[Congressional Record (Bound Edition), Volume 155 (2009), Part 17]
[House]
[Pages 22475-22481]
[From the U.S. Government Publishing Office, www.gpo.gov]




                         THE 30-SOMETHING HOUR

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Connecticut (Mr. Murphy) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. MURPHY of Connecticut. I thank the Speaker for granting us this 
time on the House floor this evening.
  I hope to be joined very shortly by a few other of my colleagues who 
are also from the 30-Something Working Group. As our colleagues know, 
this group comes down to this floor on a regular basis to talk about 
the issues that matter, not just to our constituents or to the American 
people but, in particular, to young families out there.
  We are also to be joined this evening by a few other Members who care 
deeply about this Congress' commitment to health care reform. This is 
the defining subject of this moment in Congress. It is the defining 
moment for our constituents when we're back home, and rightly so.
  Mr. Speaker and my colleagues, when I was home for August, I went out 
there and talked to the people I represent in every forum possible. I 
spent early mornings in the dew of village greens. I did town halls in 
the evenings. I set up a card table outside supermarkets, and talked to 
health care professionals, nurses, doctors, and patients.
  Listen, we certainly saw in Connecticut the disagreement over the 
solution just as we saw it all over this country, but we had an 
agreement that something had to be done. The current system is 
unsustainable. Now, there is not that kind of agreement here in 
Washington. I hear too many of my colleagues on the other side of the 
aisle and groups that are affiliated with that party talking about the 
system being okay as is and talking about the lack of need for any real 
reform.
  Well, in Connecticut, at the very least, we understand the need for 
reform. We saw it plainly earlier this year when the State's major 
insurer, which covers over 50 percent of the individuals in 
Connecticut, proposed a 30 percent increase on individuals and small 
businesses. Now, thanks to government, thanks to the State of 
Connecticut's regulatory system, it looks like we're going to be able 
to push that increase down to 20 percent. Think of that. Think of the 
impact of a 20 percent 1-year increase in health insurance premiums for 
individuals in Connecticut who are struggling to get by.
  The fact is that most people in my State and across the Nation who 
don't have health care insurance today and who are purchasing on the 
individual market, frankly, are struggling to get by. These are folks 
who are either running their own businesses, who are self-employed or 
who work for an employer who doesn't provide health care benefits. 
Those folks cannot take a 20 percent increase. Neither can the small 
businesses that are being charged those premiums as well.
  Study after study shows us that small businesses bear the brunt of 
the costs in our health care system. On average, a small business is 
paying 18 percent more in health care premiums than are large 
businesses. It's simple economics. I didn't get past econ 101 in 
college, but I learned enough to know if you're a small business that's 
purchasing anything, staples, paper or health care, on behalf of only 5 
or 10 or 20 employees, you're just not going to get the same deal as a 
company that's purchasing it on behalf of 100 or 1,000 or 10,000 
employees. So it's the small businesses in today's marketplace which 
are getting hurt the most just as individuals are getting hurt the 
most.
  So, in Connecticut, I think we're representative of most folks and of 
most businesses across the Nation. They know that this current system 
just doesn't work for people. We're not talking about tinkering around 
the edges. We're talking about comprehensive, bottom-up reform to make 
this market work again for families, for individuals and for 
businesses.
  In Connecticut, we have seen over the last 10 years an increase of 
120 percent in the premiums that small businesses have been paying. 
During that same time, wages for their employees have only gone up 
about 30 percent. Now, that's not a coincidence. The fact is that the 
costs of our health care system are sometimes invisible to employees 
and to workers because they result in a lack of wage increases. They 
result in a contraction of pay for those Employees.

[[Page 22476]]



