[Congressional Record (Bound Edition), Volume 155 (2009), Part 15]
[Senate]
[Pages 20901-20908]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. DODD. Mr. President, I want to speak, if I can, for a few minutes 
this evening on the health care bill. I suppose today or tomorrow will 
be the last time before we return in September to address the issue of 
health care reform, and I thought it might be worthwhile this evening--
in the waning hours--to give our colleagues and others who are 
interested an idea of where we are in this debate and what options have 
been proposed.
  As many have heard us say already, the committee for which I have 
been hired as sort of a pinch-hitter for Senator Kennedy--the Health, 
Education, Labor and Pensions Committee, on which I am proud to serve--
and I must say once again, with deep regret, that the chairman, Senator 
Ted Kennedy from Massachusetts, has not been able to be with us over 
the last number of weeks. I will tell you this. He is watching very 
carefully every meeting and markup and gathering that occurs, because 
he has invested so much of his public life and career to trying to 
reform the health care system of our Nation. So I was asked to step in 
for him, temporarily, until he gets back on his feet and can join us in 
this effort.
  We have spent a long time over the last number of weeks and months on 
this debate. We have spent a tremendous amount of time in the 
committee, even a lot of time before the actual markup in preparing for 
the legislation. So this evening I wish to talk about sort of where we 
are with that bill, what is in that bill in very practical terms, and 
how it would affect individuals.
  I also want to give my colleagues some opportunity to appreciate what 
will happen while we are away for 5 weeks in terms of those who will 
lose their insurance, as they will, between now and September. I have 
made the point over and over again that 14,000 people a day in our 
Nation lose health care coverage. Those are terrible numbers. They are 
more significant in some States than in others, but there is that 
erosion of coverage every day.
  As long as nothing happens, as long as no health care crisis affects 
them or their families, they may be able to survive all of that until 
they find a job or find some other means by which they can afford 
health care coverage. If, unfortunately, they are caught--as so many 
are--with that unexpected accident, that unexpected health care crisis, 
that unexpected diagnosis of a major health care problem while they are 
in that period without coverage, the implications can be staggering, 
and not just because they lack the coverage that might allow them to 
take care of that emergency accident or injury. But if they are 
diagnosed with something in the absence of a health care plan, under 
the present circumstances, there is very little likelihood that they 
are going to be able to get a health care plan that will be within 
their means to afford it because they will have that preexisting 
condition once the diagnosis occurs. So the health care costs go right 
up through the ceiling.
  So again, 14,000 a day, as we gather here, find themselves in that 
shape. I thought it might be worthwhile to get graphic about this, 
because by the end of the August recess, when we return, 756,000 of our 
fellow citizens will have lost their health insurance--while we are 
away over the next 4 or 5 weeks--and that is a staggering number.
  Some may find a means to get it back. Some may have a spouse who gets 
a job that provides coverage. But those are the numbers if you take 
every day the loss of health care coverage.
  My patient here, with these numbers, you can see the thermometer is 
now exploding. He is even having some beads of perspiration here 
because he is now worried that he or his family could be caught in that 
free fall, without the means to protect themselves against economic 
ruin. It could happen.
  So as we begin a short discussion this evening of where we are, I 
thought it might be important to share with my colleagues that while we 
leave with the full confidence of a very good health care plan as 
Members of Congress, that should an accident, a diagnosis, a problem 
occur to any one of us--while we don't want that to happen--there is no 
likelihood we are going to be put in economic difficulty because of it. 
Certainly we will probably get good care because of who we are, what we 
do, but no worry about the sort of economic ruin that this crowd of 
756,000 Americans may face if they are caught in a similar situation.
  I have hope that all my colleagues have a good recess, that they will 
get around their States and districts. I also hope they will get an 
annual physical this year, as I hope everyone does. We provide an 
opportunity, under our health care plan, to do that at little or no 
cost. That is how I discovered earlier this summer, in June, that I 
have early stage prostate cancer, and I will be going through a 
procedure in the next few weeks to deal with that matter, and I am 
confident, since I caught it in this early stage, that I will come out 
fine. I have had a chance to talk to people who have gone through this 
or had a family member and I know about the various options that are 
available. It is early stage. It hasn't metastasized. I am not going to 
be in tough shape. I believe I am going to come out of this fine. But 
that is what you get when you get an annual physical. You find out 
these things.
  There are people who, of course, don't do that. We even have had 
colleagues who didn't. A wonderful man I served with in this body for 
many years by the name of Spark Matsunaga from Hawaii did not discover 
it early enough, and he lost his life to prostate cancer. Almost 30,000 
people in our country die every year of prostate cancer. In many 
instances, if not most, it is because it wasn't diagnosed early enough. 
It is very slow growing. There is ample time to respond to it, but you 
need to find out about it.
  So when you get that physical, and I hope each of my colleagues 
remembers that if they do that and they find out they have a health 
issue, or if something happens in an accident to them, or if anybody in 
their family suffers a health crisis, they will be able to focus their 
attention on getting well because there is absolutely no risk that any 
Member of the Congress, or the millions of Federal employees who have 
the options--more than 20 of them each year, by the way--to choose what 
plan serves us best--no risk they will lose their economic security 
because they got sick or they had a bad diagnosis or they got hurt. 
Because as I said a moment ago, we all have great health insurance and 
we are not going to lose it any time soon.
  But tens of millions of Americans have insurance that does not allow

