[Congressional Record (Bound Edition), Volume 155 (2009), Part 17]
[House]
[Pages 23034-23041]
[From the U.S. Government Publishing Office, www.gpo.gov]




               30-SOMETHING WORKING GROUP ON HEALTH CARE

  The SPEAKER pro tempore (Mr. Boccieri). Under the Speaker's announced 
policy of January 6, 2009, the gentleman from Ohio (Mr. Ryan) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. RYAN of Ohio. I thank you, Mr. Speaker. This is our traditional 
30-something hour. We will be talking about health care and try to 
rebut some of the claims that have been made earlier here tonight. But 
before we do this, we have had several situations going on in the 
Pacific, and we wanted to yield as much time as the gentlelady from 
Guam may consume to talk about the circumstances that are going on in 
her district.
  I gladly yield to Ms. Bordallo.


                       Tsunami in American Samoa

  Ms. BORDALLO. Mr. Speaker, thank you very much, and I want to thank

[[Page 23035]]

the gentleman from Ohio for giving me some time to discuss the very 
serious disaster that just happened in one of the U.S. territories in 
the Pacific.
  I come to the House floor this evening in the wake of a tsunami that 
struck yesterday on the shores of the Samoan Islands, resulting from an 
earthquake centered in the Tonga Trench of the Pacific Ocean. The 
epicenter of this earthquake is estimated to have been about 120 miles 
south of the islands of Independent or Western Samoa and from American 
Samoa, which is represented in this body by our distinguished colleague 
Mr. Faleomavaega.
  The strength of this earthquake was measured by the United States 
Geological Survey at 8.0 magnitude on the Richter scale. Eyewitness 
accounts indicate that the tsunami triggered by this earthquake brought 
four back-to-back series of waves, ranging from 15 to 20 feet in 
height, to the shores of American Samoa and that these powerful waves 
penetrated up to a mile inland upon impact.
  Given the gravity of the situation at hand, I convey on behalf of my 
constituents, the people of Guam, our deepest condolences and 
sympathies to the Governor and the first lady of American Samoa, to our 
colleague Mr. Faleomavaega, and to their entire community on this 
tragedy. Our hearts and our prayers are with the families who have lost 
loved ones or who have been injured as a result of the disaster.
  Mr. Speaker, our island communities in the Pacific stand in 
solidarity with the people of Samoa, as do our fellow Americans from 
all across our country. When disaster strikes, we pull together as 
Americans and as a country, and in the Pacific, we do so as fellow 
islanders.
  The people of American Samoa are no strangers to the course of nature 
and to the forces of the sea. The Samoan culture has survived over 
centuries. Living in harmony with the sea is rooted deep in their 
culture and way of life. They are a great seafaring and resilient 
people with a strong sense of family and community. We know that they 
are pulling together at this time to comfort and to console each other 
and to begin to rebuild and recover. Their spirit has not been 
diminished or dampened. Rather, it is being tested, and they are 
answering the call tremendously.
  The fatality rate for this disaster continues to rise, as does the 
number reported to have been injured, and we grieve with our fellow 
Americans. The President this morning issued a major disaster 
declaration for American Samoa, and the Federal Emergency Management 
Agency, FEMA, under the leadership of its administrator, Mr. Craig 
Fugate, is marshaling and coordinating the relief resources as we 
speak. An AC-130 aircraft and a U.S. Navy frigate have been dispatched 
to deliver the first line of Federal relief. The arrival in American 
Samoa of other assets will follow in the coming hours, bringing 
critical food, water, medicine, medical supplies, and personnel. All 
branches of our military, including the National Guard, are organizing 
their contribution to this humanitarian mission as we speak.
  Our allies and friends in the region have already reached out, 
extending invaluable diplomatic lines of support and important messages 
of encouragement. Governor Tulafono, Congressman Faleomavaega, and 
other island leaders have been in around-the-clock communications with 
Federal officials and leaders of neighboring islands as to the 
situation on the ground and the status of recovery efforts. Mr. 
Faleomavaega, we know, would be with us today as we continue our 
legislative duties here in Congress, but recognizably is on his way 
home.
  I know several of my other colleagues intended to join me tonight in 
commenting on this tragedy and in sending words of condolence and 
encouragement to Mr. Faleomavaega's constituency. I am facilitating 
this Special Order as the chairwoman of the Subcommittee on Insular 
Affairs, Oceans and Wildlife. The chairman of the Natural Resources 
Committee, Mr. Rahall of West Virginia, is unable to join us in person 
tonight, but his remarks will be entered into the Record, and he has 
asked me to speak to this matter.
  Before yielding, however, I want to also emphasize the importance 
that this tragedy has underscored for the network of Federal disaster 
and natural hazard resources and partnerships spanning the Pacific 
region. The United States Geological Survey of the Department of the 
Interior has provided real-time data on the earthquake. The Pacific 
Tsunami Warning Center at the National Oceanic and Atmospheric 
Administration's National Weather Service issued the watches, the 
warnings and the advisories for the region with respect to the tsunami 
and continues to stand watch. The National Ocean Service and other 
components of NOAA have been working in the region and with local 
officials in recent years to improve natural hazard planning and to map 
the coastal areas for their vulnerabilities.
  FEMA's National Response Coordination Center and the Regional 
Response Coordination Center for Region IX have been critical to these 
early response efforts, as has the incident management assistant team 
and the planning and response team that they have deployed to provide 
direct support in American Samoa. The Coast Guard and other components 
of the Department of Homeland Security have also set in motion 
important services supporting these recovery efforts.
  Every branch of the armed services under the Pacific Command is also 
to be recognized for the humanitarian missions that they have put 
underway for the people of American Samoa, Western Samoa, and the 
Kingdom of Tonga. Personnel at the Office of Insular Affairs at the 
Department of the Interior and the Department of State are also 
initiating response efforts within their respective agencies and with 
the governments of the affected islands.
  And most importantly are the first responders and the civilian 
defensive authorities and personnel of the Government of American 
Samoa, including those working at the LBJ Tropical Medical Center, 
caring for the many, many injured. They are to be commended for the 
outstanding job that they are performing in this time of urgent need.
  Ultimately, after recovery, we will review and examine the sequence 
of steps leading up to and immediately following this natural disaster. 
We will do so for the purpose of further bolstering our defense and to 
improve our capability to prepare for and respond to such disasters. I 
know Mr. Faleomavaega has long been a leader in Congress for 
strengthening FEMA and NOAA's capabilities in the Pacific region, and I 
have joined him in working to protect such disaster assistance and 
weather forecasting services for the freely associated States under the 
terms of the compact.
  We have also worked to build these resources in the territories. Four 
years ago, in the aftermath of the devastating tsunami which hit 
Indonesia and affected more than 12 other countries in Southeast Asia, 
Mr. Faleomavaega introduced legislation to specifically provide for the 
establishment of a tsunami hazard mitigation program for all the United 
States insular areas. Mr. Faleomavaega's legislation was ultimately 
incorporated into an act of the 109th Congress, Public Law 109-424, 
which improved tsunami detection, forecasting, warnings, notification, 
preparedness, and mitigation for the entire United States, and is a 
basis for the United States leadership toward the development of a 
global integrated tsunami warning and education system.
  Mr. Speaker, we will have challenges before us in terms of preparing 
our island and coastal communities for tsunamis and other natural 
disasters, but we have come a long way, especially since the Federal 
Government established the Pacific Tsunami Warning Center in Hawaii in 
1948.
  On Guam, we have weathered many, many supertyphoons and earthquakes, 
among other natural disasters. We recognize the tremendous lift that is 
provided to a community when our brothers and our sisters reach out to 
lend a helping hand and words of encouragement. When backup resources 
are sent