                              {time}  2045

  When a business is making a little bit extra money in 1 year, too 
much of that additional income is going simply to pay those 10 or 20 
percent increases in health care premiums. The result is that the 
workers of those businesses get a zero percent pay increase or get a 1 
percent or a 2 percent pay increase. All the extra money the companies 
are making is going to health care. That's not sustainable either.
  On the other end, we have got to ask what we are getting for all of 
this money. It would be one thing if we were paying in for the most 
expensive health care system in the world--and it's the most expensive 
health care system in the world, not by 5, 10, 20 percent, by 100 
percent. We are paying twice as much for health care in this country as 
any other industrialized nation in this world.
  For one thing, if we were getting the added quality, maybe, maybe my 
friends on the Republican side of the aisle who are so defensive of our 
current health care system, who are so complimentary of the current 
health care arrangement in this country, maybe they would have a little 
bit better defense if all of this money that they are so proud that we 
are spending on health care today got us better results. But the fact 
is it doesn't.
  Yes, if you have access to the best health care centers in this 
country, to the best hospitals and the best doctors, you can 
absolutely, absolutely get better care. You can absolutely get the best 
health care in the world. I don't deny for a second that there are 
people from all over this world that are coming to those top centers of 
care in this country. But the fact is not enough people have access to 
those centers of excellence. There are too many people who can't get 
into the best of our health care system.
  It means, when a group like the World Health Organization surveys the 
quality of health care in the United States and all of our economic 
competitors across the globe, we turn out to be in the middle of the 
pack. Any health care indicator you look at, life expectancy, 
hospitalization rates, infant mortality, infection rates, we rank 10, 
15, 20. For all of the money that we are spending in this country, we 
should be at the top of the list regarding outcomes. Our health care 
system should be the best in the world.
  This debate around health care reform has to encompass all of those 
problems. This debate has to start with cost, about how we get at 
making sure that never again the people in my district see a 20 percent 
or 30 percent increase in health care costs in one given year.
  This debate has to get to a point where businesses can make extra 
money in one particular year and pass that extra income along to their 
employees rather than to insurance companies. This debate has to 
address the quality gap between those who have access to the best of 
our system and those that can't get there. We should be at the top of 
those lists that the World Health Organization puts out, not the middle 
or the bottom.
  That's why Band-Aids aren't going to work. In the Energy and Commerce 
Committee, my Republican friends today unveiled maybe what is one of 
their first detailed proposals for an alternate to the effort that the 
President and this Congress are putting forth. It was nothing but a 
series of Band-Aid fixes on our current system, slight tweaks to the 
system of private insurance that has gotten us into the problem that we 
are in today.
  Republicans had control of this House for 12 years. During those 12 
years, that's the strategy that they employed. Empower the private 
market, tweak and change the current private health care system here 
and there.
  The jury is in on that approach. The evidence is set. During that 
time that our Republican friends controlled this House, insurance 
premiums skyrocketed. The number of people without insurance increased. 
Our health care system got more broken.
  It is time to reset the competitive playing field. It is time to 
dramatically alter the rules by which insurance companies play. That's 
what we are talking about here today. No more incremental changes to 
our health care system that have proven to be ineffective, but serious 
reform that protects what we like about our health care system but 
fixes what is broken.
  I hope that that's the debate that we will have here in this Chamber 
and in committees throughout this Congress. That's what we need. That's 
what the businesses in my district need. That's what the constituents 
in my district need.
  Let's have a real debate. Let's have a debate on the facts, not based 
on innuendo, not based on distortions, not base on outright 
fabrications in this bill.
  I listened to our Republican colleagues who had the previous hour 
talk about this issue regarding the access that illegal immigrants will 
have to the new health care system that we hope to build here. They 
talked about an amendment in the Energy and Commerce Committee, which I 
sit on, that would, in their mind, restrict the access to the health 
insurance exchange or to the subsidies in the bill for the lower-income 
people so that it wouldn't accrue to illegal aliens.
  They failed to mention that we passed that amendment. The Space 
amendment passed. Check it out, thomas.gov online, passed by the House 
Energy and Commerce Committee, which states in as plain English as you 
can make it--and I get it, a lot of the amendments in the bills that we 
passed here are pretty hard to understand, whether you are watching 
Congress or in Congress. But this thing was about as clean as you could 
make it, that nothing in this bill shall allow people who are in this 
country illegally to access subsidies, to access government programs 
like Medicare or Medicaid.
  The existing law which requires verification of citizenship remains 
the same. Not a lot of talk.
  Mr. KING of Iowa. Would the gentleman yield?
  Mr. MURPHY of Connecticut. I yield for a moment, certainly.
  Mr. KING of Iowa. I thank the gentleman.
  I think we are talking about a different amendment. The amendment 
with the general language that says nothing in this bill, I believe was 
written into the bill, may have been an amendment that was adopted. But 
the amendment that Mr. Gingrey referred to was the Deal amendment, 
which would have required proof of citizenship. It failed by a vote of 
29-28, not exactly a party-line vote.
  Mr. MURPHY of Connecticut. Reclaiming my time, I thank the gentleman.
  My point being that you don't hear a lot of discussion about the 
amendment that did pass, the amendment that is attached to that bill 
today, which states very clearly what the law is and which, I think, is 
one of the things that leads the President, when he appears before 
groups out in the public or before this Chamber, to state that the law 
is very clear on that issue.
  I wish that we had a more honest discussion about the entirety of the 
debate in the Energy and Commerce Committee, which included the passage 
of a very clear and very restrictive amendment on that case.
  This is, I think, one example of many in which we have got to start 
matching the facts of this proposal and this debate to the rhetoric 
that's out there today. I think if we can do that, I think if we can 
get by the political jibs and jabs of this debate, there is real 
substance here.
  I will just close on this, Representative Boustany, in response to 
the President's speech several weeks ago, talked about the fact that 
there is and can be agreement on a lot more than there is disagreement 
over. I think that many of us who went home for the break found out 
amongst our constituents that folks out there were arguing around the 
margins of this bill.
  But on the guts of it, whether or not we have an obligation in some 
form or fashion to try to help people who don't have insurance today 
get insurance, whether or not we have an obligation to start holding 
insurance companies accountable for their actions, whether or not we 
have a responsibility to try to stimulate a competitive health care 
market that is in the majority of

[[Page 22477]]