[[Page 20902]]

them to get the care they need. It is not just the uninsured; it is 
people with insurance I want to focus on this evening--people who have 
insurance when they need it, with the doctor of their choice, and while 
we are gone, nearly half a million of them will lose that coverage.
  I understand we are all going to be patient on this effort of health 
care reform. It takes time to get it right. I acknowledge that. But 70 
years is long enough. That is how long we have gone in our Nation 
without addressing in a holistic way the health care issues that must 
be addressed.
  By the time we return from our recess, the number of Americans, I 
pointed out, who will have lost health insurance since our committee, 
the Health, Education, Labor, and Pensions Committee, passed the 
Affordable Health Choices Act more than 3 weeks ago, will be over 
three-quarters of a million people.
  While a bill that will improve the quality and affordability of 
health care for every American sits waiting for action, as I said, 
756,000 of our fellow citizens are going to lose that insurance before 
we come back from our recess.
  Let me take a moment and show my colleagues what that means in their 
States. I have broken this down State by State so you get some idea of 
what the implications are because sometimes these numbers can be 
daunting. It may be hard for people to see this, but I have broken it 
down. I will run it down very quickly.
  Alabama, 5,760 people will lose their health insurance over the next 
5 weeks; Alaska, 640; Arizona, 8,960; Arkansas, 2,560; California, 
70,080 people will lose their health care coverage before we reconvene 
in early September; Colorado, 3,200.
  I know the Presiding Officer has been working hard on this issue. I 
commend him for this effort. I know he will be meeting with a lot of 
his constituents. In fact, Colorado and Connecticut lose the same 
number of people, 3,200 as well.
  In Delaware, 960; in Florida, 27,200; Georgia, 13,760; Hawaii, 1,600; 
Idaho, 2,240; Illinois, 8,640; Indiana, 15,360 will lose health care 
coverage; Iowa, 2,240; Kansas, about the same number. In Kentucky it is 
7,360; Louisiana, 5,760; Maine, 2,240 lose health care coverage; in 
Maryland, 7,360; Massachusetts, over 13,000 people, close to 14,000 
people will lose health care coverage over the next 5 weeks; Michigan, 
19,840; Minnesota, 6,080; Mississippi, 4,160; Missouri, 6,720; Montana, 
960 people; Nebraska, 1,280; Nevada, over 7,000 people will lose health 
care coverage; New Hampshire, 960; New Jersey, 20,800 people will lose 
health care coverage; New Mexico, 2,560; New York, 38,080 people will 
be dropped from the health care rolls; North Carolina, over 16,000; 
North Dakota, 320; Ohio, 12,480; Oklahoma, 1,600; Oregon, 8,640; 
Pennsylvania, 16,320 people; Rhode Island--our colleague, Sheldon 
Whitehouse is here from Rhode Island. He was such a valuable resource 
in our HELP Committee over the last number of weeks, and I commend him 
for his contribution, he and Jack Reed both making significant 
contributions to our Affordable Health Choices Act. South Carolina, 
over 10,000 people will lose their health care coverage, South Dakota, 
960; Tennessee, 12,800; Texas, 15,040; Utah, 3,840; Vermont, 960; 
Virginia, 10,560 people; in West Virginia, 960; Wisconsin, 7,360; 
Wyoming, 320.
  I apologize for taking that time but sometimes you mention 14,000 and 
we don't break it down State by State. These are the projected losses 
in terms of health care coverage. They will not have the same degree of 
security that we do during the next 5 weeks.
  When we leave here, I, of course, hope none of us suffer any kind of 
a diagnosis or any kind of an accident, but as I said a moment ago, as 
painful as that may be, none of us will suffer the pain of wondering 
whether you can afford to have your child covered, your spouse covered, 
or have the means to take care of yourself if something happens.
  The people in these numbers, hopefully, will never have that problem, 
but if they do it is a major catastrophe. Roughly 65 percent of all 
bankruptcies in the last year have been caused because of a medical 
crisis--about 65 percent of all bankruptcies. Your first thought might 
be, as mine was, that is probably the uninsured who ended up in that 
shape. They didn't have insurance, they ended up with a serious problem 
and got drained of whatever few assets they had left and took the 
bankruptcy act to get out of trouble.
  Mr. President, 75 percent of the people who were affected by 
bankruptcy as a result of the health care crisis have insurance; three 
out of four people who have insurance had ended up in bankruptcy. It 
was not the uninsured, it was the insured.
  This evening--I know they are always out there marketing this idea 
that this bill we are talking about is not designed to help the 
insured, only the uninsured. Nothing could be further from the truth. 
Our major efforts are to try to bring down the costs of the insured. 
Many have such high deductibles and out-of-pocket deductibles they 
never get to engage their insurance policies.
  At any rate, these are the numbers. I think it is important for my 
colleagues to look at it.
  To my colleagues, think about constituents you are going to see over 
the recess facing these problems. Imagine a small business owner paying 
$1,000 a month on premiums with a $6,000 deductible. It is not an 
uncommon event for small businesses. Imagine this small businessman 
telling you that his insurance company dropped his daughter's coverage 
when their doctor suggested surgery to remove noncancerous tumors, 
forcing him to get a separate, more expensive policy for her.
  It doesn't have to be this way. These facts happen all the time. 
Under our bill, under the bill we passed 3 weeks ago, this small 
business owner would be able to choose an affordable plan that he or 
she could rely on, wouldn't be denied coverage for the preexisting 
condition of their daughter, and that coverage would not be taken away 
once the policy is issued. That is the difference between the status 
quo, as it is today, and what we propose in our legislation we spent so 
much time crafting.
  Imagine, if you would, a small business owner who offers health 
coverage to his 20 employees. He is paying about 60 percent of the cost 
of the premiums but unable to afford family coverage. Imagine that 
small business owner telling you that one of his employees have left 
for a job that provides family coverage.
  It doesn't have to happen. In fact, this case is one I am very 
familiar with. This was the case of a small employer in Hartford, CT, 
who employs not 20 people but about 10, and very loyal employees. I 
think most of them have been there 20 years. He had an employee the 
other day literally almost in tears, if not in tears, announcing to his 
employer that he had to leave because his wife, who had the health care 
coverage, lost her job. So they were without health insurance.
  He then went and took a job that paid 30 percent less than the job he 
had for more than 20 years in order to get the coverage. That would not 
happen under our bill. That does not have to happen. That family, if 
you will, small business, would be able to find affordable coverage for 
their employees using the same strong bargaining power and broad risk 
pooling that large businesses enjoy.
  This is one of the major problems for small business. The average 
small business pays 18 percent more in premiums than large businesses--
18 percent more--and they get a lot less coverage as a result of it 
because they don't have the opportunity to pool as much, come together. 
Our bill gives that small businessperson the same access, the same 
opportunity to that gateway, that place where these policies exist that 
they can shop for and determine what is best for them--what they can 
afford and what they want to have for their employees. That does not 
exist today. Unless we change the law, that small business operator is 
going to be faced with rising premium costs and less and less coverage 
for their employees. We change that. We fix that. That is important for 
people, I think.
  Let me mention a third scenario. Imagine a single mother, self-
employed, paying more than she can comfortably afford for an insurance 
plan--

