[Congressional Record (Bound Edition), Volume 155 (2009), Part 17]
[Senate]
[Pages 23368-23373]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. MERKLEY. Madam President, a week ago, freshman Democratic 
Senators came to this floor to discuss as a group how our current 
health care system is broken and unsustainable. Today, we return to 
address the challenge of runaway costs and how health care reform can 
bend the cost curve, making health care more affordable and more 
accessible to our families and our businesses.
  Many folks have said to me: Is this really the time to take on health 
care reform, when we are in the middle of the worst recession since the 
Great Depression? The answer is an unequivocal yes. Now is the time. 
Now is the time because health care costs are a runaway train that can 
do great damage to our families and our small businesses and large 
businesses. Indeed, consider the situation of a family when health care 
costs have doubled in the last 9 years, so families who could afford 
insurance just a few years ago cannot afford it today. Now health care 
premiums are rising even faster. They are expected to double in the 
next 7 years. As a result, many families and many individuals who are 
struggling to pay those health care premiums right now won't be able to 
do so in just a few more years. So fixing our broken health care system 
cannot wait. Indeed, reform is essential to our families, our small 
businesses, and our large businesses.
  Consider this: For a working family, every additional dollar that 
goes into a health care premium comes out of the wages that would 
otherwise go to increase the family's purchasing power. So rising 
health care premiums are a tax on family wages, a tax on family 
purchasing power, making it much harder for our families to get ahead 
and provide for their children and establish a high quality of life.
  Controlling cost is also essential to small businesses. Small 
businesses want to offer health coverage to attract and keep good 
employees, to do what is right for their employees' quality of life. 
But runaway costs are making that more and more difficult.
  Consider the example of the Hawthorne Auto Clinic founded and 
operated by Jim Houser and his wife Liz Dally. When they opened 26 
years ago, Jim and Liz were committed to offering those who worked for 
them and with them a good benefits package, including comprehensive 
health care.
  They are still able to provide health insurance to their employees, 
but it is getting tougher. Premiums have gone from 9 percent of their 
payroll to 18 percent in just the last 5 years. As a result, they have 
had to cut back on the benefits they have offered. Over the last 
decade, health care premiums have skyrocketed for small businesses 
across the board like they have for the Hawthorne Auto Clinic.
  Large businesses see the effect as well. If you build a car in 
America, it costs $1,500 in health care. If you build that same car 
across the border in Canada and Europe, the cost is zero. In fact, in 
2007, GM spent more on health care than they did on steel. So 
controlling costs is essential for our large businesses to be 
competitive in the world, to be able to build products here in America.
  If we do not build products in America, we will not have a middle 
class in America. So health care reform cannot wait. Our families need 
help with runaway costs. Our small businesses are

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looking for us to help control costs, and our large businesses need 
reform to be competitive in the world and to build the strong economy 
that will raise all boats.
  Today, freshmen Democratic Senators are here to discuss this from a 
number of perspectives. First will be Senator Roland Burris of 
Illinois. As comptroller and attorney general of Illinois, Senator 
Burris committed himself to serving the health and well-being of 
underserved populations in his State.
  I yield 4 minutes to my distinguished friend from Illinois.
  The ACTING PRESIDENT pro tempore. The Senator from Illinois is 
recognized.
  Mr. BURRIS. Madam President, I am proud to join my freshmen 
colleagues on the floor today.
  Across America there is a broad agreement on the need for meaningful 
health care reform. But there is much debate about what reform means 
and who pays the bills for keeping all our Nation's citizens well, 
including the disadvantaged.
  As the center of this controversy is a simple question of dollars and 
cents, what is cost-effective reform? According to a recent study by 
the Joint Center for Political and Economic Studies, eliminating ratios 
and ethnic health disparities in this country for the period between 
2003 and 2006 would have reduced direct health care expenditures by 
nearly $230 billion.
  Further, when the study factors in indirect economic losses, such as 
missed days of work and premature death, the total cost of health care 
disparities to our economy approaches $1.25 trillion over the same 
period. This is a cost our country cannot bear.
