[Congressional Record (Bound Edition), Volume 155 (2009), Part 15]
[House]
[Pages 20216-20220]
[From the U.S. Government Publishing Office, www.gpo.gov]


                     HEALTH INSURANCE FOR AMERICANS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from New York (Mr. Rangel) is recognized 
for 30 minutes as the designee of the majority leader.
  Mr. RANGEL. First, let me thank Congresswoman Woolsey and Congressman 
Ellison for sharing their hour with us on Ways and Means. We have been 
blessed in having such dedicated members of our committee coming down 
here in support of H.R. 3200.
  You heard from Bill Pascrell, John Yarmuth, the dynamic John Lewis. 
We had Dr. McDermott. He spends so much of his life on this very 
sensitive subject. Soon we will be hearing from Congresswoman Schwartz, 
and you may have noticed that our discussion has been on a subject that 
the whole world has wrestled with in the United States, and that is 
health insurance for Americans.
  Tomorrow night, we hope to be able to go back to our congressional 
districts to discuss this very serious and complex subject, a subject 
that many Presidents have looked at and hoped that we could provide 
some decent way to take care of American citizens. But we do believe 
that this courageous President has not only talked about the problem 
but brought together the stakeholders--the doctors, the insurers, the 
nurses, the hospitals, the unions, the private sector, the 
businesspeople--all coming together to see how they collectively would 
be in the position to tackle this problem once and for all. They even 
went as far as to suggest that we could, over 10 years, save $2 
trillion and stop the hemorrhaging of the cost of health insurance by 
working together, Republicans and Democrats. I say that, 
notwithstanding the fact that it appears as though the public debate 
has the Republicans fighting against the Democrats.
  The fact is, you can't fight against anybody's ideas if you don't 
have any of your own. And it's tragic and unfortunate that during the 
next month, it will appear as though the Republicans are just attacking 
us because they don't have any way to resolve this serious problem on 
their own.
  Having said that, we intend to move on. The Ways and Means Committee, 
as you have heard, has passed on a bill that we are so proud to present 
them. We have two other committees that have jurisdiction: the 
Education and Labor Committee--they have passed out their bill--and we 
do hope that tomorrow, we have every reason to believe, that the Energy 
and Commerce Committee will be passing out their bill.
  That means that the House would have completed its work, the three 
committees would have one bill, and that in September when we come back 
and blend these bills and merge these bills, we will be able to have a 
bill that we believe we can go into conference with the Senate as they 
wrestle with two pieces of legislation over there. And then we hope in 
September, or certainly soon thereafter, we will be able to present to 
the President of the United States a bill that tackles this very, very 
serious problem.
  This problem really--everybody listening and everybody in this House 
of Representatives has had some horror story, some story about what has 
happened with the insurance that they thought they had, the insurance 
that they lost, the insurance costs that have just soared, or even 
people who can't even think about leaving their jobs for fear that they 
would lose their insurance.
  It shouldn't be, in this great country of ours, that people have to 
worry about education and health care as we try to compete with people 
throughout the world. It should be in this country that the least thing 
that you have to worry about if you are sick is how you're going to pay 
for it. And in a country as industrialized and as wealthy as we are, we 
shouldn't be included among a handful of countries that don't take care 
of its people's health.

                              {time}  1930

  So in this bill we provide health care for some 50 million people. 
And believe me, we're providing the insurance that they're getting one 
way or the other. They're getting health care. It's not the best health 
care. Sometimes they're afraid to go into the emergency rooms. 
Sometimes they can't afford to talk to doctors. Sometimes they end up 
worse off in terms of illness than they would have been if they did 
have some insurance. But nevertheless, the State governments, city 
governments and the Federal Government pay for it; and you pay for it 
too. That's part of the reason why your insurance premiums are going 
up, because the hospitals are going to charge those that have insurance 
for it; the insurance companies that are not getting paid, they're 
going to charge you for it; and ultimately, you're going to find out 
that this fiscal crisis that our Nation has is just going