[[Page 20903]]

not uncommon--that has high copays and a high deductible, not uncommon 
at all. Imagine her telling you she rarely sees a doctor for preventive 
screenings for herself or well-child visits for her son because her 
plan doesn't cover those visits.
  It doesn't have to be that way. Under our proposal this single mother 
would be able to find a plan that she can afford that covers important 
preventive care items at little or no cost. Our bill provides 
preventive screenings like mammograms or annual physicals at little or 
no cost. That is in the affordable health choices bill. That idea of 
making sure she is going to be OK, that her child is getting those 
vaccinations and so forth that they need--that is covered by our 
proposal.
  Our bill would ban discriminatory pricing based on gender because 
that ban does not exist today. There can be a huge differential. If you 
are a woman getting health care coverage, you often pay a lot more than 
men do. Our bill eliminates insurance rating based on gender entirely. 
Men and women are treated equally going in, in terms of their health 
care coverage. If we do not change the law, those policies do not 
change. The inequity goes on.
  Mary, in this case, wouldn't have to pay more than others her age in 
her area would, rather than just paying more because of gender.
  Finally, imagine a woman who bought the best coverage she could 
afford based on monthly premiums because she knew going without 
insurance was a bad idea. Imagine her telling you she was just 
diagnosed with breast cancer at the age of 25, and only then realized 
her policy was inadequate. Imagine her telling you she now has more 
than $40,000 in medical debt.
  Under our bill, this young woman would be able to stay under her 
parents' coverage through her 26th birthday, what we call the young 
invincibles, between the age of 21, when you are dropped from your 
parents coverage, and you are on your own. That is a very significant 
percentage of our population. A lot can happen. This woman was 
diagnosed with breast cancer late. But had she been in the same 
circumstances physically, with the adoption of our legislation she 
would have qualified for that young adults coverage, which is very 
reasonable in cost, or stay under her parents' plan until she was 26 
and never have to worry about being denied because of a preexisting 
condition, which of course now she has. Having been diagnosed with 
breast cancer, those premiums for that woman will go through the 
ceiling, even as young as she is, because she has that preexisting 
condition.
  We asked our colleagues to imagine these cases because they are so 
incredibly common. These are not extraordinary cases. They are rather 
routine in many cases. We will see people in these situations--I know 
my colleagues will, during the break we are on, real people who can 
suffer by our inaction.
  Let me take a minute, if I can, to talk about what health reform 
means in my State of Connecticut as well. In the last month, an 
insurance company in my State proposed to raise rates by 32 percent on 
people buying insurance in the individual market. This news was 
shocking, given the debate going on at the Federal level, but the 
company went ahead with the proposed rate hike for Connecticut 
families. Today I received word that the Connecticut Insurance 
Department went ahead and approved a modification to the company's 
proposal that will raise the premiums for the residents of my State by 
up to 20 percent--a 20-percent increase.
  I don't know many people in Connecticut who got a 20-percent pay 
raise in the last year. I suspect very few. People are going to 
struggle because of the rate hike. People are going to struggle across 
the Nation, of course, until we take action because the rates continue 
to go up.
  Consider, if you will, what has happened in the last few years: an 
86-percent increase in premiums, in rates since 1996. In my State they 
have gone up about 46 percent in 6 years, and that was before the news 
of this latest company increase.
  We have a bill--again, that would reduce the cost for Americans, the 
Affordable Health Choices Act, which we adopted in our committee, which 
in fact addresses this very issue. I want to encourage all my 
colleagues to spend a little time looking at the bill we wrote over 
this August break.
  I will take just a minute this evening to talk about how costs would 
be lowered under our proposal. Many ask the question: How do you lower 
costs? I will use my own State as an example.
  According to America's Health Insurance Plans, which is the trade 
association for the health insurance industry, in Connecticut in 2007, 
the average monthly premium on the individual market for single 
coverage was $277 and the average monthly premium on the individual 
market for family coverage was $646.
  I ask unanimous consent to be able to proceed for an additional 10 
minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DODD. Those are the numbers: monthly payment, individual market, 
$277; family premiums, family market, $646. Keep those numbers in mind, 
if you will. These numbers were for 2007. I presume in 2009 they have 
gone up a bit, but those are the latest numbers I could find from this 
trade association. They reflect what an individual making about 
$21,000, on average, paid in 2007. That is a lower income individual, 
but there are a lot of people who have incomes at that level working in 
our country. You try to pick up the cost of $277, or $646 a month with 
an income like that. You know the outcome. You are not going to be able 
to afford it. You could not come near it.
  Under our legislation, a low-income worker at $21,000 would now pay 
$20 a month in health care premiums for individuals.
  That is $277 a month under the status quo, $20 a month under the 
Affordable Health Choice Act--from $277 to $20. That person now--even 
at $21,000, that $20 a month becomes very affordable health care. That 
is a person who would now be able to shop for a plan in the insurance 
gateway and could have options in choosing health care to allow them to 
stay out the hospital, stay healthier, be able to keep working, take 
care of their family. That is the difference. That is the real 
difference.
  For family coverage, a family of four who makes two times the Federal 
poverty level--approximately $44,000 a year--pays $646 each month for 
family coverage, as I mentioned earlier in my statement. Under our 
bill, that family would now pay $40 a month for their health care 
premiums; that is $646 under the status quo, $40 a month under the 
Affordable Health Choices Act.
  When people say it does not make any difference, you are not bringing 
down costs, you tell that to that individual making around $21,000 a 
year or that family making $45,000 a year. That is a significant 
reduction in their health care premiums. That is the real difference 
between the status quo and what our legislation offers. That is 
affordable coverage.
  What is not captured in the numbers under the status quo is the fact 
that that family in Connecticut has no guarantee they will even be 
offered a policy. For that matter, they have no guarantee, if they are 
issued the policy, they will not see it cancelled or rescinded because 
they file a claim. And they have no guarantee that policy will be 
renewed the following year. Our bill changes all of that. Connecticut 
families and families across the country can at long last be assured 
they will be able to choose among quality, affordable health care 
plans.
  Before my colleagues depart, let me say this: Let's come back to work 
here in September, come back ready to offer our thoughts and 
suggestions and constructive criticism. We are going to pass a bill 
this fall, and we are going to do it with the help of any Senator 
willing to contribute and be a part of the solution. But we are not 
going to continue to wait for the sake of waiting until the politics 
get right.
  Between adjournment tonight and when we return around September 5 or 
6, there are 756,000 people who will fall into the category of the 
uninsured.