States today not competitive, I think there is agreement on a lot of 
that.
  If we can start talking about what's really in the bill, talking 
about the amendments that passed, not just the amendments that didn't 
pass, start talking about what the words in the bill say rather than 
what the words of political pundits on the evening cable news shows 
say, I think that we can find some agreement here.
  I am glad that our leadership, Mr. Altmire here, in the House, has 
reengaged the minority side. I am hopeful that the President is 
absolutely sincere in his intention to bring Republicans to the table. 
You see in the Senate Democrats and Republicans talking to each other 
about how they can forge a compromise here between the two sides.
  There are absolutely going to be disagreements. Maybe in the end we 
can all come together on something. But if we listen to our 
constituents, if we listen to how very broken the health care system is 
in their eyes, small businesses, individuals and family, I think our 
mandate is not to put a Band-Aid on the current system, but to make 
major reforms that correct years of health care neglect from this body 
and this government.
  I would be glad to yield to my friend.
  Mr. ALTMIRE. I thank the gentleman from Connecticut, and I greatly 
appreciate the opportunity to participate tonight. We could certainly 
stand here and discuss the merits of the bill, and we will, the bill 
that has come before Congress already and the bills that we are trying 
to mold together and what we expect the end result to be. We can have a 
discussion on the need for health care reform in this country and the 
merits of the system that we have, what we can do better. We are going 
to have that discussion. But I did want to come down to agree with the 
gentleman.
  I watched some of the previous hour and Members who I consider to be 
friends and I work with. I certainly don't question intent, but we did 
hear a lot of rhetoric that does not in any way match up with the facts 
of the issues that we are discussing.
  I did not vote for the bill. I am not here to defend the bill. But 
when I hear Members come to the floor and talk about things that are 
not in the bill as though they are, and then hear them reference 
portions of the bill and greatly take out of context what they are 
talking about in that bill, I don't think that's a legitimate 
discussion on health care reform in this country.
  I am someone who wants to pass a health care reform bill. I want to 
find a way to make it work. I thought the House bill that was before us 
could have been better. I am hopeful that we are going to make it 
better. But I don't want to engage in a discussion and talk about how 
somehow we are in the process of putting together a bill that's going 
to lead to illegal immigrants getting health care or death panels or 
some of the other things that we heard over the course of the recess. 
That's rhetoric that is misplaced.
  I think, as the gentleman said, we do have the best health care 
system anywhere in the world if you have access to it. Our medical 
innovation, our technology, our research capability far exceeds 
anything available anywhere else in the world. That's true. And we want 
to preserve what works in our current system. There is no question 
about that. But there are things we can do better.
  I don't know how many people there are on the other side that think 
we shouldn't do any reform. I would expect not many, but we should be 
able to agree on the fact that in large segments of society, people who 
have insurance, they have access to the best health care system in the 
world. That's not to say that we can't do better.
  I want to engage in a dialogue of how we can improve upon the bill 
that was put forward. What can we do to achieve consensus, because in 
America that's where we end up. We start with an idea and we build to a 
consensus and we get something done. That's how legislation is passed.
  It offends me when I hear rhetoric put forth that is just not 
consistent with the facts of what's in the legislation. And, again, I 
am not here to defend that bill, but I understand that some of the 
things that we heard are just not legitimate concerns.
  We talk about what's the need for reform. I had an August where I 
went around and I talked to Rotary clubs and physician groups and 
hospital boards and went to all the fairs and had town hall meetings, 
everything that other Members of this House did. And one of the things 
that stuck out in my mind, I had, in a Rotary Club I was speaking at, a 
small business owner come up to me and handed me his statements from 
his previous 4 years, his rate increases, annual statement from the 
insurance company. The lowest increase he had over an annual period for 
4 years was a 28 percent increase. That was the lowest in the 4 years.
  He said to me, and he clearly was upset about it, that he was going 
to be unable to offer health care to his employees because he couldn't 
sustain this increase, 4 straight years of at least a 28 percent 
increase. He had to drop coverage. These are the things that we can't 
allow to happen in this country.
  When you have the best health care system in the world, you want 
everyone to have access to it. We want our small businesses to be able 
to offer coverage.

  If you are a small business owner who can't offer health care to your 
employees, it's not because you are a bad person. It's not because you 
don't want to. It's because you can't.

                              {time}  2100

  You can't afford to do it. So we need to bring the costs down for 
small businesses. Every family in America has had a similar discussion 
around the dinner table to talk about the increased cost of health 
care, the impact that's having on their family. Some of them have to 
make very difficult decisions on what they can afford and what they 
can't to keep health care. But everyone understands that costs are 
going up at an unsustainable rate.

  We all know the impact it has on government budgets, whether that be 
the Federal budget--but every State in America has experienced the 
State budget crisis that Pennsylvania has certainly experienced. And 
municipal budgets, with their health care costs. So it has an impact on 
governments at all levels. This is what we need to address when we talk 
about health care reform.

  Mr. MURPHY of Connecticut. I thank the gentleman. I spoke a little 
bit about the costs that we don't see. As my friend from Pennsylvania 
knows as a former hospital administrator, the folks who don't have 
insurance today cost us money. We have a universal health care system 
in this country. You just don't get it until you're so sick that you 
show up to the emergency room.

  Often, the care that you get in that emergency room when you become 
so sick or so ill that that's your only resort is the most expensive 
care that you could get. It's crisis care.