[[Page 20217]]

to be hemorrhaged more by sharp increases in health care. So it's not 
just a moral problem. It's not just a health problem. It's a national 
interest problem in terms of the direction in which this great country 
of ours is going. But just imagine the relief that all of us will have 
to know that if we do get sick, the insurance company would not be able 
to come and tell you that you're not covered. Just imagine, if you want 
to get insurance, no preexisting illness would prevent you from getting 
insurance. Just imagine, if you want to leave your job, you won't have 
to look at your insurance policy to see whether or not you are going to 
lose that and not be able to get another one. So this is really just 
the beginning.
  The month of August is going to be America's month, a month to 
analyze what these bills mean, what it means to you, how it can save 
you money, protect your health, and protect our country against 
illnesses that we hope we never have; but sometimes when we are hit, 
people have lost their homes, lost their bank accounts and ended up in 
dire financial need because they couldn't afford it. Tonight we hope to 
share with you some of our thoughts.
  I would like at this moment to yield to one of the dynamic Members 
from Pennsylvania, a member of our committee, Ms. Schwartz. She has 
worked so hard in this area before she got to Congress, while she has 
been in Congress and has made an outstanding contribution to the Ways 
and Means Committee. At this time I yield her such time as she may 
consume.
  Ms. SCHWARTZ. Well, thank you, Mr. Chairman. I have to say, it has 
been an honor and a privilege to serve on the Ways and Means Committee. 
I knew when I sought a position on the Ways and Means Committee that it 
would be always interesting, and we would always be doing important 
work, always sort of being in the mix of really the principal work that 
we do in Congress. I'm not sure I could ever have anticipated the 
opportunity that we've had over the last 7 months to work on the major 
issues facing this country. Really, there are few issues as important 
as the health care of Americans. I think we have seen in the Ways and 
Means Committee, under your guidance and your leadership, the fact that 
people bring their own experiences with health care. I think what is 
unique about talking about health care is that each and every one of us 
have our own experiences, both good and bad. We bring certainly the 
experiences of our constituents, the concerns of our constituents, and 
I think our hopes and our dreams for this country of how great it could 
be, if under your leadership and under our watch, to participate in 
finding that uniquely American solution to health care, affordable, 
meaningful health care for all Americans. It's really both I think an 
attainable goal and a big goal. It is one that the President has set 
out when he ran for the presidency. He sent us out, both on the 
committee and to Congress, to say, Now is the time to do this.
  I think each and every one of us can share stories that we hear from 
our constituents. I will tell just one, if I may. I have some 
statistics about the number of Pennsylvanians who don't have health 
insurance, but I think sometimes it's helpful to bring it down to a 
personal story. I was asked to visit one of the colleges in my 
district, Penn State, which is obviously well known. Its center campus 
is not in my district, but we do have a satellite campus in Abington, a 
wonderful commuter campus. I met with a group of students who wanted to 
talk about health care. There was a young woman who talked about the 
fact that she was raised by a single mother, and she was on CHIP. I 
think all of us are very proud of the Children's Health Insurance 
Program. She said her mother made $20,000, $25,000 a year. She didn't 
get health insurance through her work, and there was no way that she 
was able to afford it on her own. She got CHIP, and she was always 
grateful that her kids had health insurance.
  Well, this young woman was over 21. She no longer had access to CHIP. 
But she was working full time, was a full-time student; and because of 