[[Page 20904]]

These are insured people. We ought to be doing everything we can 
reasonably and thoughtfully to put the brakes on this kind of 
hemorrhaging that is occurring in our country. It is bad for 
individuals and their families, and it is bad for the economy of our 
Nation. It is shameful that the wealthiest Nation on the face of this 
Earth takes the insured population of our Nation and puts them at such 
risk, and their families, wiping them out, as happens too often with 
financial ruin.
  We have coverage. We are fortunate to have it. We ought to be able to 
do everything in our power to see to it that every American, regardless 
of their economic status, ought not to play roulette with their future 
and that of their families because they lack the economic security that 
others who are more fortunate financially have. That is not right. 
Health care ought not to be a choice only for those who can afford it, 
decent health care by the accident of birth. That you are born into a 
family who lacks the economic means should not place your child in a 
different situation than mine or someone else's because of those 
circumstances. That is not America. That is not America in the 21st 
century. We ought to be able to do better than that.
  The demagogues out there, chirping away about government-run health 
care or socialized medicine--that is baloney from top to bottom, and 
they ought to be ashamed of themselves. In a nation as strong as we 
are, we place this many insured people at risk because we do not have 
the courage to stand up and do what needs to be done.
  In our proposal we have crafted, we spent a lot of time working at it 
to provide relief and support on wellness and prevention and quality of 
care and to bring those costs down to the point I have described here 
this evening. Again, there may be other ideas and other ways of doing 
this. We think we have done a good job with our bill. But I wanted 
people across the country to know there are ideas out there.
  There were 23 of us who worked on that bill. We spent 5 weeks, 60 
hours, 23 sessions--the longest markup of a bill in the history of that 
committee and, we are told by some, maybe the longest markup in the 
history of the Senate on a single bill. We had 800 amendments filed, 
and 300 were actually considered. Some 160 amendments of my friends on 
the Republican side were agreed to and included in our bill, making it 
a better bill and a stronger bill. I welcomed their participation. But 
here we are, 3 weeks later, still stymied, unable to come together and 
shape a bill that would provide the relief so many people seek in our 
country.
  I thank my colleagues for their efforts, particularly grateful to 
Senator Harkin, who did a terrific job on the prevention parts of our 
bill; Senator Mikulski, who wrote the quality provisions; Senator Jeff 
Bingaman, who worked on coverage issues; Senator Patty Murray, who 
worked on the workforce issues in the bill; and people such as Senator 
Sheldon Whitehouse of Rhode Island, who joined our committee and did a 
fabulous job with Kay Hagan, our new colleague from North Carolina, 
along with Sherrod Brown of Ohio, to shape the public option that is 
included in our bill, which I am certain my friend from Rhode Island 
may describe in some detail this evening about what we have done. This 
was so creative that the Blue Dogs on the House side adopted our 
proposal on the public option as part of the House-passed bill. Of 
course, Jack Reed and Bernie Sanders, as well as Jeff Merkley on our 
committee and Bob Casey did a great job in helping us shape the 
legislation. I thank all of the members of the committee.
  I thank Mike Enzi, my colleague from Wyoming, the ranking Republican 
member, along with his colleagues on the Republican side. They did not 
vote for the bill in the end. I regret that. But they made 
contributions that made it a stronger and better bill.
  But let's come back in September and get the job done. That is why we 
are here this evening in the closing hours of our session here before 
this break begins, so that we can highlight this most important issue 
that the President has committed his administration to, and that I 
believe the overwhelming majority of Americans--when you get sick at 
home and your child is in trouble, you do not wake up and wonder what 
party you belong to or what your political leanings are; what you want 
to know is, Do we have a plan that covers this? Is someone going to see 
my child or my spouse? Are they going to get good care? Am I not going 
to go into economic ruin from this? You do not wonder whether you are 
in a blue State or red State or what political party is in power. What 
you want to know is, Does anybody give a darn, and are they doing 
anything about it? I am in trouble, my family is in trouble, and are 
you helping us out to get us back on our feet? And that is what we 
tried to do in this legislation.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Let me thank Chairman Dodd for his leadership and for 
his remarks. He said he would give us a discussion of where we are, and 
he has done a wonderful job of showing how this bill will improve the 
lives of regular Americans in a very concrete way, including 
particularly Americans who have insurance.
  To supplement his discussion of where we are, I wanted to give a 
quick discussion of where we have been because the trajectory of where 
we have been to where we are tells us something about where we are 
going. And everybody in this country, insured or uninsured, should have 
some real concern about where we are going in health care in this 
country if we do not act.
  The year I was born was 1955, and this was the headline from the New 
York Times in 1955. It is hard to read the little part here; I will 
read it to you. It says:

       The Problem of Cost. Millions of Americans cannot afford to 
     pay the costs of medical care, and they are not protected by 
     adequate health insurance.

  That was 1955. This section says:

       In human terms, this meant that the American had to scrap 
     his budget, dig into savings or go into debt, to pay some 
     $7.5 billion for doctors, hospitals, dentists, nurses, and 
     the myriad physical accessories of medical care.

  That was 1955, when the Nation's medical bill ran over $10 billion. 
They were horrified to say over $10 billion. It is now over $2.5 
trillion.
  So that is the year I was born. We were already bemoaning the state 
of America's health care system.
  This is 1979. I had just gotten out of college. And the HEW Secretary 
said: Health cost called unjustified. HEW Secretary Patricia Roberts 
said: The quality of American health care does not justify its price 
tag of more than $200 billion a year. Still bemoaning the health care 
problems, still not getting anything done about it.
  Now, 1988. This was the year my wife became pregnant with our first 
child. And here it is. Prospects: Soaring health care costs. Joseph 
Califano said--he was the former Secretary of Health and Welfare--``The 
average jump in premiums could hit 30 percent in 1989.'' But at the 
same time, we are getting less for it.
  Chairman Dodd just talked about a 20-percent jump in his State 
recently. You think this was happening today? It is from 1988, 20 years 
ago. The more things change in health care, the more they stay the 
same.
  Here is 1992. Health care costs increasing at more than twice the 
rate of wages have made benefits so expensive it would be surprising if 
companies were not responding. ``Health care costs dampening hiring.'' 
And they dampen wages, as we have seen, and increasingly businesses are 
having to avoid health care because they cannot keep up with that cost. 
That from 1992.
  So we took those stories and we put them together on this chart. This 
shows the increases in America's spending on health care in each of 
those years, starting back the year I was born, that first story, 1955, 
then 1979, then 1987, then 1992, then 2009. It increased from $12 
billion, which seemed like a big number then, to $200 billion, to over 
half a trillion dollars, to $850 billion, nearly a trillion, and now 
$2.5 trillion.

