[Congressional Record (Bound Edition), Volume 155 (2009), Part 15]
[Senate]
[Pages 20584-20598]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. DODD. Madam President, I thank my colleagues this evening. I am 
going to momentarily turn to my colleagues from Iowa, Ohio, Vermont, 
and Rhode Island--all of whom participated with us nearly 3 weeks ago 
in the markup of our bill, the Affordable Health Choices Act, which 
took up an inordinate amount of time, longer than I think any markup 
certainly in the history of our committee, maybe the longest in the 
history of this body. We actually spent about 56 hours, 23 sessions, 
and 13 days on this bill. We considered just shy of 300 amendments, of 
which 161 amendments were offered by our colleagues from the minority 
and contributed significantly and substantively to the outcome of that 
bill. They did not support the bill in the end, unfortunately, but any 
definition of ``bipartisan'' would have to include whether or not their 
ideas were incorporated in any significant degree in this bill, and 
they were. I am appreciative of their efforts.
  I am particularly grateful to Senators Harkin, Murray, Whitehouse, 
and Brown for their contributions, along with others on the committee: 
Senator Sanders, who is here; Senator Mikulski played such an important 
role; Senator Casey, Senator Merkley, Senator Bingaman, Senator Reed, 
Senator Hagan--all of whom contributed to the outcome of that 
legislation.
  We thought it might be worthwhile this evening to talk about exactly 
what is in this bill. We will be adjourning in a few days. We will be 
gone for a month. Unfortunately, during that month, nothing will happen 
on this bill. But I think it is an important month to educate our 
constituents and people across this country as to what is in this bill, 
what we are trying to accomplish with our reform efforts.
  Senator Harkin led the effort on prevention in our committee. The 
Senator was asked by our chairman, Ted Kennedy--who, as we all know, is 
struggling with his own illness, a brain tumor. We pray and hope he 
will be back to work with us and to chair his committee. But the 
distinguished Senator from Iowa, along with Senators Mikulski, 
Bingaman, and Murray, worked on various ideas. Prevention was the 
matter in which Senator Harkin became an expert. He developed very 
sound ideas in our legislation to promote the improvement of prevention 
ideas as part of our health care reform efforts. Senator Mikulski 
worked on quality. Senator Bingaman worked on coverage. Senator Murray 
worked on workforce issues, which are all so critically important. 
Senator Harkin brought to the committee his more than three decades' 
long commitment to prevention and wellness. He is no newcomer to this 
issue. In a minute, I am going to ask him, if he would, to go into 
detail about the prevention aspects of this bill and what is included.
  People ought to know what we have done. I am so sick and tired of 
hearing about socialized medicine, government takeover--nothing but 
absolute falsehoods about what is in this legislation and what we are 
promoting.
  I say at the outset, if you like what you have, you get to keep it, 
choose your doctor, hospital, choose the insurance program you have. 
What people don't have is a sense of stability and certainty that they 
are going to have the coverage they deserve if a crisis hits them in 
health care and that they will get the care they need. That is what 
people are uncertain about today. So many millions of our fellow 
citizens worry every night that the coverage they have and the coverage 
they would like to have is unavailable to them because the costs are 
rising almost on an hourly basis, and they worry about their families.
  Before I turn to my colleague from Iowa and my other colleagues, as 
well, to share some thoughts with us, I made an announcement last 
Friday which has become quite well known--the fact that I have been 
diagnosed with prostate cancer. It is in the very early stages. I am 
confident the outcomes are going to be great and all is going to work 
out well. I have known about this since June when I was diagnosed with 
it and did what I could to learn all about prostate cancer and what 
treatments and options will be available to me.
  The point I want to make is this: When I discovered in June that I 
had prostate cancer, I didn't lose a moment's sleep over whether I had 
the coverage to pay for it. I didn't lose a moment's sleep as to 
whether I have quality care. I am a Member of Congress. I have a great 
health care plan. I have great coverage. I never lost a moment's sleep 
over whether or not I would be able to access that coverage.
  What bothers me is it should not just be me or Members like me in 
this body. If every Member in this body had to go through what millions 
of Americans do every day, and that is wonder whether the quality is 
going to be there, the

[[Page 20585]]

care is going to be there, maybe they would worry. But that is not the 
case. Our efforts over these days have been to try to bring, at long 
last, that sense of stability and certainty to our fellow citizens that 
we have in this body and that the other body has and that thousands and 
thousands of Federal employees and others who have good health care 
coverage have.
  I am confident everything is going to be fine. That is not the point 
of bringing this up. The reason I bring it up is because too many of 
our fellow citizens lack the kind of security and stability that those 
of us who are here have. I hear my colleagues--some of them--say: Well, 
we ought to wait a while longer. We can't afford to do this.
  We can't afford not to do this. The cost to the average American is 
rising by the hour.
  I had one insurance company in my State of Connecticut, a few weeks 
ago, announce a 32-percent increase in premiums. They announced it 
right in the middle of this debate, to jack up those prices. Of course, 
it goes on all across the country. We have working families who are 
losing their jobs, losing their homes, and we find that 62 percent of 
people who are in bankruptcy are there because of a health care crisis. 
We find 50 percent of the foreclosures that are occurring are occurring 
because of a health care crisis.
  So my interest in raising this is to bring home the point that we 
have an obligation, it seems to me, in this body, to address this 
issue; to do it carefully, do it well but to get the job done. We have 
a President committed to that. Our leadership is committed to it. The 
members of our committee who have worked so hard are committed to it. 
All we are missing is some folks willing to come to the table and help 
us resolve these matters in a way that will allow us to have some votes 
and decide whether to go forward with accessible, affordable, quality 
health care.
  No one is talking about socialized medicine or talking about big 
government-run plans. They use those words over and over and over 
again. You ought to be suspicious when they have nothing else to say 
about health care but scare tactics and fear. That is what they have 
done day after day in this debate, and it is a disservice to the 
American people to suggest that after 70 years, with millions of our 
fellow citizens uninsured or underinsured tonight, the only answer they 
have to our health care problems is to wait longer, do nothing, and be 
scared.
  What is more, if they were more serious about some of these issues, 
we might be engaged in more of a significant debate. As I said, that is 
not true for the 47 million without health insurance, the 30 million 
underinsured in our Nation or the 14,000 in America who lost their 
health insurance today. Every day we wait, another 14,000 people lose 
health coverage. Since we marked up our bill--and we finished marking 
up our bill in that committee back 3 weeks ago this Wednesday--266,000 
people in the United States, more than a quarter of a million people, 
have lost their health insurance. That is what has happened in less 
than 3 weeks.
  My hope would be that while we are going to debate this issue at home 
over the month of August, we would come back with a renewed sense of 
commitment to getting this job done. But tonight, my colleagues and I 
would like to spend a few minutes talking about what is in our bill, 
what we tried to do with this, how we tried to increase access, 
quality, as well as affordability.
  I have heard my distinguished colleague from Iowa say on so many 
occasions--and I am confident he will probably say it tonight--we don't 
have a health care system, we have a sick care system. I think he 
coined the phrase in talking about it. I have heard him say it so many 
years in this body, talking about what we need to do to develop sound 
health care programs. So I wish to thank my colleague and ask if he 
would share with us his thoughts on this.
  Is it not the case that chronic disease accounts for about 75 percent 
of our health care costs, and these are preventable diseases in our 
country, such as diabetes and heart disease, among other things? I 
wonder if my colleague from Iowa could take a moment or two to talk 
about the cost savings achievable through increased prevention, not to 
mention what it means to individuals. It can lead to a longer life and 
a better quality of life. I thank him for his thoughts on the subject 
matter.
  Mr. HARKIN. I thank our chairman, the leader on this issue. Would the 
Senator yield?
  Mr. DODD. I yield to my colleague from Iowa.
  Mr. HARKIN. First, I say to Senator Dodd, I heard all this talk about 
socialized medicine. Socialized medicine. These are scare tactics. 
There are a lot of scare tactics going on.
  I was in my State over the weekend, and people were talking about 
euthanasia in the bill. We hear all this crazy stuff going on out 
there, and I got to thinking about this. There is a lot of money on the 
table. We spend $2.3 trillion a year, if I am not mistaken. There is a 
lot of money, and a lot of people have a vested interest in not 
changing the system because they are making a lot of money. Obviously, 
what they are trying to do is scare people.
  People elected us--and I think elected President Obama--to make some 
changes in the way we do things, but there are a lot of vested 
interests out there that don't want to change. There are a lot of scare 
tactics going on out there. They are unduly scaring people and 
obviously by people who don't want to change the system. They want the 
status quo.
  The other thing I might say, as to all this talk about socialized 
medicine, historically, when President Harry Truman first proposed a 
kind of national health insurance program, that is the issue that was 
raised in 1951, I think it was. I could be off a year. Maybe 1950 or 
1951 it was raised, when he was proposing this. The origins go back to 
an individual whose name I forget right now, but he was an advertising 
executive hired by the AMA at that time to stop Harry Truman's program. 
So he came up and he coined this whole phrase ``socialized medicine.'' 
It was picked up by then-Senator Robert Taft, and he kept harping on 
the Truman program was socialized medicine. Well, that was in 1949-
1950, I think it was, and here we are, all these many years later, and 
we hear the same arguments coming up again. It wasn't socialized 
medicine then and it is not socialized medicine now.
  What we are trying to get is a system that is stable, that people can 
rely on, that they know is going to be there for them and that is 
affordable and gives them a quality health program--as my colleague, 
Senator Dodd, said--as we have. What we are trying to get for the 
American people is the same kind of system all Federal employees have. 
We are on the same system as your local postal employee in a small town 
in Connecticut or a small town in Iowa or somebody who works for the 
Farm Service Agency in the Federal Government. We are all on the same 
plan. We have a lot of choices, don't we? Every year, I think we get 
20-some plans to pick from. We sort of have an exchange out there, 
where every year, if we don't like what we have, we can go to something 
else. Why shouldn't the rest of the American people have that kind of 
access?
  I spoke with a small businessman in Iowa last week. He has 12 
employees and spends 15 percent of his gross revenue on health care. He 
has 12 employees, and one of his employees had a kidney transplant. 
Another came down with cancer. In 2 years, his insurance premiums went 
up 100 percent. In 2 years. He has a $5,000 deductible, and he said he 
needs some work done. He wanted to go in for a colonoscopy because he 
turned 50, but a colonoscopy costs $3,000. Well, that is out of pocket 
because he has a $5,000 deductible.
  I am trying to get to my point of prevention. Because we know if he 
has a colonoscopy and something happens, they can stop it. It is one of 
the most preventable forms of cancer, this colon cancer, but it is one 
of the most deadly if you don't get it in time. So I asked Art: Why 
don't you get a different plan? He said: I can't. We only have one in 
rural Iowa I can go to.

