the wrong tier of 
drug, you may be paying 50 to 70 percent of the cost of that drug.
  If you're a senior citizen and you happen to find yourself in the 
dreaded doughnut hole, not only are you paying the full cost of those 
drugs, and potentially bankrupting yourself in the process, but you're 
paying the highest prices in the entire health care market when you 
show up at the drug store.
  You're paying more than the Federal Government pays for that drug. 
You're paying more than Blue Cross/Blue Shield pays for that drug. 
You're paying through the nose for it.
  This health care system is broken. It's broken because the people 
that got it just can't afford it any longer.
  Now, much of the cost is very visible to people. That cost that you 
now bear as an employee, that you didn't used to have to pay, that 
increased deductible or that copay, that hurt is felt. We're feeling it 
for you because we're hearing those stories increasingly about people 
that just can't come up with the money to pay that high deductible, 
people that just don't have the cash to fill in the drug company 
doughnut hole. That hurt is visible and real for our constituents.
  But there is an invisible pain. There is an unseen hurt that we need 
to talk about here on this floor because there are a lot of businesses 
that are passing along the cost of health care, but there are also a 
lot of businesses that are eating the cost of health care, that don't 
want to have a high-deductible plan for their employees. So what they 
do is they pay it instead.
  The business decides that they will pay the 10 percent increase in 
premiums, but it just means that their

[[Page 17902]]

employees don't get a wage increase that year. Or when they were 
supposed to get a 5 percent bump up, they only get a 2 percent bump up.
  There are millions, millions of employees in this country who should 
be making more in take-home wages but aren't because the businesses 
that they work for are paying more in health care costs than they ever 
have before.
  Now that's just not me talking; that's just not anecdotes I hear from 
the business owners and the employees in my district. That's data. 
That's data that shows that over the last 10 years the premiums charged 
to employers from health care insurance companies have risen by 120 
percent during the last 10 years--120 percent jump. More than double--a 
more than doubling of health care premiums charged to businesses.
  During that same time, average wages have grown by only about 20 or 
30 percent. During that same time, wages have grown at less than the 
overall rate of inflation. Guess what? That's because of the cost of 
health care eating into the money that people take home from their 
paychecks.
  Lastly, the invisible cost comes here. Guess what, Mr. Speaker and my 
colleagues? We've got a system of universal health care in this 
country. We're not inventing a system of universal health care. We've 
got one now. It's just the most inhumane, most unconscionable, most 
inefficient universal health care system in the world because our 
Federal law guarantees you health care, but only until you get so sick, 
you get so crippled, that you get so desperate that you as an uninsured 
individual have to show up to the emergency room. And so you get care, 
but it's too late.
  It's the most expensive, most inefficient way of delivering universal 
health care. There is a cost to that, because when that individual who 
could have just gotten a prescription to cover their growing infection 
and instead lets it get to such an extent and such a degree of severity 
that they have to show up at the emergency room and they have to have 
major surgery to cure that festering illness and infection, there's a 
cost to that of 10 to 20 times what the cost of the preventative 
service might have been.
  That cost doesn't just sort of evaporate in the air. It doesn't 
disappear into the ether. It's real. It's substantive. The hospital 
picks up that cost and forces private insurers to reimburse them more 
to help them cover the costs of the uninsured. Charges some of it back 
to the government. Every taxpayer in this country, a portion of your 
tax dollars that you send to the Federal and State government goes to 
hospitals and emergency rooms to cover the cost of all those 50 million 
people that walk in without insurance.
  So there are costs all throughout the system, both visible and 
invisible, that we cannot sustain. And so we've come down here to the 
House floor today to not just focus on the problem--I think you've got 
to talk about the disease in order to get a diagnosis--but to talk 
about the fact that for the first time in almost a generation we are on 
the verge as a United States Congress of rising to the massive 
challenge that confronts our health care system.
  We are on the precipice of passing real health care reform that 
lowers the cost of health care for everybody in the system whether 
you're an individual paying it or you're a business having to bear the 
burden of the cost, and at the same time makes the system more fair for 
people right now that are paying more for health care just because they 
happen to be sicker than somebody else; for those millions of people 
who can't find health care in the first place because they happen to 
have a preexisting condition.
  For all those senior citizens out there who are trying to decide 
between 20 different plans that the difference can only be deciphered 
in the fine print of the paperwork that they send you in the mail, 
we're going to make this system more transparent, we're going to make 
it more fair, we're going to give people more choice. And by doing 
that, we're going to lower the cost of the American health care system 
for everybody so that those very visible costs that are holding 
families back are controlled and those invisible costs that too often 
aren't seen by wage earners or by taxpayers disappear over time.