the commuter campus, doesn't either require or offer a way for students 
to buy health insurance, she looked for it, but it was unaffordable for 
her. There was no way. She actually tried to find an affordable health 
policy but couldn't find one. So she took a chance. She had said just a 
short while before she had gotten sick; and friends of hers felt that 
she was sick enough that she ought to go to the emergency room; and she 
went to the emergency room and ended up with a $7,000 bill. I don't 
know if she was held overnight. We didn't get into the details of what 
care she received. But she was healthy. She was doing fine. But 
suddenly she is faced with $7,000 in a bill. She had no idea how she 
was ever going to pay that $7,000, stay in school and continue on her 
path. She had a promising future ahead of her. It was going to ruin her 
credit rating. All of these things. There were consequences; and yet 
she still said to me, Well, how can we be in this great country and not 
be able to help her out? I think that's why we're here.
  It is for the 50 million Americans without health coverage, certainly 
for the many, many more millions of Americans who have health coverage 
who find that if they go to the hospital, something's not covered, that 
they have a pre-existing condition and are not able to find the 
coverage, even though they have health insurance. This is why we're 
here. I had one small business owner tell me, ``I want to be able to 
provide health insurance, but I can't afford it,'' or ``I provide it, 
but one of our small group of employees got a serious illness, and we 
saw a rate increase of 40 percent from one year to the next.''
  We talk about double-digit inflation. We know that in the last 8 
years, we've seen health premiums double in price; and of course we are 
concerned about the Federal Government as well. We have a deep concern 
about absolutely maintaining our commitment to seniors in this country 
under Medicare. They rely on it. Imagine our seniors not having access 
to health care. This is something that we did 35 years ago--not you and 
I, but any of you who were here--to get Medicare coverage for all 
seniors. But again, we see the unsustainable growth in costs. So what 
are we going to do about it? We actually have a bill before us. We 
passed it out of the Ways and Means Committee, it was voted on by the 
Education and Labor Committee; and of course, as we speak, the Energy 
and Commerce Committee is going through the bill.
  What it does is it addresses just the issues, the concerns and the 
realities of the families that I talked about. It finds a way to bring 
down the costs under Medicare by really instilling in our system a goal 
of quality and the value of our dollars, encouraging primary care.
  Part of the bill that I want to, again, thank the chairman, his staff 
and other Members for including in this bill is for the increased 
opportunity for loan forgiveness and debt repayment so physicians and 
nurse practitioners can go into primary care. Increased reimbursements 
in primary care. A new category of medical homes so that if a primary 
care physician, nurse practitioner or physician's assistant wants to be 
able to provide ongoing care between visits, make that phone call to 
see how somebody, like an early diabetic, is doing, make sure they get 
the kind of care that they need, make sure that they followed up on 
their prescriptions and that they're following the instructions, that 
they understand the diet and the exercise that they have to engage in 
so that they don't end up on renal dialysis years later, lose sight or 
any of the number of things that can happen with untreated diabetes, is 
just one example. We actually encourage payments that are bundled--that 
is our term--but it really basically says, We're going to look out for 
what happens to you in the hospital and when you go home. New 
possibilities of encouraging physicians to get together and provide 
both primary care and specialty care and to keep people out of the 
hospital. These are life saving and cost saving for the government.
  We have got almost $500 billion in savings that have been already 
included in the bill that we have before