  Part of the problem is a lack of coverage. People of color make up 
about one-third of the population of the United States, but they 
represent one-half of the Nation's uninsured. Providing quality, 
affordable health care options, including a public plan, will help 
address this problem.
  We must also change the way people receive their care. In 
disproportionately high numbers, many Black and Hispanic Americans use 
high-cost emergency room care for all their health needs. Often, by the 
time they seek treatment, their ailment has reached catastrophic 
levels. This drives everyone's costs up and puts extra strain on a 
system that is already stretched to the breaking point.
  But with certain basic steps on the front end, we can create a 
healthier nation and save a lot of money on the back end. For example, 
by encouraging and enabling health care providers to reach out to their 
communities, with culturally competent prevention and wellness 
initiatives, we can prevent some of the chronic conditions and 
catastrophic health care problems that have such a high cost for our 
economy.
  Basic nutrition education and access to healthy foods could 
drastically reduce the wide disparities in diabetes and heart disease. 
Expanding the prevalence of racial and ethnic minority health care 
professionals could increase the cultural competence of our health 
workforce.
  The health reform bills under consideration take significant steps to 
address the health disparities our country faces. I would like to take 
this opportunity to thank the HELP Committee and the Finance Committee 
for their tireless work in this effort.
  As a final combined bill comes to the floor, I look forward to an 
opportunity to debate and improve upon the provisions that will help 
our Nation's disadvantaged populations get access to the health care 
they need.
  This is not only a moral imperative in its own right, but it will 
help us achieve the health cost savings our health system so 
desperately needs.
  Mr. MERKLEY. I thank the Senator very much for his comments and his 
emphasis on making the best use of every dollar while addressing ethnic 
disparities in our health care system and the dire need to invest in 
prevention and wellness.
  Next, we will hear from Senator Jeanne Shaheen from New Hampshire. As 
Governor of New Hampshire, Senator Shaheen enacted the New Hampshire 
Children's Health Insurance Program, which provides affordable health 
and dental coverage to tens of thousands of children in her State.
  She also initiated a senior prescription drug program, providing 
seniors with lower cost prescription drugs. I yield 4 minutes to the 
Senator from New Hampshire.
  Mrs. SHAHEEN. Madam President, I wish to begin by thanking Senator 
Merkley for coordinating this effort today. I am pleased to be able to, 
once again, join my fellow freshmen Senators discussing how critical it 
is for the Senate to act on health care reform.
  As the Senate moves to reform our broken health care system, we must 
address the skyrocketing cost of health care. We must ensure quality in 
our health care system. Over the past several months, I have heard from 
many individuals and families from New Hampshire who are dealing with 
the rising costs of health care. The stories they tell me are the most 
poignant reminders of why we must reform our health care system.
  Recently, I heard from a man named Jeff, who is from Loudon, a small 
community close to the capital city of Concord. Jeff had recently lost 
his job and with it his health insurance. So when he experienced 
swelling of his right leg and shortness of breath, he was afraid to go 
to the doctor because he was afraid he could not afford the cost.
  So he ignored the symptoms until they got so bad he had to call 911. 
He was taken to a local hospital. Doctors realized he had a blood clot 
in his leg which had migrated to his lung. This was a life-threatening 
condition called a pulmonary embolism. Since treatment, his condition 
has improved dramatically.
  However, the final bill from the hospital was over $200,000. To this 
day, Jeff remains in debt. Think how much we could have saved if he 
could have gone to the doctor when he first felt those symptoms. 
Stories such as these are unacceptable. They can happen to anybody. The 
truth is, similar to Jeff, we may all be one medical condition away 
from financial disasters because of the high cost of health care. So we 
must work to protect hard-working individuals and families as we put 
forward a bill.
  I am proud to come from New Hampshire for so many reasons but one of 
them is because of the great work that is done by the Dartmouth 
Institute of Health Policy. For more than 20 years, Dartmouth has been 
a leader in comparative effectiveness research and has revolutionized 
our understanding of our health care system. Because of the Dartmouth 
Atlas Project, we now know there are huge variations in the way health 
care resources are used and how money is spent depending on where we 
live.