  And so for folks out there that have insurance--and that's the vast 
majority of the people in my district and throughout this country--
you're paying for the health care of those that don't have it today, 
and you're likely paying a lot more through taxes to your government 
that go to hospitals to pay for the uninsured, towards increased rates 
that you're paying in private insurance, that the private insurers pay 
hospitals to pay for the uninsured. You're paying more to pay for that 
crisis care than you would if we just got some preventative care for 
those folks.

  Mr. ALTMIRE. If I could make a point before you leave that issue. 
This reminds me of a couple of things that I heard when I've been back 
in the district. One of them was a gentleman who clearly was 
uncomfortable with the health care reform bill as he understood it and 
told me all the reasons why we shouldn't do it.

  The point he made was, Look, people who don't have health care, they 
get insurance and they get high-quality care. And he talked about his 
15-year old nephew who had gone to the Children's Hospital of 
Pittsburgh with a

[[Page 22478]]

hip injury of some sort, and he didn't have any insurance. His family 
didn't have insurance. And he got the treatment. And it was great 
quality, the best he could get. He's fine now. Everything is great.

  I said, Well, you said he didn't have any insurance. How did he pay 
for it? The gentleman said, Well, Children's Hospital paid for it. I 
said, No, that's not the way it works. You and I paid for it. That's 
how it works. And he said, What do you mean? And I'll explain what I 
mean.

  But there was a similar story of a woman who came up to me at a 
meeting, and she was very upset--was not a fan of the President, or 
me--and told me all the reasons that she thinks we as a Congress are 
doing a bad job. And she was really getting herself worked up. And she 
said, And don't you dare take my money to give it to those people who 
don't have health care, because I've worked hard to get where I am. And 
I've earned everything that my family has. And we have insurance. And 
we deserve it. And if those people don't have it, well, that's too bad 
for them. That's not my problem.

  The point of both those stories and what I said to both these people 
was, It is your problem. Because we can have a discussion about whether 
it's a moral imperative to offer coverage to people who don't have it. 
Is it our obligation as a country to make sure that whatever number of 
uninsured we can agree on, if it's 47 million or 31 million or 1, 
should we, as a country, have an obligation to cover those people?

  That's an interesting philosophical argument, but I'll tell you what 
the moral imperative is. The moral imperative is that we, who are 
insured, the people that I was talking to, we're already paying for 
them. The moral imperative is we're subsidizing them right now. And the 
people who don't have insurance get their treatment and their health 
services in the most inefficient, most costly setting--the emergency 
room--which leads to increased rates for us.

  The woman who I told you about who said that she didn't want to pay 
for other people's health care had an interesting story when I started 
to explain to her that she was already paying. She said, Oh, it's 
interesting that you mention that because, she said, she just had 
surgery done at a hospital in February and the insurance company denied 
part of her claim, and she had to pay $18,000 out-of-pocket, and 
because she was paying for it, she read that bill very closely and she 
noticed everything cost a lot more than it should have.

  So she called the hospital, she told me, and she said, Why does an 
aspirin cost $10? Why does everything on this bill cost five times more 
than it should? And the hospital said to her, Well that's because we 
have so many people who come through here who can't pay at all, we have 
to shift those costs to make up for the difference with the people who 
can pay. And she got it. And so did the gentleman who talked about the 
Children's Hospital.

  The point of those stories is that's why we're going to pass a 
reasonable, rational bill that's going to improve the health care 
system in this country when all is said and done, because everyone in 
America, even those who have great concerns about this administration 
and this bill and those who are never going to support the 
administration or this Congress for political reasons, they have had a 
situation in their lives that has demonstrated for them why we can do 
better or how we can do better.

  The woman I'm talking about with her $18,000 bill--but everyone has 
had something happen. They had to wait 9 months for an appointment with 
the dermatologist. They had a bad quality experience with a nursing 
home for their grandparents. They're that small business owner who just 
had his fourth straight year of 28 percent increase in his rates. 
Everyone has had something happen.

  We've all had to spend time on the phone, maybe upwards of an hour, 
haggling with an insurance claims adjustor who has just denied our 
claim or is arguing with us about that.

  So when you hear these stories, and you hear about how we shouldn't 
pay for people who don't have insurance and that that's not our 
problem, it is our problem. We're already paying for them. What we're 
trying to do by reforming the system is making sure everyone has 
coverage that wants it in a rational way so that we're not going to 
subsidize them in the least efficient, most costly setting, as we do 
today.

  Mr. MURPHY of Connecticut. Mr. Altmire, this is a remarkable debate 
in the sense that many players even within the health care system that 
potentially have something to lose off of health care reform, that 15 
years ago, during the Clinton health care reform debate, were fighting 
from the outside with torches and pitchforks to make sure that health 
care reform didn't happen, are part of the debate this time around. 
That you have the drug companies and the insurance companies and the 
doctors coming to the table--not everybody being holly-jolly about 
what's in this bill or what's in other proposals--but everyone at this 
point, after 15 years since the last major debate over health care, of 
almost complete neglect of the ills within our system, everybody 
realizes that there's need for reform.

  Certainly our constituents do. But even those institutional players, 
some of which have gotten pretty fat off the existing system, know that 
this thing is broken and know that we have to fix it.