[[Page 20586]]

  What we are trying to do is get more plans for people out there in 
small towns in Iowa, in Connecticut, and everywhere else so they do not 
have to be stuck with one plan; they can shop around and get other 
plans.
  He asked me if he could get on the public option plan that we have in 
our bill. I said: Sure. Small businesses such as you? Absolutely. That 
means he can get in a pool with everybody else around the country and 
reduce his costs. I just remembered that, and I remembered him talking 
about trying to get a colonoscopy. This kind of gets to the nexus of 
what I wanted to talk about, briefly, which is the focus on keeping 
people healthy.
  President Obama said very clearly, when he addressed a joint session 
of Congress earlier this year, that we have to make a major investment 
in prevention and wellness because that is the only way we are going to 
keep people healthy and reduce medical costs. Well, President Obama 
gets it. He understands we have to make a major new investment. That is 
what we have done in our bill--our Affordable Health Choices Act--which 
Senator Dodd so greatly led through our committee. We make a major 
investment in prevention and keeping people healthy.
  My colleague is right. I started out saying we have a sick care 
system instead of health care. I started saying that in 1992; that we 
have a sick care system, not a health care system. If you get sick, you 
get care, one way or the other. But there is not much there to try to 
keep you healthy in the first place and to focus on prevention. Again, 
our bill has a very strong prevention provision in there.
  Some ideas on what we have tried to do. The real health reform starts 
with prevention, it does. If we don't do prevention and wellness, you 
can jiggle the payment system all you want and you are not going to 
save a dime, unless we start focusing on keeping people healthy in the 
first place. Is there support for that out there? Sure. The American 
people get it. They understand this. They were asked: Should we invest 
more or not invest more in prevention and wellness? Well, you can see 
that 76 percent of the American people said we had to invest somewhat 
or strongly; invest more, 53 percent; invest somewhat, 76 percent; not 
invest any more, 10 to 16 percent.
  The American people get it. They get it. You can talk to anyone you 
want about health care and ask them: Would you rather just have 
something that takes care of you when you get sick or would you rather 
have more focus on keeping you healthy? I will tell you the response 
will be: I want to stay healthy. People want to stay healthy. But in a 
lot of cases, they don't know how. There are not the support systems 
there to do that.
  Again, on saving some money; a lot of times we hear that: Oh, this 
won't save money, and the CBO--Congressional Budget Office--doesn't 
score it. But we asked voters. The poll question was: Will prevention 
and wellness save us money? Seventy-seven percent said yes. Yes, it 
will save us money. Again, the American people get it, that we have to 
focus more on prevention and health.
  We have some problems with CBO. That is the Congressional Budget 
Office, for those who don't understand the jargon around here. The 
Congressional Budget Office doesn't score us very well. Score means 
they do not give us much savings when we invest in prevention and 
wellness. Well, I have gone over that with the Congressional Budget 
Office, and the problem is they do not give a savings because they do 
not give savings on what they call secondary savings. Secondary savings 
is what prevention provides. It saves you money from going to the 
hospital or getting sick. But they do not give us a good score for that 
on savings. But do we have data on that? Do we know if it saves money? 
Sure, we do.
  This is from the Trust for America's Health. They did a big survey of 
community-based interventions and for $10 per person, in 1 to 2 years, 
they save $2.8 billion; 5 years, $16.5 billion; 10 years, $18.5 
billion. That is just $10 per person, and that is just community 
programs. So we address the whole gamut. We address the community-based 
programs and the clinical-based programs.
  For example, what we do in our bill is we set up an investment fund 
to do a number of different things. Let me give one example. We are 
going to train health professionals in how to work with prediabetic 
individuals, people who have tested high, who look like they are 
prediabetic. We will train them to work with them to manage their 
condition, to get them on the proper diet, to manage them as they go 
along. What is so important about that? Well, what is important about 
that is that right now, for example in Medicare, Medicare will pay 
$30,000 to amputate your foot if you have diabetes. They will not 
reimburse one cent for nutrition counseling before so you don't get 
diabetes. But they will pay for nutrition counseling after you get 
diabetes. That doesn't make any sense.
  Right now, the cost of diabetes in our society is $174 billion a 
year. That is $174 billion a year on diabetes. Well, it doesn't take a 
genius to figure out that if we can get hold of people who test 
prediabetic and get them on a well-managed program so they do not come 
down with diabetes, we will save money. But the Congressional Budget 
Office doesn't score that as any savings.
  So at the clinical level we will do that. We will reimburse, for 
example. There will be a reimbursement for cancer screenings, for 
smoking cessation, nutrition counseling, colorectal screening. There 
will be reimbursements for that, and you will not have to pay any 
deductibles or copays. So for my friend who is now facing $3,000 for a 
colorectal screening, this will not cost him anything. No copays, no 
deductibles, and the insurance company has to reimburse for that.
  Again, if we catch these things early, it is just like mammogram 
screening. We know if we get breast cancer early, it is curable. Again, 
let me say something that is public. The mayor of Cedar Rapids is a 
woman. I was in Iowa this weekend, and it was announced she has breast 
cancer. She went in today for a small surgery, and she will be back to 
work tomorrow because they got it early.
  Mr. DODD. If my colleague will yield at this point, again, because I 
am exhibit A. I had an annual physical this year. At my annual 
physical, my PSA score spiked--shot up. That was a signal to the 
doctors that maybe something more serious was happening.
  They decided a biopsy was appropriate. A biopsy showed I had cancer. 
But I had the annual physical, which my health care plan pays for. If 
you don't have a health care plan, that physical can be very expensive, 
so people don't get their annual physical. Prostate cancer is the 
slowest growing form of cancer, it is the easiest to manage. If you 
have to have cancer, it is the best one to have. If you have to have 
one, that is the best one--if you catch it early. A number of our 
colleagues have had prostate cancer. But the important thing, as my 
colleague pointed out, is to have an annual physical, get the 
screening, and detect it early. I will be able to deal with this, and I 
am told I will have a very healthy life for many more years to come.
  If I had gone years without detecting this and it migrated or 
metastasized into my lymph nodes or bones, I could be in serious 
trouble. Spark Matsunaga, our former colleague from Hawaii, died of 
prostate cancer. John Kerry, our colleague, his dad died of prostate 
cancer. Thirty thousand people a year die of prostate cancer, because 
they never caught it. That is what screening does. That is why what you 
are saying has such value.
  (Mr. Merkley assumed the chair.)
  Mr. HARKIN. I appreciate the Senator saying that, and that is why we 
have to have more focus on this prevention and getting people in for 
early screenings. If you get it early, you are cured. We know that. So 
we want to remove any of the obstacles people have going in and getting 
screening.
  Again, the Congressional Budget Office says they cannot figure out 
the savings. I said: Why don't you go look at Pitney Bowes. It is a big 
company, 200-some thousand employees, scattered all over the United 
States----

[[Page 20587]]


  Mr. DODD. Headquartered in Connecticut.
  Mr. HARKIN. I didn't know that. Pitney Bowes, and their CEO, Mike 
Critelli, went on a big program of wellness and prevention for all 
their employees. I think they called it Health Care University or 
something such as that. Here is what they found.
  They found, through their wellness and prevention program, they 
reduced their number of hospitalizations for all their people by 38 
percent--38 percent. Think of the savings. They reduced their 
disability payments and claims by 50 percent, just through their 
wellness and prevention programs.
  Again, this will save us money. It will make people healthier. Not 
only that, I say to my friend, just the productivity level--people will 
work harder, they will work better when they are healthy and they are 
well.
  One other thing I wish to mention. We have a fund in the prevention 
title of the bill that will increase over the years to a significant 
amount of money. People say: What are you going to use that money for?
  Right now at the Centers for Disease Control and Prevention, for 
cardiovascular disease prevention and heart disease prevention, the 
current funding is $50 million for all States. That is barely enough to 
even print a pamphlet to get information out to people--$50 million for 
cardiovascular disease. Yet angioplasties alone and bypasses, we spend 
over $90 billion a year--just on those two items. But if they are 
caught early and if there are prevention programs out there, we can cut 
those down.
  You mentioned diabetes. Right now diabetes costs us $174 billion a 
year--for diabetes. So the current funding is $62 million a year for 
diabetes prevention and control in the entire United States.
  Arthritis, the current funding is $13 million. For nutrition, 
physical activity and obesity, right now $42 million is all we spend 
through the Centers for Disease Control and Prevention--$42 million a 
year.
  You get my point. My point is, we are not focusing enough on 
prevention and wellness. That is what this bill does.
  I thank our chairman, I thank Senator Dodd for his great leadership. 
That is what people have to understand. In our bill, we have defined 
what we want to do on prevention and wellness. Frankly, I think we had 
good support on both sides of the aisle for that. I think the American 
people support putting more emphasis on keeping people healthy.
  Andrew Weil, Dr. Andrew Weil has come out with a new book, ``Why Our 
Health Matters.'' One of the things Andrew Weil pointed out to me a 
while ago--he said the natural state of the human body is to be 
healthy. It is in our DNA. Our body wants to be healthy. Yet everything 
we do lends itself to be unhealthy. We have to do things to make it 
easier to be healthy and harder to be unhealthy. Right now we do the 
opposite. It is easy to be unhealthy and hard to be healthy--especially 
after you find you have to make all these copays and deductibles. There 
is not much out there if you are prediabetic. Where do you go to get 
the kind of counseling and help you need so you don't get diabetes? I 
suppose if you have a lot of money you can probably do it, but for the 
average person, they have no idea where to go.
  The last thing I might mention, I say to Senator Dodd, also in our 
appropriations we have, and we hope we get some more in other bills, 
but: workplace wellness programs, to buttress what Pitney Bowes and 
Safeway and others have done in that area.
  For this bill, it is key to reducing costs and changing the structure 
of health care in America. I am grateful for my colleague's leadership 
in pulling this together and making sure in this bill we have a very 
strong investment in prevention and wellness.
  Mr. DODD. I thank my colleague, Mr. President. Before I turn to 
Senator Brown and Senator Whitehouse--and there are a lot of things to 
talk about in the work Senator Harkin and the committee did on 
prevention--one of the great successes in this bill is a matter he 
worked out with our friend and colleague from New Hampshire, Judd 
Gregg. You mentioned Pitney Bowes and Safeway. The Presiding Officer 
is, of course, a member of our committee as well and will recall this 
conversation. But the amendment we worked out will allow for companies 
to reduce by as much as 50 percent the premium costs of employees who 
decide to take personal responsibility for improving their health care: 
getting involved in smoking cessation programs; those who can lose 
weight will go on programs to take that poundage off.
  I will never forget Steve Burd, the CEO of Safeway, telling us that 
for every pound a person who could lose weight loses in a year, it is a 
$50 savings in premium costs--for every 1 pound. Think about what that 
can mean in terms of not only a healthier employee but also bringing 
down that cost of health care, not to mention, of course, that person 
is less likely to contract diabetes or related problems.
  You get a cost savings, you get a healthier person, you get a more 
productive worker. That language exists in this bill because of what 
Tom Harkin did with Judd Gregg on a bipartisan basis to make this a 
better and stronger bill. I commend the Senator and thank him for it.
  Mr. DODD. Mr. President, I see our colleagues from Ohio and Rhode 
Island are here.
  Mr. BROWN. I yield to Senator Whitehouse.
  Mr. WHITEHOUSE. I ask my distinguished colleague from Iowa a question 
about prevention because it strikes me, if you are a community health 
center and you want to invest in a health prevention strategy that will 
help the community you serve have healthier lives and therefore lower 
the costs to the system for everyone--you put out the money for that 
program if you are the community health center, you have to staff it, 
you take all the risks, you do all the work, and yet the benefit of 
what you have done doesn't come back to you. It goes to private 
insurers, it goes to the Federal Government, it goes to patients and 
better health. But it makes it a very unfortunate business proposition 
for anybody who is doing this on their own, which suggests this is an 
important place for the Federal Government to invest because the 
market, by itself, will not take care of this because you invest and 
you don't get it back. You invest and it goes to the insurance company. 
You invest and it goes to Medicare.
  I know Senator Brown wishes to make some statement. I wish to make 
that point because Senator Harkin's work has been so important on this, 
and I think that is an important thread.
  Mr. HARKIN. I thank my colleague. I think that is a very good point.
  Mr. BROWN. I appreciate the leadership of Chairman Dodd and Senator 
Harkin on the whole bill. Senator Harkin has led the way on prevention. 
Senator Whitehouse and I worked together on writing the public option 
which provides a choice--not any government mandates, not as the other 
side would like to create, this fear in the public that it is going to 
lead to single payer.
  Also, I thank the Presiding Officer for his work on tobacco and other 
issues on the HELP Committee too.
  I listened as we began this evening. Before Senator Dodd spoke, we 
heard from a colleague, a Republican colleague from the South, from 
Mississippi, I believe. We heard over and over all these scare tactics, 
all the kinds of words they use about single payer, about government 
takeover, about socialized medicine. It just serves to scare the 
public, to confuse the public.
  What they have done especially is trying to scare senior citizens 
into thinking we are going to do something to their Medicare, require 
them to come in and not just have a living will but have a plan on how 
they are going to die. Some of the things they are saying are 
absolutely amazing.
  I wish to kind of cut through that for a moment because I know we 
tend to use words--we talk about exclusivity and single payer and the 
gateway and the exchange, all these words we use around here. I wish to 
cut through that. I wish to share tonight, as I have