  This chart shows the difference in spending among different regions 
per Medicare patient. It is amazing to me that Medicare costs can range 
from the lowest spending referral region, which as you can see is just 
over $5,000, to the highest spending referral region, where in some 
parts of the country Medicare pays over $14,000 to provide the same 
kind of treatment that in other parts of the country is provided for 
only a little over $5,000.
  Unfortunately, the research also shows that just because someone is 
in a higher spending area, it does not mean they are going to live 
longer or have better health outcomes. Simply put, more costly care 
does not mean better care. There is a fundamental problem with our 
health care system, and this is something we have to work on.
  Things do not have to be this way. We can find savings in our system 
and still provide high-quality care. As I mentioned last week, we can 
save significantly on Medicare costs by reducing hospital readmissions. 
I have introduced bipartisan legislation with Senator Collins to do 
that. We have the opportunity to fix a problem that has been around for 
generations. We need to work together to achieve this goal.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. MERKLEY. I thank Senator Shaheen so much. It is enormously 
valuable to have her experience fighting for health care at the State 
level and

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bringing that to this conversation, recognizing we do have a 
partnership between what the State can do and what the Federal team can 
do and that the goal of reforming the way we deliver health care can 
have a huge impact on price.
  Next, we turn to Senator Michael Bennet from Colorado. As the highly 
successful superintendent of Denver Public Schools, Senator Bennet 
committed himself to ensuring the health and educational well-being of 
Denver's school-aged children.
  I yield 4 minutes to my friend from Colorado.
  Mr. BENNET. I thank the Senator from Oregon.
  It is good to be here this morning with all my colleagues to talk 
about health care reform. There is a lot of disagreement about what the 
right answer is.
  What I would like to spend my time on this morning is why the status 
quo is not an answer. I think that if we can get agreement on that, we 
can solve the issues that confront the working families in my State and 
all across the country.
  The median family income in Colorado has actually declined by $800 
over the last 10 years. At the same time, the cost of health insurance 
has gone up by 97 percent. It has doubled during that time. That has 
happened all over the country. This slide shows the difference between 
the rate of increase in wages in my State, from 2000 to 2007, versus 
the rate of the increase in insurance.
  I have talked to small businesspeople all over the State of Colorado 
who have said they are trying to continue to insure their employees 
just as they have for generations in family-owned businesses, but they 
are finding they are having to make a tradeoff between people's wages 
because the cost of insurance is getting so large.
  By 2016 in my State, working families in Colorado are going to be 
spending roughly 40 percent of their income on health care if we do not 
change the status quo. It is also having a profound effect on the 
finances of the Federal Government. The biggest drivers of our deficit, 
as the red line shows, are rising Medicare and Medicaid costs. If we 
can change that, we can begin to restore our Government to fiscal 
health. If we do not change it, we are going to continue to pile 
mountains of debt onto our kids and our grandkids, something that no 
one in my State wants us to do.
  Finally, the last slide shows we are consuming almost 20 percent of 
our gross domestic product on health care, devoting almost one-fifth of 
our economy to health care, when all our competitors across the globe 
are devoting less than half that to health care. It is no different 
than if you had two small businesses across the street from each other, 
one spending one-fifth of their revenue on their light bill, the other 
is spending less than half of that on their light bill. You do not need 
an MBA to know which of those two companies is going to be able to 
invest and grow their business.
  The Senator from New Hampshire talked about a very important cost 
control measure in this bill that has to do with the transition of 
care. Right now in this country, one out of five Medicare patients is 
readmitted to the hospital within the first month that they leave. That 
is because nobody is following up to make sure they are getting the 
care they need to stay well. Nobody is checking to see whether they 
fill their prescriptions or whether they are taking it.
  In Colorado, we have a great model in Mesa County and Grand Junction, 
where the hospital readmission rate is not 20 percent but 2 percent. 
This alone is costing us $17 billion a year.
  If we can do it smarter, more cheaply, and provide the kind of 
quality we see in Grand Junction, the Mayo Clinic, and other places 
across the country, we should. That is what this reform is about. It is 
time for us to put politics aside and come to an agreement that will 
create a much improved situation for working families and small 
businesses. The status quo is eating people alive. We ought to be able 
to do better than that.