                              {time}  1930

  So I'm really glad to be down here this evening. I see Representative 
Speier's joined us, so I'd love to hear from her as well. We're going 
to be joined later on, I know, by Representative Ryan and others to 
focus some attention on this problem of health care and the approach 
that we're going to take in this House. So I'd love to have 
Representative Speier from California join us to talk a little bit more 
about the challenges that we confront and some of the solutions that we 
put forth.
  Ms. SPEIER. Well, thank you to the gentleman from Connecticut. I want 
to thank you for your leadership and for your comments because this 
issue can't wait. I think we know that better than most.
  But tonight what I would like to do is talk to the 80 percent of 
Americans who have health insurance, who basically ask, Well, why 
should I care about health care reform? I have health insurance. And to 
the 80 percent of Americans who do have health insurance, I have a few 
things to tell them.
  Right now, for all of us that have health insurance, we are in a 
position of paying for those that don't have health insurance. It's 
called cost shifting. So for the premiums that we pay, part of each 
premium is actually paying for the uninsured. It's called cost 
shifting. And it's estimated that every American family pays $1,100 per 
year for the uninsured.
  So, for instance, you go into the ER with a broken ankle, you get 
health care. The uninsured person goes into the ER for that same broken 
ankle, they get health care because we have a Federal law that requires 
that all people get health care when they return to the emergency room. 
But we pay $2,000 for that broken ankle, not because it costs $2,000, 
but because the individual who came in with no health insurance didn't 
pay. And that's where the cost shifting takes place.
  So with health care reform, it's going to be much like many States in 
the country have as it relates to auto insurance. There's a mandate for 
auto insurance, and now we're going to mandate that every American have 
health insurance. And for those who can pay, they will pay. And for 
those that can't pay, we will help them pay.
  Now, the next question I want to answer is why is health care so 
expensive.
  Currently, the United States pays twice as much as any other 
industrialized country in the world for health care; $6,700 for every 
man, woman, and child. Now, compare that to what's paid in Germany or 
Canada, where it's $3,000. Or take the country of Japan, where it's 
$2,500. And the cost of living in Japan is just as high as it is here 
in America.
  Now, the conventional wisdom would suggest that, well, our health 
care is more expensive because our outcomes are better. You get better 
care if you pay more money. Well, that's simply not true. The U.S. 
ranks first in unnecessary deaths among the 19 industrialized nations.
  Now, let me repeat that. The U.S. ranks first among--the most 
unnecessary deaths that take place as a result of a lack of health 
care. In fact, the number is pretty staggering. It's like 22,000 
Americans will die this year for lack of access to health care.
  We waste a lot of money on health care spending. Recent estimates are 
that one-third of the care provided in this country, to the tune of 
some $700 billion, doesn't improve anyone's health. Now, if a third of 
the care that's being provided isn't providing additional health care, 
then it's wasteful spending. And when they talk about $700 billion of 
wasteful spending, it's time for all of us to sit up and think, wait a 
minute. What's really going on here?
  And 20 percent of the health insurance premium goes for overhead and 
profits. Now, when I tell you that in 1994 only 4 percent of the health 
care premium went for profits and overhead, you've got to scratch your 
head and ask, how did we go from 4 percent in 1994 in overhead and 
profits to 20 percent in 2009?

[[Page 17903]]