[[Page 20588]]

every night we have been in session for the last week or so, some 
letters I have gotten from people in Ohio. I know the Presiding Officer 
gets these from Portland, OR, and Eugene and Senator Dodd gets these 
from West Hartford and New London and New Haven and I know Senator 
Whitehouse and Senator Harkin get letters such as these from their 
States. But this is the reason we are doing this health care bill. This 
is the reason we have worked hard, doing our jobs, as we should, to 
pass legislation that will protect what works in our health care system 
and fix what is broken.
  We know many people want to keep their health care plans that they 
have. If they are satisfied and want to keep them, we want to help them 
keep them, but we want to build some consumer protections so they 
cannot be denied care when they call their insurer when they need a 
health care treatment; so they can't be discriminated against; they 
can't have a community rating system gamed. That is what people have 
seen. So if you have your own health insurance and are happy with it, 
we want you to keep that, but we want some consumer protections around 
it.
  This bill is full of assistance for small business that works so very 
hard to help people, small businesses that want to insure their 
employees but often cannot afford it. This bill will work so well to 
encourage and assist people who want health insurance to get that 
health insurance.
  Let me stop talking, except to read a few of these letters I have 
received in the last few days.
  Jon, from Franklin County--central Ohio, Columbus area--writes:

       I am a self-employed 28-year-old with Type I diabetes. 
     After being denied coverage by many health insurance 
     companies, the only plan I could find charged outrageous 
     monthly premiums.
       After having a policy for 5 months, the insurance company 
     increased my monthly premium by another $100.
       It is vital I have health insurance. I was diagnosed with 
     Type I diabetes at age 12, and I have taken very good care of 
     my health with diet and exercise.

  As Senator Harkin talks about.

       I didn't ask for this disease but ask you to vote for 
     reform--especially the public insurance option.
       We need realistic premiums and choices without penalties.

  That is what the public option does. If you don't have health 
insurance or you have inadequate insurance or insurance you are 
dissatisfied with, you can go into what is called this exchange. You 
have a choice, a menu of options. You can go with Aetna or with an Ohio 
medical mutual fund, mutual company, or you can go with the public 
option. Nobody forces you to do anything, but providing you a wide 
range of options will give you much better insurance than you might now 
have if you are dissatisfied.
  Thomas from Knox County, a Navy veteran--that is about 25 miles from 
where I grew up, in Mansfield:

       I would like to urge you to support health care reform that 
     includes a public insurance option. While private insurance 
     is adequate in many cases--

  Thomas, the Navy veteran, writes--

     there are far too many instances where private insurance is 
     denied or is inadequate to meet the needs of the insured.
       A neighbor of mine, a retired minister, was forced to sell 
     his home and move in with his son after battling cancer and 
     having tremendous debt as a result. And he was insured.

  We know how often that has happened. As Chairman Dodd has pointed 
out, people who so often have declared bankruptcy because of their 
illness often had insurance, but their insurance had lifetime caps. One 
of our consumer protections we are building into the health care system 
with this bill is no more lifetime caps so people can get the insurance 
they thought they had, can get the coverage they thought they had.
  Why we would allow, in this country, that a retired minister has to 
sell his house and has to move in with his son because the insurance he 
had when he got seriously ill would not cover his illness?
  What does that say about our failures in the past in enacting health 
reform?
  Thomas from Knox County, a Navy veteran, says:

       Please do not vote for any plan that would only fatten the 
     wallets of the insurance and drug industry without 
     significantly fixing the problem for the average American 
     citizen.

  What Thomas is talking about is what has happened in this body and 
what happened in the other body, where I was a Member, 5 years ago when 
the Bush administration pushed through a Medicare plan that betrayed 
the middle class. It was a plan that the drug companies wrote, the 
insurance companies wrote. It was a Medicare plan that simply did not 
work for the middle class. It worked very well to fatten the wallets, 
as Thomas said, of the drug and insurance companies.
  Let me share a couple more.
  Lia from Miami County writes:

       Recently our daughter graduated with her masters degree and 
     was ready to join the workforce. Last summer between 
     semesters she had major back surgery. We are so proud that 
     along with her recovery, she managed to carry her full 
     curriculum with great grades. But she developed complications 
     and subsequently endured three surgeries and 2 weeks in the 
     hospital.
       Her student health insurance expires at the end of July. 
     During her recovery, she was not able to search for a job and 
     has been denied from multiple insurance carriers due to her 
     preexisting conditions. We are now faced with additional 
     medical expenses and no insurance coverage.
       I fully understand the need for healthcare reform to assist 
     those who are facing the same issues that we are with our 
     daughter. Please stand up for those in Ohio and other states 
     that are doing their best to create a better life. Please 
     support healthcare insurance reform with a public and a 
     private option.

  She understands we want both. A public option will, frankly, make 
private insurance companies more honest. Private options help make the 
public option work better too. It will make it more flexible, and it 
will make it respond better to market conditions. Having them compete 
with each other will work for Lia from Miami County, from Piqua, or 
Troy, that area of the State north of Dayton.
  The last letter I would like to share is from Mary from Cuyahoga, 
from the Cleveland area:

       Please, please, please, do whatever you can to get the 
     healthcare reform bill through Congress this year, and stop 
     the insanity we are experiencing now. My husband and I are 
     retired. He has had diabetes for the past 28 years. Thank God 
     for Medicare. But he is part of the doughnut hole generation.

  What that means is, again, what happened 5 years ago when the Bush 
administration pushed their partial privatization of Medicare through 
the House and through the Senate, the bill that was written by the drug 
companies for the drug companies, the bill that was written by the 
insurance companies for the insurance companies, it simply did not 
provide senior citizens who had high drug expenses with their drug 
benefits. There was something called a doughnut hole where people 
simply lost the coverage for which they were paying.

       My husband has now reached the limit of the payments that 
     Medicare will make on his medications. Now he has to spend 
     thousands of dollars out of his pocket to stay healthy. Why 
     would you pay for only a half year of his medications? What 
     is he supposed to do the rest of the year? Hope for the best?
       My husband had taken charge of his health through better 
     diet and exercise. Yes, we need to take responsibility for 
     our health, especially a disease such as diabetes, but we 
     need healthcare that will help when all of our efforts fall 
     short and illnesses take over. Please vote for healthcare 
     reform.

  All of us get letters like this every day. Thousands of these letters 
are sent to the Capitol every single day from people who are 
struggling. Most of these letters, I have found, come from people who 
have had health insurance, they have lost it because of a preexisting 
condition, they have seen it fall far short of what they were promised 
because they had a very expensive illness, or they have sometimes seen 
their health insurance go away because they have lost their job.
  In every one of these cases I have read tonight, in every letter I 
have read, the dozen or so, couple dozen letters I have read here on 
the floor of the Senate, in every single one of these cases the 
legislation that those of us--Senator Whitehouse and Senators Harkin 
and Dodd and the Presiding Officer, the Senator from Oregon, Mr. 
Merkley--the legislation we wrote will take care of this. It will 
protect

[[Page 20589]]

what works in our system. It will fix what is broken. It will give 
people who already have their insurance and are satisfied with it more 
consumer protection so they can keep their insurance they are satisfied 
with. It will give those who do not have insurance an opportunity to 
buy decent health insurance, with a public option, if they so choose, 
or to go to a private insurance career.
  I yield the floor.
  Mr. DODD. I thank my colleague and thank him for making that 
contribution on so many points, particularly on the public option. As 
our colleague from Ohio has pointed out, and some may find it somewhat 
alarming--but the whole idea of competition is about as basic in 
America as any I can think of. The idea that people can have choices 
out there is something we cherish in this country.
  In fact, what exists today in so many case is the lack of choice. I 
listened to my colleague from Iowa talk about western Iowa, rural Iowa, 
where you only get one or two choices. In the State of Virginia, almost 
70 percent of all insurance is written by two companies in the entire 
State--two companies in the entire State of Virginia. That is not 
untrue in most places. I cannot speak specifically State by State, but 
it is not uncommon that in many areas the choices are very limited. So 
today, for most Americans, the ability to shop for the best health care 
plan that serves their needs and the needs of their families is very 
limited.
  What is being discussed here is not a subsidized plan, not taxpayer 
subsidized in any way, but a plan that would offer an option, a safety 
net in many cases, probably for some kind of illness that can afflict 
someone, which most people worry most about that could ruin them 
financially. It is a pretty straightforward kind of a plan that would 
provide some basic coverage, at a competitive price, a nonprofit 
operation that would take the element of profit out. I know that may be 
intimidating to people, to have someone out there competing with an 
idea. If it is not a good plan and people don't like it, they will not 
go to it, in which case it will not work very well. If it is a well-
drafted plan that does what many would like it to do, it might just 
have the effect of bringing down the cost in a competitive environment.
  I mean, under a capitalistic system, competition is what contributes 
to price fairness. If one company controls the whole game, or two do, 
you get a predictable result--price fixing--and you pay an awful price 
as a consumer, whether you are buying shoes or automobiles or any other 
product or service.
  So the idea of injecting a level of competition--I find it somewhat 
ironic that our Republican friends are frightened of this idea. I 
traditionally think that all of us embrace the free enterprise system 
as providing the best results for our country throughout 200 years of 
history. Why in the 21st century should that be any different from the 
20th or the 19th century, where competition helped produce the 
greatness of this country?
  I appreciate the Senator from Ohio today raising the point about the 
value of injecting some competition. We all know ultimately that could 
have the desired effect of bringing down those costs and making 
insurance or health care coverage more affordable. At some point, I 
hope someone might explain to me why competition is a bad idea. I 
though quite the contrary, and it is almost un-American to suggest that 
we ought to make this a noncompetitive environment, that everything 
else ought to be competitive but not health care. It seems to me that 
quite the opposite ought to be the case.
  I see my colleague from Rhode Island here, who made a significant 
contribution in crafting the public option and the very public option 
that was praised by the so-called Blue Dogs in the House, the more 
conservative Democrats in the House who were reluctant to be supportive 
of that specific health care package. But to their great credit, they 
took a good look at what we had created in our bill on the public 
option, and they were so impressed by the work done by our committee--
specifically, our colleagues from North Carolina, Senator Hagan, 
Senator Brown from Ohio, and Senator Whitehouse from Rhode Island, who 
were the principal authors of this provision in our bill--that the 
House Blue Dogs insisted that this language be incorporated in part of 
their health care effort in the House. I thank my colleagues from Rhode 
Island and Ohio and Senator Kay Hagan from North Carolina for their 
work in this regard.
  Possibly my colleague from Rhode Island would like to talk about that 
or some other aspect of this bill.
  Mr. WHITEHOUSE. I would be delighted to talk about that. But the 
first thing I would like to do is react to a point the distinguished 
chairman has just made regarding how ironic it is that some of our 
friends on the other side are so opposed to increasing competition in 
the insurance industry. One of the things that is particularly ironic 
is that a great number of our colleagues on the other side go home to 
their home States to a health insurance system that already is a public 
option for their business community, their workers' compensation 
system.
  The two places you get health care are from the general health 
insurance marketplace and from the workers' compensation marketplace. 
You can get workers' compensation coverage, and it will cover small 
workplace injuries, it will cover catastrophic workplace injuries, it 
will cover temporary conditions, and it will cover lifetime chronic 
conditions. It has all of the elements of health insurance coverage and 
the need for it.
  Well, when our colleague from Wyoming, the distinguished ranking 
member of the HELP Committee, goes home to Wyoming, he goes home to a 
single-payer public option for workers' compensation health insurance. 
So it can hardly by anathema to have a choice public option.
  The distinguished gentleman, Senator McCain, who was the Republican 
candidate for President, goes home to Arizona to a competitive public 
plan providing workers' compensation health insurance in his home 
State.
  The Republican leader himself, Senator McConnell, goes home to 
Kentucky, to a State where there is a public plan that delivers health 
insurance, a competitive public plan. And I suspect his employers like 
it and the people are comfortable with it.
  Our colleague, Kay Bailey Hutchison, is shortly to go home to Texas 
to run for Governor. When she does, she will go home to a State that 
has a competitive public plan that delivers health care through the 
workers' compensation system.
  Our distinguished friends in Utah, Senator Bennett and Senator Hatch, 
who have done so much work on health insurance issues over the years, 
go home to Utah, where their business community has a competitive 
public plan for delivering health insurance.
  So, in addition to the irony of being against competition, their 
business communities, I believe, are highly favorable to a public plan 
that competes in the market to deliver health insurance that the 
business community funds, the workers' compensation health insurance 
market. So I guess ironies abound here.
  I would also like to compliment Senator Brown for keeping it real 
here on the Senate floor and reading those letters and reminding us 
that when push comes to shove around here, it is not the nametags and 
the labels that matter, it is not ``socialized medicine,'' it is not 
``government takeover,'' it is people who have real problems.
  I was struck by a letter that was brought to my attention today. I do 
not know exactly what day it came in, but I saw it today. A working 
couple with a son, sort of the ideal American family, doing nothing 
wrong, doing everything right, playing by the rules, working hard. The 
son becomes grievously ill, has a very grave illness. Over the years, 
his condition worsens, and ultimately his disease takes his life. They 
were insured through this whole period, but the insurance was not 
enough. There were copays, there were limits, there was cost sharing. 
As a result of all of this, they are deeply in debt. They had to take 
time off work

