[Congressional Record (Bound Edition), Volume 155 (2009), Part 14]
[Senate]
[Pages 19117-19123]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. DODD. I thank the Presiding Officer. I am going to take a few 
minutes, if I can, to talk about health care again. I did on Wednesday 
evening, and I intended to speak yesterday, but there was an objection 
raised to having any morning business yesterday while we were 
considering the Defense authorization bill. So as a result of that, I 
was unable to come to the floor and talk about the health care issues 
in our country and the pending legislation in this body and in the 
other body.
  As some may know--I know my colleagues are aware of this--I have been 
in the position of being the acting chairman of the Senate HELP 
Committee. The committee is chaired by our dear friend and colleague 
Senator Ted Kennedy, who is wrestling with his own health care crisis 
at this very hour and so has been unable to be with us these last 
several months as we have begun the process of marking up, that is, 
considering the legislation dealing with health care. So as the person 
sitting next to him on that committee, I was asked to assume the 
responsibility of chairing the committee as we considered the health 
care legislation.
  We have finished our work. We finished it a week ago on Wednesday 
after

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numerous hours. I point this out to our colleagues--I know many of them 
may be aware of this already--we on the HELP Committee spent close to 
60 hours in consideration of our bill. I am told it was the longest 
time that--at least in memory of all here--the committee has spent on 
the consideration of any single bill.
  We had some 23 sessions over 13 days. There were around 800 
amendments filed before our committee. We considered just shy of 300 of 
them. Of that 300, we accepted 161 amendments from our Republican 
friends on the committee.
  Many of these amendments were technical amendments. But they were not 
all technical amendments. They were worthwhile and positive amendments, 
and there were a number of very important amendments that were offered 
by our Republican colleagues that I think strengthened and made the 
bill a better bill, substantially a bipartisan bill.
  At the end of the day, after all of these hours and work, we did not 
have the votes of our Republican friends on the committee. But their 
contribution to the product was significant. As I mentioned earlier, 
Senator Gregg and a number of our Republican colleagues on the 
committee were concerned about the long-term fiscal impact of the new 
voluntary insurance program for long-term care. We agreed with that 
amendment. It was a tremendous help.
  Senator Isakson of Georgia raised the issue of end-of-life care, 
drawing on his own family experiences. We were able to accommodate his 
ideas in that area.
  Senators Enzi, Gregg, and Alexander suggested that we increase 
employers' flexibility to offer workplace wellness programs with 
incentives for employees. That was a very sound proposal, one that has 
been recommended to us by others. It was added to the bill. Senator 
Harkin did a very good job, along with others, in reaching that 
accommodation.
  Senator Hatch's amendment was dealing with follow-on biologics. The 
full Hatch proposal was adopted by the committee.
  Our friend Tom Coburn from Oklahoma proposed an amendment to empower 
individuals to make healthy decisions by having the CDC establish a 
Web-based prevention tool that would create personalized prevention 
plans for individuals. That was accepted as well.
  We accepted Senator Hatch's proposal to establish a coordinated 
environmental health tracking network at the Centers for Disease 
Control and Prevention.
  Senator Murkowski offered an amendment which allows insurers to rate 
based on tobacco use. Specifically, Senator Murkowski's amendment 
allows insurers to vary premiums from one to one and a half for the use 
of tobacco.
  Several amendments were offered by Senator Burr, and accepted by 
unanimous consent, to ensure that the community health insurance option 
is operated on a level playing field with all of the other private 
insurers, and provided a clarification that Federal and State laws 
relating to rating preexisting conditions, fraud and abuse, quality 
improvements, and many other provisions apply to the community health 
insurance option as well.
  Senator Hatch and Senator Coburn offered amendments that will now 
ensure that independent insurance agents and brokers will be eligible 
to be navigators in the gateway.
  My point is that in addition to the technical amendments, there were 
substantive amendments that were adopted as part of the committee 
effort. I invite our colleagues' attention. We have offered to brief 
any single member or others who are interested. This bill has now been 
on the Web site for the public to read there, to add comments and 
ideas, or to pose questions regarding provisions of the bill.
  While we are waiting to see what the outcome in the Finance Committee 
will be, the second half of the equation, it is worthwhile to note that 
in the Senate, there are two committees with jurisdiction over health 
care. The HELP Committee has completed its committee work, and we 
invite our colleagues' attention and ideas and thoughts on how we might 
improve or add to the provisions dealing with quality and prevention, 
dealing with workforce issues, dealing with the fraud and abuse issues 
that are critically important, as well as coverage questions which are 
also essential.