[[Page 23036]]

and leaders work together in time of need, we pull together and we 
recover. This is the American way. But it is also deeply rooted in the 
values of the indigenous people of the Pacific, including our Samoan 
friends.
  Again, I know Mr. Faleomavaega, his constituents, and Governor 
Tulafono have the support of this body with respect to recovery from 
this disaster. We look forward to working with them in the coming days 
and weeks to ensure the lines of relief are there for their community.
  I want to again, Mr. Speaker, thank Mr. Ryan of Ohio for his 
indulgence in allowing me to utilize some of his time tonight. Mr. 
Speaker, I want to thank my colleagues for keeping the people of 
American Samoa, Western Samoa, and the Kingdom of Tonga who have been 
impacted by this tragedy in their thoughts and in their prayers.

                              {time}  1730

  Mr. RYAN of Ohio. Mr. Speaker, we also have the Representative here 
from the Northern Mariana Islands, Mr. Sablan.
  I yield to the gentleman.
  Mr. SABLAN. I would like to thank the gentleman from Ohio for 
yielding to me.
  Mr. Speaker, people in the Pacific Islands may be separated by 
thousands of miles, but we all feel that we are part of one family.
  The tragedy that is unfolding now in American Samoa is not remote to 
us in the Northern Mariana Islands. We feel the horror and the pain, as 
if it were happening to us.
  I am not speaking metaphorically. Some in my own family have 
relatives from American Samoa and our islands are home to many American 
Samoans. They are school principals. They are program administrators. 
They are utility engineers. They are neighbors. They are friends. They 
are family. And they fill a vital and much-appreciated role in the life 
of the Northern Mariana Islands.
  So today we are terribly, terribly saddened by the loss of life in 
American Samoa, by the images of homes washed away, by the knowledge 
that it will not be days or months but truly years before the people 
and life of American Samoa can be said to be recovered.
  I come to the floor today hoping to raise the awareness of this House 
to the challenges our fellow Pacific Islanders and fellow Americans now 
face in American Samoa, and I hope that this House and the Federal 
Government as a whole will respond as Americans traditionally respond 
when community in our Nation is struck by natural disaster, with every 
possible aid and assistance to help American Samoans rebuild.
  I placed a call late yesterday afternoon to our colleague and friend, 
Congressman Eni Faleomavaega, just when this tragedy was taking place. 
He and his staff were already on the phone calling Federal and 
territorial offices to respond to this horrible tragedy. He is now on 
his way to American Samoa to do what he has to do for his people and 
the islands.
  I want to commend President Obama, Homeland Security Secretary Janet 
Napolitano, Interior Secretary Ken Salazar, and the new Assistant 
Secretary for Insular Affairs, Anthony Babauta, who have already 
responded with the appropriate speed.
  Even as the earthquake struck yesterday and the series of tidal waves 
began to sweep across the heavily populated coastal areas of American 
Samoa, the Interior Department was keeping the Speaker's Office and the 
rest of this House informed of events. The President has promptly 
issued a disaster declaration, and the Federal Emergency Management 
Administration is taking all appropriate response actions. The Coast 
Guard is on hand, and other elements of the U.S. military are assisting 
in bringing personnel and supplies as quickly as they can to American 
Samoa.
  But the distances to cover are vast. The logistical difficulties are 
very great. A disaster of this magnitude only serves to highlight the 
particular vulnerability of islands to natural disasters and, indeed, 
to any disruption to the normal day-to-day life.
  Island communities, because of their isolation, do not have the same 
resilience that communities on the continent take for granted. The 
people of American Samoa cannot drive away from the devastation to seek 
shelter with friends and families in other parts of the United States. 
There are but a few air flights a week in and out of Pago Pago, and the 
cost is prohibitive for a community with income levels way below the 
national average.
  FEMA cannot drive in with trailers to provide emergency housing, or 
tarps and tents to provide temporary shelter. There are no highways 
across the ocean. Power plants are stand-alone, not connected to some 
continental network. Fuel supplies are not replenished by pipeline but 
depend on long-distance tankers. Food stocks on-island are limited. Few 
people can afford to keep much in reserve. And now the thin line of 
supply for food is also no doubt disrupted.
  Mr. Speaker, I hope I have made the point. Americans in American 
Samoa need the help of the rest of America. In the days of sorrow ahead 
for American Samoa, throughout the long days of recovery American Samoa 
now faces, I urge my colleagues to open their hearts and support every 
effort to give comfort and aid to a people who are truly in need.
  Mr. RYAN of Ohio. Reclaiming my time, I thank the gentleman and 
extend the condolences from the people of my district in Ohio and the 
rest of the House. Tsunamis and hurricanes and all of the natural 
disasters that we watch on TV, I think it's important that the 
Representatives come here today and share with us kind of the human 
side of it, and we realize that these are human beings that have been 
hurt and families that have been displaced. And we want to just extend 
our condolences to the gentleman and the gentlewoman and also the 
gentleman who couldn't make it here from American Samoa.
  Our hour tonight, Mr. Speaker, what is left of the hour, is to talk 
about an issue that is pressing for the country. It has been the topic 