  Next question that I want to answer is how does this health care 
reform make it safer for me.
  I want to tell you a dirty little secret. It's a dirty little secret 
about health care that no one wants to talk about, and it's about 
medical errors, and we have known about it for decades. The Institute 
of Medicine put out a report that said there are 100,000 deaths in 
America every year because of medical errors; 100,000 deaths.
  Now, I'm going to talk about a specific bacteria infection that 
people get typically in the hospital. It's called Methicillin-resistant 
Staphylococcus aureus. Now we say MRSA for short. Now, the MRSA 
infection rate is growing by leaps and bounds. In fact, there's 100,000 
cases of MRSA a year. Two-thirds of those people that get that 
infection get it in the hospital setting.
  Now, of the 100,000 people that will get a MRSA infection, 19,000 of 
them will die because of that infection. Now, that's a stunning figure.
  If there was a 747 that crashed in the United States every week, 
that's the equivalent of 19,000 deaths. And if there was a 747 that 
crashed every week in America, we wouldn't tolerate it. We'd call on 
the FAA. We'd call on the airlines. We would stop it. But we've done 
very little to stop the spread of MRSA in hospital settings.
  Now, this health care reform bill takes an important step, not a full 
step. It doesn't go all the way, but it does now require that hospitals 
will have to report their hospital-acquired infections.
  What we need to do, furthermore, is put the protocols in place so 
that we can stop these infections from occurring and we can stop the 
deaths as well.
  Now, the last thing I want to talk about is something that not 
everyone is necessarily familiar with if you're in a group health 
setting, and it's called a preexisting condition. If you're in a group 
health setting, it doesn't matter if you have a preexisting condition. 
You are covered. But if you're in the individual market and have a 
preexisting condition, good luck.
  And I'd like to show you these health care horror stories, 
preexisting conditions. These are the types of preexisting conditions 
that can prevent you from getting health insurance in this country. 
Depression, sprained ankle. How about a misdiagnosis for bipolar 
disorder?
  This is an actual case. A young woman was given a bad diagnosis. Her 
doctor confirmed that she never should have been diagnosed; yet, when 
applying for individual insurance, she was denied due to her 
psychological history, even though it was a misdiagnosis.
  Well, look down that list. Diabetes, gallstones, anxiety, stress. How 
about tested for multiple sclerosis? Not that you have multiple 
sclerosis, but that you were tested for it becomes a preexisting 
condition and you can be denied health insurance in the individual 
market.
  Let's move down to bunions. How about too thin or too heavy? How 
about too healthy?
  Believe it or not, this was a reason given to a gentleman for not 
giving him health care. In Florida, he sought insurance in the 
individual market because he was working for an architectural firm that 
didn't offer it. He'd been healthy all his life. He'd never been to the 
doctor. He did all the right things. He was a health nut and stayed in 
shape. And so when he went shopping and he was declined coverage, it 
was because there was a ``lack of current medical records.'' Now, he 
explained that he didn't have any medical records because he hadn't 
been to a doctor because he's been healthy. But for that reason, 
because he was too healthy, he was declined health insurance.
  I had a story that just came into my office today. It's a family in 
my district, and they called because they were concerned. They have 
twin sons. One of their sons just had a dislocated shoulder from an 
athletic event. Not unusual. But because he had that dislocated 
shoulder, they had been told by their health care insurer that they 
will now exclude coverage for any shoulder injuries for both sons, even 
though the twin brother was not engaged in the athletic activity and 
didn't dislocate his shoulder.
  So, health care reform makes preexisting conditions a thing of the 
past. All of this would be wiped away. All of these horror stories 
would be gone. Americans could breathe a sigh of relief that now, no 
matter what your ailment, and believe me, all of us have a preexisting 
condition of one sort or another; it just hasn't been tested because 
we've been in the group health market. But all of us will be able to 
access health care and health insurance through the health care reform 
proposal.
  You know, much like you, I came to Congress to make this country a 
better place. With real health care reform, I believe we'll have an 
opportunity to do just that.
  Thank you. I yield back.
  Mr. MURPHY of Connecticut. Thank you very much, Representative 
Speier. Thank you for drawing attention to what this reform effort that 
we're talking about here tonight means, not just to these people that 
you're talking about that have been denied coverage for preexisting 
conditions, but what it means to all the folks that have insurance out 
there.
  If I had a dime for every person I've run into that has talked to me 
about the fact that, you know what, they're not really happy in the job 
that they're in. They want to go do something else, or that they really 
have a great idea, a business that just has been germinating in their 
mind and they want to go out and start it, but they can't leave their 
current job. They can't go out and start that business because they're 
going to lose their health care because their daughter is sick and 
they've got some health care for her now, but if he leaves or she 
leaves and goes out and does what they really want to do with their 
life, or starts that small business, that they're going to lose that 
health care coverage. There are millions of Americans who have health 
care today and are trapped, are trapped in their job, are trapped in 
their place of employment, because they can't dare lose the coverage 
that they have.
  Now, in the most powerful country in the world, in the beacon of 
freedom from around this globe, that kind of servitude to your 
employer, just because you have insurance that you can't leave, just 
doesn't seem right.
  But it also is just absolutely silly economic policy. Think of all of 
the innovation that we're stifling. Think of all of the great 
entrepreneurs who never get to go out and invent, who never get to 
start that business because they can't leave the insurance that they 
have. So this really is fundamentally about trying to make health care 
for those that have it more meaningful, more real, but also more 
flexible. And I thank you for drawing attention to this issue.
  Well, we are blessed to have with us on the floor Representative 
Ryan. We were talking earlier. This is kind of a hybrid health care 
hour/30-Something hour, and one of the things we're talking about here, 
Mr. Ryan, is that this is hard; right? This is a big problem. We've got 
one the most confusing, most complicated health care systems in the 
world, and we're going to take on a very complex and convoluted system 
at a lot of different angles.
  So the bill that is going to come out is going to be big. It's going 
to have a lot of pages to it, because in order to tackle a really 
complicated and confusing health care system, you have to have the guts 
to think big. You've got to take on all of the various problems that 
have been created in this system, whether it be high cost health plans, 
preexisting condition exclusions, post-claims underwriting, all of the 
various tricks of the trade that insurers and others have used to try 
to make money and exclude people we've got to take on and do things 
with.
  But it also makes it really easy for folks who are critical of health 
care to just sit back and say, Well, what you're proposing isn't any 
good, and we're just going to sit back and criticize rather than 
propose alternatives. And that seems to be the dynamic once again 
that's playing out on this floor, that

[[Page 17904]]

the Democrats are going to offer real solutions, real opportunities for 
this country to move forward on health care, and we're going to be met 
with opposition that defends the status quo and really doesn't offer 
alternatives. So we're here tonight to----
  Mr. RYAN of Ohio. Will the gentleman yield?
  Mr. MURPHY of Connecticut. Absolutely.
  Mr. RYAN of Ohio. Because we have, hot off the presses here, a copy 
of and a chart of the Republican health care plan. And it has been the 
Republican health care plan for a good many years now, and it will 
continue to be the Republican health care plan, and it looks very 
similar to the Republican energy plan. Not quite sure exactly what it 
is. Lots of question marks. No real solutions for the American people. 
And as you, I think, articulated a few minutes ago, this is a major 
issue for real people all over the country, for people who have lost 
their jobs because of the downturn in the economy, for people who come 
from communities who have been dealing with the global restructuring, 
with the loss of manufacturing jobs.