  Obviously I had hoped that we might stay here in August to deal with 
this issue or continue the process, but the decision has been made to 
delay consideration of the health care issues until the fall. I 
understood how this works, and things have not moved as quickly as we 
all would have liked.
  Some say we need to slow down a little bit, we are going too fast on 
this issue. I remind my colleagues that it has been 70 years, 7 
decades, with many administrations serving our country in that time, as 
well as many Congresses that have convened to grappled with this issue.
  While we have dealt with various aspects of health care, from 
children's health and Medicare and Medicaid in that time, every single 
Congress, every single administration, has failed in reaching the kind 
of consensus necessary to adopt national health care reform measures.
  We have been challenged by the American people now to try and defy 
those odds, to do what no other Congress and no other administration 
has ever been able to achieve. I understand we are going at it a little 
too fast in the minds of some, but for those out there beyond the halls 
of Congress, that issue of how fast we are going may seem rather 
perplexing.
  I am stating the obvious here. I know my colleagues know this, and I 
presume many of our fellow citizens do. Every single one of us who is 
serving in this Chamber, every single Congressman who serves down the 
hall, every single employee you see here, has very good, comprehensive 
health insurance coverage. We are blessed, as a part of the Federal 
employees benefit health package. We never have to worry, Lord forbid, 
something happens to one of us tonight, or tomorrow, to our children, 
or our spouses. We are well covered with insurance. And so taking a 
break in August and sort of rolling along poses no real threat to any 
of us or the Federal employees who have this health care program.
  But for millions of other Americans who do not have the privilege of 
having the kind of coverage we do, this is an unsettling time, a very 
unsettling time. In this country of ours, millions of our fellow 
citizens do not get to sleep with that same sense of security and 
assurance. If something happens to their family, Lord forbid, they know 
they are going to wake up with the inability to either take care of the 
health care problem or maybe at the same time go through a financial 
crisis that destroys their economic future.
  I have said this many times, and it is worth repeating. Of all of the 
bankruptcies that occur in the United States, 62 percent of them occur 
because of a health care crisis in that family; 62 percent. Of the 62 
percent that go into bankruptcy because of a health care crisis, 75 
percent of those people have a health insurance program. They are not 
uninsured. These are people with health insurance.
  So if you are out there today and saying: Well, I have got health 
insurance, I could not possibly end up in financial ruin, the fact is 
that the overwhelming majority of people who have gone into bankruptcy 
because of a health care crisis have been covered with insurance.
  Fifty percent of all foreclosures are occurring as a result of a 
health care crisis in a family. Today, before the sun sets in the 
United States of America, 14,000 of our fellow citizens will lose their 
health care coverage. Fourteen thousand people today and every single 
day in America, that many people will lose their health care coverage.
  So while we sit here and say: Look, we are going too fast on this 
subject. Slow down. Boy, slow down. That is easy for us to say because 
none of us ever has to worry about what most Americans have to worry 
about, and that is, God forbid, they end up with a health care crisis 
and end up being destroyed economically or sitting with

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the anger and frustration of knowing that I cannot provide for my 
child, I cannot provide for my spouse, and they need the kind of 
medical care they deserve.
  This is the United States of America. We rank 37th in the world in 
medical outcomes, and we spend more money than any other nation, way 
beyond, way more than any other country in the world on health care. So 
we pay the most and we rank like a Third World country when it comes to 
outcomes. I do not think most Americans like to think of our country as 
being incapable of taking care of our Nation in such a way.
  It has occurred to me that some people in this town seem to think 
this process of health care is about them: Did I get appropriately 
consulted? Did I get invited to enough meetings? Did I get a headline? 
What do my consultants think I should say about all of this? What are 
the right words to use here? Let's hire people to tell us how to 
describe all of this.
  Well, let me ask all of my colleagues: Is anybody here worried that 
they are going to lose their health care insurance over the August 
break? Is anybody here unable to afford the care they think they may 
need for themselves or their family? Has any Member of this body or the 
other body been staying up late at night recently with a sick child for 
whom they cannot afford to get treatment?
  Has anyone I serve with here spent the last 3 hours bouncing from 
voicemail to voicemail as you try to find out why the insurance company 
you pay thousands of dollars to every month suddenly refuses to pay for 
your spouse's cancer treatments?
  Is any Member of Congress, as they go through the August break back 
in their States and districts or on vacation someplace, stuck at a job 
that pays too little because they have a preexisting condition and will 
not be able to get coverage anywhere else they may get hired?