[[Page 20905]]

  Look how much it has bumped from 1992 to 2009. This, my friends and 
colleagues, is what is called a trajectory. It is going to keep going 
if we do not do anything about it.
  The latest estimates for my home State of Rhode Island are that in 
2016, which is not too far from now, in 2016, probably about this far 
up on the graph, $26,000 a year is what a family will have to pay for 
family coverage--more than $26,000 a year. That means if you are a 
comfortably earning hard-working individual pulling down a salary of 
$52,000, half of your income, pretax income, goes out the door for 
health care before you start anything else. That is not sustainable. 
That is why we talk about Thelma and Louise instead of Harry and 
Louise. That is why we need to change the direction of our health care 
system, not just for the uninsured but for everyone so that all 
Americans can have a secure health care future. No American will have a 
secure health care future if this trajectory is allowed to continue.
  So if you are out there asking, How would a change in the direction 
of our health care system help me, think of Thelma and Louise headed 
off the cliff because that is what the American health care system is 
like right now. The cliff is coming, and we are all in the car 
together, and together we have to solve this problem. Because we have 
to solve it together, it is very disappointing that so many of our 
friends on the other side have refused to participate in this 
conversation and have reverted to labels and name calling: socialized 
medicine, government mandates--things that have nothing to do with our 
legislation but are designed to scare people and to provoke those who 
have not sat down and read the bill and do not know better. It is 
unfortunate.
  What does it measure up against? Let me show you a couple of other 
things. We have had a lot of talk in recent days about the stimulus 
plan and how effective that has been--a $787 billion stimulus. There it 
is, that $0.88 trillion is the stimulus for all of the barking and 
moaning we have had about how much that cost this country. That is what 
it is. The $8.9 trillion is what George Bush ran up in debt for this 
country during his Presidency.
  Three-quarters of the debt this country bears, George Bush ran up 
during his Presidency. It was an orgy of fair-weather borrowing. When 
we didn't need to go into debt to protect our economy, when things were 
humming along, that is what he did, $9 trillion. Here is our unfunded 
Medicare liability, $38 trillion. We don't have $38 trillion now. 
Unless we do something about this cost, we are truly going off the 
cliff in that car with Thelma and Louise, following that trajectory of 
cost I showed.
  It is not all going for health care that makes everybody better. It 
is going to a lot of other things. Here is one thing it is going to. 
Insurance industry profits. Have you noticed your wages going up a lot 
in the last couple years? For a decade, from 1999 to 2009, wage growth 
has been 29 percent. That is less than 3 percent a year and way less 
than 3 percent a year compounded. That is what wage growth has been 
like. If you don't feel like your wages have gone up much in the last 
decade, you are right. They haven't. For many Americans, wages flat-
lined for a decade. How about your insurance premiums? Did they flat-
line? No, sir. The insurance premiums went through the roof, increased 
120 percent, more than doubled in one decade. That is the steep curve I 
showed you, 120 percent. How about insurance industry profits? Up 428 
percent in the same period that wages were up 29 percent. So there is 
something we can do something about.
  On insurance, so many Americans are uninsured, it is worth taking a 
look at this. We have all used and heard the figure about 46, 47 
million Americans who are uninsured. That is the people who are 
uninsured at any given minute. As I stand here at this desk right now, 
out there in America there are about 47 million people who are 
uninsured. But some people gain insurance and some people lose 
insurance. Over the course of a year, the number of people who lose 
their insurance, whose families lose their insurance, is nearly 87 
million. If you started on the east coast and moved your way west, and 
when you got to the Mississippi and you started into Minnesota, Iowa, 
Missouri, Arkansas, and Louisiana and you took the population of every 
single State west of that all the way to California, the population of 
all these States is about 87 million, to give you an idea of how many 
Americans lose their health insurance and have to go without it at a 
point during the year.
  Then there are catastrophic levels of waste in our health care 
system. Our former Treasury Secretary, a Republican, knowledgeable 
about this, ran the Pittsburgh Regional Health Initiative for years. He 
said $1 trillion of annual waste is associated with process failures. 
He has calculated $1 trillion a year of waste in our health care 
system.
  The Lewin Group is a group many people talk about here. They are 
described on the Senate floor as the gold standard in health care 
information. Sources of potential excess costs: Excess costs from 
incentives to overuse services, from poor care management and lifestyle 
factors, excess costs due to competition and regulatory problems, 
excess costs due to transactional inefficiencies; $151 billion here, 
$519 billion here, $135 billion here, $203 billion here. As we say in 
Washington, a billion here and a billion there, and pretty soon it 
starts to add up. This adds up to over $1 trillion in waste in 
congruence with what the former Treasury Secretary said.
  It is not just newspapers that are saying it. It is also President 
Obama's own Council of Economic Advisers. Their report on July 9 said 
that:

       Efficiency improvements in the U.S. health care system 
     potentially could free up resources equal to 5 percent of 
     U.S. GDP which is above $700 billion a year.

  They also noted:

       [It] should be possible to cut total health expenditures by 
     about 30 percent without worsening outcomes . . . [which] 
     would again suggest that savings on the order of 5 percent of 
     GDP could be feasible.