[[Page 20590]]

and spend time caring for him, and so they have had employment issues.
  Now, this is, again, sort of the ideal American family. They are both 
working hard. They have a son whom they love. They are doing everything 
right, and they are playing by the rules. And because he got sick and 
because our health insurance system is such a nightmare for a family in 
that situation, they have lost their son, they have lost their savings, 
and they are about to lose their home. They are about to be put out of 
the house that has all of the memories of their son.
  You know, there are people for whom this is very real, and we have to 
keep our eye on that ball and not on all of the smoke and all of the 
fear mongering that is happening around here. A lot of that smoke and 
fear mongering is happening around our public plan.
  Well, it is not that complicated. It is competitive. It is fair. It 
has no special subsidies for people who are in that plan versus in 
competing private plans. It has no special advantage. And it honors 
President Obama's programs and the promise of all of the Presidential 
candidates that if you like the plan you have, you get to keep it. You 
are not forced out of anything.
  So if it has no special advantages, if it has no special subsidies, 
why do we support a public option? Why is it better? Well, I would say 
that there are three reasons we can have some confidence that a public 
option will make a difference for the kind of people Senator Brown was 
talking about, the family I was talking about, people who suffer 
through our existing health care system.
  The first is, a public plan does not need to take profit out of the 
system.
  In 2007, in Rhode Island, one of our insurers, United Health Care, 
asked permission to remove $37 million as its profit in that year from 
Rhode Island back to its home headquarters. My State isn't as big as 
Ohio. It is not as big as Iowa or Connecticut. It is a small State. It 
has a million people. In one year to take $37 million out of that 
State, when they only had a 16-percent market share, think of that. A 
16-percent market share in a State of a million people is about 160,000 
folks they cover, assuming that everybody had coverage; $37 million out 
of those 160,000 people in 1 year gone for profits.
  Stop doing that. Stop paying exorbitant salaries such as United 
Health Care's chief executive who got $124 million in salary. That is a 
lot of money that could go back into other things in health care. That 
could help families either get better coverage or pay lower premiums. 
So there is one thing--no profit, no excess cost.
  The second is, you could have better dealings between insurers and 
providers and hospitals than we have right now. Fifteen percent of our 
health care costs from the insurance side goes to overhead and 
administration. Most of that goes to denying claims and making life 
difficult for providers, doctors, and hospitals, when they submit their 
bills. There is a war, a claims war going on right now between the 
insurance industry and doctors and hospitals. And 15 percent of what we 
pay for health care gets burned up on the insurance company side of 
that war. The insurance companies are bigger and smarter, and they set 
the rules. So you can bet that the doctors' side of responding to that 
costs more than 15 percent.
  In fact, the Lewin Group has estimated that 36 percent of a 
provider's overhead cost goes to fighting with the insurance industry. 
Everybody in this place has had the experience or somebody they know or 
love has had the experience of trying to get a claim paid, having it be 
denied, submitting a bill, having it be denied, having to wait for 
treatment that you need while your doctor tries to get prior 
authorization from the insurance company that says: No, we need more 
papers. All of that is expensive. None of it provides any health care 
value, zero. It is all administrative overhead and nonsense.
  In some cases it is big. I was at the Cranston, RI community health 
center. It is not a big organization. Rhode Island is not a big State. 
Cranston is not our capital city, not our biggest town. Its community 
health center does not have an enormous budget. They spend $300,000 
every year on the consultants who help them try to negotiate this 
payment claims war they are stuck in--$300,000 a year. On top of that, 
50 percent of their personnel time, half of their personnel time, goes 
to fighting with insurance companies. So you take a little place such 
as the Cranston community health center and you can tell them: Half of 
your personnel costs can go away or can be devoted to prevention, as 
the Senator from Iowa has suggested, instead of fighting with the 
insurance industry. That is an improved model. That is something the 
public option can pursue.
  You don't have to fight the providers that way, and the amount of 
waste that is burned up on all of that warfare for no health care value 
whatsoever is an opportunity for this public option to achieve.
  The third area is to more broadly change the business model. There is 
a failed private insurance business model right now. It is pretty 
simple to summarize. No. 1, if they think you are going to get sick, 
they deny you insurance. You don't even get in the door. No. 2, if they 
make a terrible mistake and let you in the door and then you have the 
temerity to get sick, they look for a way to deny coverage. They go 
through the form and look for a mistake you might have made so they can 
throw it out. They find something that might have been a preexisting 
condition. They look for a loophole. If they are stuck, if they can't 
find a loophole, then they deny payment. They tell you that the 
coverage you need isn't what you need or they refuse to honor the 
doctor's bill when it comes through the door. But a business model for 
an entire industry of denying insurance to the people who they think 
will get sick and then denying coverage to the people who actually do 
get sick and, when they can't dodge their coverage responsibilities, 
denying payment to doctors or hospitals or trying to have some person 
who is not even a doctor second-guess the coverage that your doctor 
tells you you need, that is a terrible business model. It has caused 
immense pain across the country, and it has been a disaster. There is a 
better business model. A public option can pursue it.
  Mr. DODD. If my colleague will yield on that point, those very fact 
situations the Senator describes would be totally prohibited under the 
bill we marked up in our committee nearly 3 weeks ago. Every one of 
those fact situations would be prohibited under the legislation we sent 
to the body for its consideration.
  Mr. WHITEHOUSE. Yes, it would. And it is an important piece of this 
legislation that has received far too little attention so far in the 
debate. It has caused an immense amount of personal pain, human 
anguish, and suffering that our health care system causes.
  The distinguished Senator from Ohio, Senator Brown, and I wrote an 
article about this. We wrote: Your health insurer should be your 
advocate, not your adversary. The community health insurance option 
will invest in prevention so that when you are healthy, you stay that 
way. It will invest in care management coordination, if you have a 
chronic condition, and it will fight for you, not with you, to get you 
the best possible care with the least possible hassle.
  That is what this is all about. The new business model can look in 
these areas: Quality improvement. We know that improvement in the 
quality of care in this country can save dollars. But as we were saying 
earlier in our colloquy, it doesn't save money for the person investing 
in the quality. It saves it for the system. A public option will have 
the public purpose necessary to pursue those quality improvements that 
will drive down cost.
  Health information infrastructure. We have the worst health 
information infrastructure in this country of any industry. The only 
industry that has worse information infrastructure is the mining 
industry. It is pathetic. But the same principle applies. The doctor 
investing in that equipment on their desk puts out all the money, takes 
all the risk, absorbs all the hassle, and the savings go to the 
insurance companies.

[[Page 20591]]