  Has anybody here been driven into bankruptcy or lost a home, as 
10,000 people will today? Their homes will get a notice of foreclosure 
because of medical bills their insurance company would not cover.
  Has anyone in this Chamber or anyone in the other Chamber, a small 
business owner, had to choose between cutting coverage or laying off 
your employees whom you care about, who have been loyal to you and 
helped you build your products every day? Has anyone had to talk about 
laying them off or not providing the health care coverage that you 
have? I suspect no.
  Then why are so many in Washington acting as if this were about us, 
about whether you are a Blue Dog or a Red Dog, a Democrat, a 
Republican, a conservative, a moderate, a liberal, as if that was the 
most important issue, rather than the people who sent us here to 
grapple with an issue they wrestle with every single hour of every day. 
We are in danger of losing this once again, of failing, as has every 
other Congress and every other administration for 70 years, because we 
are forgetting that this is about the people who sent us here, asking 
us to try and come up with answers that would relieve them of the fear 
and frustration that confronts them every day and grows as a result of 
our inability or unwillingness to come up with national health care 
reform.
  We in this Chamber have good insurance and we're in no danger of 
losing it. The same is not true for the American people. That is why it 
isn't about us. It is about the 47 million people who are uninsured, 
the 87 million who are underinsured, the 14,000 a day who lose their 
insurance, and the millions who will lose it if we don't act. It is 
about the people who pay our salaries and our great health insurance as 
well, the people who sent us here to fight on their behalf. When we 
pretend this is about us, when we treat health care reform as if it is 
some kind of a game, a political contest--who is going to face their 
Waterloo, who is going to lose, who can go in for the kill and defeat 
someone, put them into trouble, maybe they will lose an election over 
this--as it appears in the minds of some, then is it any wonder why the 
American people get so angry and frustrated when they watch us talk 
about ourselves, as if we were the only people on the face of the 
planet?
  If any of us had to go through some of the things I suspect every one 
of us has heard from constituents--and there is nothing unique about 
what I am about to say; you can go to almost any State at almost any 
hour and repeat some of the stories I will share this morning, as I 
have heard in Connecticut--there wouldn't be anybody calling for more 
delays if they listened carefully. Sometimes we get involved in 
numbers, as we mention 14,000 and 87 million and 47 million. It sort of 
glazes over the eyes in a way. Is there anybody involved in these 
numbers? Are any stories involved? This legislation would be done by 
now if we paid more attention to some of these individual stories.
  In 2005, a young woman in Connecticut named Maria was diagnosed with 
non-Hodgkin's lymphoma. When she asked her insurance company to cover 
her treatments, the insurance company found out Maria had once gone to 
a doctor for what she thought was a pinched nerve. Even though no tests 
had been done for cancer, the insurance company decided the doctor 
visit meant Maria's condition was a preexisting condition and denied 
her claim. Maria died from that illness.
  A young man in Connecticut named Frank disclosed on his insurance 
application that he sometimes got headaches. Several months after he 
got his policy, he went in for a routine eye exam. His eye doctor saw 
something he didn't like and sent Frank to a neurologist who told Frank 
he had multiple sclerosis. Frank's insurance company decided Frank 
should have known his occasional headaches were a sign of multiple 
sclerosis, and they took away his coverage retroactively. Frank's 
doctor wrote them a letter saying there was no way anyone could have 
possibly suspected that an ordinary headache was related to multiple 
sclerosis. But the insurance company left Frank out to dry. He was 
stuck with a $30,000 medical bill he simply couldn't afford. His 
condition got worse. He left his job and went on public assistance.
  This is Kevin Galvin. I have held a series of townhall meetings in my 
State, four or five of them over the last number of months, to invite 
people to share their concerns and stories about health care. The first 
one I held, to give Members an idea, I held outside Hartford at 8:30 in 
the morning, on a Friday morning. My first reaction to my staff was: 
Why are we having a townhall meeting at 8:30 in the morning? No one 
could possibly be there. Mr. President, 750 people showed up at that 
small community college on the banks of the Connecticut River in 
Hartford to be heard and to listen and talk about what was going on in 
their lives.
  Kevin has shown up at a lot of my townhall meetings to talk about 
this issue. I met him at a number of gatherings we have held around the 
State to listen to people's concerns.
  Kevin owns a small business, a maintenance company. He employs seven 
people in that little firm--some older, some younger--and can't afford 
to insure them. His younger employees use emergency rooms in their home 
communities as their regular doctor. If one of them has a child with an 
ear infection, they will spend all day, as Kevin has told me, in the ER 
waiting for them to get basic treatment, costing the employee a day's 
pay and Kevin a day's work from that employee.
