[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[Senate]
[Pages 25084-25088]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. WHITEHOUSE. Madam President, I have spoken many times on this 
floor about the urgency of the need to reform our broken health care 
system, to expand access to insurance, to improve below average 
results, and to bring down costs. In a speech to the joint session of 
Congress, the President eloquently described the challenge of this 
moment:

       I am not the first President to take up this cause, but I 
     am determined to be the last. It has now been nearly a 
     century since Theodore Roosevelt first called for health care 
     reform. And ever since, nearly every President and Congress, 
     whether Democrat or Republican, has attempted to meet this 
     challenge--in some way. . . . Our collective failure to meet 
     this challenge--year after year, decade after decade--has led 
     us to the breaking point.

  We are at the breaking point for Nancy from Barrington, RI, a single 
mother and accomplished music teacher who lost her full-time job and 
currently teaches part time at a local university. Nancy has paid the 
full cost of health insurance out of pocket so her two children would 
not go without coverage. But now they have graduated from college, they 
are no longer eligible to be on her insurance policy, and they work at 
jobs that don't provide health care benefits. So Nancy is now thinking 
about selling her home, their childhood home, to prevent her family 
from going without health insurance. Nancy writes:

       Between the three of us, we are desperate for a workable 
     solution to our health insurance needs. For the first time in 
     my life I feel utterly disenfranchised by my own society.

  We are at the breaking point, not just for Nancy but for so many 
Rhode Islanders who have shared with me their stories--stories of loss, 
stories of sorrow, stories of frustration, stories of personal and 
family disasters, in a treacherous health care system that offers all 
the care you need until you need it.
  We are also at the breaking point nationally. Our country's economic 
future may well depend on the reforms and investments we now craft to 
control costs and wring savings from the system.
  One measure of the potential savings is the recent report of 
President Obama's Council on Economic Advisers, comparing the share of 
America's gross domestic product spent on health care to the share 
spent by our industrialized international competitors, and evaluating 
the wide variation in health care expenses region to region within the 
United States.
  The report estimates annual excess health care expenditures of about 
5 percent of GDP. That translates to over $700 billion a year in excess 
cost. They are not alone. The New England Health Care Institute reports 
that as much as $850 billion in excess costs every year ``can be 
eliminated without reducing the quality of care.'' That is $850 
billion.
  Former Treasury Secretary O'Neill, the Treasury Secretary in the Bush 
administration, has written recently that the excess cost in our health 
care system is $1 trillion a year. The Lewin Group, a consulting firm 
that is well regarded on health care issues, has estimated that excess 
cost exceeds $1 trillion per year. So is it $700 billion a year? Is it 
$850 billion a year? Is it $1 trillion a year? Whatever it is, it is a 
savings target worth an enormous executive and legislative effort, 
particularly when the evidence is that achieving these savings will 
actually improve health care for the American people.
  Where will these savings come from? Well, the savings await us in 
quality of care. For instance, the Keystone Project in Michigan reduced 
infections, respiratory complications, and other medical errors in some 
of Michigan's intensive care units between March 2004 and June 2005, a 
little over a year. The project saved 1,578 lives, 8,120 days that 
patients otherwise would have spent in the hospital but did not have to 
because they did not get the infections or the complications and, as a 
result, over 165 million health care dollars, just in Michigan, just in 
intensive care units, just in 1 year, and not all of the intensive care 
units.
  In my home State, the Rhode Island Quality Institute has taken this 
model statewide with every hospital participating. We are already 
seeing hospital-acquired infections and costs declining. There is a 
similar opportunity in disease prevention. The Trust for America's 
Health found that investing $10 per person per year in programs that 
increase physical activity, improve nutrition, and prevent tobacco use 
could save the country more than $16 billion annually within 5 years.
  Out of that $16 billion in savings, Medicare would save more than $5 
billion, Medicaid would save more than $1.9 billion, and private payers 
would save more than $9 billion. So that is quality of care and 
prevention.
  A third area for significant efficiencies and savings is the 
insurance industry's contentious, inefficient billing and approval 
process. The battle