So we are underinvested. A public option can make those investments in 
our electronic health record infrastructure.
  Prevention strategies. I won't dwell on that because the Senator from 
Iowa has done such a good job already. Same principle: A public option 
can pursue the public purpose of protecting public health through 
prevention in a way that insurers never will because they don't have 
the financial interest at stake. Finally, you can develop new models of 
payment to make all those happen, because the way we pay for it now is 
piecework. Procedure by procedure, the more you do, the more you get 
paid. Not the healthier your patients are, the more you get paid; the 
more you do, the more you get paid.
  There is enormous hope for the whole system. In fact, it may be the 
only hope for our whole system is to change that business model to a 
model that works on quality improvement, prevention, investment, 
payment reform, and electronic health record infrastructure for 
everybody. A public option will lead us in that way.
  Perhaps you can trust the private insurance industry to do this, 
although they never have so far. But perhaps now suddenly something 
will change and you can trust them to start doing this for the first 
time, when they never did before. But I don't think it is a wise bet to 
put all of our eggs in that one basket. Give us a public option and let 
them compete. I think they can help transform this world.
  The last thing I will say it is cost control. We have heard a lot 
about cost control on this subject. There is no better way to have cost 
control than to get a public option out there doing all these things--
stripping the excess profit out of the system, lowering the 
administrative costs, ending the warfare with providers that provides 
no value, and working to a business model founded on quality, 
prevention, electronic infrastructure, and clearer payment signals. 
That is where we need to go. The public option takes us there.
  Nobody cares more about this than the distinguished chairman and 
particularly the people he has heard from in Connecticut. I would 
revert back to the chairman to discuss the personal aspects of this on 
the part of the people he serves.
  Mr. DODD. I thank my colleague. There will be many more opportunities 
for us to go over this, but I want to make some points that are 
important and are part of the legislation that came out of our 
committee and that are now available for colleagues and others to 
consider.
  Under our legislation, you can never discriminate again for a 
preexisting condition. So when someone comes in and says, I am sorry 
but that condition precludes you from getting coverage, under our 
legislation, drafted and approved by our committee, that would not 
happen. Never again can a preexisting condition be used to deprive 
coverage.
  No exorbitant out-of-pocket expenses, deductibles, or copays. 
Insurance companies will have to abide by yearly caps on how much they 
can charge for out-of-pocket expenses. There will be minimal or no cost 
sharing for preventive care. The insurance industry would fully cover 
regular checkups and tests that help prevent illness such as mammograms 
or eye and foot exams for diabetes, the kind of thing Senator Harkin 
talked about. It doesn't make sense to pay $30,000 to amputate your leg 
instead of paying for the coverage to determine if you are susceptible 
to the illness.
  No dropping coverage for the seriously ill. Companies would be 
prohibited from dropping or watering down insurance coverage for those 
who become seriously ill. No gender discrimination. There has been a 
problem of tremendous discrimination in the cost of coverage based on 
gender. Under our legislation, insurance companies would be prohibited 
from charging you more because of your gender. No annual or lifetime 
caps on coverage. Again, you have coverage. You have never had to use 
it. All of a sudden you get that crisis in your family, and then you 
start reading the fine print and discover all you get are two hospital 
visits or three doctor visits. You have a serious problem on your 
hands. That coverage you have been paying for month after month, year 
after year, all of a sudden might as well not exist at all. Under our 
bill, the industry would be prevented from placing annual and lifetime 
caps on coverage that you receive.
  Extended coverage for young adults: Children would continue to be 
eligible for family coverage, not stopping at age 21 but up to 26. That 
is a huge gap, 21 to 26. Then we have young adult plans that would 
allow another option. Young people often think they will live forever 
and never have any problems. We are trying to help out this age group 
that too often slips through the cracks. This group often doesn't think 
coverage is that important and, as a result, suffers when they are 
faced with illnesses or accidents.
  Lastly, guaranteed insurance renewal is the point I wanted to raise--
when you discover all of a sudden that you are no longer covered. Under 
our legislation, the industry would be required to renew any policy as 
long as the policyholder pays premiums in full. The companies wouldn't 
be allowed to refuse renewal because someone became sick. Every one of 
these provisions is now written into our legislation. Our bill 
absolutely makes major reforms that will make a difference on behalf of 
the citizenry who are counting on a program that would not deprive them 
of the coverage they deserve.
  I see our colleague from Oregon is here. I want to say that Ron Wyden 
has been a tremendous advocate of health care reform for so long. He 
has written a bill that has attracted a lot of bipartisan support. He 
and I have had long conversations about some of his ideas. I have asked 
him to take a look at what we have done as well. I am confident we will 
end up with health care reform. And I want to thank Ron Wyden for his 
energy and passion about this issue and the very creative ideas he has 
brought to the table.
  Mr. WYDEN. Mr. President, I wanted to come tonight as a member of the 
Finance Committee and particularly highlight the extraordinary 
contributions that those on the HELP Committee have made in the 
prevention area. This is going to be a landmark bill. This is going to 
be an absolute turning point in American history when we finally say 
that instead of spending loads of money on various health care 
services, we will start keeping people healthy. You look, for example, 
at the Medicare Program. Medicare Part A will pay thousands and 
thousands of dollars on senior citizens' hospital bills. And then 
Medicare Part B, the outpatient portion, can't do anything to reward 
somebody for staying healthy. Along comes Senator Harkin, who has 
consulted very extensively with the private sector, worked on a 
bipartisan effort. Senator Enzi and Senator Gregg were very involved. 
And you found the sweet spot. Prevention.
  What you all were able to do in the preventive area is to show that 
you could give very dramatic incentives to reward people for staying 
healthy, lowering their cholesterol, lowering their blood pressure, 
picking up on some of the good work that is being done in the private 
sector but not getting into where one could, in effect, be said to be 
discriminating against an individual who would have a lot of health 
problems and would have difficulty just with an incentive-based system.
  That is a very thoughtful approach, in my view, to moving this 
country forward. I hope we will be able to pick up on it in the Senate 
Finance Committee. There is a lot of bipartisan support for it. I came 
to the floor tonight to particularly highlight that.
  There is time, perhaps, for one other thought. I was struck--as we 
talk about the lack of choice in this country--the distinguished 
Presiding Officer and I woke up this morning to our statewide 
newspaper, the Oregonian, which described, in great detail, our health 
insurance as Members of Congress. Senator Harkin and I have talked 
about this, Chairman Dodd as well. It described how Senator Merkley and 
I have access to 23 health care packages, which, by the way, understand 
the HELP lesson. They cannot discriminate against you if you

[[Page 20592]]

have a preexisting condition. You go into a big group so you can play 
hardball with the insurance companies.
  What is striking about this--and Senate Merkley and I heard about 
this on the front page of our newspaper--is most of the country thinks 
this is some kind of ``Cadillac,'' gold-plated operation. But, as the 
newspaper pointed out today, that is what somebody who works for the 
Forest Service gets in central Oregon, that is what somebody who is a 
janitor, for example, the paper said, gets at the Bureau of Engraving.
  I very much look forward to working with all of you on the HELP 
Committee, as Chairman Dodd and I have talked about, to make sure 
everybody can have a wide array of choices, have a lot of clout to take 
on the insurance companies, get reduced administrative costs, which is 
what you get with the big groups, and, by the way, have a financial 
incentive to choose one of these Harkin-type packages that reward 
prevention.
  One of the things that is troubling about this debate is if we do not 
get the choice issue right, a lot of Americans are not going to be able 
to choose those kinds of packages. I think, under the Senator's 
leadership, we will be able to do it.
  The last point I would make is--and I thank the Senator for all the 
time--I think working together over the next few months we can close 
the sale with folks who have insurance. This is going to be the key to 
getting health reform passed.
  Mr. President, 150 million-plus people say: Not only do I want to 
make sure I am not worse off, I want to be better off. Well, we want to 
make sure they are going to be able to choose a package such as Senator 
Harkin has been able to advance in the HELP Committee, where they get 
rewarded for prevention. We want to make sure they can choose a package 
where they can get lower premiums. We want to make sure everybody can 
keep what they have, but if they do not like what they have they can go 
somewhere else, which is what we can do as Members of Congress.
  So I think tonight's program, particularly focusing on prevention and 
the incentives you all have laid out--and as Senator Whitehouse has 
talked about, changing this insurance model, which in many respects is 
inhumane to reward all this cherry-picking and, in effect, sending the 
sick people over to government programs more fragile than they are--you 
all have done some very good work, particularly in prevention and 
making sure the consumer gets a fair shake with the insurance industry.
  Working together, particularly by adding choices, we are going to be 
able, over the next few months, to show we can close the sale with 
those who have insurance in this country and come back in the fall and 
win bipartisan support to go where this country has not been able to go 
for 60 years; that is, quality, affordable coverage for all Americans.
  We have already made it clear that in any legislative effort we are a 
part of, we will mandate good health for the Dodd household because we 
are all thinking about you, and we want you to know how much affection 
we have for you and how much support both personally and professionally 
we have for you from all of us in the Senate.
  Mr. DODD. I thank the Senator.
  Mr. WYDEN. I thank the Senator for giving me all this time.
  (Mr. Whitehouse assumed the chair.)
  Mr. DODD. I thank my colleague.
  Mr. HARKIN. Mr. President, I wish to thank my friend from Oregon, 
with whom I have had numerous conversations, going back over years, on 
the whole wellness ethic and how we can kind of get this big ship of 
health care moving in a different direction. Senator Wyden has been one 
of the great leaders in this area, and I have consulted with him often 
on this issue. I look forward to his work on the Finance Committee.
  Of course, on workplace wellness, we have to make sure small 
businesses are able to help their employees in wellness programs. We 
know from other businesses and what they have done--some larger 
businesses but some smaller ones that have done good workplace wellness 
programs--it pays off immensely in savings but also in productivity. Of 
course, that is something the CBO does not look at--increased 
productivity. They do not look at that.
  But I say to Senator Wyden, he is absolutely right. What we have 
done, what we anticipate will be coming now from the Finance Committee, 
and in putting these together, we will have a whole new--what is that 
fancy word called Paradigm--a new paradigm in health care in this 
country, where people will have a lot of choices. They will be able to 
shop. They will not be like my friend Art in Storm Lake, IA, who only 
has one place to go with a $5,000 deductible.
  Now we will be able to take a lot of these small businesses and they 
will be able to go on these exchanges and they can be in a pool with a 
lot of other people all over the country. We know a principle of 
insurance--I say to Senator Wyden, he knows this very well--one of the 
basic principles of insurance is: The more people in the pool, the 
cheaper it is for everybody.
  So we set up the bigger pools with our small businesses, my farmers 
and farm families to get into bigger pools, and not just these small 
pools that cost them so much money. But the idea behind it, of course, 
the one big paradigm, is to start focusing on wellness and health 
promotion, keeping people healthy. We have to put more incentives in 
there for people.
  You talk to anyone. Go out and talk to anyone and ask them would they 
like to be healthier or would they like to be sick. That answer is 
easy. They want to be healthy. What kind of help do you get? When you 
go to your doctor, when you talk to your doctor and stuff, do they tell 
you how to be healthy? Well, I do not know. I do not think so. When is 
the last time you went to a doctor and walked out without getting a 
prescription? So the doctor gave you a prescription. Go get a drug. We 
have to change this. In our bill, we do.
  Again, part of our prevention package is to focus on medical schools 
and how we get more people in general practices and family practices 
and residencies in prevention and wellness so they begin to understand 
how they can start working with people to keep them healthy.
  So this is a way we are going to try to shift this so the person can 
say: Yes, I want to be healthy. And do you know what, I went to my 
health care practitioner--maybe a doctor, maybe a nurse practitioner, 
maybe a physician's assistant, and it could be a host of different 
people; it could be a chiropractor--and, do you know what, they spent a 
lot of time with me, and they gave me a program to follow to stay 
healthy. And guess what. They check up on me and they find out: Are you 
following your program? Come in. You come in here in 6 months. I am 
giving you this program to show you how to stay healthy. And they call 
me up after a month. Someone in the office called me up, asking: Are 
you doing this? In 6 months, I have to come back in to make sure I am 
doing it.
  No one has ever done that before. But in our bill, you see--in our 
bill--they will be able to get reimbursed for that. They will be able 
to get reimbursed for keeping someone healthy and not just taking care 
of you when you are sick.
  I wish to thank my friend from Oregon. He has been a great leader in 
this area for so many years. I look forward to working with the Senator 
to get us over that finish line sometime this year.
  I thank Senator Dodd again for all his great leadership. I say to the 
Presiding Officer, the Senator from Rhode Island--talking about the 
public option, to digress for 1 second away from prevention--here is 
one of the reasons we need a public option: From 2003 to 2007, the 
combined profits of the five largest health insurance companies went up 
170 percent. Their profits went up 170 percent. The CEO compensation 
for the top seven health insurance companies right now: $14.2 million a 
year.
  Well, that is why we need a public option out there, to kind of put 
some brakes on that, to give some competition out there so these health 
insurance companies know they have to be a