  I think that they also see some real wisdom in the approach that we 
are building here. I've listened to Republicans and critics of health 
care give me story after story of how bad the Canadian system is, and 
the anecdotes they've heard about people waiting in lines in England 
and France. I listened to all those stories. And I heard them at my 
town halls from people.

  My response is: No one here is talking about importing some system 
from Canada or England or Europe or any other country. We're talking 
about developing a uniquely American solution to what is, 
unfortunately, a very uniquely American problem. That means basing our 
solution on the marketplace, basing our solution in the world of 
private employer-based insurance that we have today.

  Now there are absolutely people out there in this Chamber and in this 
country who want to see a Medicare-for-all system. There are others 
that say we should completely divorce health care from the place of 
employment. But for many of us those are changes that are a little bit 
too radical for our constituents.

  So what I think we have to work on--and, again, a point in which I 
think we can get more agreement than you might otherwise think there 
could be on this issue of health care--is in making this market 
actually work.

  In half of the States in this Nation, Mr. Altmire, as you know, 
there's one insurer that controls more than half of the market. In 70 
percent of the States there are two insurers that control almost three-
quarters of the market. There's not a lot of choice out there for most 
people today.

  Maybe the greatest contribution that we can make is to take this 
ingenious thing that we created in this country, the most vibrant 
capital marketplace in the world, and make it work for health care.

  Now it's never going to work perfectly for health care because it's a 
strange system in which the people paying for health care are often not 
the people that are choosing the health care. So the health care 
marketplace is never going to work like buying a car or a gallon of 
gasoline. We can make it work a lot better than it does now.

  And so the reforms that the President has proposed to establish 
health care exchanges, these regional health care marketplaces where 
insurance companies would really have to compete against each other for 
the business of individuals and small businesses, the reforms in this 
bill to make sure that insurance companies can't try to push out of 
their portfolios people that are sick or people that have certain 
expensive diseases, those are all engaged in the process of trying to 
make our health care marketplace work better.


[[Page 22479]]


  And so we talked about the distortions surrounding the benefits in 
this bill to illegal immigrants. I say the same thing about those who 
come down to this floor or go out in public and talk about this 
proposal or any of the like proposals that we're debating as a 
government takeover. The CBO has been pretty clear on what the 10-year 
results of the bill that passed the Energy and Commerce Committee would 
mean.

  Mr. Altmire, as we've talked about, there are a lot of people, 
including yourself, who want to see some changes to the proposal that's 
out there from Energy and Commerce. So I don't want to present that as 
the bill that's going to come to this floor for a vote. But let's take 
it as a foundational point of argument.

  The Congressional Budget Office--again, the nonpartisan sort of 
analyst arm of this Congress--says that if you pass the bill out of 
Energy and Commerce, in 10 years more people would be on private 
insurance than are on it today. That private insurers in this country 
would have more business--not the same, not less--because we would 
reinvigorate that private marketplace and get more people into private 
insurance by helping them with tax credits both through business tax 
credits and individual tax credits to buy insurance.

  That's a concept that I want to support, using the marketplace that 
is broken right now as the way that we fix health care going forward. I 
think that that's one of the points that we can get some agreement on 
going forward, Mr. Altmire.

  Mr. ALTMIRE. The gentleman said a couple of things that I wanted to 
comment on. I will get to the public option momentarily. But I agree 
with the way the gentleman characterized the discussion about Canada 
and Great Britain, the two countries that we most often hear the horror 
stories from.

  Look, I don't live in Canada. I don't live in Great Britain. I don't 
know what it's like to live under those systems. But I do know this. I 
have a master's degree in health care administration. I've spent a 
career in health care policy.

  I can tell you it is interesting to study what other countries do--
not just Canada and Great Britain, but other countries around the 
world--and everyone has a different system. That's a nice political 
science or health policy discussion to have. But, as the gentleman 
talked about, that has nothing to do with what we're doing in this 
bill.

  This bill doesn't in any way bring to America what Canada does, 
certainly. It's not even close. There's no comparison to be made. It 
doesn't do anything close to what Great Britain does, which is even 
more to the left of Canada.

  And so we can watch the TV and hear the horror stories. And they're 
interesting to listen to, but it has no place in this discussion 
because it has nothing to do with the proposals that we're voting on.

  With regard to the public option--and I'm going to use another 
example from when I was back in the district. I continued to hear 
people say, You know what? The government is inefficient, it's bloated, 
it can't do anything right. They would say, You can't name one program 
that the government has ever run that's worth anything. Everything it 
touches is bad. And if you have them touch a public option, it's going 
to cost too much, it's going to be inferior care.

  And I would say, Look, the public option is going to be self-
sustaining. We do need to work out the details of what exactly it's 
going to look like, but it's going to be self-sustaining, with no 
taxpayer subsidies. It's going to compete on a level playing field with 
the insurance companies. It'll have to meet all the same regulatory 
requirements that they meet.

  And there is some disagreement on this. I would like to see it have 
negotiated rates like the insurers. There are other opinions on that. 
But the point is it's going to be a fair fight. And it'll have to meet 
all the same requirements as the private insurers.

  If you believe that the government can't do anything right, that 
they're going to mess up everything that they touch, and it's going to 
be inferior quality at a higher cost--and, under the terms of the bill 
no one is forced into the public option; it's voluntary--then what are 
you afraid of if you believe the private market can do everything 
better?