  By the way, to remind people who say we can't afford any additional 
costs, think of this: If you have an insurance policy, on average, your 
family is paying $1,100 a year on your insurance policy to cover people 
such as Kevin's employees, the uninsured. That is the average cost per 
family. That is a tax on every insurance policy to pick up the cost of 
Kevin's employee, the one who shows up in that emergency room. You 
don't get free medical care there. They are charging for it. How do 
they charge? The premium costs go up for everyone else, on average, 
$1,100 per family.
  Kevin has three employees in their twenties and thirties who have 
never had a physical, never had a dental

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cleaning by a hygienist. One of them, age 28 with two children, was out 
of work for 12 weeks and nearly died from a staph infection he got from 
an untreated cavity. Kevin stepped in, paid that man's salary during 
those weeks, and also all of his medical bills. That is the kind of 
person this individual is. Even though he doesn't have the kind of 
business that allows him to pick up the insurance tab for all his 
employees, Kevin stepped in to make a difference in that family. I know 
many do that. He is not alone in that regard. But it is awfully 
difficult to make a business work when you have to turn around and pick 
up the wages for someone who is not there at work, not to mention the 
medical bills and expenses.
  Another one of Kevin's employees recently left for a job with health 
insurance, even though the new job gives him far fewer hours and pays 
one-third less than he got from Kevin. Another employee has been with 
Kevin's company for 24 years, relying on his wife's job for their 
health insurance. She got laid off recently. They will be able to get 
COBRA insurance for a short period, but Kevin's employee has a 
preexisting condition and his wife is a breast cancer survivor. You 
tell me whether you think they will get health care coverage, under the 
present circumstances, with one of them having a preexisting condition 
and the other being a breast cancer survivor. You don't need to be a 
Ph.D. in health care issues to know what is going to happen. Under the 
present circumstances, if we do nothing around here, that guy and his 
wife get nothing. They will be looking for any kind of help they can 
get.
  They, similar to millions of our fellow citizens, are looking to us, 
those of us gathered here. I don't know what Kevin's politics are. I 
don't know whether he is a Democrat or a Republican, a liberal, 
conservative, moderate, a Blue Dog. I don't think he thinks that way. I 
think all he thinks about is trying to take care of his employees and 
his family. I don't think Maria's family--Maria, with non-Hodgkin's 
lymphoma--wondered what politics they were. I don't think any American 
does. All they know is, once again, we are sitting around here deciding 
we will drift off for a few more weeks or months because we can't seem 
to come together, or we are going to sit there and attack each other 
politically, as this problem grows by the hour. We don't have to worry 
about that. I say that respectfully, but nonetheless, it does impact 
the decisionmaking process.
  When you don't have an ounce of concern about your insurance and your 
ability to take care of yourself and your family, you lose some of the 
motivation, it seems to me, that we ought to have, when it comes to 
addressing these issues.
  I will be talking about this every day we are in session and every 
day until we get to the point of coming together and addressing this 
issue. It is what I tried to do for nearly 60 hours, replacing my dear 
friend, Senator Kennedy, on the committee. I thank my 22 other 
colleagues who stayed there day after day to work on this. I 
particularly thank Tom Harkin of Iowa, who spent hours working on the 
prevention side of this bill, doing everything he could to come up with 
ideas to encourage behaviors that would reduce cost and improve the 
quality of health; Barbara Mikulski, who is going through her own 
medical issues, having broken her ankle in four different places and 
undergoing treatment, she did a magnificent job working on quality 
issues; Jeff Bingaman from New Mexico, who did the work on coverage 
issues and the important issue of how we pay for this to come up with 
ideas that will reduce cost and make health coverage more affordable. 
Then, of course, there was Patty Murray, who did a great job working on 
workforce issues. I see Jack Reed of Rhode Island, who is a member of 
our committee and did a great job on a number of issues affecting the 
bill. On down the line: Kay Hagan; Jeff Merkley; Sheldon Whitehouse was 
tremendously helpful; Bernie Sanders did a great job; Bob Casey; 
Sherrod Brown of Ohio was terrific as well.
  I thank my Republican colleagues--even though they didn't vote for 
the bill in the end, I have mentioned the ideas they brought to our 
bill that made it a better bill: Mike Enzi, Judd Gregg, Lamar 
Alexander, John McCain, Lisa Murkowski, Pat Roberts, Orrin Hatch, Tom 
Coburn, Johnny Isakson, Richard Burr. The idea is, we came together and 
it worked. We have a product now. We look forward to working with the 
Finance Committee. But we need to get on to the business of getting 
this done. We cannot sustain the present situation, and the American 
people deserve a lot better. They need the same kind of security we 
have provided for ourselves as Members of Congress. I don't think the 
American people are going to accept the notion that they should have to 
live with the fear and frustration that is associated with having the 
kind of health care system presently in our Nation, knowing we can do 
better.