[[Page 20218]]

us. And of course we have found ways to help small businesses with tax 
credits, to be able to provide health coverage for their employees and 
encourage all employers to cover health care. Then for the group that 
is already insured, to say, You're never again going to have 
preexisting condition exclusions; you are never again going to have to 
worry about the insurance companies finding a reason to deny coverage 
because of a health condition; that you won't again have to worry about 
going bankrupt because we will say, You don't have to pay any more than 
10 percent or 12 percent of your annual salary. You will never again 
have to lose your home or go bankrupt over health costs. These are just 
some of the consumer protections that we are going to build for people 
who already have insurance. And of course if you lose your job or you 
are between jobs--and many Americans change jobs every 3 or 4 or 5 
years--that you will have that continuity of coverage. And last, but by 
no means unimportant, we are going to find a way to help all those 50 
million Americans who don't have access to affordable coverage through 
a new marketplace called an exchange; and we're going set them in a 
benefits package; and we are going to provide some subsidies for lower 
income, working folks. At the end of the day, we're going to do what 
the President told us he wanted to do, and that is to contain costs for 
government, for businesses and for families. We're going to make sure 
that insurance is meaningful, and we're going to make sure that every 
American has access to health coverage. At the end of the day, it's 
going to be a great day.
  Mr. RANGEL. I would like to recognize Dr. McDermott because when 
people have nothing to compete with, I think it's natural just for them 
to be critical. I hear talk, Dr. McDermott, that this plan that we're 
creating for all of America is actually a takeover of all insurance 
plans by the Federal Government. They say that the Congress and the 
Federal Government want to get in between a patient and their doctor 
and to watch out because the government is coming. It bothers me that 
they would say that because it would appear as though we're only 
talking about Democrats who are sick and have doctors. We're trying to 
help all Americans. Could you share with us the public option, what 
this does for America and what opportunity it gives to people who don't 
have insurance?
  Mr. McDERMOTT. Well, Mr. Chairman, you raise the issue I think that 
is probably our biggest and most tough issue to deal with, and that's 
the question of fear. People continue trying to convince people that 
they have to be afraid. We had a speaker here just a moment ago who had 
a beautiful picture of a little child, and the fear was that the 
government is going to come and take over their health care. Now 
nothing could be further from the truth in what we've put together.
  If you look at America, you have 150 million people in private 
insurance. Then you've got 50 million people in Medicare; you've got 50 
million in Medicaid; and then you've got 50 million who don't have 
anything. Now these people who have insurance today in their 
employment, each month when 300,000, 400,000, or 500,000 people lose 
their jobs, they suddenly are over in the basket with the people who 
don't have health insurance. So we're not talking about people who 
aren't trying or people who haven't been paying their taxes or haven't 
been working. We're talking about us, the middle class, who are in 
danger in this present system because if your employer stops paying 
your insurance, you don't have anything, and you're suddenly over here 
trying to buy it for yourself. It wouldn't matter if you are older, 
you've got a problem, you've got a problem kid or whatever. You are 
going to have a very tough time. Now the answer to that is for the 
government to say, Here is a public option that you can buy into at an 
affordable price.
  The problem with individual insurance, most people by the time 
they're 30 or 40, you know, something's starting to go wrong, whatever; 
and the premium for those kinds of insurance programs is $1,000 a 
month. Many people are paying $12,000 out of pocket trying to buy an 
individual program. That is unreachable for most of the working class 
in this country. They can't come up with that kind of money. The only 
solution is to have a government-subsidized program that they can buy 
into.
  Now people say, Ah, there it is. The government's going to make all 
the decisions. No. You're going to buy an insurance program that will 
be paid for by a government mechanism, but the delivery of the health 
care is going to be by private physicians, private hospitals, private 
nurses. The whole thing is private.
  Mr. RANGEL. How could the government get in between the doctor, the 
hospital and the patient? What are they talking about?
  Mr. McDERMOTT. It's part of the scare tactics. If you watch 
television tonight when you go home, you will see commercials on there 
saying that the government is somehow going to get between--they did it 
in '93, '94. It was Harry and Louise. Harry and Louise were sitting at 
the kitchen table, and Harry says to Louise, You know that Mrs. 
Clinton, she is going to take away our health care. They're doing that 
same thing again now, making it appear that that's what's going to 
happen when no such thing is being planned.