                              {time}  1945

  Many people from my district for the last 30 years, whether they were 
in the rubber industry in Akron or in the steel industry in Youngstown 
or in the auto industry in Warren, have had to deal with this 
tumultuous change in our economy. This is prior to Wall Street's 
pulling the rug out from the national and, really, from the global 
economy, and this is prior to the bad policies over the past, you know, 
8 to 10 years that our friends on the other side have consistently 
pushed.
  You know, from a lot of the people who do have some criticism, maybe, 
for what's going on, I don't hear anyone saying the answer is to cut 
taxes for the top 1 percent and to get defense spending kicking. We've 
been doing that. Prior to the Democrats' coming into office a couple of 
years ago in the House and then prior to President Obama's getting 
elected, we had a policy where there were tax breaks for the top 1 
percent, and they were supposed to invest all of that money into our 
economy. It never really happened.
  I think what happened over the course of the last couple of years was 
that the Reaganomics--supply side economics--cut taxes for the 
wealthiest and then hoped the crumbs fell somewhere in Youngstown, 
Ohio, for some of the workers to maybe get a bite of. It has not 
worked. With the deregulation of Wall Street, we saw what happened 
there. It has caused a global recession almost to the likes of the 
Great Depression. The only things I feel are saving this from being a 
Great Depression are the Great Depression programs--unemployment 
insurance, Medicaid, Medicare, Social Security, the Pension Benefit 
Guaranty Corporation, and the health care tax credit that we increased 
from 65 percent to 80 percent in the stimulus bill. Those are the only 
things preventing people from being on the streets. They've lost their 
homes, and they have no health care. If it weren't for these basic 
safety nets that we've set up, there would be cheese lines again. Let's 
be honest about it. No one wants to admit it.
  So what we are trying to do here with energy, quite frankly, and now 
with health care, is to shift what's going on in our country. It has 
taken us a long time. Since 1980 this supply-side economic policy has 
been happening. What we are trying to do is to shift 30 years of this 
nonsense that has been implemented and to restructure our country, to 
unleash the power, as Mr. Murphy stated earlier, of the American 
people. Those people in our districts who don't have health care or who 
have lost their jobs and who are scared in America need to be helped. I 
make no bones about it, and I don't think anyone else does, because the 
top 1 percent has been fine. They will be fine.
  What we are trying to do is to restructure the system. We are trying 
to take health care as it currently is, Mr. Speaker, and squeeze the 
fat out of it, squeeze the special interests out of it, take the 
savings to help cover everyone, and invest at the front end by making 
sure that we don't have co-pays for preventative care, to make sure 
that no one will lose their insurance or will have to go bankrupt 
because of their health care issues. To me, this is basic common sense.
  The security for the American people is what we are looking for so 
that they can confidently go about their business, so that they can 
create wealth, take chances and be entrepreneurs. That's what this is 
all about.
  If you take these two pieces of legislation, the health care and the 
energy, you are talking about unleashing the potential, the innovation, 
the entrepreneurship, the talent, the intellect, and the skill of the 
American people.
  Mr. MURPHY of Connecticut. Will the gentleman yield?
  Mr. RYAN of Ohio. I would be happy to yield.
  Mr. MURPHY of Connecticut. Let me go back to a number that I used at 
the outset of this hour.
  Over the last 10 years, a time during which the Republicans had 
control of this House and the Senate and during which the Republicans 
had control of the White House, the employers in my district saw health 
care costs go up by 120 percent. Now, they've had a lot of things 
increase during that time. Frankly, Mr. Ryan, the only thing that 
competes for that are energy costs, probably during that same time, 
depending on what oil was costing from coming abroad. Energy prices 
might have gone up by 120 percent, but nothing else has increased by 
120 percent. That is an unsustainable rate of growth for our employers, 
and it puts them at a tremendous disadvantage vis-a-vis the rest of the 
world. We live in a global economy today.
  If we want to go back and diagnose all of the reasons that our 
economy, essentially, went into a free fall at the end of last year--
and that were abated at the beginning of this year, in part, by the 
actions that this Congress took--you've got to look at health care 
costs. You've got to look at the fact that $1,500 of every car produced 
in this country can be accounted for just with regard to retiree health 
care benefits. That number is essentially zero for their competitors in 
Asia or in Europe. This economy is weighed down by a health care system 
that costs twice as much as every other health care system in the rest 
of the world.
  So, if we want to talk about economic revitalization, if we want to 
talk about making this country globally competitive again and about 
coming out of this recession stronger than we were when we went back 
into it, then we've got to do something about costs.
  We spent some time today in our committee, Mr. Ryan, with the 
nonpartisan Congressional Budget Office. They outlined for us the 
economic effects of our bill, and they made it very clear: The reforms 
that are outlined in our bill are going to lower the costs of health 
care insurance for individuals and for employers, that the menu of 
options that we are going to present, an increased menu of affordable 
options for businesses and for individuals, is going to lower the costs 
of health care. In an era where most businesses are crossing their 
fingers and are hoping and praying that this year's premium increase is 
only 10 or 11 percent, a decrease in cost is almost unthinkable for 
those businesses, and it's central to why we're doing health care 
reform.
  Mr. RYAN of Ohio. I thank the gentleman.
  These numbers are from 2004, but they illustrate the point, and we'll 
get them updated.
  The United States in 2004 spent $6,100 per person on health care with 
one's life expectancy to be 77\1/2\ years. In Canada, France and 
Germany, they spent $3,000 and a little bit of change, and their life 
expectancies are 3 years more than ours, 2 years more than ours and 
1\1/2\ years more than ours. We're spending double. So what we're 
saying to our employers is that the status quo can't stand. We are 
being wasteful with our health care dollars. We are wasting money in 
this system.
  So, if you're a conservative, if you're a businessperson and if 
you're standing in the halls of Congress and if you have to look at and 
analyze the health care