  Again, two calculations coming to the same point, savings of over 
$700 billion a year.
  That is one of the things we are trying to do. In addition to family-
by-family improvements, small business-by-small business improvements, 
individual-by-individual improvements that Chairman Dodd has wrought 
through this bill, we are also trying to turn around a health care 
system that has been out of control, that has not been reformed for my 
entire lifetime. So that now is our moment, and it is on a trajectory 
that will break this country if we don't do something about it. We 
simply cannot continue a cost curve such as this that is already at 
$2.5 trillion and is accelerating northward. We can't be competitive 
with our international competitors in trade if we do this. We can't 
sustain our families if we do this. We simply cannot keep this 
government fiscally solvent if we do it. We have to turn the car before 
it gets to the cliff. If we can't do that, then shame on us.
  I think we need to be in this together. One of the ways we will do 
this is through a public plan. A public plan is important because there 
are a number of ways in which you change those cost curves. You don't 
have to take services away from people because of all that waste. What 
you have to do is deal with the waste. You build in electronic health 
records for every American so the efficiencies that other industries 
have enjoyed from the computer revolution finally hit health care 
which, according to the Economist, has the worst information 
infrastructure of any American industry except mining--the mining 
industry and then health care. Huge improvements and huge savings from 
that.
  Quality improvements can save money. It has been demonstrated over 
and over again, as in Senator Stabenow and Senator Levin's home State 
of Michigan. They did quality improvements in intensive care units. In 
15 months, they saved $150 million and 1,500 lives, and it wasn't even 
in all the intensive care units. It was just in one State. It was that 
one kind of quality improvement program, just in intensive care units. 
So huge gains to be made from quality improvements.

[[Page 20906]]

  Prevention. Senator Harkin spoke the other day about what can be 
gained from preventing particularly conditions that arise from 
diabetes. Enormous savings, if we can focus on all that.
  Transparency and improved administrative efficiency so doctors and 
insurers aren't fighting all the time. We can do all those things, but 
somebody has to lead. The question for us is, can we trust the private 
insurance companies to lead in all those areas. If you look back, you 
see they never have. We are way behind where we should be. They are not 
leading. It will take a competitive public option to pick up those 
issues and run with them and show what we can do.
  I will close with this. One of the things we are hearing is you can't 
possibly have a public option. It is a line in the sand. The very 
distinguished ranking member of the HELP Committee has said it is 
intolerable to have a public option. It simply would not work. It can't 
happen. There are two ways we get health insurance in this country. One 
is through a private health insurance provider. The other is through 
workers' compensation, which the business community runs in order to 
protect itself against the injuries and illnesses and diseases and 
catastrophic harms that can happen to people at work and that they have 
to protect themselves against. All across America, there are State 
funds, public options that deliver health care insurance, State by 
State, over and over again. So when the ranking member goes home to his 
State of Wyoming, not only is a public option for delivering health 
insurance not anathema, it is what he goes home to.
  He goes home to a single-payer public option for health care, one his 
business community appears perfectly satisfied with and he appears 
perfectly satisfied with.
  Their Presidential candidate, John McCain, goes home to Arizona to a 
public plan with 56 percent market share. It competes in a lively 
workers' compensation health insurance market. The distinguished 
minority leader goes home to Kentucky, and in Kentucky his business 
community enjoys a public option for workers' compensation health 
insurance. So we should be able, in the spirit of coming together in 
the face of this national emergency, to put aside the old notion that a 
public option simply can't exist, can't happen. It happens in nearly 
half our States. It is supported by the business communities in those 
States. It delivers care efficiently, and none of the Republican 
Senators from those States have, to my knowledge, ever complained about 
it in that context.
  I will conclude with that. I think we are at a turning point, and it 
is important, as we go, that we remember this is a long struggle we 
have been on. My entire lifetime, since 1955, it has gotten 
dramatically worse, and the rate at which it has been getting worse is 
increasing. It is worsening. We have to do something about it now--for 
everybody in this country, for businesses large and small, and for 
people and families, insured and uninsured, and we are pledged to do 
that.
  I thank the very distinguished chairman and yield the floor.
  Mr. DODD. Mr. President, I thank our colleague from Rhode Island. He 
has been very eloquent in talking about the historical framework of 
this debate, going back, even predating the 1950s, when we determined 
the need for a national health plan in this Nation, not only to deliver 
health care to people but also to deal with the economic problems 
associated with health care costs. I thought it might be worthwhile to 
invite my colleague to share some additional thoughts on this view. 
Today, as I am told, we are spending about 17 percent of the gross 
domestic product on health care costs. I am told, by those who are 
economists looking at this, that if we don't alter anything but merely 
sort of stumble along, that percentage of our gross domestic product 
will jump from 17 percent to 34 percent of the gross domestic product, 
which is a staggering amount when we consider how expensive that would 
be and the result, in practical terms, to the very premium costs the 
Senator from Rhode Island has identified.
  I also talked the other day to a leading businessman in our country, 
the former chief executive officer of Pitney Bowes, a well-known, 
established company, headquartered in my home State of Connecticut but 
has facilities in many States across the country. It employs thousands 
of people. The former CEO is a man named Mike Critelli. He is no longer 
the CEO, but he was the CEO who was responsible for bringing a wellness 
plan to Pitney Bowes. I think my numbers are pretty accurate on this 
point. I think their premium reduction, as a result of putting a 
wellness plan in place there, reduced those costs by around 30 or 40 
percent. They decided to alter the lifestyles of their employees by 
offering them incentives--the opportunity to reduce weight, quit 
smoking, improve diets, all these things.
  Talking to Mike Critelli, he did it because, one, he thought it was 
the right thing to do. Certainly, improving the quality of the health 
of your employees is a decent thing to do. But Mike Critelli also 
pointed out to me that in addition to being the decent thing to do, it 
was a very sound practice for business. Very simply, he said: If I 
could increase the productivity of my workers, which is the critical 
element, if the United States is going to compete in the 21st century, 
if wage rates are not going to drop down to Third or Fourth World 
country levels, we are going to have higher wage rates. We are going to 
have higher costs to produce our products.
  The one advantage we bring over third-rate and fourth-rate nations 
that don't pay as much for employment is the productivity of the 
American worker, which historically has exceeded that of almost any 
other worker anywhere in the world.
  Mike Critelli's point is that having a good wellness plan in place 
increases the productivity of that worker, and that is our edge in a 
global economy. So we need to start thinking in these terms.
  I hear people in the business community say we can't afford to do 
this. We can't afford not to do it. You can't have 34 percent of your 
gross domestic product be consumed with health care costs.
  Our advantage is productivity. As Mike Critelli points out, if your 
workers are sick, if they are obese, if they have diabetes, if they 
have chronic illnesses at a young age, as many do today, then the 
ability of that worker to produce those products and services is going 
to be curtailed and we suffer.
  So there needs to be some lights turned on for some in the business 
community about this debate. Some are having sort of a Pavlov's dog 
response to it. If you mention health care reform, they reach back 
decades to the age-old bromides and responses to this issue without 
thinking about what this means in the 21st century, freeing up the 
ability of workers to produce better products in a highly competitive 
marketplace.
  Let me mention one other thing I do not think we have talked about. 
Forty-four years ago from last week, Lyndon Johnson signed Medicare 
into law. Last week was Medicare's birthday. Medicare was signed into 
law 44 years ago, in 1965. Obviously, that was a great benefit to 
people over the age of 65, and what a difference it made. It took that 
population, which was the poorest sector of our population, the 
elderly, and put them on a standard of living that allowed them to lead 
decent lives after productive years of working.
  So with prescription drugs, doctors visits, and the like, put aside 
the problems today with Medicare we know exist and we have to deal 
with, it did something else I do not think we have paid enough 
attention to. It was a source of relief and stability to a family. 
Because all of a sudden those parents--which a younger generation had 
to put aside resources to provide for that crisis that was inevitably 
going to happen to those aging parents--became less of a burden because 
Medicare existed. The cost of prescription drugs, the visits to the 
doctor, the hospitalizations--all of a sudden, magically, 44 years ago 
from last week, a good part of that burden was lifted off the shoulders 
of the children of Medicare recipients.