[[Page 25085]]

over approvals for treatment and claims for payment creates a colossal 
burden on our health care system, causing perhaps 10 to 15 percent of 
the insurance industry's expenditures because the hospitals and the 
doctors and the providers have to fight back. That 10 to 15 percent of 
the insurance companies' expenditures casts a cost shadow over the 
provider community which is probably bigger than the insurance industry 
spends, because they are less efficient at fighting back than the 
insurance company is at tormenting them.
  It all adds no health care value. None. It is pure administrative 
costs and cost shifting. Rhode Island providers have told me over and 
over that half of their personnel are absorbed in this battle and not 
providing health care. They are at the doctor's office, they work 
there, but they are not providing health care. They are busy fighting 
with the insurance company.
  Even the insurance industry estimates that $30 billion per year could 
be saved through simplifications of the process. That relates to a 
fourth area, the overall inefficiency and waste that plagues the 
private insurance market.
  While administrative costs for Medicare run about 3 to 5 percent, 
overhead for private insurers is an astounding 20 to 27 percent. A 
Commonwealth Fund report indicates that private insurer administrative 
costs have more than doubled in the past 6 years. From 2000 to 2006, 
they increased 109 percent.
  The McKinsey Global Institute estimates that Americans spend roughly 
$128 billion annually--$128 billion annually--on excess administrative 
overhead in the private health insurance market.
  A fifth savings area is investments in our infrastructure of health 
information technology; secure electronic health records, for instance, 
electronic coordination between your doctor and your specialist and 
your pharmacy and your hospital and your laboratory. These investments 
promise big savings as well, $162 billion per year, according to one 
RAND study, and possibly twice that.
  Finally, reform of how we pay for health care will yield enormous 
dividends. At the moment we mostly pay on a piecework basis. The more 
you do, the more you are paid. No surprise that we do a lot and pay a 
lot. Since the best care, the best quality care is so often less 
intrusive but better designed and better coordinated, this payment 
reform presents another win-win opportunity: better health care and 
lower cost, hand in hand.
  There is a problem, though. For many of these reforms, CBO cannot 
fully score the savings they would yield, and thus their importance has 
been minimized in our debate. CBO can only estimate health care costs 
and savings that have historic precedent. For example, on the cost side 
we have the experience of Medicaid, and the Children's Health Insurance 
Program. So CBO can estimate how much it will cost to expand the 
coverage to needy families, as we importantly do in this bill.
  On the savings side, however, CBO's capability is limited because 
there is not a lot of information to forecast from. CBO's Director has 
been refreshingly candid about this. In a recent letter to Senator 
Conrad, he wrote the following:

     . . . changes in government policy have the potential to 
     yield large reductions in both federal health expenditures 
     and federal health care spending without harming health. 
     Moreover, many experts agree on some general directions in 
     which the government's health policies should move, typically 
     involving changes in the information and incentives that 
     doctors and patients have when making decisions about health 
     care . . . Yet, many of the specific changes that might 
     ultimately prove most important cannot be foreseen today and 
     could be developed only over time through experimentation and 
     learning.