[[Page 17905]]

situation, you will come to the conclusion that it is better for us as 
a country to put money upfront toward preventative care and to save 
money on all of these costs that happen down the line.
  We have universal coverage now, but it's through an emergency room, 
Mr. Speaker. That's no way to run a health care system. Don't come to 
us, you know, unless it's an emergency. Then come to us. Then we'll 
take care of you. No business would run that way. You would put money 
up front. We'll give you a prescription. We'll help you with your 
wellness. We'll help you deal with your stress reductions. We'll help 
you deal with mental health. We'll help you deal with a lot of these 
issues so that you don't come to our emergency rooms as often for 
health care.
  I have a CEO in my district who talks about his hospital. He has said 
to me more than once, Give me the opportunity to get that person and to 
give him a $20 prescription instead of my having to deal with him when 
he comes to my emergency room where it costs me $100,000. That's what 
we're trying to do here. That's what this whole health care reform is 
all about.
  I want to yield to a friend of mine. We have worked on a variety of 
issues together and will continue to. He is a great Member from Rhode 
Island, and he is a very dear friend, Mr. Langevin.
  Mr. LANGEVIN. I thank the gentleman for yielding.
  I just want to echo your comments because you're right on target.
  Clearly, in the United States, we have a health care system that is 
broken. We're in crisis and it's unsustainable. It is clear, when you 
look at statistics from around the world, that we have the highest 
costs and yet the worst outcomes when it comes to health care. That's 
because, when you look at the number of uninsured and when you 
aggregate it, well over 47 million Americans are without health 
insurance. That is the reason we are on a path that we cannot sustain, 
and it's not serving anyone in terms of delivering good health care and 
good quality when we have a system that has so many who are uninsured 
and when we're spending our dollars so inefficiently. So I want to be 
here tonight to add my voice to this clarion call for health care 
reform.
  I want to begin, of course, by thanking my colleague from Connecticut 
(Mr. Murphy) for organizing this Special Order to discuss health care 
reform. I thank Mr. Ryan for his contributions to this effort tonight, 
and I thank the other speakers who have spoken or who will speak later.
  Let me say that I believe that we need to have a frank discussion, an 
honest discussion, with the American people about this issue. It's an 
issue that directly impacts everyone in this country--individuals, 
families, businesses--at every level of our government. Regardless of 
one's age, gender, race, religion or income level, everyone has a 
direct stake in our health care system, and it's important that 
Americans are properly informed of their choices as Congress moves 
forward with health care reform.
  Now, I think every Member of Congress certainly is in agreement on 
one fact, which is that our current health care system, as I said 
before, is not sustainable. I'm really disturbed, I have to say, by 
allegations from my colleagues on the other side of the aisle that 
proposing real solutions which offer substantive changes to the status 
quo is somehow seeking to socialize medicine or is seeking to ration 
care. I think this is something that we should address, so I'd like to 
offer some insights into this, some clarifications on this point.
  First of all, the thing that we must acknowledge--and Mr. Ryan was 
talking about it earlier, the unfortunate truth--is that we're already 
experiencing rationing under the current system. We experience it when 
insurance companies deny individuals coverage based on their health 
statuses or preexisting conditions. We see it in the millions of 
families whose premiums and co-pays are so high that they have to forgo 
basic care and life-sustaining treatments or have to choose between 
medications and groceries. We see it in businesses that can no longer 
offer insurance as a benefit to the employees, not because they don't 
want to but because they simply can't afford it. Each of these 
circumstances represents a form of market-based rationing, which is a 
basic failure of our current health care system, of our private health 
insurance markets, due to skyrocketing costs.
  I want to be very clear to my colleagues and to the American people 
that reducing costs and expanding health coverage to all Americans 
doesn't mean reducing quality, access or choice. On the contrary, we 
can and we must use the money already in the system more efficiently to 
ensure access and to expand everyone's choices of insurance coverage--
of doctors and of more effective treatments.
  The most recent draft of the House proposal, while far from a 
finished product and while far from perfect, does build on the 
strengths of our current system, the employer-based system, and then 
supplements that with a health insurance exchange. What does that mean?
  Well, it means that Americans who are happy with their current health 
care coverage can keep it, but those who don't have coverage through 
their employers will be able to shop for their choices of private 
health plans just like Federal employees and Members of Congress do. 
They will also have the option, of course, of choosing a public plan 
alternative, which, I think, is vitally important. Those Americans who 
cannot afford to purchase insurance in the private market will receive 
assistance in paying for the coverage that they do choose.
  Under this new system, private health insurance companies will now 
have to play by a new set of rules. The insurers are no longer going to 
be in the driver's seat. We are putting the American people in the 
driver's seat.