  I thank my colleagues for the work we have done already and urge 
them, over this break, if they are not here working, to listen to their 
constituents, hear their voices, and then come back to this Chamber in 
early September with a serious determination to do what no other 
Congress and no other administration has been able to achieve in nearly 
a century: to come up with a health care plan for the Nation.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Rhode Island.
  Mr. REED. Mr. President, I ask unanimous consent to speak up to 30 
minutes in morning business.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. REED. Mr. President, let me begin by thanking and commending 
Senator Dodd, who was at the helm of the deliberations on health care 
reform in the HELP Committee. His patience, his understanding, and his 
determination were probably the three critical factors that got this 
bill through the committee and to the floor. He has made a singular 
contribution to the progress of this debate on health care, which he 
eloquently described as so central to every family in this country. I 
know he is performing these duties with the notion that the real 
champion of health care, Senator Ted Kennedy, is in the wings urging 
him on and helping him and guiding him. But Senator Kennedy's presence 
was palpable. I think our efforts today and in the days ahead will 
culminate, I hope, as does Senator Dodd, in legislation that can be 
signed by the President, with Senator Kennedy there and Senator Dodd. I 
can't think of two people who would more deserve such a place of honor.
  We hear often from the opponents of health insurance reform that the 
vast majority of Americans have health insurance and are happy with it. 
That is true. But it is only one side of the coin. Americans are glad 
they have insurance, but they are worried they might lose it because 
the cost keeps going up. All Americans worry when they see friends and 
family members who don't have insurance or who lose their health 
insurance. They worry when they are faced with completing piles of 
paperwork having to do with their health insurance policy. And they 
worry when they get the runaround from their insurance carriers about 
what is and is not covered. They certainly are not particularly happy 
when they are either denied coverage or denied reimbursement of a claim 
because of a preexisting condition. It is clear that we must improve 
health care for the Nation.
  The opponents of health care reform are talking about a government 
takeover and bureaucrats, but those are merely scare tactics. The 
reality today is there are Americans who are uninsured, who show up in 
hospital emergency rooms with out coverage that wind up in higher 
premiums for all of us. There are Americans who are being denied 
insurance, even though they can pay the premium, because of a 
preexisting condition. All of that has to be addressed.
  Today we face a choice between a broken status quo or a better and 
less-expensive health care system; between being denied health 
insurance or a marketplace where competition and choices are vibrant; 
between a health

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insurance system that will double in cost or one that will actually 
control costs; between a health care system that leads to thousands of 
families losing their insurance every day or a system that covers more 
of our relatives and neighbors; between a health insurance system that 
will keep adding to the deficit or a system that helps reduce 
government costs over the long run.
  That is the choice facing the Senate and the American people. The 
stark reality is that our health care system is broken. The status quo 
is untenable. In the face of this, the HELP Committee and the President 
made the right choice to fix it.
  In contrast, the Republicans have chosen to simply protect the 
existing health care system--the one that is denying care to millions 
of Americans, the one that cannot be sustained financially by families 
or by government. They would rather talk about Waterloo and a host of 
other hobgoblins than do the hard work of health reform that we must 
do. We can succumb to fear or we can roll up our sleeves and pass 
health care reform. I believe that we cannot wait any longer.
  In fact, that is what is ongoing at this moment. Senator Baucus is 
reaching out, as Senator Dodd reached out, to develop a plan that will 
not only pass this Congress but also benefit the American people in the 
long run.
  There are many specific elements in the HELP Committee bill and the 
bill Chairman Baucus will bring from the Finance Committee. But there 
are five key principles by which we are guided.
  One, we will pay for the cost of reforming the health insurance 
system.
  Two, we will start controlling costs today and in the future.
  Three, we will preserve and expand insurance choices for the American 
people.
  Four, we will cover as many Americans as we can through commonsense 
steps that increase health security and stability for families.
  And, five, we will reward efficiency and quality care.
  Everything we do in health care reform should be guided by these 
principles because they are the right principles and they are what the 
American people expect.
  Now, let me take a moment to talk more about our health care system 
and how we got here. At the turn of the 20th century, significant 
technological and medical advances yielded superior treatments, more 
effective training of physicians, and higher quality care.
  More Americans demanded access to these new and improved services. 