  Mr. MERKLEY. I thank the Senator. I appreciate his pointing out how 
health care costs are also a factor in the rising deficit contributing 
to the national debt and challenging our international competitiveness 
in the world.
  I now turn to Senator Mark Begich of Alaska. As mayor of Anchorage, 
he was committed to protecting and strengthening the health care needs 
of small businesses and has continued his advocacy in the Senate.
  I yield 4 minutes to Senator Begich.
  The ACTING PRESIDENT pro tempore. The Senator from Alaska.
  Mr. BEGICH. Madam President, I thank Senator Merkley.
  I am pleased to stand here again with my freshmen colleagues and 
resound the call for meaningful health insurance reform. We know reform 
is critically important and long overdue. We know reform will provide 
coverage to tens of millions of currently uninsured Americans. As I 
said last week, we know reform will bolster America's small businesses 
and help rebuild the economy. Here is something else we know: We must 
have reform that bends the cost curve and slows down the growth of 
health care costs. If we extend insurance to millions more people but 
do nothing to slow skyrocketing health care costs, we will not have 
reformed anything. We only will have added to the problem of an 
overburdened, unsustainable health system. Today we stand together to 
offer our ideas for reducing overall health care costs.
  My focus this morning is on promoting good health and preventing the 
burden of chronic disease. The HELP and Finance Committees have done a 
great job on this subject. I commend them. I also want to make sure 
that when the final reform bill comes to the floor, we will not waiver 
on our commitment to prevention. I want to frame these brief remarks 
around a handful of words: nutrition, physical activity, tobacco use, 
and personal responsibility. Common sense tells us that smart 
investments that reduce the burden of chronic disease will make a huge 
difference not only in cost savings but also in healthier and more 
productive lives. The dollar amounts are staggering. Here are a few 
examples of why health reform must include a substantial commitment to 
prevention and good health.
  Each year we spend $2.2 trillion on health care, and 75 percent of 
all health care costs go to treat chronic diseases, many of which could 
have been prevented. Each of our States is paying the price. Listen to 
the most recent numbers from the State of Alaska and think again of 
poor nutrition, lack of physical activity, and the toll of tobacco. 
Alaska currently spends $600 million annually for heart disease and 
stroke hospitalization, $419 million for treatment related to diabetes, 
$491 million for medical care related to tobacco use and lost 
productivity from tobacco-related deaths. We spend $477 million on 
direct medical costs of obesity. We need to do something, and we need 
to start now, in my State and every State.
  We know prevention can work. Even though youth smoking in Alaska is 
still too high, it has been cut in half since 1995, thanks to sustained 
antitobacco funding. I know as a former mayor, when I came into office 
we had double-digit increases in health care costs; when I left, a less 
than 1-percent increase. Why? Because we created wellness programs, 
created personal responsibilities and incentives for people to live a 
healthier lifestyle.
  Let's make a similar commitment in health reform this year. Let's 
promote personal responsibility. Let's give more American families the 
tools they need to take charge. Let's improve our Nation's highways and 
transportation systems. And as we do it, let's make sure sidewalk 
trails are part of the package. Let's hire more PE teachers and build 
upon proven community programs. Let's save lives and save dollars by 
keeping tobacco away from kids.
  As reform moves forward, our promise is to keep it deficit neutral, 
now and into the future. Health care reform, health insurance reform 
now, is important.
  I yield the floor.
  Mr. MERKLEY. I thank my colleague from Alaska for his remarks and his

[[Page 23371]]

emphasis that prevention and management of chronic diseases are 
essential to bending the cost curve. I now turn to Senator Warner from 
Virginia. Before serving as Governor of Virginia, Senator Warner helped 
create the Virginia Health Care Foundation, which is providing health 
care to more than 600,000 underserved Virginians. I yield 4 minutes to 
Senator Warner.
  The ACTING PRESIDENT pro tempore. The Senator from Virginia.
  Mr. WARNER. Madam President, I thank my colleague, the Senator from 
Oregon, for helping organize this morning. I thank all other colleagues 
for once again coming together and speaking with different voices but 
with similar themes. I also thank our newest colleague, the new Senator 
from Massachusetts, for being here. I know he will take time in another 
moment to give his maiden speech. Being here and giving us moral 
support is helpful.