[[Page 20907]]

  And it unleashed a level of investment that allowed our economy to 
prosper and grow. For other reasons too, but not the least of which, 
all of a sudden, there was that security in a family. They were not 
going to face financial ruin because, all of a sudden, their parents 
had a crisis they were going to have to pay for out of their pockets.
  I do not know if there are any economic models that examined that, 
but I do not think we attribute enough of Medicare's success to the 
contribution it made to the overall economy of our Nation 44 years ago 
because of that stability and certainty and security in a family, where 
your parents--that aging population--at least had a safety net that 
would protect them against that financial ruin that can befall a 
family.
  I think we are missing a point in this debate in that what people are 
really worried about is that lack of certainty, that lack of stability. 
People are socking away money today because: If I lose my job, if I end 
up with a preexisting condition, if we move, I could lose my health 
care coverage, and all of a sudden my kids, my wife, myself are put in 
the danger of economic ruin. That uncertainty, that lack of stability, 
that lack of security has a negative impact on the consumer choices 
people make. I might like to buy that second car. We may need it but--
do you know what--756,000 people are going to lose their health 
insurance in the next 5 weeks. I might be one of them. And if something 
happens, how do I pay for that problem? So--do you know what--we are 
going to delay that purchase or this other thing we might have done 
because I don't have the stability, the certainty, and the security 
there is a safety net there. Lord forbid a crisis hits my family.
  So while there is the comparison between Medicare's recent birthday 
44 years ago and what we are trying to achieve--we are thinking about 
it in a very small context: How much does that doctor visit cost? How 
much is that prescription drug? There are benefits to this that exceed 
the parameters of what we are trying to achieve because of the 
investments we are making that I think have a larger impact on the 
overall economy of our Nation.
  So I wanted to say to my colleague from Rhode Island, by talking 
about these rising costs--and no end in sight, by the way--unless we 
find some way to put the brakes on all of this and begin to reduce the 
problems--how do you do that? If all of a sudden you have a child who 
is getting good dental care at an early age, that child is less likely 
to have a problem as they get older. If we can convince children and 
families to eat better because we make the incentives to do so--3,500 
children today started smoking in the United States, and 3,500 start 
smoking every single day. And every single year, 400,000 people die 
because of tobacco-related illnesses--400,000 die--not to mention the 
number of people who have lifelong illnesses and die prematurely.
  Of the 3,500 who start smoking today, 1,000 become addicted. You do 
not have to have a Ph.D. in medicine to know that if you are a user of 
tobacco products, you are consuming a product with 50 carcinogens in 
each cigarette.
  Here we know if we can begin to change that lifestyle, which we have 
done, by the way--and, again, I thank my colleagues because, for the 
first time in 50 years since the Surgeon General pointed out that 
tobacco could kill you, only a few weeks ago we did what we have never 
been able to do before: Tobacco marketing, sales, and production are 
now under the control of the Food and Drug Administration. By the way, 
the Food and Drug Administration regulates mascara, lipstick, and pet 
food. But we could not get the Food and Drug Administration to regulate 
tobacco products. Now that has changed as a result of the actions of 
this Congress.
  But that is an example of what I am talking about. If we can stop a 
child from smoking, then that child grows up with a far greater 
likelihood they are going to reach retirement age in far better shape, 
which means far less usage of that Medicare dollar and that hospital or 
that doctor's visit. So you may not see the benefits of some of this 
immediately but over the longer term we will. And that is bending that 
curve. We are all talking about bending that curve of cost. We can do 
that making these kinds of investments.
  I am told only 2 percent of hospitals in this country have complete 
electronic medical records--2 percent. Yet we know that we lose about 
100,000 people a year from medical errors in the United States. It is 
the fourth leading killer of Americans. Electronic medical records 
reduce those numbers significantly because you have clarity in the 
records, you have portability of those records as people move around, 
you have the opportunity to determine what other conditions a patient 
may have, and you avoid the kinds of errors that produce the tragedy of 
a lost life. That savings alone in lives and dollars, we are told by 
some, could be as much as $500 billion. Electronic medical records--
that one issue--could produce those kinds of savings and results.
  So when we have these debates and people talk about these things in 
such simplistic terms, without understanding the larger economic 
implications--and if we do not, the numbers our friend from Rhode 
Island have shown us, if history is any indicator of where we are 
going, those numbers will continue to skyrocket and skyrocket to the 
point that it will bankrupt and break this country financially.
  What an indictment of a generation: Faced with a reality and the 
predictability of a situation, we are spending days around here with 
the inability to come together and make the tough, hard decisions the 
American people have elected us to do. That is the tragedy in some 
ways. I respect the fact we need a break and people are going home, but 
it is so troubling to me we are going to do this at a time and leave 
these issues hanging in the balance.
  Mr. WHITEHOUSE. Mr. President, will the Senator yield for a moment?
  Mr. DODD. Mr. President, I will be happy to yield to my colleague.
  Mr. WHITEHOUSE. Mr. President, I want to respond to what the Senator 
was saying, that this trajectory is very likely to continue. Every 
signal and every prediction is it is going to continue and we will hit 
that 35 percent, spending a third of our entire economy just on health 
care, and that really does break our country. It is a terrible 
indictment of our generation if we allow it to happen.
  But we also have a great opportunity here, which the chairman has 
also pointed out. As you know, over and over again, as the 
distinguished Presiding Officer knows, over and over again, in 
legislation, we are asked to make hard choices between two things, and 
if you go one way, you cannot go the other. Economists would call it a 
zero sum game. You cannot have both. There is no win-win.
  This is a situation where there is a win-win. As the distinguished 
chairman pointed out, we are spending 17 percent of our gross domestic 
product on health care in this country. It is the worst record, the 
highest expenditure, of any country in the world. Most other developed 
nations spend 8 or 9 percent. That is the average of the European Union 
of their gross domestic product on their health care.
  For that exaggerated expenditure, what do we get? Lousy health 
outcomes. We are way behind our developed competitor nations in 
obesity. We have far higher rates of obesity in our country. We are way 
behind in child mortality. We have far greater rates of child mortality 
in the United States than there are in our developed nations with which 
we compete. There is far greater longevity in those countries than 
ours. Americans do not live as long as people in our competitor 
nations, the developed ones, and a lot of it has to do with our health 
care system.
  So by bending that curve, by investing in prevention, by improving 
the quality by investing in electronic health records, by eliminating 
those medical errors, we accomplish two things at once. We improve the 
health statistics of our Nation, we have people who live long, we have 
less babies who die in childbirth, we have a thinner and less obese and 
less ill nation, and we lower the costs, and we do it together.
  So it should be something we could agree on, on both sides of the 
aisle,