                              {time}  2000

  We're going to make sure there is a basic new set of rules and 
fairness in our health insurance system. Again, the health insurers 
will no longer be able to deny coverage based on a person's previous 
health condition, and they'll have to participate in a more transparent 
and competitive marketplace. This means reducing out-of-pocket costs or 
unexpected fees when patients become sick and need the care that they 
have paid for and have been promised. Greater transparency will 
translate into more manageable costs so that when we open our bills or 
statements, we know exactly what we're paying for. Most importantly, 
under this vision of health care, doctors and patients will make 
medical decisions, not insurance companies or the government. I cannot 
overstate this point enough. Medical decisions should always be left to 
the patient and his or her health care provider. That's what we're 
going to ensure under this system. This is the health care system that 
we can and we must strive for, one that offers stability for families, 
where coverage is not lost because someone changes or loses their job 
or becomes unexpectedly ill. These are, as we know, without a doubt 
challenging times. We face extraordinarily high unemployment in this 
country. In my home State of Rhode Island right now, the unemployment 
rate has reached 12.1 percent. This is on my mind every single day when 
I come to work, at night when I go to sleep, the first thing when I 
wake up in the morning is this on my mind, and how do we fix that and 
get our economy back on track. Well, fixing health care is going to be 
vitally important to do that because the current status quo is just 
unacceptable. Even more unacceptable is that every job lost places 
access to even the most basic health care coverage at even greater 
risk.
  As I conclude here tonight, let me just say this: That in a Nation 
that has led the world in health care innovation, every citizen should 
have access to affordable high-quality care. I believe this to be true 
not only for moral reasons but because this is what will ensure that we 
remain the global leader in health care innovation in the 21st century. 
It also makes sure that our workers and our businesses will continue to 
be competitive in this global economy in which we now live.

[[Page 17906]]

  I urge my constituents and Americans from across the Nation to engage 
in a real, honest, clear discussion on health care reform and to demand 
a universal health care proposal that puts the American people first. I 
am just proud to be able to join this Special Order tonight, talking 
about the need for health care reform. Again, I want to thank and 
commend the gentleman from Connecticut (Mr. Murphy) for organizing this 
event. I'm pleased to be here with you, with Mr. Ryan and with all of 
our colleagues who care passionately about health care reform. This is 
our time. This is the year when we are going to fix health care in 
America once and for all for the American people.
  Mr. MURPHY of Connecticut. I thank the gentleman who has been such a 
great leader on this for a very long time. I think he is right. This is 
our moment. But it's no coincidence that it's taken a long time to get 
here because there are a lot of forces that are aligned against health 
care reform happening here. For whatever reason, for a long time they 
had control of the levers of power down here. The folks that have been 
doing very well off the status quo have stopped health care reform from 
happening here for a long time. There are a few individuals out there 
who are running some of the big health care companies, who are down on 
Wall Street, who have made their fortunes off this health care system. 
But what's happened is they've priced their products, whether it be a 
drug or a medical device or an insurance plan, to such an expensive 
degree that people can't afford to get it; and so the cost of their 
fortune ends up being people's lives, people's health. So it is no 
coincidence that it's taken us this long to get here. There are 
powerful interests that are aligned against getting health care to 
people that don't have it.
  Mr. RYAN of Ohio. If the gentleman would yield, one of the reasons is 
the projection for costs. If we do nothing, this plan here, if we 
implement or just let the Republican health care plan continue, that 
means an $1,800 increase next year and down the pike. So the reason Mr. 
Langevin thinks about this before he goes to bed and when he gets up is 
because we know the cost of inaction. We don't have to explain to 
people in the heartland what the cost of inaction is. It's an increase 
of $1,800. It's more people being knocked off the rolls, more people 
calling our offices saying, Hey, can you help us? I just got denied 
coverage. It says in my policy I got covered, but now I'm not getting 
covered. All of this happens, and it is a cost to all of us. So I think 
the reason we have to act now and why it's so important is because the 
cost of inaction is an $1,800 a year increase.
  Mr. MURPHY of Connecticut. That is absolutely right. As I was saying 
earlier, some of that cost is sort of invisible to people because all 
of the money that we send to emergency rooms to cover the uninsured, 
all of the extra medicine that is being practiced out there that 
doesn't need to be practiced that we're paying for through our Medicare 
and Medicaid systems is buried in the people's tax bills. The wages 
that people never got because their employers took all of the extra 
money they earned that year and sent it to the insurance company to pay 
for their increased premiums. So that increase in the health care 
system that we're going to see if we don't enact health care reform is 
visible in some places, to some people out there, and it is invisible 
in other places. I just see no way to get this economy back up and 
running unless we take on the high cost of this health care system.
  Now it's one thing to sort of be for cutting costs in our health care 
system. We heard a lot of people on the Republican side of the aisle 
talk in unison with us about cutting cost. It's another thing to be for 
things that cut cost. I want to talk for just one second about the 
element of the Democratic plan that saves our health care system about 
$100 billion over the next 10 years and is giving small employers and 
individuals the option, if they want to, to buy into a government 
health care plan--you know, not unlike the one that you and I have 
access to or the Medicare plan that lots of other folks have access to. 
All we're saying is that people and businesses should have the choice 
to go out there and buy a not-for-profit government-sponsored health 
care plan. If they think that their private insurance is better, then 
stay there. But if they think that maybe they'll do better on a 
government plan which costs less because it doesn't have to pay the big 
CEOs' salaries, it doesn't have to return big returns to shareholders, 
if they think they'd be better off there, let them go there. And our 
nonpartisan budget office has told us that that's going to save the 
health care system about $100 billion a year. The Commonwealth Fund, a 
nonpartisan research group, estimates that an individual might be able 
to save $1,100 a year by choosing that government-sponsored health care 
option. Now it's up to them whether they want to do that. But we are 
hearing from both our budget experts here and our budget experts 
outside of this building that there are real cost savings. That's why 
when we're looking at surveys on this issue of whether or not the 
public wants to have the option to buy into a public health care plan, 
every single survey they have done shows that 65, 83 percent, 76, 72 
percent want that option. In fact, on this chart the most remarkable 
thing is that the highest survey here, the survey that shows 83 percent 
of people wanting the option to buy into a government-sponsored health 
plan, that survey was done by a group called EBRI, which is essentially 
all of the major institutional health care companies' research arm. So 
even when the groups out there that are a little bit more skeptical 
about health care reform do a survey, they find the same thing that 
everybody else finds. So listen, I think that there could be some real 
bipartisan agreement here on cutting costs. But it's one thing to stand 
up on the House floor if you are a Republican and say that you want to 
cut costs. It's another thing to actually be for legislation that does 
it, that actually implements cost-cutting measures.
  Mr. RYAN of Ohio. That's the money that we reinvest back into those 
cost-saving measures, that we reinvest back into preventive care so 
that kids will have dental, kids will have oral, which could be the 
same thing. Kids will have hearing checkups. All of these things will 
be included for young kids. Vision. These are all things that, as we 
save this money and steer it back into the front end of this program, 
we are going to have healthier citizens.
  Now I was reading an article last night that hit me about energy, and 
it also makes a good point about health care. We are in a direct 
competition, Mr. Speaker, with China. I don't think anybody will deny 
that. I think we all know that we are in a direct competition with Asia 
and with China. In China they lose 400,000 people a year, who die 
because of the air pollution in China. So the point on the energy bill 
is, they are clearly not doing enough. At some point those people are 
going to say, We want clean air. And once we jump ahead in the energy 
field and start making these products and exporting them to China, we 
now have created a massive export market. But the philosophy is 
different because we are saying that our values, our priorities here 
are about putting the money on the front end, making sure everybody's 
covered. This chart here, the difference in the $6,000 that we spend 
per citizen and the $3,000 and some change that Canada, France and 
Germany spend and have a higher life expectancy is because they cover 
everyone. They allow people to get preventive care so they're 
healthier, so that they can go to work, so that they don't miss weeks 
at a time of work. They get the prescription, and they can go back to 
work.
  I mean, we heard a lot over the last decade or two about family 
values. What is a deeper value than the health of your kids and the 
health of our families? There is not one. Because if you don't have 
health, you don't even have happiness. There are very few unhealthy 
happy people. When you are unhealthy, you are unhappy. So this is 
fundamental to the values that we have as a country. It will unleash a 
level of productivity in this country. All of the anxiety that people 
have will