  One of the things we all get to do as freshmen Senators is sit in 
that chair and preside over the Senate at various times. Consequently, 
we often get, perhaps more than other colleagues, a chance to hear the 
folks on the other side and their talking points. Monday afternoons, I 
get to hear it for uninterrupted hours. What I hear time and again from 
our colleagues on the other side is complaints about the various 
proposals this side--and, hopefully, some on the other side will join 
us on--has put forward.
  What I do not hear from the other side is what happens if we take 
their approach, which is doing nothing. What I do not hear from the 
other side is a simple recognition not of the moral challenges of 
covering close to 30 million additional Americans, but the fiscal 
challenges of not acting, a fact that we all brought forward last week 
when we pointed out, if we fail to act, we will see Medicare go 
bankrupt by 2017; if we fail to act, our deficit numbers will continue 
to explode; if we fail to act, an average Virginia family, and an 
average Colorado family as well, will be spending close to 40 percent 
of their disposable incomes within the next decade paying for health 
care. Senator Merkley and Senator Begich have mentioned if we fail, 
American business cannot compete when we have to pay $3,000 to $4,000 
more per employee than our competitors across the world in terms of 
increased health care costs.
  Some may say that the simple reason for these increasing health care 
costs is because we have an aging population. We do. But an aging 
population is not the only reason for rising health care costs. Our 
rising health care costs are increasingly driven by an inefficient 
delivery system, by a system that does not reward value, by a system 
that does not compensate based upon any rational basis. That is where 
so many of the reforms are focused through the Senate Finance Committee 
and the HELP Committee bills--and others we will be putting forward in 
later weeks, perhaps even on the floor, that will bring these reforms 
to the overall delivery system.
  Again, some of my colleagues have already mentioned wellness. Senator 
Shaheen mentioned the enormous differential between states in terms of 
Medicaid reimbursements. We can and must do a better job.
  For example, if as we see here, we can put health care reform in 
place and drive system reform, we could potentially save $3 trillion 
over the next 10 years across the entire system. If we fail to act, we 
leave those costs in a system that does not provide good quality health 
care and, with 70 percent of the cost going for chronic diseases, does 
not provide better coverage, either.
  On this last chart, in terms of what we are talking about in expanded 
savings, if we fail, if we simply expand the current system--this is 
based upon Lewin Group studies, the Commonwealth Fund that has been 
cited many times on the other side--if we simply put in place expanded 
coverage without reform, we will continue to explode the deficit. But 
if we put in place the kinds of reforms we are talking about, which is 
wellness, and increased transparency--and I strongly believe in a free 
market system--but we have no transparency in our system in terms of 
what costs are and what people actually pay. If we take advantage of 
some of the best examples in the private sector, where health reform is 
taking place right now, we can bring about not only reform but bring 
about reform with lower costs, higher value, and truly make sure 
Americans all across the country get the coverage they need and that 
does not break the deficit.
  The ACTING PRESIDENT pro tempore. The Senator from Oregon.
  Mr. MERKLEY. I thank the Senator from Virginia, particularly for 
noting the consequences if we fail to act and the absolute necessity to 
reform an inefficient delivery system. I turn now to Senator Tom Udall 
of New Mexico. As a Member of the House, Senator Udall was a champion 
of preventive health care initiatives, including legislation to 
encourage employers to offer wellness programs to workers.
  I yield 4 minutes to the Senator from New Mexico.
  The ACTING PRESIDENT pro tempore. The Senator from New Mexico.
  Mr. UDALL of New Mexico. Madam President, if we want to do something 
about runaway health care costs, the way to control them is to 
institute prevention and make prevention a major part of this bill. We 
are in danger of systematically neglecting prevention. I believe if we 
focus on prevention, we can get control of the cost curve. Prevention 
can mean clinical services such as mammograms and colonoscopies and 
cholesterol screens. The good news is that most of the bills being 
considered would make these services much more accessible and 
affordable. But successful reform also means addressing another aspect 
of prevention. I am talking about primary prevention, the kind that 
keeps people from getting sick in the first place.