  I'm not afraid of that competition. I think the private market can't 
compete and win. I think there are some families and businesses that 
would choose the option and feel that's a better deal for them--not 
because it has an unfair advantage, but if it's a level playing field 
and you don't think government can do anything right for those that 
have that belief, then why are you afraid of the competition?

                              {time}  2115

  Mr. MURPHY of Connecticut. Reclaiming my time, we have example after 
example of where the private sector and the public sector compete 
pretty well side by side, and most of the examples involve public 
sector entities that are heavily subsidized, and they still compete 
side by side with private entities.

  Public colleges haven't run private colleges out of business despite 
the fact that they are heavily subsidized by the government. Public 
hospitals haven't run private hospitals out of business despite the 
fact that they are often subsidized. The same thing for even smaller, 
more mundane examples. Public golf courses and private golf courses, 
public pools and private pools. There is example after example of where 
public entities can coexist side by side with private entities, and 
they actually compete with each other.

  I think this is such an important point, and I go back to the CBO 
estimate here, Mr. Altmire. Assuming that you create that level playing 
field, which you and I both want, with an insurance exchange that 
includes a public option, the CBO tells us that not only will you have 
more people in private insurance when all is said and done but the 
number of people in the public option will be about 10, 12 million 
people, 2, 3, maybe 4 percent of the overall health care consumers out 
there. A significant number but by no means a government takeover, as 
some people would have us believe. This is an option for people that 
can compete.

  For me, I look at government health care and I think, well, you know, 
if it's good enough for our soldiers, if it's good enough for our 
veterans, if it's good enough for our Federal employees, if it's good 
enough for Members of Congress, if it's good enough for State 
employees, if it's good enough for every individual in this country 
over 65, then I think that my constituents should have the choice of 
whether it's good enough for them. I don't want to make that choice for 
them. I don't want to be like a European country that says your only 
choice is public insurance.

  But I also don't like the arrangement we've got today where our law 
as set by the Federal Government tells my constituents that your only 
choice is private insurance. I give my constituents credit. I mean, I 
think that they'll be able to make the best choice for them. And I 
think if we do that, then we will get to where I think a lot of us want 
to get to, which is to really stimulate and reinvigorate that market, 
Mr. Altmire.

  Mr. ALTMIRE. I agree with the gentleman on those points.

  I would say also let's look at the totality of what we're talking 
about with reform. When we talk about making reforms in the private 
insurance market that I think everybody agrees with, this is what 
you're going to get from health care reform: no more preexisting 
condition exclusions. No more caps for people with chronic diseases, 
annual caps or lifetime caps, out-of-pocket costs. Insurance companies 
won't be able to deny you coverage or drop your coverage because you 
get sick or injured. These are all practices that we know exist. They 
won't be available after this bill passes.

  The help for small businesses who can't afford health care to be able 
to help them, hopefully through tax credits or some other way, to 
afford coverage for their employees; to do the reforms in the system to 
incentivize

[[Page 22480]]

quality of care, not quantity of care. We've talked about this many 
times on the floor where the current system is a fee-for-service 
system. The number of times you show up in the doctor's office, the 
number of tests they run and procedures they order, that's the amount 
of money that they make. So they have a financial incentive for you to 
be sick. The more often you're there, the more things you have wrong 
with you, the more money they're going to make. Well, that's a perverse 
incentive.

  We want to change the reimbursement system to incentivize quality to 
keep you healthy and keep you out of the system before you get sick. 
And that's why we're going to incentivize prevention and wellness, to 
make those services that senior citizens especially can access the 
Medicare system at no cost so that you can have the diabetes screenings 
and the mammograms and the flu shots and things that are prevention at 
no cost. They're going to prevent people from getting sick in the first 
place.

  So these are things that I think we all agree on when we talk about 
reform.

  Mr. MURPHY of Connecticut. Reclaiming my time, on this point of 
reforming the way that Medicare works to start paying for outcomes, 
start paying for systems and doctors and providers and hospitals that 
get results rather than just paying for volume, it is incredibly 
discouraging to me to watch Members of this body that proclaim to be 
fiscal conservatives come down here and eviscerate the efforts of the 
President and of the Democratic side of the aisle to try to rein in the 
cost of Medicare.

  I hear sort of arguments out of two different sides. Opponents of 
reform talk about the fact that the government can't run anything, that 
they can't run Medicare; but then they also at the same time attack the 
fact that this bill for the first time in a long time tries to rein in 
the cost of Medicare, actually tries to fix the abuses out there.

  Yes, in this bill there are reductions in the cost of Medicare. 
Nobody should apologize for the fact that we are going to rein in the 
abuse and waste and sometimes fraud in the Medicare system. It just 
doesn't make any sense, Mr. Altmire, that there are health systems with 
the same medical populations and one is spending $16,000 per year on 
every Medicare beneficiary and the other community is spending $8,000 
per Medicare beneficiary. And when you actually look at it, there's no 
difference in the outcomes that they get. Why are we rewarding systems 
of health care that just add volume upon volume of care and get no 
added benefit out of it?