[[Page 20593]]

little bit more stringent on maybe what they pay their CEOs, and maybe 
the profits will not be so high because they will have a public option 
out there that will act as a check both on their profits but also a 
check on the quality of care they provide. That is why the public 
option is so vital and necessary.
  Well, again, I say thank you to Senator Dodd for having us here 
tonight, and I thank him again for his great leadership on this health 
care bill.
  I say to my friend from Oregon, we are going to get it done. We are 
going to make this a wellness society, not a sick society.
  Mr. DODD. Mr. President, I thank our colleague from Iowa, and I 
thank, again, Ron Wyden for his contributions.
  I wish to reintroduce a constituent of mine, Kevin Galvin. I spent 
the morning with Kevin today. He is a true American hero, in many ways. 
He did not want to become an American hero.
  Kevin employs, I think, 13 people. He has a small business in 
Hartford, CT. He started out in a hardware business about 27 years ago 
and changed his business model to meet the needs and times of our 
country. He was never able to provide health insurance for his people, 
and it bothered him deeply because he did not have enough business, and 
health care coverage, even years ago, was more expensive than he could 
afford.
  Students sometimes ask: Can one person make a difference? This 
person--I suppose the legislative leaders in my State would acknowledge 
this as well--this one person, on his own, over 2 years, organized 
19,000 small businesses in my small State to lobby my State legislature 
about doing something at long last to make a difference for small 
businesses on health care. They achieved it about a week ago, in no 
small measure because one guy, who employs about 13 people, got fed up.
  The average small business pays 18 percent more for health care than 
larger businesses and gets a lot less coverage than others do as well 
for the very reason Senator Harkin pointed out: pooling, the idea of 
being able to work together, get together. They can hardly lift up 
their heads. In a small business, you are struggling every day to 
survive.
  Seventy-five percent of our employers employ fewer than 25 people in 
our country. The majority of people in our Nation get a job in a small 
business. Yet they work so hard every day trying to keep that business 
afloat, particularly in times such as these.
  It bothered Kevin Galvin so much, that employees of his, in some 
cases, had to leave him. They did not want to leave but had to because 
their spouse lost their job, which is what they were relying on for 
health insurance. He told us about one fellow today, who I think was 
with him 20-some-odd years, who had to go off and find a job that paid 
30 percent less in income but because they had a health care plan. He 
left the job he loved to take a 30-percent pay cut so his family could 
have health care.
  A young man whom we talked to today, an employee, a Hispanic 
American, in Hartford, CT, is raising a family on his own and has a 
child with a severe disability and his parents have Alzheimer's and 
there is no coverage under this guy's plan, Kevin Galvin's plan, in his 
workplace. But they are doing everything. Kevin does whatever he can to 
help that family out because he loves that young man who has worked 
with him. He cares about him. But he cannot afford to do it forever. He 
cannot survive as a businessperson that way.
  So we need to pay attention. Our bill does. We talked about 
prevention. But one of the things I am most proud of in our bill is 
providing those credits to small businesses so they can afford 
coverage, giving them the option of going to those alternative plans 
out there that may suit their needs the best, which they do not have 
today, allowing them to come together, so they have an opportunity to 
drive down those costs when they bargain together for the best cost for 
their employees, as the Senator from Rhode Island pointed out.
  But I wished to point out Kevin Galvin. Today we met in his shop in 
Hartford, CT. The Secretary of Health and Human Services, Kathleen 
Sebelius, was there. The new Administrator for the Small Business 
Administration, Karen Mills, was there. Congresswoman Rosa DeLauro was 
there. The speaker of the State house was there. The president of the 
State senate was there. The head of the small business community was 
there. They were there to say thank you to Kevin Galvin for what he had 
done.
  If one person like that can make a difference, we ought to listen to 
them. When the Kevin Galvins of this country--he is a small business 
guy with 13 employees, struggling every day. He decided he was going to 
do something about it, and we ought to listen to him. He made a 
difference in my State. But if we listen to him, we can make a 
difference with small businesspeople all across this country. If we 
will take the language we wrote in our bill that can make a difference 
with small business--13 million people in this country who work for 
small business every day don't have health insurance. Of that 47 
million, 13 million--being able to make a difference in their lives, 
giving them the kind of coverage, the accessibility and the 
affordability to health care, can make a huge difference.
  One thing we don't mention enough: This week is the 44th birthday of 
Medicare--this week. It is a great program. It took the poorest sector 
of our society out of poverty, the elderly. It also did something else. 
How many of us in our generation were able to do other things and make 
investments in other things because in 1965, this Congress, the men and 
women sitting in this Chamber--mostly men in those days--passed 
Medicare? All of a sudden, that financial burden children had to look 
at--the cost of pharmaceutical drugs their parents needed, going to the 
doctor with their parents--all of a sudden, a lot of it got taken care 
of. It was a financial benefit to their children.
  I don't know if there are any economic models that look around and 
say: How much did that program not only benefit the elderly who got 
Medicare, but how did it benefit their children who were then able to 
make investments in their own children's education and in that better 
home and that better neighborhood, buying that second car? How much did 
our economy actually grow and improve because we invested in Medicare? 
We always talk about what it did for those who receive Medicare, but 
how about those who didn't receive Medicare but had removed from them--
or at least partially removed--the burden of those costs they would 
otherwise pay?
  How many people today, because of the uncertainty about their health 
insurance, are not making the kinds of investments in other things 
because they are trying to protect themselves against that crisis that 
could befall them? We don't talk about that.
  All I hear about is how expensive this is. It is going to be 
expensive, but if we don't do something about it, it will be a lot more 
expensive--expensive to our economy, expensive to individuals, and 
expensive to our Nation.
  So when we talk about these issues, it isn't just those who benefit 
as a result of having access; it also is the relief, it is the sense of 
comfort, that sense of confidence that, Lord forbid, something happens 
to me and my family, I am protected against catastrophic ruin--
catastrophic ruin that can happen. I don't think we talk about that 
enough here. One of the reasons is because none of us here--none of us 
here--have to worry for one single second about that. None of us are 
going to be economically ruined as Members of the U.S. Congress if a 
health care crisis befalls us. Not one of us. Yet the millions of 
people we represent worry about it every single day.
  That is at the heart of all of this, to be able to establish a system 
in our country which protects our Nation--the greatest, the wealthiest 
Nation in the history of mankind--from the absolute and very 
predictable knowledge that you have either been sick, you are sick, or 
you are going to get sick. I guarantee you, if you are a human being 
living in this country, that is going to happen to you. To what extent

[[Page 20594]]

does that occasion, that event put you and your family in financial 
ruin? It happens to millions in this country. So that as much as 
anything else ought to motivate us to get back here and do the job.
  I see my colleague from Oregon is here, Senator Merkley of our 
committee, who has done a great job as well.
  Mr. MERKLEY. Mr. President, I thank the Senator very much for his 
presentation and leadership on health care.
  The Senator was just talking about Medicare, and when our HELP 
Committee was meeting, I heard a very interesting statistic; that is, 
while Americans spend 17 to 18 percent of our GDP on health care--more 
than any other country on the planet--our health outcomes overall are 
significantly less than several dozen other nations in the world. That 
is part of the puzzle we are addressing. But then I heard another piece 
of the puzzle; that is, for American citizens who are 65, their health 
prospects are among the best in the world. The question was posed 
before the committee: What is the difference? The difference is very 
simple, as the Senator from Connecticut has so described, and that was 
the creation of the Medicare Program. All of our citizens 65 and older 
have health care. If we can take it and make it a nation where all of 
our citizens 65 and under have health care, wouldn't it make a 
tremendous difference?
  Mr. DODD. My colleague is absolutely correct. This is the point. 
People probably know, but the younger generation may not realize it. 
Prior to 1965, the poorest population of our country were our elderly. 
It was a great tragedy--the generation that grew up and then 
contributed so much. The 20th century--of course, by 1965, those were 
the veterans of World War I. They were the people who had lived through 
the Depression and held us together as a nation time after time, and 
here they were reaching their retirement years, and, as we all know, 
when health care problems become pretty routine.
  A generation that came before us sitting in this very Chamber decided 
we could do better than that, and so crafted Medicare. The leadership 
again began with President Kennedy and culminated with the work of 
Lyndon Baines Johnson putting a package together with Hubert Humphrey 
and others, putting together that Medicare Program and taking a 
substantial portion of our population and giving them the assurance and 
the confidence that as they grow older and face health care problems, 
the Nation would be there to back them up and to say thank you as a 
gesture of gratitude for the contribution they made.
  Also, there was a note of selfishness in that it relieved that 
younger generation from the burden of financially caring for parents 
beyond their economic means, in many cases. So it freed up their 
children to provide for that generation's grandchildren. In so many 
ways we have benefited from that.
  So while we talk about the recipients of Medicare--and that is 
extremely worthwhile--we all benefited from that. It was a great 
economic relief to an entire Nation, not just the recipients of 
Medicare's assistance and support.
  Mr. MERKLEY. Mr. President, if I could carry on a second point 
related to the Senator's comments, and that is simply as you address 
small business and Kevin Galvin, your constituent, to help organize 
small business, whereas we did a tremendous job in regard to our 
seniors 65 and older, we haven't done such a good job for our small 
businesses.
  I know that over the past many years, small business owners have been 
coming to me and saying: Jeff, we just can't afford these double-digit 
increases we are getting every year in health care premiums, and we are 
having to shift some of the cost to our employees. We are having to 
consider shutting down our insurance program completely. We as small 
businesses can't get the same good deal the large businesses are able 
to get. Can't you do something about that?
  I think with the bill the Senator from Connecticut has steered 
through committee, he has done such great work in laying out a plan 
that will help our small businesses in several different ways.
  First is to create a pool where they will have the negotiating power 
of hundreds of thousands of individuals rather than having to go as a 
small business of 5 or so or 25 employees to the health care market, 
because when you go by yourself with 5 or 10 or 25 employees, it is 
like leading a lamb to slaughter. Now they will be able to go to the 
health care marketplace where they will be able to be a part of a 
larger pool and negotiate a much better deal.
  The second is, they will have so many options when they get to that 
health care marketplace, whereas now there may be only one company that 
will hear them out and give them a possible plan, and then they will 
have many more to choose from.
  So I think those pieces are a tremendous improvement to what I think 
has been a long neglected part of the health care puzzle.
  Mr. DODD. Again, I thank my colleague for mentioning that. He is 
absolutely correct. As I mentioned earlier, the average small business 
pays a lot more for insurance than larger businesses do, and they get 
far less coverage than others do as well. That is why we provide new 
credits in this bill: $2,000 per employee, family coverage; $1,500 for 
couples; and $1,000 for individuals. That may not satisfy all of their 
health care costs, but it is a major break and an assistance to small 
businesses and guys such as Kevin Galvin who would like to be able to 
buy that coverage for his employees out of loyalty to their family.
  One thing about small business is it becomes a family. Everybody 
knows everybody. You know about what their kids are doing. You know 
what is going on in their homes. There is a far greater deal of 
flexibility in trying to meet the needs because it is a family in so 
many ways. So being able to jump in and help them provide, as Kevin has 
tried to do with his own employees over the years, we open up the 
insurance gateway to all small businesses to give affordable insurance 
options to employers.
  This gives small businesses the same bargaining leverage as I 
mentioned earlier, protection from hiking up rates on small businesses, 
watering down coverage, or denying coverage altogether just because one 
worker gets really sick--and you heard cases of that. I think Senator 
Harkin talked about that small business where one employee contracted a 
very serious illness and the industry then jacked up the premiums for 
everyone, thus making it impossible for other employees to get 
coverage. Our bill, as our colleague from Oregon, Senator Merkley, 
mentioned, bans that case.
  We exempt businesses from having to pay any penalty if you employ 25 
or fewer employees, and that is a great asset. Again, 75 percent of all 
employers employ 25 or fewer in our country. We don't count seasonal 
workers. Our colleague Senator Kay Hagan offered that amendment in our 
committee to exclude seasonal workers toward the total size of a small 
business, which is important in small agricultural communities where 
seasonal workers become absolutely critical. But if you start adding 
them all up, it would drive that small business into a larger number 
category. I assume in Oregon that could be a major problem, I know in 
the agricultural sector of your State, and it helps self-employed 
workers by allowing them to purchase health insurance through the 
gateways.
  So a lot of businesses are single employers. They employ themselves. 
That could be tremendously costly, and by pooling, it makes it possible 
for those people to drive down those costs.
  So a major part of our bill, as Senator Merkley has pointed out, is 
focused on small business--again, the great engine of our economic 
success in this country, and we pay a lot of attention to their needs 
in this bill.
  Mr. MERKLEY. There is just one last point I wish to make, but I am 
happy to yield to my colleague.
  Mr. HARKIN. I thank my friend from Oregon.