  Evidence suggests that primary prevention should focus on three 
behaviors: physical activity, nutrition, and smoking. But the reality 
is, whether through personal choice or lack of options, too many 
Americans are struggling. Today two-thirds of Americans are overweight 
or obese and often more than 20 percent smoke. Things are even worse 
for minorities who often suffer the most from the lack of preventive 
care.
  In my State, we have a diabetes epidemic among Native Americans and 
Hispanics. We are in this crisis today because we have neglected 
prevention for years. Of the more than 2 trillion we spend on health 
care each year, only 4 cents of every dollar is invested in prevention. 
It doesn't make sense. Studies have shown that primary prevention will 
not only save lives, it will also save money. In New Mexico, a $10-per-
person investment in community-based prevention programs would save $88 
million annually. Nationally that translates to more than $16 billion 
annually. That is a return of $5.60 for every $1 invested.
  We have solid evidence that we can spend less on health care while 
saving more lives. So what should we do? Experts say effective 
prevention must address three levels: the individual, the 
institutional, and the environmental. Individual prevention is about 
Americans making the right choices for themselves. This means choosing 
nutritious foods, maintaining an active lifestyle, avoiding excess 
weight, avoiding smoking, drug abuse, and excessive drinking. 
Institutional and environmental prevention helps individuals stay on 
the path to a healthy lifestyle. This could mean incentives for 
physical activity, disincentives for smoking, and nutritional labeling 
on menus. It could also mean more bike paths and more school gardens.
  Legislation approved by the HELP Committee would establish a new fund 
to support these activities. This kind of dedicated, stable funding 
stream is critical to effectively address America's legacy of neglect 
regarding prevention. There is an often-quoted parable that tells of a 
nurse fishing downstream. As she fishes, she sees a person coming down 
the river struggling for life. The nurse pulls him out. Then, another 
comes and again must be rescued. This happens all afternoon and the 
nurse tires from constantly pulling people out of the river. 
Eventually, she realizes she has to get upstream, to see what is 
pushing them in the river in the first place.

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  It is time for America to look upstream, to see where the real 
problems lie. It is time to honestly address these preventable health 
problems.
  Madam President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Oregon.
  Mr. MERKLEY. Madam President, I thank Senator Udall for his clarion 
call for primary prevention to save lives and save dollars.
  We now turn to Senator Mark Udall of Colorado. As a Member of the 
House of Representatives, Senator Udall championed legislation 
highlighting the health benefits of physical activity for the public.
  I yield 4 minutes to the Senator from Colorado.
  The PRESIDING OFFICER (Mr. Warner). The Senator from Colorado.
  Mr. UDALL of Colorado. Mr. President, let me start by thanking my 
colleague, the Senator from Oregon, for holding this important 
gathering on the floor of the Senate this morning.
  Mr. President, as my fellow freshmen have stressed, health insurance 
reform is essential in helping us lower spending, chip away at our 
Federal deficit, and strengthen our economy.
  While the reform proposals before us would contain costs across the 
board, I wish to focus on a particular area of health care reform near 
and dear to nearly 45 million Americans, and that is Medicare. 
Reforming how we pay for Medicare and how we spend those valuable 
taxpayer dollars is one of the biggest cost-containing tools we can 
include in health care reform, and it will also improve the health of 
seniors.
  Coloradans have rightly asked me and Senator Bennet how health care 
reform can reduce government spending on Medicare while at the same 
time strengthen benefits and improve their health. They want to know 
how they can be getting more as the government spends less.
  The answer is that health insurance reform can make our government 
and us smarter consumers. Because right now, 30 to 50 percent of 
spending on health care does not make a patient healthier. That is a 
lot of room for savings.
  Let me give you an example. Today, Medicare actually pays doctors and 
hospitals more to amputate a leg than it does to treat early diabetes 
and actually prevent that amputation. Our government should be paying 
for quality outcomes, not writing checks that encourage expensive care 
that could have been prevented in the first place.
  Let me give you a couple of examples of how reform can change these 
incentives, help improve care for our seniors, and also decrease costs 
for all of us, the taxpayers.