                              {time}  1945

  There is no question that the government is not going to be between 
you and your doctor and making a decision what needs to be done.
  Mr. RANGEL. Well, why would the private insurance companies be 
against the public option? I mean, if the Congress is saying--and the 
President wants--that we have 50 million people out there with no 
health insurance, another 25 million with low health insurance, and we 
are now going to give them a subsidy, we are going to give them enough 
money so that they can walk in and get the type of health plan they 
want, why would the health insurance companies out there fight against, 
campaign against, put ads against the public option? Why would they do 
this?
  Mr. McDERMOTT. Well, because our bill, Charlie, has one thing in it; 
it says to insurance companies you can't cherry-pick the healthy 
patients you want to take care of and leave the sick ones to somebody 
else.
  What we say is if you're an insurance company, you've got to cover 
everybody; you've got to open the doors wide and let anybody come in. 
Insurance companies don't want that. What they want are healthy 
patients who pay a premium, for whom they have to pay out very little 
money, then they can give the rest to the stockholders. Now, there's 
nothing wrong with that, that's the free enterprise system. But they're 
afraid that if we have a government system that is there for the 
people's benefit and has a 3 percent overhead, whereas an average 
insurance company overhead is 14 percent--and they know the people are 
going to take the lower premium in the government plan, or they're 
afraid of that--so they say, you've got to put us on a level playing 
field.
  Well, you can't make profit off people's sickness and have a level 
playing field with a government plan.
  Mr. RANGEL. Well, let me ask Congresswoman Schwartz. If, indeed, the 
private insurance companies are fighting against the public option, 
does our legislation demand that a person has to join the public 
option? How does that work in our legislation?
  Ms. SCHWARTZ. Right. It's a really good question. Of course not. We 
are not in any way telling people where they have to get their coverage 
or where they have to buy their insurance. If in fact people get a 
subsidy--and, really, understand that everyone is going to have to pay 
something. We're not giving away too much free here, everyone is going 
to pay their share. We're going to help people.
  But we're saying to the insurance companies, fine, come in and 
compete. That's great. We're going to create a marketplace where you 
can offer new products to another 30 million, almost 40 million people, 
and then each of those individuals or families or very small businesses 
will be able to choose between private insurance companies and a public 
option.

[[Page 20219]]