[[Page 20595]]

  Mr. President, I can't thank Senator Dodd enough for getting the 
information out on what our bill does. A lot of people don't know that 
we have a very comprehensive bill. This one dealing with small 
businesses is so important.
  Now, it is true we excepted businesses that employ fewer than 25, as 
we should. However, I just told the story about my friend in Iowa who 
employs 12 people, and they buy health insurance but they only have one 
plan, and this would give them more.
  I believe that with the bill we have and setting up these exchanges 
and letting different insurance companies come on the exchange, and 
with a public option there are a lot of small businesses out there that 
would like to cover their employees; they just simply can't afford it 
or the deductible is so high that it is not even worth it. Now I 
believe they will be able to take, with our bill, after it is fully 
implemented--it takes about 3 years to phase in, if I am not mistaken--
there will be a lot of small businesses out there that employ 10 or 15 
people that now will be able to get an insurance policy for their 
people that will be a heck of a lot more reasonable than what they can 
get now, and they will be able to shop for that.
  So even though we have exempted them, I think a lot of small 
businesses want to cover their employees. They live in the same 
community; they go to the same church; they know one another, and they 
want to buy some health coverage for their employees. They can't now, 
but I believe under the bill we have through our committee, once we get 
it fully implemented, we will have that public option out there, we 
will have the exchange with all of the insurance programs out there, 
and they will be able to now shop around and find one that can fit 
their needs. So we will have a lot more support for small businesses 
that way.
  Mr. DODD. Absolutely.
  Mr. HARKIN. I thank the Senator.
  Mr. MERKLEY. I thank the Senator very much.
  The distinguished chair, Senator Dodd, mentioned earlier that this 
bill is not just for the uninsured; this is for the insured because we 
have a broken health care system for the insured. My colleague from 
Oregon made this point, that we need to close the deal for insurance in 
this country.
  I can tell you that folks with insurance have been telling us lots of 
stories about the challenges they face under our current broken status 
quo health care system. The first is that right now, their insurance is 
largely tied to their job, so if they should lose their job, it is a 
huge calamity--not just because they lost their job but also because 
they lost their insurance. It is a double whammy. This bill would 
change that for our families who currently have insurance.
  Second, our families who currently have insurance, their costs are 
being driven up, in part because they are covering the costs of the 
emergency room treatment for those who don't have insurance. In the 
last couple of years, we have had more and more people without 
insurance transferring more costs in the emergency room and, therefore, 
more costs to the insurer. Therefore, more companies--particularly 
small ones--are saying we cannot afford health insurance anymore.
  This is a downward cycle, a death cycle in insurance that we break 
with this bill--helping out those who have insurance by taking away the 
burden of paying for the emergency room for those who don't.
  A third factor is that other pieces are driving up health care more 
than 10 percent a year of health care premiums. That means health care 
is going to double every 7 years. That is unsustainable in this country 
for those of us who are fortunate enough to have insurance.
  Then, also, citizens have been recognizing that they would like to 
have portability--to be able to take the insurance they have and, 
should they change jobs--as Americans do, on average, every 3 years--be 
able to have the same insurance plan, the same set of choices, the same 
doctors, the same doctor for themselves and their spouse and their 
children. That portability becomes an inherent feature of the bill, 
helping those who have insurance.
  The list goes on. Those who currently have insurance sometimes get it 
at a very poor deal. As the chairman pointed out, it is 18 percent more 
for an individual than a small business. Now they will be able to be 
part of a larger pool and get a much better deal.
  Finally, many of those who currently have insurance don't have 
existing conditions covered. If they have a bad back or a heart 
condition or cancer or diabetes, and they cannot have that fundamental 
health care issue covered by their insurance, then they don't have any 
form of health care insurance that matters for the issue they are 
wrestling with.
  So in so many ways, the plan the committee has put together 
profoundly improves on our broken health care system for those who have 
insurance today in America.
  Mr. DODD. I thank my colleague. There is so much to talk about, and 
there are so many pieces of this. I was listening to Secretary Sebelius 
today, and I am sure all of us have mentioned this in our own States, 
and we hear colleagues talk about this ``tax'' being imposed as a 
result of this bill. There is no tax being imposed by this bill. 
However, there is a tax that exists today, which is $1,100 for the 
average family, and that is the amount the average family pays in 
health care premiums every year to cover the uncompensated care--that 
is, for those of the 47 million who show up in emergency rooms for 
health care. We take care of them.
  If you show up in a hospital, just walk in, and you have a problem, 
there is not a hospital in America that doesn't take you into that 
emergency room. They don't throw you out on the streets and say: I am 
sorry, you don't have any money, so you are going to have to suffer.
  Communities all across the country do this job every day. We need to 
understand that, of course, it is not free. That care costs. It is the 
most expensive health care in the country that occurs in an emergency 
room. The cost of that, on average, is $1,100 per family in the United 
States. If that is not a tax, I don't know what is. You are not getting 
anything for it. You are helping to pick up the cost of the people who 
don't have coverage who are showing up--usually in a critical state, 
because they have waited until such a point that it is catastrophic, 
and they haven't had any prevention, as Senator Harkin talked about 
earlier, and they waited forever.
  Now it has come down to a crisis, and they show up in the emergency 
room with the child at 1 or 2 in the morning. It is not just filled 
with car accidents and violence. People walk in every night because 
they have a child or a spouse who needs care. They are reaching out in 
desperation, and that is expensive health care. We are paying a tax of 
$1,100, and the average family pays that.
  Mr. WYDEN. If the chairman would yield on that point, the reason I 
wanted to speak at this point is, in fact, today there is an 
entrepreneurship tax in America. What it means is, if you have a health 
care problem and you work in a small business and you have a good idea 
and you would like to go out and set up your own small business, you 
are not going to be able to do it because you have a preexisting 
illness. You are locked into your job. What your insurance reforms do 
in the HELP legislation, and what I think a lot of Senators want to do, 
is lift that entrepreneurship tax.
  This is very appropriate that you talk about taxes because that is 
what this always comes down to. Your insurance reforms specifically, as 
a result of making sure that person who has a good idea--perhaps that 
gentleman's business the Senator just described--they are going to be 
able to do what makes America great, which is use their ingenuity and 
talent because when they go to their next job, they are not going to 
face insurance discrimination.
  I appreciate the Senator bringing up the entrepreneurship tax. I am 
looking forward to working with the chairman over the next few weeks. I 
think there is additional work we can do on the exchanges. The Senator 
from Oregon, Mr. Merkley, my colleague who is doing such a good job, 
talked about some of those options. I think we can get additional 
people more bargaining power,

[[Page 20596]]

and in effect build on the good work done in the HELP Committee.
  Thanks for all the time tonight. You have done a first-rate job on 
prevention. Again, I appreciate lifting that entrepreneurship tax. That 
is why I wanted to take a minute to point that out.
  I look forward to working specifically with my colleagues on the HELP 
Committee. Let's expand those exchanges because that makes the system 
work for us and Members of Congress.
  I checked the other day. My pool--put on the front page of our 
paper--is 1 million people. That is a lot of folks to spread costs and 
risk among. Senator Harkin and I have talked about it. It is not 
possible to replicate that exactly, for a variety of reasons. We can 
get close. We can get pretty close because we can build on the good 
work Senators have done in the HELP Committee, expand the exchanges, 
and give more people choices and more opportunities to lower their 
premiums and, in my view, close the sale with the insured people over 
the next few months.
  I thank the Chairman for all the time.
  (Mr. Merkley assumed the chair.)
  Mr. DODD. I thank my colleague from Oregon, a great advocate. We 
appreciate his involvement this evening with us. As a member of the 
Finance Committee, it will be critically important that we come 
together.
  Mr. WHITEHOUSE. I wanted to follow up on Senator Merkley's discussion 
of the different ways in which somebody who is watching this, and who 
is insured, can look forward to some benefit from all of this. A simple 
one would be to think, in your own experience, how often you have gone 
into your doctor's office and maybe been referred to a specialist or 
you brought a family member in and you had to take a clipboard and fill 
out on paper for the umpteenth time your personal health insurance, 
your billing information, your Social Security information, and 
whatever it is they want. You have to fill it out over and over again. 
That is the experience many people have with our health care system.
  Compare that to going online at--pick one--say, Amazon. You log into 
Amazon and they say: Welcome, Sheldon Whitehouse. Good to have you 
back. Here are all the books you bought in the last year or so. Based 
on that, we think here are more books you might like. Choose something 
you would like, and your billing information is here.
  Put those experiences side by side and show where our bill can take 
the American health care consumer, and what that means for quality of 
care, and not just for the convenience of not filling out the form, but 
when you are a pharmacy, it is connected to your laboratory, it is 
connected to your doctor, it is connected to the hospital, and you are 
the center of it, and all of it is private and secure. That is a new 
and better world for everybody, including those who have insurance.
  Who has not had somebody they know go into a hospital and come out 
with a hospital-acquired infection? It has happened over and over. I 
have had a friend who went in for a simple knee surgery, arthroscopic 
surgery. He was a big athlete in college, and he needed a simple 
surgery on his knee. He got a hospital-acquired infection--a strong, 
big guy--and it nearly killed him. It took him out of work for weeks. 
Mercifully, he recovered and everything is fine. It was touch and go 
for a while, and the cost of all of that was tremendous from that 
hospital-acquired infection. He required weeks of medical care. 
Everybody has had that experience. About 100,000 people every year--
Americans we represent--die every year because of hospital-acquired 
infections.
  Senator Harkin tells me that it is the fourth leading cause of 
death--hospital-acquired infections. They don't care if you are insured 
when it comes to hospital-acquired infections. The insured will get one 
just as quickly as the uninsured. The quality provisions of this bill 
will prevent that and diminish that. That number should be under 5,000. 
It should be a rarity. Instead, it is a commonality. The system has to 
change for that to happen.
  If you have an illness, try to find a prevention program. Ask anybody 
you know where they can go to find somebody who will support them in 
getting an appropriate, sensible, supported prevention program for 
themselves. It is rare to find. It is almost impossible. As I said 
earlier, when I was talking about the person who had a leg removed for 
$30,000 because there was nobody there to prevent them from letting 
that disease get to that stage, there are big savings there. It is a 
human consequence. You can have all the insurance in the world, but if 
it doesn't have a prevention option, you are not helped.
  The last thing I will say is that so many of us who feel comfortable 
right now with our insurance only feel that way because we have had the 
good luck not to have the experience of having some loved one or 
ourselves get very sick. People's viewpoints change when they have had 
that experience. They find the limits of their policy. They see how 
fast the copays add up. They see the fine print in what they thought 
was a great policy when times were good and they were healthy, with 
just a little injury here and there, and everything was taken care of 
fine; but when they got really sick they found that policy they thought 
they could count on wasn't there for them.
  Now the leading cause of families going into bankruptcy and losing 
everything in this country is somebody in the family having a health 
care disaster that wiped them out. That should not be. It happens over 
and over and over. It happens to the insured. That is not the 
uninsured. If you are uninsured and you have medical bills, you know 
you will have problems, but it is the insured who are caught by 
surprise. They have their homes, their stock portfolios, perhaps, on 
the side; they have a nest egg, and maybe they help support their 
children a little bit. And, boom, comes the illness and suddenly they 
have all these costs and these bills and it is piling up and they 
cannot keep up and they start to get behind. Before you know it, they 
have lost it all, and they are in bankruptcy.
  Americans have that experience every day and every one of us have 
heard from somebody in our State who is right there. So I think the 
point the chairman has been making, and Senator Merkley made, about how 
important it is for people who have insurance, in terms of improving 
their lives, their quality, and their care and prospects is very poor. 
I applaud the Senator for having made that point.
  Mr. DODD. I thank my colleagues from Rhode Island, Iowa, Senators 
Wyden and Merkley, and Senator Brown who spent a little time talking 
about this. There is a lot more to talk about, such as the quality 
issues that Senator Mikulski of Maryland spent a long time helping to 
develop, and Senator Murray from Washington on workforce and the 
coverage questions that Jeff Bingaman worked on, as well.
  We hope in the few days we have between now and adjournment--and we 
know a good part of the time will be taken up with the Sotomayor 
nomination--we will have a chance to talk further about this bill and 
say to our colleagues: We welcome your comments. There are five 
committees of Congress charged with the responsibility of health care. 
Four of the five have met and completed their work. Our committee, the 
HELP Committee, has completed its work. We know the Finance Committee 
is working to complete its work. I want to make clear that the HELP 
Committee product will be very much a part of this effort. We welcome 
the work of the Finance Committee. But much of health care coverage is 
the shared purview and responsibility of the Health, Education, Labor, 
and Pensions Committee, under the leadership of Senator Kennedy of 
Massachusetts, as well as the Finance Committee. Senator Kennedy has 
championed for four decades this effort. Regrettably, he cannot be with 
us because of his own struggles with illness. But he has helped frame 
this. It has been a bipartisan effort over the years.
  We are determined as we move forward in this debate that the product