[[Page 17907]]

be channeled and unleashed into more positive endeavors and at the same 
time begin to move us in a direction where we are not going to bankrupt 
the country. We are going to make the country healthier, more 
productive, create more wealth and at the same time contain our health 
care costs, which will probably end up saving us a lot of money in 
Medicare. I mean, one of the things that people forget is, all of these 
people who don't have health care that are older, that think, I'm going 
to wait until I get on Medicare; and then once they get on Medicare, 
the problem is exacerbated. The cancer has spread, and a variety of 
other problems ensue. So this is an opportunity for us to say that as 
we try to compete in a global marketplace, we have the opportunity to 
enhance the intellect, the productivity and the health of our citizens.
  Mr. MURPHY of Connecticut. You know, there are a lot of really great 
companies out there who have figured this out. I think of a company in 
my State, Pitney Bowes, who has been a leader in health care reform 
because they've figured out over time how much money they were losing 
to sick workers, how much productivity they were losing because they 
had a health care plan that somebody else was administering out there 
that had a financial incentive to deny care. So they decided that they 
were going to take on their health care plan themselves, that they were 
going to put health care clinics in their facilities, that they were 
going to put health care close to their employees, that they were going 
to give rewards to employees that worked out, that invested themselves 
in keeping themselves healthy. There are companies out there that have 
figured out really great models to provide better health care, more 
immediate onsite care for their employees; and they have benefited not 
just because they feel good about keeping their employees healthy but 
because their bottom line has been strengthened by the fact that their 
employees are healthier, showing up for work more often and ready to 
produce and ready to compete.
  You mentioned the fact that this health care system is going to 
bankrupt this economy. Right now we're spending 17 percent of our GDP 
on health care, and economists are telling us that in the not so 
distant future $1 out of every $3 that we're spending in this country 
is going to be on health care. That is just unsustainable. But on a 
much more local level, these are personal bankruptcies too. We think of 
bankruptcy in this country as, you know, being somebody that went out 
there and bought too many snake oil securities or made a real bad bet 
in a real estate investment and then all of a sudden they've gone 
belly-up. No, Mr. Ryan. You know this. Half of the bankruptcies in this 
country, half of the families that have to go into bankruptcy do so 
because they had an unexpected medical cost, a cancer or a terminal 
disease that bankrupted their family. Lives, families devastated 
through no fault of their own, just because they got sick and they 
either didn't have insurance or they had insurance that wouldn't cover 
the full extent of the illness.