  I see that the public option is an opportunity to ensure that there 
really is competition, because I think in many of the markets across 
the country we have one major insurance provider, that's it; so not a 
lot of competition. If you believe in the free market system, you need 
a little competition there. If you only have one product to buy, and 
it's very expensive, you don't have a lot of choices.
  The insurance companies--I'm not here to beat up on insurance 
companies, but I will say, they have said if everyone's in, they want 
to be able to have the opportunity to sell a good product to people. 
That's fine; we're fine with that. We want them to step up to the plate 
and offer new insurance products to individuals and small groups. And 
again, as Mr. McDermott said, make sure it covers certain benefits, it 
doesn't exclude people, it doesn't cherry-pick, as you say.
  There are going to be rules. And we are going to make sure that 
consumers are protected under these rules. That is very important. But 
no one is going to be told to go into the public option, no one. They 
can choose the insurance.
  Mr. RANGEL. Well, Dr. McDermott, I've heard Republicans say on this 
floor, in this House of Representatives, and others on television, that 
this public option that's being offered to people to take if they want 
it is really a Democratic socialistic, communist attempt to knock out 
the private sector. Where do they get this idea, and what do they mean?
  Mr. McDERMOTT. It's very strange. And people who talk about believing 
in competition and believe in the marketplace, as Representative 
Schwartz says, there are places in this country where there is only one 
option; and if you have nobody to compete with, they control the 
prices. And for them to get the idea that it's socialistic to put 
somebody in there to compete is really saying they're afraid to 
compete.
  They know they can't win. They have failed over the last 18 years. 
They knocked out Mrs. Clinton's efforts in `93. They had an open field. 
The entire country was open to the private sector, and they cannot 
figure out how to cover 50 million people. So we come stepping in and 
say, we have a way. And they say, oh, no, no. If the people ever get 
wind of what you're doing, they will leave us. They're afraid that 
people will leave them because they have been in it for the profit and 
not in it for the benefit of the patients. And that's really why I 
think they're afraid.
  Mr. RANGEL. Well, some of the private insurance companies say we just 
don't have enough resources to take care of all these poor folks that 
you're giving subsidies to. Let me ask you, Congresswoman: Is there 
anything that we're doing to provide the workforce and to provide the 
environment so that sick people can feel secure in getting health care 
once they have the subsidy?
  Ms. SCHWARTZ. Right. And understand that subsidies are provided. Poor 
people in this country do get Medicaid, and we're expanding that. These 
are really people who work--and many poor people do as well--every day 
and simply don't make enough money to be able to afford the high rates 
of insurance. That's part of it. We want to bring down the cost of the 
insurance. Again, we hope that the private insurers step up to the 
plate and help us do that, but they haven't done a great job of 
containing costs over the last number of years which is why we're in 
this situation.
  But once people have insurance, we are really working hard to make 
sure that the delivery system, all those doctors and nurses and--well, 
you can name all the other health providers--are both available and 
that we're training enough. We anticipate that if we don't do something 
about the lack of primary care physicians, in 2025 there will be 46,000 
too few primary care doctors. That is pretty astounding. A lot of us 
are getting older--all of us are getting older, I guess--neither of you 
are, of course--but we also want to make sure that we have the kind of 
care for every age.
  And we're not getting the quality out of the system that we know we 
should, and that also is an issue that we have taken up in this 
legislation. We want to encourage our hospitals and our doctors, 
through financial carrots--there might be some sticks, but mostly we 
are really creating incentives for our doctors and our hospitals to 
improve quality.
  One of the examples that many of us are becoming aware of is 
infections that you get in a hospital, or when you leave the hospital 
after surgery, that you don't have the right kind of followup once you 
get home and you end up back in the hospital. That's not only really 
hurtful for the person who is affected, who's sick, but it's also very 
expensive for all of us. So if we can, and our hospitals can, if we can 
encourage our hospitals--and in fact insist upon our hospitals really 
making sure that they reduce the number of infections and readmissions, 
we would all be better off. And that's what we're trying to do.
  There are many pages of what we call delivery system reforms, ways in 
which we are encouraging everything from home visits after a baby is 
born to a family, to, as I talked about, primary care, medical homes, 
and ways that doctors will be able to organize themselves in a way that 
is much more efficient in quality.
  And we're setting out a real goal of changing some of the ways we pay 
doctors and hospitals, to encourage them to really look at quality and 
to save dollars and improve health outcomes. That is one of the most 
discouraging things; for all the dollars we spend, $2.5 trillion--not 
all government, half of it's in the private sector--we don't have the 
kind of healthy Americans that we should. And that is part of our goal, 
here, to extend coverage, for the government to be smarter in the way 
we finance it, and for people to take more personal responsibility in 
their own health care as well.
  Mr. RANGEL. Dr. McDermott, before you came here you've practiced, 
you've been out here, you've worked with patients and doctors and 
hospitals. One of the most frightening thoughts that we have is that 
you get sick and you don't have enough coverage--or you don't have any 
coverage--you face bankruptcy, you lose your home, you lose your 
dignity, and sometimes even lose your family merely because you didn't 
have the resources to deal with a catastrophic illness. What provisions 
are in this legislation to protect Americans against that?
  Mr. McDERMOTT. Well, the plan that would be provided for every 
American who was in a health insurance plan, whether the private one 
they were in before or the one that they're in in the government 
option, would give them the protection for the basic things that 
everybody needs in a health care system.
  I have a story you reminded me of. One night I was going out of a 
hospital in Seattle and a telephone operator stopped me and said they 
want you up on the coronary care unit. So I went up there, and there 
was a guy putting on his clothes and said, I'm leaving the hospital. He 
had had a heart attack the day before. They wanted him to stay in the 
hospital. He said, Look, I have no health insurance. If I lie in this 
bed, it costs me $1,000 a day, and I can't afford it. And what if I 
die? I then leave my family with a big bill. So either way I'm caught. 
And when we put this program together, we give people the assurance 
that if you have a heart attack, or whatever, and you need 
hospitalization, you will being taken care of.
  Mr. RANGEL. Well, let me thank the speaker and Mr. Ellison and Ms. 
Woolsey for giving us an opportunity to share what's in our bill. We 
will be back tomorrow. And we hope during August all Americans can look 
forward to the President of the United States signing a bill that will 
give them confidence that wellness is the top priority for this 
Congress.
  Mr. Speaker, I yield back the balance of my time.

[[Page 20220]]



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