of conversation here in the United States Congress for several months. 
It's been a topic in the country for decades going back to Teddy 
Roosevelt, Franklin Roosevelt, upward and onward to Truman and Johnson 
and as of late, in recent history, President Clinton in the early 1990s 
and now President Obama to try to deal with the situation of health 
care in the United States of America.
  This is an issue that we hear as elected Representatives day in and 
day out where we get letters from constituents who have problems with 
the insurance industry, who have been hurt, displaced, not covered. The 
coverage that they have doesn't necessarily work.
  I think this whole debate breaks down into two separate categories. 
There's the financial aspect of health care reform and bending the cost 
curve and making sure that our country doesn't go belly up because we 
keep going down the same road and we don't muster up the courage to 
have change. And then the other track is the social justice track, the 
idea that the way that human beings, the way that American citizens are 
now getting treated by insurance companies is unfair, not right, cruel, 
and something that needs to stop.
  So collectively as a country in the past election, the country 
overwhelmingly voted for change, and they overwhelmingly voted for 
health care change. And one of the major planks in President Obama's 
platform was health care, health care reform, bringing some justice to 
the system, and helping to bend the cost curve in the system.
  I think everybody recognizes the social justice side. I think 
everyone has heard stories. It has happened to them. It has happened to 
family members. It may happen to somebody that they know where someone 
is denied coverage because they have a preexisting condition or a 
family goes bankrupt because of a health care catastrophe in their 
family.
  And what this reform does is it eliminates those two major problems 
that we have in our health care system, where we are collectively as a 
country saying it is not right for a human

[[Page 23037]]

being, a United States citizen to have to file for bankruptcy because 
they got sick or someone in their immediate family got sick. Now, I 
hope we can all agree upon that.
  When some of our friends on the other side talk about liberty and 
freedom and they cue up the patriotic music to try to destroy health 
care reform in the United States, I would like to ask the question, How 
free is the person that just had to file bankruptcy because they got 
sick? How liberated is the person who has to file bankruptcy because 
they got sick? Is that their idea of freedom, Mr. Speaker? Is that the 
TEA baggers' idea of liberty, Mr. Speaker? I don't believe that it is. 
But that is the great debate we are having in this country.
  There are people in this country who will end up on one side of that 
fence or the other. And the side that President Obama and the Democrats 
have been pushing is to say that when you go bankrupt because you got 
sick or someone in your family got sick, you are less free. You have 
fewer options.
  There are others who are trying to kill health care reform, who say 
if you go bankrupt, tough luck. We'd rather have the concept of 
liberty, the concept of freedom.
  But our job when we come to Washington and make laws and reforms is 
to actually take these ideas that the Founding Fathers have given us 
that are written all over these buildings, all over Washington, D.C., 
in State capitals all over the country, and that our kids read about in 
the history books and on the computer that when they are implemented, 
those definitions mean something. And this health care reform will make 
American citizens more free. It will allow them more opportunity, more 
options. It's bad enough you've got to deal with being sick and you're 
sick enough that you have to spend so much money that you go bankrupt; 
then you've got to be bankrupt, which is not a pretty process. It 
strangles your ability to be free.
  So I have to laugh, if it wasn't so sad, when we hear about people in 
this debate talk about liberty and freedom. You're doggone right it is. 
And we are trying to enhance liberty, enhance freedom, actually make it 
work for people. In my congressional district, if we do nothing, we 
will have 1,600 families go bankrupt because of health care concerns, 
1,600 just in my district.
  Half of the bankruptcies in the United States of America are because 
of health care issues. Now, to me that doesn't sound like the principal 
of freedom. And we're going to fix it.
  The same with preexisting conditions. So you're in a job and you have 
health care and you or your spouse has some kind of condition that you 
know if you get out of the current pool that you're in, you're going to 
end up in the shark tank, basically, right now and you're not going to 
be able to get health care coverage. So you want to start a business or 
you want to go somewhere else where maybe you could make more money or 
you could express more of your talent, more of your ability. You could 
grow. You could learn new things and maybe provide more for your 
family. But you don't do it because you know if you leave your job that 
you won't be able to get health insurance.
  Now, I ask my friends who talk about freedom and liberty, is that 
person more free? Is that person liberated to pursue happiness? I don't 
think they are.
  So I will have the debate all day long, Mr. Speaker, with the TEA bag 
groups and the TEA baggers and everybody else who wants to have this 
debate about freedom and liberty because this reform bill and the 
insurance reform components of this are about increasing people's 
freedom. It's about protecting them in a market in which they need some 
consumer protections in order for them not to be strangled, not to be 
strapped, not to be forced to go bankrupt.
  I yield to my friend from right across the border in Pennsylvania.