  Now, I'm not saying that the way that you fix that is easy. I'm not 
saying that there is some silver bullet that comes in here and all of a 
sudden finds a way to reward value over volume. But I'm saying that for 
those out there that have come down to this floor and have gone out in 
public and railed against the cuts in Medicare in this bill, they've 
got to pay attention to the reality.

  The reality is the benefits stay the same for beneficiaries. In fact, 
they get better. As you said, we're not going to require seniors to pay 
for the costs of checkups and preventative health care anymore. We're 
going to eliminate the doughnut hole over time. We're going to start 
paying their physicians more to take care of Medicare patients rather 
than what the Republican majority insisted on, which was an annual 4 
percent cut.

  Are we going to say to health care systems and hospitals and 
providers who are just ordering tests and procedures for the sake of 
reimbursement and volume and not for quality that they shouldn't get 
paid as much as they do now? Absolutely. But that's our obligation as 
stewards of the taxpayer dollars, as people that care, like our 
constituents do, about preserving the life of Medicare.

  So I hope that we can join together in this conversation. I hope that 
my friends out there that claim to be fiscal conservatives don't spend 
the next 2 to 3 months out there railing against every single 10-year 
reduction in Medicare spending in this bill because, again, if we want 
to come together, there is nothing more appropriate to come together on 
than spending our taxpayer dollars wisely on existing government 
programs like Medicare. I want Medicare to be around when I turn 65, 
and if we don't tackle the excessive costs in some parts of our 
Medicare system right now, it's not going to be, Mr. Altmire.

  Mr. ALTMIRE. And on that point, Medicare, as we all know, is 
scheduled to go bankrupt within 7 years. It's already, as a trust fund, 
paying out more than it's taking in. It has for the last few years. 
It's going to be completely insolvent in the year 2016. That's because 
of rising health care costs which are, unlike Social Security, which is 
going to be solvent through the year 2040, and because of demographics, 
it takes a downturn thereafter, but health care costs are 
unpredictable.

  Retirement costs are very predictable. You can generally figure out 
how long a population is going to live in the aggregate, what kind of 
money they're going to make, what their salary progression is, and what 
their retirement benefits look like. That's easily predictable.

  Health care benefits aren't. You don't know how much technology is 
going to change, how much prescription drugs are going to cost, how 
much high-technology treatments are going to cost, and what the future 
holds with regard to new innovations and technologies down the road. So 
for that reason, it's impossible to predict Medicare costs in the same 
way. The first baby boomer becomes eligible for Medicare in the year 
2011. That's a big part of it too demographically.

  So what we're trying to say is what can we do to preserve and protect 
Medicare for the long term? That's the whole point of health care 
reform, to bring down those costs, to make Medicare solvent, to make 
the reforms necessary so that it can last into the future and be there 
certainly for all the current beneficiaries, the baby boomers, for the 
gentleman and myself, and for our grandchildren. That's why we have to 
reform the Medicare system, the payment system, and that's why we need 
to reform our health care system.

  But we spend as a Nation $2\1/2\ trillion a year. This year, 2009, 
we're going to spend $2\1/2\ trillion as a Nation for 1 year on health 
care. So what are we talking about?

  Now, we used to in this House score things over a 3-year period; and 
then people, I think rightly, said that doesn't give you an estimate of 
sort of the long-term impact of the legislation; let's do it over 5 
years. So for a while, several years, we scored all the bills over a 5-
year period. Now in the interest of transparency and to give the public 
an idea of the full long-term costs, we actually score legislation that 
comes to this floor over a 10-year period.

  And what's the cost of this bill going to be? The President of the 
United States stood right behind where the gentleman stands about a 
month ago and told us that it's going to cost somewhere in the 
neighborhood of $900 billion over 10 years, which is going to be fully 
paid for. It's not going to add to the deficit. We'll talk about that. 
But $900 billion over 10 years. So on average, that's $90 billion per 
year in a system where we're spending $2\1/2\ trillion this year, and 
it's going to go up exponentially every year for the next 10 years.

  Is there anyone out there who doesn't think we can find 
inefficiencies in the system and waste that we can squeeze out to the 
tune of $90 billion a year in a $2\1/2\ trillion system, that we can't 
make it more efficient and save enough money to make the reforms that 
we're talking about?

  I just think that the American people, when they think about these 
numbers, need to remember that we're talking about reforms that are 
going to increase quality, that are going to increase benefits for 
people, but that we are talking about in the aggregate a relatively 
small portion of the health care system as a whole when you talk about 
this stuff.


[[Page 22481]]

  Mr. MURPHY of Connecticut. Mr. Altmire, you've been a great leader on 
this question, which is to say, listen, to fix the problems with our 
health care system, we're going to need to spend a little bit of money 
up front, with tax credits to individuals or to small businesses to 
help them afford insurance, money to plug the doughnut hole to pay for 
preventative care for our seniors, expansion of Medicaid programs to 
cover some more people. We have got to look to savings first. And that 
is a point you've made to dozens of Members on this floor. To say, 
listen, exactly as you put it, and you're much more eloquent on this 
subject than I am, we can squeeze savings out of this system.