But for many the cost was too expensive. The problem intensified during 
the Great Depression and doctors, because of the financial crisis, were 
ill-equipped and unprepared to help many who needed help. We have made 
progress since then.
  In the 1960s, this Congress--a predecessor Congress--adopted the 
Medicare Program and the Medicaid Program. We have also seen 
investments in the construction of hospitals under Federal legislation. 
We have seen a system grow up somewhat unwittingly through the tax 
system to subsidize employer-based health care. All this has led to the 
present situation.
  But, even today, the parallels between our current health care system 
and that of the system at the turn of the Century are frighteningly 
similar. The cost of care is still too expensive and doctors are still 
ill-equipped to treat every patient that walks through their door.
  Throughout those years, Presidents and Congresses have recognized the 
need for comprehensive reform, to make health care affordable and 
accessible for all Americans and affordable for the Nation as a whole. 
Harry Truman, Jimmy Carter, Bill Clinton all endeavored to change the 
health care system. We are still at that great task, and this is a 
daunting task, but this time we must succeed.
  In the face of this task, some have said it is too hard, it cannot be 
done. Instead, incremental reform would better serve the country. In 
2003, under President Bush's urging, the Medicare prescription drug 
benefit, Medicare Part D was passed. That was done without paying for 
it. It was done with deficit spending. And it was done supposedly with 
a $400 billion pricetag over 10 years that later turned into $1.2 
trillion over 10 years. That was an initiative supported by President 
Bush and the Republicans.
  So we are in a situation now that is different. We have presented a 
bill that costs half as much, has gone down in price, and that will be 
paid for. We are determined to pay for it. We are determined to make it 
contain costs over the long run because the current costs are 
skyrocketing out of control.
  We have also seen the need, because of the current economic crisis, 
to accelerate our reform efforts. In my State of Rhode Island, 12.4 
percent of the population is unemployed. That is adding to the rolls of 
those who are uninsured. They are losing their coverage if they are 
being dismissed from their work or their employer is scrapping coverage 
just to save the company and keep some people employed.
  We have seen the premiums for those who still have access to coverage 
increase dramatically. In Rhode Island, family premiums have increased 
97 percent since 2000. Over 20 percent of middle-income Rhode Island 
families spend more than 10 percent of their income on health care. We 
know these numbers are going to get worse, not better, if we do 
nothing. They are going to get to the point where families cannot 
afford it, where State governments cannot afford it, where the Federal 
Government cannot afford it. We have to recognize that, that sitting 
back, doing nothing, proposing the old remedies will do nothing for the 
American people.
  My Republican colleagues believe that giving everyone a tax credit, 
$5,000, will get everyone in America covered. But that is less than the 
cost of an insurance policy. Moreover, they are not proposing to reform 
the insurance system. If we do not do this, we will continue down the 
path toward a social and economic crisis.
  So we have acted. And we must continue to act. President Obama is 
determined to make this effort succeed. I recall the debate in 1993 and 
1994 and we are much further ahead than we were in 1993 and 1994. We 
all talked about health care reform in 1993--a major issue in the 
election--but by the time we got down to passing legislation, it was 
the summer of 1994 and we ran out of time. We cannot run out of time 
now. The President is right to insist we keep moving as fast as we can 
until we reach the objective.
  The President said it very well Wednesday evening:

       If somebody told you that there is a plan out there that is 
     guaranteed to double your health-care costs over the next 10 
     years, that's guaranteed to result in more Americans losing 
     their health care, and that is by far the biggest contributor 
     to our federal deficit, I think most people would be opposed 
     to that. That's what we have right now. If we don't change, 
     we can't expect a different result.

  ``If we don't change, we can't expect a different result.''
  So we must move forward with health care reform and we must do it 
deliberately and we must do it in a timely way. As one who sat on the 
HELP Committee under the leadership of Chairman Kennedy and Acting 
Chairman Dodd, we took great effort to work through these issues. We 
spent hours and hours consulting with every single stakeholder: 
patients, providers, doctors, nurses, hospitals, employers, small 
business owners, large business owners, Governors, economists, and our 
Republican colleagues. We had 13 committee hearings. We had 14 
bipartisan roundtable discussions. And we spent hours--20 hours--with 
our Republican colleagues in an informal walk-through of the bill, 
getting their impressions and feedback. We entertained hundreds of 
amendments--160 amendments to be exact. Major contributions were made, 
as Senator Dodd indicated, by our Republican colleagues, along with my 
Democratic colleagues. Then the committee passed this legislation.