                              {time}  1745

  Mr. ALTMIRE. I thank the gentleman from Ohio.
  I sat with the gentleman for a while and listened to one of the 
groups that came before us, and I couldn't help but think about the 
fact that they seem to miss the fact that I would agree: The worst 
possible thing we could do in health care reform, as a Congress, is to 
pass a bill that makes the system worse. We are capable of doing that. 
We are not going to do that, but that would be the worst possible 
outcome.
  But a very close second is to do nothing. The gentleman from Ohio 
said that businesses and families in this country struggle every day 
with the decisions relating to the cost of health care. I, in visiting 
my district recently, had an opportunity to speak to a Rotary Club in 
my district. A business owner came up to me afterwards, and he showed 
me his health care statements for the past 4 years, his annual 
increases. The lowest increase on an annual basis that that small 
business owner had experienced, he had 12 employees, was 28 percent. 
That was the smallest increase he had. He told me, I can't do this 
anymore. I can't afford health care. I'm going to have to tell my 12 
employees this week that I have to drop them. He couldn't offer health 
care any more.
  Well, that is unacceptable in America. And that is what is going to 
continue to happen if we sit back and do nothing while the cost of 
health care continues to rise two and three times the rate of inflation 
every single year.
  I had a woman come up to me at one of my meetings who was one of 
these people who had attended one of the TEA parties that the gentleman 
refers to. She was very angry, and she was telling me all the reasons 
why she opposed what she perceived us to be doing on health care and 
everything else that was getting under her skin. She was really getting 
herself worked up. She looked at me, and she said, Don't you dare take 
my money to pay for those people who don't have health care. Because, 
she said, I have worked hard for everything I have, and my family is 
covered, and if those people aren't, well, that's too bad. That's their 
problem. I'm not worried about them. I have worked to put myself in a 
position to provide for my family. She said, forget about those people. 
That's not my problem. I'm not paying for them.
  I said, Well, here is the issue: You are paying for them, because 
they show up at the hospital, they get treated, and the hospital sends 
the bill to us. That's how that works. And this woman who came to this 
event to fight, she wanted to take me on. When I said that, she 
softened. And she said, You know, it's so funny that you say that 
because I just had a procedure done at the hospital in February, and 
the insurance company denied part of my claim, and I had to pay $18,000 
out of pocket. So she went through the bill very closely because she 
was the one paying the money. She called the hospital, and she said, 
Why does everything on this bill cost more than it should? Why does an 
aspirin cost $10?
  And the hospital told her, Well, that is because we have so many 
people who come through our doors that can't pay at all, we have to 
shift those costs to the people who can pay. So therefore, everything 
on the bill costs five times more than it should.
  Similarly, I had a gentleman tell me about all the reasons why he 
didn't want to do health care reform. He said that we have the best 
system anywhere in the world and everything worked fine, and even if 
you don't have insurance, you get treated, and everything is free, and 
it's great. He said, I have a nephew who is 15 who had a hip problem, 
and he showed up at Children's Hospital of Pittsburgh and he got the 
best care anywhere in the world. And he is great, and he is fine now. I 
stopped him. I said, wait a minute. You said he didn't have insurance. 
How did he pay for this great care that he got? He said, well, I guess 
Children's Hospital paid for it. And I said, well, no, that is not what 
happens. We paid for it, because Children's Hospital eats those costs, 
and then they transfer the loss to the people who have insurance. 
That's the way that works. And he got it.
  The point of this story is we can hear all the examples on the other 
side politically of why it's better to do nothing, and we should make 
everybody very afraid of reform. But everybody in

[[Page 23038]]