  First, reform can lower the rate of unnecessary hospital 
readmissions. Right now, one-quarter of all Medicare patients who are 
discharged from a hospital end up going back into that hospital for the 
same problem. Health reform would reward hospitals such as Saint Mary's 
in Grand Junction, CO, which coordinates care and followup to make sure 
patients do not end up back in the hospital.
  Second, reform can hold hospitals accountable if they are not doing 
enough to reduce the number of patients who develop infections in their 
facility. Such infections cause seniors to stay in the hospital longer, 
cost tens of thousands of additional dollars to treat, and--in the 
worst cases--they are life threatening.
  Health care reform would also invest in and encourage innovative ways 
to deliver more efficient care to seniors. So-called patient-centered 
care can prevent seniors from being admitted to the hospital in the 
first place.
  You will notice a theme here: The government would be paying less 
when we pass health reform, and seniors would be healthier for it.
  I have not even touched on the billions of dollars per year in waste, 
fraud, and abuse that health insurance reform will help wring out of 
the system. I also have not discussed the tough cost-controlling 
mechanisms, such as a new Medicare payment advisory body to ensure 
Medicare dollars are being spent efficiently to improve patient care 
and balance our Federal checkbook.
  The reforms we are considering are critical to changing the way the 
government pays for Medicare so we can ensure its long-term 
sustainability. The reality is, if we do not act, as was mentioned 
early this morning--if we keep spending as we do today--Medicare will 
be bankrupt by 2017, just 8 years from now. That is a sobering thought.
  If we take the step to reform our health care system, it will have 
the immediate effect of extending the life of our Medicare trust fund 
for 5 more years, and at the same time we will lay down a foundation 
that will keep costs down in the long term so we can make Medicare 
sustainable for generations to come.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. MERKLEY. Mr. President, I thank Senator Udall very much for his 
remarks. I thank the Senator for his emphasis on quality outcomes and 
patient-centered care as a way to improve care and to decrease costs.
  We will now turn to Senator Kay Hagan of North Carolina. As a State 
senator in North Carolina, Senator Hagan worked to extend health 
insurance to uninsured children, to expand care for uninsured patients 
living in rural areas of the State, and to end insurance discrimination 
against mental health care patients.
  I yield Senator Hagan 4 minutes.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mrs. HAGAN. Mr. President, I thank my fellow colleague from Oregon, 
Senator Merkley. I also welcome our new colleague from Massachusetts.
  I am joining my freshmen colleagues on the floor today to talk about 
how health care reform will improve women's access to care. I received 
a heartbreaking e-mail this week from a young woman in North Carolina. 
When this woman was 27 years old, she was diagnosed with breast cancer. 
She had a 16-month-old son and was in an abusive relationship with her 
husband. Her husband knew she would not leave him because she could not 
afford medical treatment without his employer-provided insurance. She 
looked into COBRA. She looked into other individual insurance plans. 
But her breast cancer was, obviously, considered a preexisting 
condition. So for 7 years, this woman stayed in an abusive relationship 
because she had to have health insurance for herself and her child. 
Unfortunately, women across America face similar challenges to exactly 
what that woman has faced. Inefficiencies and discriminatory practices 
in our health care system disproportionately affect women. In a 
majority of States, insurance companies are permitted to charge women 
more than men for the exact same insurance policy. In Washington, DC, 
and in eight States, insurance companies can deny coverage to victims 
of domestic violence, citing that as a preexisting condition. In all 
but 12 States, insurance companies are allowed to charge women more 
than they charge men for coverage. In my family, my daughter, who just 
graduated from college--out there looking for health insurance on her 
own--was quoted many times more money for her coverage than if she had 
been a male.
  Only 12 percent of individual market policies provide comprehensive 
maternity care. When women do have health insurance, it often does not 
cover basic preventive care such as mammograms and Pap smears. In the 
HELP Committee and in the Finance Committee bill, insurance companies 
can no longer charge women more than men or use preexisting conditions 
to prevent anyone from purchasing health insurance, and we are ensuring 
that basic preventive screenings will be covered.