  And as you enunciate, it's important to remember that that 10-year 
cost of this bill, whether in the end it's $900 billion or $700 billion 
or $600 billion, that's the gross cost, not the net cost. That can be 
paid for in whole or in large part by the savings that we're talking 
about here to the current government health care expenditures.

  Now, listen, for those people that say I don't want the government 
involved in health care, guess what? It's too late. Fifty-five percent, 
somewhere in that neighborhood, of health care dollars in this country 
are spent by the government. Medicare, Medicaid, the veterans system, 
et cetera. We have not just the obligation but the opportunity to 
modernize those programs, glean real savings out of them, and turn it 
back around to people who are left out right now.

  And for those opponents of reform who go around demagoging the 
Medicare reductions in this bill and say we cannot touch Medicare, 
those Democrats had better not make any changes to Medicare, well, Mr. 
Altmire, as you pointed out, Medicare's going to go bankrupt. So if you 
don't control Medicare costs, if you're one of the people on this House 
floor or out there on the stump saying that Congress, whatever they 
pass on health care reform, can't touch Medicare, then you have only 
one other option in order to preserve Medicare for your kids and your 
grandkids, and that's to increase taxes. That's to increase the amount 
of money that comes out of everybody's paycheck to pay for Medicare.

                              {time}  2130

  So I can certainly understand a disagreement about where we need to 
rein in costs on Medicare and where we shouldn't, but I hear a lot of 
commotion out there by people who say we should not touch it. I agree 
we should keep benefits where they are and improve them, but we do need 
to find efficiencies in the system.

  Turning to another subject, Mr. Altmire, you and I both have young 
children. I know in the 12 months that I have had the joy of being a 
parent, there is not a day, not a week that goes by that I don't think 
about the cost of what we are doing to my son.

  As someone who, frankly, voted for the stimulus bill, what I thought 
was a necessary means to get this economy back up and running and to 
stabilize what had been up to that point a free fall, I approach this 
health care bill with the same bottom line that the President does: We 
need to pass a bill that finds a way to get coverage to more people and 
reins in the cost of care. And to the extent that requires spending 
some money at the outset in order to get a better system in the long 
run, it has to be done in a deficit-neutral way. ``Deficit-neutral'' is 
kind of an inside Washington term, but the bottom line is this, we 
can't borrow any money to pass health care reform.

  I think that is a growing commitment on behalf of both sides of the 
aisle here. It is certainly a bottom line for the President. And again, 
I think a central tenet of health care reform has to be do what you 
push for, squeeze the savings out of the system as much as we can in 
order to pay for what we need to do, and then make a rock-solid 
commitment that we won't borrow a cent in order to pay for it.

  Mr. ALTMIRE. I agree with the gentleman. I have said that I will not 
support a bill that adds one penny to the deficit. Even more important 
than that, the President of the United States said that from the podium 
behind you. He will not sign a bill that adds one penny to the deficit.

  I heard time and again over the course of being back in the district 
concerns about the spending that is taking place in Washington and the 
increase in the debt and the annual deficits over the past 9 years. I 
have young children, as the gentleman said. I completely agree, we have 
to do this in a way that is not going to add one penny to the deficit 
or the national debt.

  One of the Senate bills which has been finalized and is being marked 
up this week, in fact, saves money over 10 years. I don't know if that 
is going to be the finished product. Certainly it is not word for word, 
but it is possible to do health care where we might actually bring a 
bill to the floor that, at minimum, is not going to add to the debt but 
might even reduce the debt over a 10-year period, or reduce the deficit 
on an annual basis.

  That is something that I think the American people should consider 
when they talk about the need for health care reform, but also the need 
to bring down our long-term deficit. We can't ever address our long-
term deficit without doing health care reform. It is too big a part of 
our economy to ignore.

  Mr. MURPHY of Connecticut. Estimates are, within the next 30 years, 
health care costs will consume 50 percent of gross domestic product in 
this country. Think of that. One out of every two dollars spent in this 
country by the government or private sector will be spent on health 
care. Today, it is creeping up on 20 percent, but in 30 years things 
will be out of control.

  You are exactly right, there is no way to talk about deficit and debt 
reduction without talking about health care reform. We have examples of 
how we have been able to do that just in the last week.

  Last week we passed an education reform bill that modernized our 
student loan program, got $87 billion worth of savings, and applied a 
significant portion of those savings not to new student loan programs 
but to deficit reduction. Frankly, that should probably be a model for 
everything that we do here. If we can glean savings out of government 
programs, we need to apply all or part of that to paying down the debt.

  We are at the close of our hour, so if you have any closing comments, 
Mr. Altmire. I appreciate you joining us down here for this hour.

  I am optimistic by nature. We both focused on the points of agreement 
we think we can get here. I do make a point to call out my Republican 
friends when I think they have tried to lead folks out there astray on 
a particular point on the bill, but it is because I want to have an 
honest debate in the end. I think if we are all talking about the 
facts, we can get to a point of agreement, because our constituents out 
there want us to get there because the problems in our health care 
system dictate that we create a real solution that isn't incremental 
and isn't small and around the edges, but attacks the foundation and 
the gut and the root of our problems.

  So I look forward to coming back down to the House floor and 
continuing to push forward this case for reform.

                          ____________________