the country, every family and every business and every individual in 
the country, regardless of their political affiliation, has had an 
experience in the health care industry that shows them that we can do 
better. They have had to spend a half hour on the phone haggling with 
an insurance claims adjuster who has just denied their claim. There is 
that small business owner who has to make the heart-wrenching decision 
to drop coverage for his 12 employees. There is someone who had to wait 
9 months for an appointment with the dermatologist or had a bad quality 
experience with a grandparent in a nursing home. Everybody has had 
something happen that shows we can do better.
  Yes, we have to preserve what works in our system. I'm one who 
believes as much as anybody in this Congress that we do have the best 
health care system anywhere in the world. Our innovation, our medical 
technology, our research, our quality of care at the high end exceeds 
anything available anywhere else in the world. There is no question 
about that. And we need to preserve that. But that doesn't mean we 
don't pay too much, costs go up too much, we are pricing our small 
businesses out of the market.
  And if you get sick or injured and that insurance company is able to 
drop you, well, what is the point of having health care insurance to 
begin with if you only have it until you get sick or until you get 
injured?
  So what we are saying in the legislation that we are considering is, 
insurance companies won't be able to drop you as soon as you get sick 
or injured after you have paid premiums for years and years. They won't 
be able to do preexisting condition exclusions. They won't be able to 
set your rates based on your individual health status. They will have 
to take all comers, no lifetime caps or annual caps on out-of-pocket 
expenses for people with chronic diseases, which is a big problem in 
the insurance industry. These are the problems we are trying to solve.
  We are going to help small businesses afford health care by helping 
business owners like the one I talked about in that Rotary Club to be 
able to qualify for tax credits to help him afford coverage for his 
employees. We are going to give more information to health care 
consumers in the country so they can compare based on cost, based on 
quality, and based on access to provider, all the plans that are 
available to them. We're going to squeeze out the inefficiencies of the 
current system and apply those savings to bringing more people into the 
system, those who are outside the health care system that simply can't 
afford health insurance now. These are the reforms that we're talking 
about.
  So when you see the charts and graphs on the other side of the big 
bureaucracy identical to what those charts were in 1993 and they 
recycled them from 16 years ago, that's not what we're talking about. 
And we can come down here and have a discussion on the merits of the 
Canadian health care system or what they do in Great Britain. And 
that's interesting. That's an interesting discussion to have. But it 
has nothing to do with what we're talking about. That's not what we are 
doing in our bill. It's completely unrelated. But in order to scare 
people and gin up political support to foist a failure upon this 
Congress and this administration so that they can use it for political 
purposes, they make things up.
  Mr. RYAN of Ohio. If the gentleman would yield. The issue coming from 
the other side is interesting, because just a couple of years ago, our 
friends had control of the entire government. They had control of the 
House, and they had control of the Senate. Your class came in, and we 
had a great year. But prior to 2006, there were 6 years that President 
Bush, the Senate and the House were all Republican. They could have 
implemented some kind of health care reform. It didn't have to be 
necessarily what we are doing, but really, not to do anything to try to 
bring some justice to the system and, in the process, spend $2.5 
trillion over 10 years on the Bush tax cuts that went to primarily the 
top 1 percent of the people in the country.
  Now we're talking about a bill here that is deficit neutral, that 
will be paid for, that is $900 billion over 10 years, a little more 
than a third of what they spent on tax cuts, and we'll start bending 
the cost curve and bring some justice to end these stories. I think 
it's important to talk about that, because we all run into the business 
person you talk to who says they don't have health care any more, from 
the example you used earlier.
  So let's track those 12 families. Now they are out, and they are 
swimming with the sharks. Hopefully no one has a preexisting condition 
so when they go out now on their own, out of the plan that they were 
in, and they try to get some coverage, hopefully they don't have a 
preexisting condition. But what if they do?
  And I bet that there is somebody in that group, some family, some 
spouse, some worker there that probably does, and they are not going to 
be able to get insurance or they are going to have insurance that is 
going to cost so much that it is going to be really not helpful. And so 
they may go without. Now, not having gotten any treatments, they may go 
1 year, they may go 2 years, but now all of a sudden a very small 
problem turns into a very, very big problem, so that at some point, 
this person ends up in the emergency room. If they are older they end 
up in the Medicare program. In both instances, they cost us a heck of a 
lot more money than they would have if they were able to stay in that 
plan, get preventative care and get consistent treatment. They could 
have dealt with a sickness that they may have had so it doesn't become 
chronic and costly.
  That's what's happening all over the country. Our friends are 
scratching their heads saying, How in the heck does this get so 
expensive? Well, it happens every day. We see these situations 
happening all the time. A lady called in to one of my telephone town 
halls about a month ago. She is 60 years old. She makes $32,000 a year. 
She works. And her company, same situation, just dropped her health 
care. She basically said on the call, I may just wait until I get into 
Medicare. So here you have someone that is working, 60 years old, and 
can't get health care in the United States of America.
  That is a whole other topic of how bad and wrong and cruel that is, 
but just from the sheer numbers standpoint, this person is going to go 
5 years without health care? And then when she goes into the Medicare 
program, she will have how many different problems that could have been 
prevented in those 5 years? You wonder why Medicare is going to go 
belly up.
  Well, part of the reform is to make sure that those people that are 
that age, all Americans, but people that age will have some basic level 
of health care.
  Mr. ALTMIRE. I would just say before turning it over to the gentleman 
from Connecticut, on that point, as I said, we are already paying for 
the people who don't have health care. So to our colleagues listening 
here tonight and to those who may be paying attention to this debate, 
we are trying to bring people into the system so that we can spread out 
the risk pool and bring insurance costs down for everybody by bringing 
more people into the risk pool. So if somebody gets sick and they have 
insurance, they can show up and get an antibiotic in the first place, 
so it doesn't evolve into pneumonia where they spend 6 days in the 
hospital 2 months later, and then we have to pay their bill.
  That's the point. We are trying to rationalize the system so that we 
bring down costs so people who have insurance today, that's the point 
here. We can have a philosophical argument about what our moral 
obligation is as a society on offering coverage to everybody and should 
everybody who lives in the United States of America have access to 
health insurance. That's not the debate we are having. The debate we 
are having is, we need to get them their health care in the most 
appropriate, cost-efficient setting, and that's not the emergency room. 
That's not the appropriate setting for them, and that's only going to 
drive up costs.
  So by getting them into the system, we are bringing down insurance 
costs