[[Page 20597]]

my colleagues have worked on so diligently over these past number of 
months is going to be very much a part of our health care program.
  I express my gratitude to each member of the committee who helped 
produce this result that took so long. We have taken this time to 
explain to our fellow citizens what we tried to incorporate in our bill 
that will get us to the point of increased accessibility, increased 
quality, and affordable products. That is what we are gaining. That is 
the purpose we are driving at to get those three goals met.
  I think we achieved a good part of it with this bill. More needs to 
be done, but, obviously, it is a great step in the right direction.
  I see another partner of ours in this effort. He played a critical 
role with community health care centers. I say to my colleague from 
Vermont, last week I was in New Britain, CT. I have many community 
health centers in Connecticut. As a result of the stimulus package, 
several of them received some real help to expand because they are 
overcrowded. Getting electronic records is critically important. Their 
patients have greater needs, but they have a medical home now.
  I have three volunteer clinics in Connecticut, one in Norwalk, CT, 
one in Danbury, CT, and one in Bridgeport, CT, under AmeriCares. That 
program only serves the uninsured. It is completely voluntary.
  In Norwalk, I have 60 physicians in the area who volunteer their time 
to come in and serve the needs of the people of the greater Norwalk 
area, not to mention retired doctors, nurse practitioners, and others 
who help.
  I say to my colleague, that he has been a tremendous voice--in fact, 
our bill increases by 400 percent the commitment to community health 
centers across our country. We can expand community health centers and 
provide that medical home for so many people. They are a source of 
prevention, early detection, providing for the needs of families--all 
of these things that occur in these remarkable facilities called 
community health centers.
  The best champion, other than Ted Kennedy, who helped author the idea 
to begin with, is our colleague Bernie Sanders from Vermont. I thank 
him for that effort.
  Mr. SANDERS. Mr. President, I thank Senator Dodd for his kind words 
and extraordinary efforts over the last several months to lead the 
fight in health care reform.
  Let me pick up on one issue Senator Dodd raised. Most Americans do 
not understand this, but in the midst of a disintegrated health care 
system, we have 60 million Americans who do not on a regular basis have 
access to a physician--60 million. What happens when those people get 
sick? If you are in Vermont and you are kind of stubborn, you delay 
going to the doctor when you should go, and you wait and you wait. And 
6 months after you first were feeling badly, you go crawling into the 
doctor's office, and the doctor says: Why weren't you in here 6 months 
ago?
  And the person says: Well, I felt awkward. I didn't have any health 
insurance. I was embarrassed.
  The doctor says: I am getting you to the hospital because you are 
really sick.
  So instead of treating people when they are initially ill, what we 
end up doing for people who do not have access to a doctor on a regular 
basis or do not have any health insurance is we wait until they become 
very ill and then we send them to the hospital and spend tens of 
thousands of dollars, in some instances, when we could have treated 
them with much less suffering and at much less cost.
  There is another point that is not widely known, and that is, 
according to the Institute of Medicine, in this country today, we lose 
about 18,000 Americans every single year who die because they do not go 
to a doctor when they should go to the doctor. That is six times the 
number of people who were killed on 9/11 every single year.
  What Senator Dodd is talking about and what many of us have worked on 
is significantly expanding the federally qualified health center 
program, started by Senator Kennedy four decades ago, widely supported 
in a bipartisan manner.
  What studies tell us is, if, in fact, we can do what is in this 
legislation and provide a community health center with physicians, with 
dentists, with low-cost prescription drugs, with mental health 
counseling, do you know what we would end up doing, amazingly enough? 
We save money. We save money. We invest over a 5-year period about $8 
billion, and we end up saving money because we keep people out of the 
emergency rooms, we keep people out of hospitals, we keep people alive. 
If that is not a good investment, I don't know what is.
  So the fight to make sure that every American has access to a doctor, 
to a dentist, to low-cost prescription drugs is certainly, in my mind, 
one of the crowning achievements of the Health, Education, Labor, and 
Pensions Committee piece of health care reform.
  A month ago, I asked people on my e-mail list, which is not only 
Vermont, but all across the country, to write to me and tell me their 
relationship, how they are dealing with private health insurance 
companies. Within a week, we had over 4,000 responses. The booklet is 
available on my Web site, sanders.senate.gov. I urge people to take a 
look at it. If you want to know what is wrong with health care in 
America, this booklet will tell you.
  People are writing from their hearts, from their own suffering, 
describing the health care crisis. I want to read and comment on a few 
of the statements sent to my office. This is from a fellow in Swanton, 
VT, a small town in the northern part of Vermont:

       My younger brother, a combat decorated veteran of the 
     Vietnam conflict, died three weeks after being diagnosed with 
     colon cancer. He was laid off from his job and could not 
     afford COBRA coverage. When he was in enough pain to see a 
     doctor, it was too late. He left a wife and two teenage sons 
     in the prime of his life at 50 years old. The attending 
     doctor said that if he had only sought treatment earlier, he 
     would still be alive.

  People talk about waiting lines in Canada or in Great Britain. Let's 
talk about over 18,000 Americans dying every year because either they 
do not have any health insurance or, if they do, they cannot get access 
to a doctor.
  When we talk about the health care crisis in America, it is not just 
the pain that millions of Americans are experiencing, the fear, or the 
tens of millions of people who stay at their job today. Do you know why 
they are staying at their job? Not because they particularly want to 
stay at their job, but because they have good health insurance and 
their wife has an illness that needs to be covered. Talk about economic 
nonsense, absurdity--millions of people staying at work because they do 
not want to give up their health insurance. What President Obama says, 
because of the economic crisis, we have to address health care, is 
absolutely right.
  Some of our friends on the other side say what they have always said: 
Let's do nothing. You want to do nothing? Within 10 years, the amount 
of money you are paying for health care today will double. If you are a 
small business person today in Vermont or around the country and having 
a hard time providing health care to your workers or maybe your family, 
think about what happens when the cost of health care doubles. Think 
about large corporations that have to compete with European, 
Scandinavian countries, and companies where health care becomes a right 
of all people and not something placed on the employer.
  In this year, amazingly enough, when we talk about health care and 
economics--and Senator Whitehouse was alluding to this a moment ago--
there are 1 million people this year, it is estimated, who will go 
bankrupt because of medically related illnesses. Most of those people 
have health insurance--1 million Americans. And our friends say: We 
can't go forward; now is not the time to go forward on health care 
reform. Tell that to 1 million American families who have suffered 
bankruptcy.
  In my view, the evidence is overwhelming that our current system is 
extraordinarily wasteful and bureaucratic; that in a very significant 
way, the function of our current health care system is not to provide 
quality health care to every man, woman, and child,

[[Page 20598]]

but, in fact, to allow people within the industry--the private 
insurance companies, the drug companies, the medical device suppliers--
to make as much money as they possibly can.
  Amazingly enough, according to the papers in the last few days, the 
health care industry has spent over $130 million in the last quarter on 
lobbying. There are 100 Members in the Senate and 435 Members of the 
House--to spend $130 million?
  Where do they get that money? They get that money, if they are a drug 
company, by charging the American people the highest prices in the 
entire world. I was the first Member of Congress to take Americans over 
the Canadian border a number of years ago where women with breast 
cancer who were fighting for their lives were able to pick up breast 
cancer medicine at one-tenth the price. The drug companies cannot lower 
prices in this country--they have to charge us the highest prices in 
the world--but somehow they do manage to come up with tens and tens of 
millions of dollars to try to buy Members of the Congress.
  While more and more people are losing their health insurance, we are 
seeing many of these private insurance companies seeing huge increases 
in their profits. We are seeing the insurance companies, the drug 
companies paying, in some cases, tens of millions of dollars in 
compensation packages to their CEOs.
  For anybody to suggest that this country does not need health care 
reform is simply not to understand what is going on from one end of 
this country to the other. We are a great nation. There is no reason in 
the world why we should end up spending almost twice as much per person 
on health care as any other nation and yet have inferior health care 
outcomes in terms of infant mortality, in terms of life expectancy, in 
terms of preventable deaths.
  We can do better. And right now, despite all of the lobbying money 
coming in from the health care industry, the moral imperative is for 
Members of Congress to think about the folks back home, the people who 
have no health insurance, the people who are underinsured, the people 
who are going bankrupt, the people who are staying at their work, not 
because they want to but because they have a decent health insurance 
program or the small business people who cannot invest in their company 
because they are busy spending all of their money on health care. We 
can do better than that. We must do better than that. Now is the time.
  I hope the American people work with us in standing up to very 
powerful special interests and moving us toward real health care 
reform.
  I yield the floor.
  Mr. DODD. Mr. President, I want to briefly, before he leaves the 
floor, commend my friend and colleague from Vermont. He has been a 
remarkable advocate, and this evening is yet one more example of it. He 
speaks with that passion I love to hear about these issues and talks 
about real people and what they go through every day.
  I was thinking as he was talking, I say to Senator Sanders, there is 
a wonderful small business guy in Connecticut named Penn Ritter. I have 
known his family a long time. He got up and talked about his business 
and how difficult it has been to buy health care for his employees. He 
talked about one particular case which is very moving.
  They were laying people off. The economy was down. They didn't need 
people. One of the people they were going to lay off had terminal 
cancer. He knew if he laid him off, he would have no access to the kind 
of health care coverage he would need to go through the difficult 
period he was about to go through. But the verdict was clear. This 
small business decided this was not going to happen. So they kept the 
man on, not because they could afford to keep him on--because they 
couldn't afford it--but in good conscience they couldn't do that. There 
are people like that in small businesses all across our country, in 
every community in which we reside, who make a difference every day. 
There are wonderful providers and hospitals and places that take in 
people and treat them every single day. I would like to see us, in this 
Congress, at least rise to the level of our citizenry who do these 
things every day--the Penn Ritters of America, the doctors who work at 
Manchester Memorial Hospital in Connecticut, those people who work at 
AmeriCare, those volunteer doctors who show up every day. I could go 
down a long list, and every one of us can talk about what happens in 
our communities by caring people who help people maneuver and navigate 
in a difficult time during this health care crisis.
  The least we should be able to do is to figure out how to meet the 
challenges they meet every single day, and my colleague from Vermont is 
as eloquent as any other Member on this subject matter, and I thank him 
for his comments.
  Mr. SANDERS. I thank my colleague very much.
  Mr. DODD. Mr. President, I yield the floor, and 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. DODD. 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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