[[Page 20908]]

but, unfortunately, these old canards about socialized medicine and how 
we could not possibly have a public option--except for the fact we 
already have it in half our States, including our own; but we are not 
going to talk about that right now, we are just going to say we could 
never have it--that is the quality of the debate, when we have this 
huge win-win in front of us.
  I hope everybody has a chance to sort of think about this over the 
break when we are gone and that we can come back with a new spirit of 
bipartisanship to really address this problem, seize that win-win, 
change the cost curve down, and solve this problem for the American 
people.
  I will make one last point.
  We have misled the public a little bit in our discussion, and we have 
done so because of the Congressional Budget Office and its professional 
capabilities. The Congressional Budget Office is very good at 
predicting what costs are going to be. So everybody has heard that our 
bill might be $600 billion, that the Finance bill might be $900 
billion. They see the costs and they say: Well, how could you possibly 
be talking about savings when all we hear about are costs? All CBO can 
say about savings is that--and this is a quote--large reductions in 
health care costs are possible--large reductions. But they cannot 
quantify it. They cannot give us a number. And they have told us why 
they cannot give us that number.
  They cannot give us that number because we can give the Obama 
administration, here in Congress, the tools to solve this problem. We 
already passed the electronic health records legislation. If, God 
willing, we pass the chairman's legislation from the HELP Committee, 
they will have the tools to improve the quality and turn the curve. 
They will have the tools to improve prevention and turn the curve. They 
will have the tools to reduce the unnecessary, wasteful administrative 
fighting between doctors and hospitals and insurance companies, that 
try not to pay them. That whole fight can disappear or at least shrink 
a lot, and that will help turn the curve.
  But CBO cannot predict how effectively the Obama administration will 
do that. Like any CEO, the President of the United States and his staff 
are going to have to manage this problem, and that is where the savings 
will come. So people should not be misled that there are not real 
savings possible. Not only are they possible, they are mandatory. We 
have to turn this curve, and we have to do it dramatically. We can do 
it because we could drop our GDP expenditure of this by 50 percent and 
still have health care as good, if not better, than all of our 
competitor nations: France, New Zealand, Canada, England, Holland--all 
these countries--Japan. We can do it.
  The promise is out there. We should not let the CBO scoring fool the 
public. That is my last point.
  Mr. President, I yield the floor, and I will relieve the 
distinguished Presiding Officer so he can speak as the Senator from 
Colorado.
  Mr. DODD. Mr. President, I will do the same. And, again, my thanks to 
Sheldon Whitehouse of Rhode Island. He has just been a stellar advocate 
of the kind of change we need.
  I know the Presiding Officer, as well, as a new Member of this body, 
has spent an inordinate amount of time on these questions, as well, in 
his own State and has listened to people in Colorado talk about this 
issue and what we can do together to get it right. I welcome his 
participation immensely as well.
  I wish all of my colleagues a very healthy and safe break in the 
month of August, as I do for all Americans. But I hope my colleagues 
will keep in mind, I did not recite these numbers to put anyone on the 
spot. But sometimes we need to talk about numbers that are real to 
people, and these are real numbers that will potentially affect many of 
our fellow citizens. So we need to come back here with a renewed 
commitment to get this done.
  We have the capability. We have good people here who care, I know, 
about these issues. And none of these decisions we can make are going 
to necessarily predict with absolute certainty that everything is going 
to work as well as we hope they would. But you have to begin. And we 
have to take a chance and work forward and hope these ideas we put on 
the table work. And to the extent they do not, you modify and change 
it, as will certainly be the case in the years ahead. But inaction, 
just saying no, is unacceptable. The answer ``no'' to health care ought 
to be rejected by every citizen in this country. This is a difficult 
problem, but being too difficult is an excuse that history will never 
forgive us for. It will never tolerate that excuse: This was too hard 
to do. When you think about previous generations and hard choices and 
difficult decisions, we wouldn't be here today if those generations had 
quit because it was too hard. We are here today because they made hard 
choices, they made the difficult decisions, and we have no less of a 
responsibility as a generation to do it on this issue. This is hard and 
it is difficult, but that will never be an acceptable answer to future 
generations if we bankrupt our country because we couldn't figure out 
how to solve this problem.
  Mr. President, I yield the floor.

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