[[Page 23039]]

for everybody, and we are getting them their care in a way that is more 
appropriate and more cost effective.
  I yield to the gentleman from Connecticut.
  Mr. MURPHY of Connecticut. I just was in a meeting with some of my 
hospital CEOs, and they are talking about having a tough year this 
year. And they said that they were hopeful, though, that they might see 
some increases from their private providers, from their private 
insurance companies that send them obviously a lot of money. And they 
said that because they were making the case to their private insurers 
right now, Mr. Ryan and Mr. Altmire, that because they had had so many 
more people coming in without insurance because the number of people 
that no longer have coverage has increased, and the number of people 
coming through their doors that don't have any source of payments has 
gone up, they are hopeful that they will be able to convince the 
private insurance companies to raise their rates by 5 percent or so to 
compensate for all those people that are coming in the door without 
insurance.
  That happens every day out there in the negotiations between 
hospitals and doctors and private insurers. The pressure is on private 
insurance companies to make up for all the people that show up without 
insurance. The insurance companies don't eat that money. They pass that 
along in higher premiums. So everybody out there who is on private 
insurance today, the 70 percent of individuals who are happy with their 
current coverage, need to know that your premiums are higher so that 
those insurance companies can help compensate and keep in business the 
hospitals and physicians that are caring for all the people that don't 
have insurance.
  Now to your point, Mr. Ryan, about how Medicare is taking on the cost 
of all these folks that are uninsured from age 55 to 65 and then show 
up at the door of Medicare with all sorts of problems--let me share 
this story. In Connecticut, our major insurer, Blue Cross Blue Shield, 
is walking around with a chart trying to sort of push back, as far as I 
can tell, on health care reform. And their chart shows, as they claim, 
that the cost of taking care of a Medicare or Medicaid patient is 
comparable or a little bit more than the cost of taking care of 
somebody that has no insurance today.

                              {time}  1800

  Apparently, the reason they're showing that chart is to make an 
argument that you should just leave these people uninsured, because if 
you put them on insurance, it will actually cost you more.
  We know that's not true. We know that by giving insurance to people, 
by allowing them access to their primary care physician to get them 
preventative care, that's going to cost less than leaving them 
uninsured. But they make a totally unfair comparison. They're comparing 
the cost of someone who is uninsured to the cost of the Medicare and 
Medicaid system which have the sickest, the most expensive people on 
their rolls.
  And so I think it's a caution for all of our colleagues who look at 
our current government health care program, Medicare and Medicaid, and 
say, ooh, if you really look at the per patient cost there, those are 
pretty expensive programs. Well, they're pretty expensive programs 
because Medicare and Medicaid insure the most expensive people out 
there, insure the sickest of the sick, the old and the frail and the 
elderly. All of the end-of-life care is paid for by that.
  Mr. RYAN of Ohio. And why do the programs even exist? Because you 
can't make money off of sick people. I mean, how disingenuous to walk 
around saying, boy, look how expensive Medicare is. No kidding. 
Everybody is 65 and older. Yes, that's expensive, but no one was doing 
it. So we decided as a country that it may be a good idea to protect 
those senior citizens and provide them a little bit of dignity.
  Mr. MURPHY of Connecticut. And you know what the insurance companies 
call the money that they spend on health care? They call it medical 
loss. Medical loss, that's what it is to an insurance company. To you, 
it's a medical benefit. It is care that you get that keeps you alive. 
To an insurance company, it is called medical loss. It is a bad thing 
to spend money on you.
  That doesn't mean that there are bad people running insurance 
companies. It just means that in the end, if the motivation is profit, 
if the motivation is to return as much money to your shareholders as 
you can, then every dollar that you're spending on care is less money 
that you're getting as a return on your investment, which is why so 
many of us believe that there is just an inherent conflict between good 
business and good medicine. It doesn't mean that the two can't coexist. 
It means that government has to step in and try to set a set of rules 
to make sure that in every instance good business doesn't trump good 
medicine, and let me give you an example of why that is.
  Every insurance company executive will tell you, yeah, listen, if it 
was up to me, I wouldn't deny care for all these people that have 
preexisting conditions. But if I stop doing that, then I'm going to be 
at a disadvantage against all my competitors. If I start accepting in 
all of these patients with cancer and hypertension and lupus and 
whatever it may be, well, then I'm going to get all the sick people, my 
premiums are going to go up, and I'm not going to be able to compete 
with everybody else.
  And so they tell you, listen, if it was up to me, I would do it, but 
you need to set the playing field even between all of us. Insurance 
companies, listen, we might be fighting them on a lot of things, but 
they'll actually come in and tell you that if the government comes in 
and says that we should all take patients with preexisting conditions 
and we're all living by the same rules, well, then that's fair; we can 
live with that in the end.
  The fact is that I listen over and over again to our Republican 
friends say that, yeah, we're for that, too. We think that we should 
stop people with preexisting conditions from being excluded from 
insurance. Well, they had control of this Congress for 12 years. They 
had the House. They had the Senate. They had the Presidency. They had 
everything. They didn't do it. They didn't do it. They would have had 
insurers with them on that. They would have the public with them on 
that, but they didn't do it.
  So it just is beyond me how we can listen to so many of our 
colleagues on the Republican side of the aisle come down here and tell 
us that they were for this all along, that they were for trying to stop 
these discriminations against people with preexisting conditions, 
because they could have done something about it. They could have done 
something about it.
  And for all those people out there that say, listen, government 
should stay out of health care, this is a prime example of where 
government needs to come in and set fair rules that insurance companies 
needs to play by, because if you leave it up to the private sector, 
they're going to push sick people off of their rolls, push sick people 
off to the side.
  I don't want a government takeover of health care, you don't want a 
government takeover of health care, but there are some places that 
government needs to step in and fix it.
  Mr. RYAN of Ohio. Well, you think about how a game started like 
basketball or football or just of any sport; right? At some point, you 
know, Naismith puts up the peach basket and starts throwing a ball and 
they decide, well, we'll cut a hole and the ball will fall through. 
That will be good. But then you start getting teams, and at some point 
someone threw an elbow at somebody's face and hit them with an elbow in 
the face and they couldn't play anymore. And the people organizing the 
game said, you know what, that's not really fair. That's not what the 
game is. So that's illegal because here's the game. You each get five 
people. You put it in the thing, but whatever the rules are, and then 
rules consistently evolve to make the game more fair.
  And so here we are in the United States, well, we're saying that 
government is not going in to run anything.