  This work must continue with that same intensity. I know Senator 
Baucus in the Finance Committee is doing that. I hope we return in 
September fully engaged and ready to move on this issue.
  I wish to make a few points about the legislation that is emerging 
from both the HELP Committee and I anticipate

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from the Finance Committee. First of all, we have included in our bill 
items--and the Finance Committee will do the same--that will ensure 
that this is fully paid for, unlike the Medicare Part D plan enacted by 
the Bush administration.
  CBO has informed us, in their hearing before the Budget Committee, 
that they are not convinced we are going to be able to dramatically 
reduce costs going forward. Now, we are all bound by them. This is the 
yardstick we use. But I wish to make a point about the CBO projections. 
By their rules, CBO cannot consider some things that we feel will be 
instrumental in not only improving the health of Americans but bringing 
down the costs. They cannot and will not predict the effect of a 
healthier and livelier America.
  The Trust for America's Health, for example, found that investing $10 
per person per year in proven community-based programs to increase 
physical activity, improve nutrition, and prevent smoking and other 
tobacco use, would save the Nation at least $16 billion annually within 
5 years. Out of this $16 billion in savings, it is estimated Medicare 
could save more than $5 billion, Medicaid could save more than $1.9 
billion, and private insurance companies could save more than $9 
billion.
  Those savings are not factored into the CBO's projections for several 
reasons: One, they are hard to predict, and they do not want to take 
that risk; but, second, they will only record savings that accrue 
directly back to the Federal Government. The millions that are being 
saved by private insurance companies through prevention--that is a 
savings they will enjoy, the country will enjoy, the families will 
enjoy, but it will not be scored by CBO.
  We have also taken some significant steps to ensure that we crack 
down on fraud and abuse in the public and the private insurance 
sectors. The National Health Care Anti-Fraud Association estimates that 
3 percent of all health spending each year--more than $70 billion--is 
lost to fraud perpetrated against public and private health plans. 
Federal antifraud efforts in the Medicare Program have been 
demonstrated to return $17 for every $1 invested in these activities, 
and we have expanded these activities in this legislation.
  We also expect cost savings through the use of health information 
technology. In the American Recovery and Reinvestment Act, we provided 
$19.2 billion to hospitals, doctors, and clinics for this purpose. 
According to the RAND Corporation, we could save up to $77 billion each 
year in medical costs through health information technology. Once 
again, this type of savings is not included in the CBO calculations.
  But in addition to the savings we anticipate, we are still going to 
pay for the cost that the CBO has calculated. The Finance Committee is 
committed to do that. And it should be noted, significantly, that 
President Obama has already received commitments from health care 
industries to share in the cost of payment and contribute to this plan. 
The American Hospital Association has pledged $155 billion in 
anticipated cost reductions. The drug companies have promised $80 
billion. These groups, along with insurance companies and doctors, have 
also pledged to slow the rise in health care costs over the next 10 
years by 1.5 percent. This is much different than in 1993 and 1994. 
These concessions will not cover the whole cost, but that is where the 
Finance Committee will augment with their proposals.
  The President has engaged not only the Congress but also the major 
stakeholders in the health care system. Indeed, one of the things I 
find remarkable is that some people are running around talking about 
that this is a nationalization of health care, it is a socialization of 
health care, it is going to be government bureaucrats. Well, if that is 
the case, why is the private insurance industry not only cooperating 
but pledging to participate in cost reductions? They must feel their 
security and safety financially and economically are not being 
jeopardized.
  So we are going to pay for this. We are also going to expand coverage 
in a way where not only you can get it, but you can keep the coverage. 
The same thing goes with respect to keeping your doctor.
  One of the guiding principles the President announced initially was: 
If you like your health care, you can keep it. We have stayed true to 
that principle in terms of the construct that has emerged from the HELP 
Committee.
  We have also tried to provide assistance to those people who need 
health insurance that is affordable. They will have the choice of a 
health plan that meets their needs and their budget. Again, many of the 
proposals my colleagues on the other side have made throughout the 
years, including tax credits are not sufficient to pay the premiums, 
and as such are ineffectual. We are going to make sure you not only 
have insurance but that you can afford that insurance.
  So we have listened to a whole range of proposals. We have listened 
to those who are proponents of the single-payer system. We have 
listened to those who stress a strong community option. I think we have 
clearly staked our reform on a more competitive market that will have a 
public option to spur competition but will not in any way displace the 
primacy of private health care insurance.
  We are moving forward with this legislation. We have created a system 
where citizens can come and select the choice of private insurance or a 
community option, a publicly-organized option. We have also insisted 
upon insurance reform so that preexisting conditions, limits on policy 
payments--all of those things would be a thing of the past.