                              {time}  2015

  The dirty little secret out there is that a lot of insurance plans, 
you may not know this because it is in the fine print, have a lifetime 
limit on the amount of money they will spend on you. So you're okay 
until you get really, really sick. But for that 1 or 2 percent of 
people that are spending millions of dollars on their care over their 
lifetime, your insurance runs out even if you think that you have it
  So this is about individual people whose lives are shattered, 
shattered by having expenses that they can't control. That is what this 
health care reform is about as well, Mr. Ryan.
  Mr. RYAN of Ohio. And when you look at the company you were 
mentioning, no co-pays on prevention, no rate increases for preexisting 
condition, there will be a big sigh of relief in this country when this 
is passed. An annual cap on out-of-pocket expenses, and we are saying 
to people in America, in 2013 or whatever the date is that this gets 
implemented, you will not go bankrupt because of a health care 
condition that you may have or a member of your family may have. It is 
said and done. That is what this bill is about.
  Mr. MURPHY of Connecticut. Mr. Ryan, it is not that we are not going 
to ask people to contribute to the cost of health care. We are talking 
about caps on the amount of money that you're going to contribute. But 
we are still going to expect people to step up to the plate and pay for 
part of health care, to have a little bit of exposure and scratch in 
the game themselves. And that is important. It is important to have 
shared responsibility.
  Nobody is talking about the government coming in here and either 
taking over our health care system in general or paying for everybody's 
health care or even asking insurance companies to pay for 100 percent 
of health care. We want individuals to have some scratch in the game. 
We just don't want it to end their lives.
  Mr. RYAN of Ohio. Exactly, and flip their families and send them out 
of their homes and the whole ripple effect that happens. And there is 
another point to this that is in here but it is not in here. As we talk 
about prevention, and there's great sections in here about community 
health clinics and different preventative measures that are going on 
and that we are going to continue to promote preventative medicine and 
public health training grants and those kinds of things that I think 
are very, very important to what we are trying to achieve here.
  It is sending a signal, and I think President Obama has been sending 
a signal, people have got to take care of themselves as well. This is 
not just, okay, you can now do whatever you want and you're going to be 
covered. Like Congressman Murphy said, Mr. Speaker, each citizen will 
have skin in the game, and their health care decisions at some level 
will affect what they pay. But what we are saying is, we will be 
helpful, you will contribute, there will be shared responsibility here, 
and at the time you have to do what you need to do to take care of 
yourself.
  And we all have that responsibility now as we have the demographic 
train coming down the pike with baby boomers going into Medicare, going 
into Social Security and all of these issues. We have got to be a lean, 
mean, productive economic force in the world so that we can drive our 
economy and help pay for a lot of this debt that has been accumulated 
over the course of the last 8 to 10 years and move us forward.
  But, again, we know the cost of doing nothing. We know exactly what 
will happen. Health care bills will go up another $1,800 on average 
next year and as far as the eye can see. Again, this is not a plan. 
This is our friends on the other side; this is their Republican health 
care plan, a bunch of lines going to a bunch question marks and back 
again and maybe, you know, at some point, maybe off the chart somewhere 
there is a solution there. It hasn't worked.
  They had an opportunity here when they controlled the House, the 
Senate, and the White House to implement whatever it is they come up 
with. Maybe they have a couple of these squares they can fill in. But 
whatever it is they came up with, they had a chance to implement it. 
And now it is Johnny-come-lately, and we are going to get this done. 
And I think the President is committed to this; we are committed to 
this.
  Every time I go home, I meet thousands of Delphi employees who have 
been left behind in the GM bankruptcy, both salaried and union, and 
steel workers who have lost their jobs and had their pensions cut in 
half, those in the PBGC, lose their health care. This is what this is 
about. Those are the people that will benefit from this, Mr. Murphy.
  I want to thank you as we wind down here for the opportunity to do 
this. We will be here tomorrow and possibly Friday and next week, day 
in and day out, because it is that important for us to pass this. I 
really believe that the health and welfare of our country depend on it. 
And I think that the energy bill and with this, I think this is 
transformational for us and I think a great

[[Page 17908]]

opportunity for places like northeast Ohio.
  And I yield back to my friend.
  Mr. MURPHY of Connecticut. I thank you for joining us here. We will 
be down here talking about this because it is so important to get 
health care for America. As you said, our friends on the other side of 
the aisle had 8 years to get this done. And people may say, well, Mr. 
President, you're taking on a lot really quickly. But we are paying for 
the costs of inaction. We are paying for the costs of a Republican 
Party which for whatever reason decided not to do much about the cost 
of our health care system.
  And we are going to get this done. We are going to get this done so 
that nobody loses their livelihood, nobody loses their access to the 
apparatus of opportunity just because they get sick and can't afford to 
treat themselves. We are going to lower the cost of doing business. We 
are going to lower the burden of the cost of living for families, and 
we are going to do it this year.
  And with that I yield back.

                          ____________________