[[Page 23040]]

What we're going to do is create new rules, and one of the rules is you 
can't be denied for a preexisting condition because it's unfair. We are 
all agreeing as a country, and our friends on the other side, we will 
see how they vote when they have an opportunity to vote for this, 
because it's unfair. Going bankrupt in the United States for a health 
care reason is unfair. We want to change that rule. That rule no longer 
applies. And so what we're trying to do is make the game of health care 
more fair.
  But there's a point that I wanted to just touch on for a minute. One 
of the points I wanted to touch base on that Mr. Murphy just made is 
how the insurance industry has acknowledged that this will be a level 
playing field for all the different insurance companies, and if we do 
preexisting condition, making sure that no one can pay any more than a 
certain percentage of their income out of pocket per year to prevent 
bankruptcies, those kinds of things. There's an important point that I 
think we need to acknowledge and talk about more.
  If insurance companies have to cover everyone, if they can't play the 
game that they're playing now--the game now is how do I get sick people 
off of my rolls so they don't cause me a medical loss and how do I not 
get people on my rolls that I know are going to cost me money, and 
those people are going to be diabetics and heart disease and cancer 
patients.
  And I had one cancer patient come to a roundtable I had who said, you 
know, she had cancer and then she lost her job and then was out with 
another job trying to get insurance on her own. She was denied. Her 
cancer had been gone for years and years, but it hadn't been gone 10 
years, so insurance companies would continue to deny her coverage.
  And so what we're saying here, if everybody is covered, if insurance 
companies can't deny anybody coverage, they will have to take you. 
There is a new business model that will be created within the insurance 
industry, because the game of keeping people off your rolls, or getting 
sick people off your rolls, is over. The new game for the insurance 
company is going to be how do we keep the people that are in our pool 
under our coverage healthy.
  So you are going to see them investing money into wellness, 
prevention. They're going to be very interested in what the kids are 
eating at schools. They're going to be very interested in the 
pesticides that we're putting on our food that may cause cancer. 
They're going to be very, very interested in obesity rates. They're 
going to be very interested in what physical education programs look 
like in our schools.
  We can have a real ally among the insurance industry to partner with 
us, with nutritionists, with dietitians, with, you know, preventative 
and wellness groups. We will now have an ally. Instead, the insurance 
companies are now the enemy because they don't want to make these 
investments.
  Now they're slowly starting to because I think they're reading the 
tea leaves here is that they're going to be slapped down and they're 
going to have to cover everybody, and because of that, they are going 
to be able to make investments, and I think it's going to end up being 
a very, very good thing.
  Mr. MURPHY of Connecticut. I agree, and as I said, I think that's 
why, on this issue of setting a level playing field amongst insurers, 
where they're not allowed to keep out people who are sick, where 
they're also not allowed to price people who get sick at an 
exorbitantly higher rate than other people, you know, insurers want to 
be part of that change because it does allow them to get back to trying 
to be about wellness and about health care rather than trying to be 
about moderating risk.
  So I think in this fight we have allies. Now, listen, insurers may 
not like other parts of this bill. They may not want the public option 
to put pressure on their rates to come down, but there are a lot of 
other pieces here that they're partners on.
  I want to just present one other example of where it's appropriate 
for the government to come in here and set new rules, and you said it 
right here. You know, if you don't want the government regulating 
health care, well, then you've got to dial the clock back about 50 
years or so, because the government right now not only is paying about 
55 percent of all health care dollars in this country, but we're 
heavily regulating health care insurance today.
  It happens mostly at the State level, but every single State has a 
pretty well staffed insurance department that's regulating health care 
today. It just doesn't do it very well, in large part because if you're 
an individual buying health care insurance or you're a small business 
purchasing on behalf of you and maybe five others, you're getting a 
pretty raw deal. It's pretty simple economics. You are negotiating on 
behalf of one or five versus large employers who can either bear the 
risk themselves and they just self-insure or they have enough employees 
so that when they're trying to cut a deal with the insurance company 
they can get a pretty good deal. But for that one guy out there that's 
just buying an individual policy, he's paying the highest rate. He's 
paying the highest rates because he's got no purchasing power.
  So we're just trying to change the rules for him. He would still go 
out and purchase insurance, but he would be able to purchase insurance 
in an exchange that this legislation sets up, where he would be joined 
with everybody else in his State or in his region who is looking for an 
individual policy, and we would join their forces together and 
negotiate on their behalf. We'd have insurance companies bid into the 
exchange to bid to have the right to offer coverage to all of those 
individuals, and we would leverage the purchasing power of thousands of 
individuals.
  Now, health insurance companies would still be regulated, just like 
they are today, but rather than operating in a market in one State at a 
time, rather than operating in a market where they are allowed to 
essentially negotiate with one person and one person and one person, 
they would now be negotiating with a pool of individuals, which would 
lower the costs for those people. Just a different way to structure the 
market. Still a regulated insurance market. It's just a different set 
of regulations.
  It's another example of where government, by setting a more fair set 
of rules for insurance companies and individuals, can lower prices. 
That's what this legislation is talking about doing; not taking over 
the health care system, but establishing a different set of rules that 
benefits our constituents, individuals, and small businesses who have 
gotten the short end of the stick so far.
  Mr. RYAN of Ohio. And so you go to this exchange that's going to be--
there will be an essential benefits package that will be set by the 
Surgeon General and a group of experts who will decide what the 
essential benefits package would be, you know, dental, maternity, 
hospital, all the basics, and every insurance company that goes into 
this exchange, that will be the bare minimum. So there won't be any of 
this, I'm paying a lot of money out of pocket but my coverage is 
terrible, or, I don't have any to begin with. There will be this 
essential benefits package which will be the baseline coverage for 
every single private insurer that comes to the exchange.
  Then they can build on that with premium plans, Cadillac plans, 
however high they want to go, so people who have a lot of money, there 
are still going to be plans up there because insurance companies will 
be making money.
  What we're asking here in the House side now is, in addition to all 
of these private insurers, we put in, basically, a Medicare program, a 
Medicare program that will compete with all of the other private 
insurers. Everyone, 80 percent of the people who have Medicare like it. 
Sixty-five percent of the American people say this is a good idea. But 
that Medicare that would be in the exchange with all the other 
insurance companies would compete with all of them, but they wouldn't 
have to put money into marketing. They wouldn't have to pay a CEO $100 
kajillion a year or, turns out, like $200,000 a minute or an hour, 
whatever it is nowadays and