  We believe this legislation will provide greater stability for 
Americans, not only financially but for peace of mind, the notion that 
when I go to the doctor, I won't have to worry, will the insurance 
company accept this claim; when I go to the doctor and I make the 
claim, will I then be told that what happened to me 20 years ago was a 
preexisting condition and my visit will not be covered; the peace of 
mind that if I have employer-based health care and I lose it, then I 
will be able to access a plan for me and my family. I think these are 
important aspects of this legislation, as important as some of the 
financial aspects.
  We also want to make sure we increase the efficiency, the efficacy of 
the health care system. We have adopted quality measures. We have 
learned from experience that we can make changes--some of them are very 
simple--that will increase the efficiency and the effectiveness of 
health care. One simple approach is a checklist of safety measures in 
ICU that has been adopted in my State of Rhode Island. Studies have 
found that the checklist cuts infection rates 66 percent within 3 
months and within 18 months of implementation saved about $75 million 
and 1,500 lives. Those types of innovations, those types of reforms are 
designed now to be dispersed throughout the system.
  We also have to prevent readmission to hospitals, and we have adopted 
legislation in the bill that will help do that by clearly planning for 
the discharge of a patient. We are building up the workforce which is 
necessary. We have emphasized significantly the issue of wellness and 
prevention. Our bill will provide coverage for all recommended 
preventive services, remove barriers to access, such as copayment and 
deductibles for preventive services, and encourage employers to offer 
wellness programs.
  As has been said before, we want to transform the system not only 
organizationally and financially, but we want to transform it from a 
system that treats sickness to one that promotes wellness. This 
legislation will go a long way to do that. And in doing that, it will 
affect the cost for all of us.
  I think we also have to recognize that everyone has to be a part of 
this effort. If we were to require insurers to take everyone but not 
require everyone to purchase insurance, we would have the classic 
problem where the healthy would not buy insurance, the sickest who need 
insurance would buy it, and the system wouldn't work. It would be too 
costly for those who need coverage

[[Page 19123]]

and those who don't have coverage would get sick, and drive the costs 
up higher and higher. So our legislation requires the responsibility of 
every American to participate. We will help those who are of modest 
income to meet this obligation.
  We also are still working through many significant issues. I think 
the time we now have will be used wisely. There are many different 
aspects of this legislation that we recognize can be improved, and we 
hope they will be by the Finance Committee deliberations and by our 
floor deliberations.
  My colleagues are proposing ideas. For example, Senator Rockefeller 
has suggested that we use the procedure for the Medicare Payment 
Advisory Commission--these are experts on health care--to provide not 
simply recommendations but binding policies subject to a vote by 
Congress on the types of treatments that would be offered, the medical 
issues that have to be addressed. I think this would give us an 
interesting way to deal with the issue of effectiveness of treatment as 
well as cost of treatment, and I think this is something we must 
consider as we go forward, again, dealing with this issue of cost which 
is so central.
  I raised this issue with Chairman Bernanke, the Chairman of the 
Federal Reserve. He, in his rather professorial way, certainly 
recognized the need for reform, but he also stressed that reform from 
an economic standpoint has to have cost containment, cost controls, and 
I think this idea Senator Rockefeller has proposed is something that 
has to be seriously looked at.
  We have reached a point now that we need reform. We can't afford to 
wait. This is the second time in my relatively brief career in the 
Congress that we have faced the issue of national health care reform. 
In 1993 and 1994, we faltered. It has gotten worse since then, not 
better, and it will get much worse if we don't succeed this time.
  So I would encourage all of my colleagues to work together. What I 
sense is that Americans want, need, and deserve access to 
comprehensive, affordable, quality, efficient health care. That is what 
my constituents are asking for.
  We have a plan for overall reform as well as to bring down spending. 
The current path is unsustainable. Those who advocate a less costly, 
better health insurance system have an obligation to offer something 
more than a tax credit proposal here or there or give all of the 
responsibility to the private sector. We need a real plan. A plan that 
will give all Americans the security and stability that they need in 
their health insurance plan. We cannot afford another missed 
opportunity. I urge all of my colleagues to come together on this most 
vital of issues and pass health care reform this year.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Kaufman). The Senator from Missouri is 
recognized.
  Mr. BOND. I thank the Chair.
  (The remarks of Mr. Bond pertaining to the submission of S. Res. 224 
are located in today's Record under ``Submitted Resolutions.'')
  Mr. BOND. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BARRASSO. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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