  I am focused on sending our President a bill that ends discriminatory 
practices against women, provides security and stability for people 
with insurance, expands access to health insurance for those without 
it, and slows down the skyrocketing cost of health care. Women across 
America cannot afford inaction any longer.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. MERKLEY. Mr. President, I thank Senator Hagan very much for

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her comments and her observations about how the current health care 
system, the current rules of insurance, including the ability to turn 
down patients and to deny folks with preexisting conditions, works to 
discriminate against women and prevent preventive health care.
  We will now turn to Senator Kirsten Gillibrand of New York. As a 
Member of the House of Representatives, Senator Gillibrand was a 
champion of children's and family health care issues and was a leading 
voice on the need to improve health care services for America's 
veterans.
  I yield my friend from New York 4 minutes.
  The PRESIDING OFFICER. The Senator from New York.
  Mrs. GILLIBRAND. Mr. President, right now we are engaged in a 
historic debate about the future of our health care system. The crisis 
has reached historic proportions, and Congress must act now.
  In 2000, family health insurance purchased through an employer was 
approximately $6,700. In 2008, it nearly doubled to $12,600. If we do 
not act now, by 2016, family health insurance is expected to double 
again, to nearly $24,300.
  We pay nearly twice the average of what other developed nations pay 
for health care: $2.2 trillion a year--more than 16 percent of our 
gross domestic product. However, the United States ranks 29th in the 
world in infant mortality.
  We have more than 47 million uninsured Americans. In 2007 and 2008, 
86.7 million Americans--1 out of every 3 Americans under 65--went 
without health insurance for some period of time.
  There is a hidden tax in America's health care system that all 
insured Americans pay to cover the cost of emergency care for the 
uninsured. For more than half of the 47 million Americans who do not 
have insurance, the only care they receive is through the emergency 
room. In fact, that hidden tax costs about $1,100 per year for family 
insurance premiums and over $400 per year for individual insurance 
premiums.
  Every day we fail to act, 14,000 Americans lose their health 
insurance. We must provide affordable, quality health insurance to 
every man, woman, and child in this country. But we also must take 
additional steps to contain costs and make sure our system is more 
efficient. The health care reform plans we are considering today will 
address a number of these issues.
  First, health care providers will be rewarded for the quality of the 
care they provide, not just the quantity. Hospitals and clinics around 
the country will model the success at places such as Bassett Healthcare 
which is in Cooperstown, NY, and is one of the leading health care 
providers in terms of positive outcomes because of the quality of care. 
We will also employ new methods to reduce medical errors through 
accountability and through health care IT, and prevent costly illnesses 
through better care management, through diet, exercise, and preventing 
diseases, such as preventing childhood obesity.
  Second, we will address the needless redtape and excessive 
administrative costs in our current health care system. Senate health 
insurance reform combats this problem by setting administrative 
standards that insurance companies must meet, and providing new tools 
to combat fraud. I would like to see a universal, one-page form that 
all people can use for reimbursements for all insurance companies that 
can be submitted on line. Changes like that could transform 
efficiencies in the market.
  Finally, we will make use of health care technology that could reduce 
health care spending by $77 billion a year. Currently, just 1 in 25 
American physicians utilizes fully functional electronic medical 
records. Senate health insurance reform expands the use of electronic 
prescribing, electronic health records, and electronic support for 
diagnosis and treatment options. Studies have shown that one out of 
every four tests is needlessly done because there is no record of that 
test. This must change.
  We know our Nation's health care costs are steadily bankrupting our 
government and our citizens, and we owe it to every generation that 
comes after our own to act now.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. MERKLEY. Mr. President, I thank my Democratic freshmen colleagues 
for coming to the floor today to talk about our broken health care 
system and the absolute necessity to control costs in this system, that 
we are on a train headed for a wreck. It is making it so difficult for 
families and small businesses and large businesses to afford health 
care, to establish a high quality of life, strong, thriving small 
businesses and international competitiveness for our large businesses. 
We can and must improve our health care system. The moment is now.
  I thank my colleagues for coming to the floor and sharing their vast 
experience in so many different capacities and bringing it to bear on 
this challenge that touches the life of every single American.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Tennessee.

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