[[Page 23041]]

would compete. And by not having to put all that money into advertising 
and all those other things could help bring costs down, and everyone 
else in the exchange would now have to compete with that.
  So you want to talk about choice, that public option and the way 
we're setting up the exchange is all about choice. And if you're a 
family of four making less than $89,000 a year, you're going to qualify 
for some health care credits, some subsidies. So you will get the 
subsidy from the government based on your income, and then you go to 
the exchange and pick any plan you want. No government bureaucrat's 
telling you what--no, you've got to pick this plan; no, I mean that 
one; you pick this one. There's none of that.

                              {time}  1815

  You get the credit and then you go to the exchange. And if you want 
the public option, you could pick it. If you don't want it, you don't 
have to pick it.
  Mr. MURPHY of Connecticut. Mr. Ryan, I think for those of our 
colleagues who are against this exchange, they've got to go to their 
constituents and the American people and explain to them why they don't 
believe that individuals should be able to join together and negotiate 
for lower rates.
  If they're against the public option, they have to make the argument 
to their constituents why they don't think their constituents should 
have the choice to choose the same kind of health care that Members of 
Congress and Medicare beneficiaries and soldiers and veterans and 
public employees have. This is about banding people together to get 
lower rates, giving people more choice. And the reason why both of 
those ideas, Mr. Ryan, and I'll wrap up, have broad public support, 
every single poll that comes back says 60, 70 percent support the idea 
of the insurance exchange and a public option within it is because 
that's what they want. That's what they want, the ability to negotiate 
together and the ability to have more choice.
  Mr. RYAN of Ohio. And how do our friends who talk about freedom and 
liberty want to deny the ability to basically buy into a Medicare-type 
program? That seems to me like it's limiting the consumers' choice, 
limiting freedom. And what we're saying is they have all got to 
compete. They have all got to be there. We're going to help you pay for 
it because we know if you don't get insurance you're going to go cost 
us a heck of a lot more money in the emergency room and this is all 
about choice.
  And you know, if you like what you have, you keep it. That's fine. So 
you know, this is good. I think about the 1,600 families in my district 
that go bankrupt because of health care. I think of the people that 
will have opportunity and options because of what we're trying to set 
up here and reform this system.
  But as we close, Mr. Speaker, I would just like to say, if you look 
at what we have tried to do and what we have done over the course of 
the last 7 or 8 months, we've taken on the oil industry; we're taking 
on the insurance industry. Since we've been here, we've raised the 
minimum wage, increased money for Pell Grants, taken the banks out of 
student loans so that people can afford to go to college, make 
investments back into the middle class, infrastructure money, stimulus 
money, thousands of teachers are at school right now because of 
stimulus money that is coming out, invested in the green technologies, 
green energy.
  If you look, issue by issue by issue by issue, everything that we 
have done has been sticking up for the middle class and taking on the 
special interests that have been driving down wages, driving up health 
care costs, making it difficult for small businesses, making it 
difficult to go to college, cutting every business in on the deal, no 
matter what; and it's important to recognize that this reform proposal 
and this reform bill is all about giving the middle class consumer 
protections, choice, and affordable health care in a system that has 
justice.
  So I want to thank my friend from Connecticut, I want to thank our 
friend from Pittsburgh, western PA, who was here. And, again, our 
condolences out to people in the Pacific who are going through a very, 
very difficult time who shared with us earlier in the hour.
  With that, we yield back the balance of our time.

                          ____________________