  So to summarize: Large reductions in costs are possible. The general 
direction in which to move to achieve them is agreed. But 
experimentation and learning are necessary to get there.
  Even with those analytical limitations, CBO has recognized some cost 
savings created by several innovative reforms in the Finance 
Committee's bill. For example, CBO forecasts that an independent 
nonpartisan commission of experts with authority to determine provider 
payment rates under Medicare will save the Treasury $22 billion over a 
10-year period.
  It also credits Medicare payment reforms that seek to prevent 
hospital readmissions with $2.1 billion in savings; incentives that 
encourage physicians to group together in cost savings organizations 
with $4.9 billion in savings, and payment reforms aimed at preventing 
health care-acquired infections with $1.5 billion in savings.
  But as you have seen, in comparison to the numbers I talked about 
earlier, those are trivial projections, chump change against the excess 
cost of our health care system. Americans owe the Congressional Budget 
Office a particular debt of gratitude for how incredibly hard they have 
worked these past weeks and months. CBO performs a valuable service.
  But its professional discipline requires it to score legislation 
basing its calculations on what it can chronicle has happened in the 
past. And we have not yet been where we need to go in health care 
reform. Moreover, getting there will require leadership, creativity, 
and perseverance in executive administration, with constant adjustments 
and improvements along the way to achieve our goal.
  Those factors of executive administration are beyond the capability 
of CBO to predict. The distinguished Presiding Officer was the Governor 
of the State of New Hampshire. She knows well, having served as 
Governor, what a difference executive administration can make in areas 
where there is intelligent and sustained focus. Well, CBO cannot 
predict whether intelligent and sustained focus will occur, so they 
cannot predict the answer to that question.
  Let me mention one further reform now that we are on the subject of 
executive administration, a final reform that can bring leadership and 
creativity toward achieving all of these goals in quality, in 
prevention, in payment reform, and in information technology. That is 
the reform that can bring leadership and creativity to pulling all of 
those reforms together, a public health insurance option, a government-
run publicly handled plan that can provide affordable coverage in a 
market where premiums have increased 128 percent in 8 years.
  A public option can bring vigorous competition to a market so 
monopolistic it would make Andrew Carnegie blush, will force private 
plans to minimize bloated administrative costs which have increased, as 
I said, 109 percent over those 6 years. The public option can pass 
along savings to consumers in the form of reduced premiums, and can end 
the wasteful practice of fighting with doctors and patients over 
reimbursement.
  The public option is our best chance for executive implementation of 
the delivery system innovations and reforms I have described. Skillful 
executive administration will be required just as for every other 
element of reform. But public plans across the country, driven not by 
private motives but by the public good, set new standards of quality 
and efficiency in a market that has lost its way.
  The point of this reform must be to turn around a health care system 
that is now spiraling out of control. We spend 18 percent of our GDP on 
health care. The next highest spending nation in the world is 
Switzerland at 11 percent. Even if our success is limited to shaving a 
few percentage points off our national expenditure on health care, that 
success will be worth hundreds of billions of dollars a year. Yes, 
there will need to be an initial investment in health care reform, but 
the potential savings are multiples larger.
  CBO's inability to score these savings does not mean they aren't real 
and achievable. Given the looming threat to America's fiscal security 
that is now presented by our health care costs, these savings are not 
only real and achievable, they are essential. They are necessary. We 
are bound to achieving them, and we must not fail. For that reason, I 
call on the Obama administration to begin defining a health care 
savings target from delivery system reform--from health information

[[Page 25086]]

infrastructure, from quality improvements, from illness prevention, 
from more transparency and less bureaucracy, from reform of what we pay 
for in health care and, ideally, all implemented rapidly and fairly by 
public plans around the country. They need to set a target.
  If the administration does not set a savings target, there is no way 
the vast apparatus of the Federal Government will wheel adequately 
toward achieving this goal. If we fail to achieve those savings, all 
our dreams--our dreams of universal coverage, our dreams of 
affordability, our dreams of a public option--will crumble like castles 
built on sand.
  Let's take the most conservative number from President Obama's own 
White House, $700 billion a year in annual excess cost. Let's assume 
the best we can do is to eliminate less than one-third of that excess 
cost--not all of it, not even half of it, less than one-third. Let's 
assume it takes a few years to meet that goal; let's say 4 years. That 
would still permit reform savings of $200 billion a year by 2014. By 
then, our annual health care expenditures will have climbed well over 
$3 trillion. So that $200 billion annual savings would be only one-
fifteenth, about 7 percent, of the cost, then, of our bloated health 
care system, a system now costing twice as much as other developed 
nations' health care systems that cover everyone. That goal, 7 percent 
off a system that costs twice as much as in other nations, does not 
seem unreasonable.
  I will ask the administration: What is your annual savings target out 
of that $700 billion to $1 trillion a year in excess cost? What is it, 
and when will you achieve it? Soon you will have a bill out of this 
Congress that gives you the tools to achieve these savings. When you 
have that bill, I will ask for a number and a date.
  I will urge the administration: Be bold. President Kennedy did not 
know how to get to the Moon when he promised that we would, but he knew 
we had the talent and the technology to do it, if we had the 
President's commitment behind it. Sure enough, it happened.
  I would also remind the administration of this: We have to achieve 
these savings anyway. This is not an extra political hurdle the 
administration would have to clear. This is the bar we must clear if 
our Nation is to return to fiscal health and if our dreams of universal 
coverage and affordability and good public health and a humane, 
efficient health care system are all to be realized. Again, if we don't 
clear that bar, all those dreams crumble in our hands like dust.
  Let's step forward now and make a commitment to some hard, firm 
measure of savings out of our bloated and inefficient delivery system.
  I thank the Chair.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Begich). The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. BROWN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BROWN. Mr. President, I ask unanimous consent to speak for up to 
15 minutes in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BROWN. Mr. President, pretty much daily over the last couple of 
months when the Senate has been in session, I have come to the floor to 
share letters I have received from people in Findlay, OH--where I was 
today--Toledo, Sandusky, Mansfield, Lebanon, all over the State. These 
are letters from people who want to tell me why we need health care 
reform. These are letters mostly from people I have not met, people who 
know we need to change some things in this country.
  What is interesting is that one of the common themes that run through 
these letters--in letter after letter after letter--is that people 
thought they had pretty good health insurance. They were satisfied with 
their health insurance. If you asked them a year or two ago: Do you 
have good health insurance, they would have probably said yes. But then 
they found they had a child who was diagnosed with a preexisting 
condition, so they were denied insurance, or they got sick and they 
went above the annual or lifetime cap on costs they did not even know 
was in their insurance policy, so the insurance company then rescinded 
them--is the term they use--there was a rescission to eliminate or take 
away their policy, or they were discriminated against for other 
reasons, or in many cases they lost their job and lost their insurance.
  In case after case, these are people who are mostly middle class, 
people playing by the rules, paying their taxes, raising their kids, 
keeping their communities prosperous, and they typically have lost much 
of what they had.
  I want to share some of these letters with my colleagues, 
particularly colleagues who are not so certain, colleagues who still 
defend the health insurance system and think we do not need significant 
change, so that they would maybe understand some of these problems a 
little better.
  The first letter is from Wilkins from Youngstown, which is in 
northeast Ohio. He writes:

       I'm an unemployed former steel worker from Youngstown. I've 
     been struggling to afford my premiums for COBRA while on 
     unemployment and looking for a job.

  COBRA is a bit of a cruel hoax. It is a good program for people who 
can afford it. But COBRA is for when you lose your job that you can 
keep your insurance if you pay what you are already paying, plus you 
pay the employer's side of the insurance. That is almost impossible to 
do for most people who lose their job for a very long period of time. 
They are only eligible for COBRA for up to 18 months anyway. He writes:

       Due to a pre-existing condition of high blood pressure, I 
     had no choice but to continue my coverage under COBRA.

  If he had a break in his health care, if he canceled his health 
insurance and tried to get other less expensive insurance, he would 
have been denied coverage because of his preexisting condition. He 
writes:

       I'm 59 years old and have been working temporary jobs just 
     to get by, but none offers health insurance. I barely make 
     enough to afford my blood pressure medication.
       I've depleted my savings while watching my unemployment 
     insurance run out.

  That is something else that this Chamber must consider. I just saw 
Senator Shaheen from New Hampshire a moment ago. She has helped lead 
the fight on extending unemployment benefits for people whose insurance 
has run out, something, unfortunately, day after day we have tried to 
do here, and a Republican Senator has stood up and objected and we have 
not been able to push that through yet. Unemployment insurance makes so 
much sense with so many people--from Dayton to Springfield to 
Chillicothe to Zanesville--who cannot find a job and have seen their 
unemployment insurance run out.
  Wilkins writes:

       I'm sick of high insurance premiums. I worked for 38 years 
     and now I have no health care coverage.
       They threw me away like an old shoe. It's me today and it 
     could be anyone tomorrow.
       I may not have three years to live until I receive Medicare 
     if I can't afford my medicine.
       I need health reform now. It just can't wait.

  One of the other themes that runs through these letters is that 
people who are in their late fifties or early sixties and do not have 
insurance are just praying--praying--they can get enough help and stay 
well enough, stay healthy enough so they can make it until they are 65 
and they can get Medicare.
  What does that say? Wilkins from Youngstown worked for 38 years. He 
lost his job because of what has happened in the steel industry. He 
cannot afford COBRA. He cannot afford his blood pressure medicine. He 
is working part-time jobs just to try to get by. He is praying he can 
get to 65 so he can get health insurance under Medicare--a program that 
looks a lot like the public option would look if we pass that 
legislation in the next couple of months.
  Robin from Cuyahoga County, in the Cleveland area, writes:


[[Page 25087]]

       My son just graduated from college and his coverage under 
     his Dad's employer is coming to an end.
       While he has found an entry level job, he is not currently 
     a full-time employee and does not have health insurance.
       He is incredibly healthy, but when he was in high school he 
     was diagnosed with a heart condition, which could require 
     surgery as he ages, but not for decades [his doctor 
     believes].
       As my son was searching for insurance, he was honest about 
     this condition. Each company he called denied him.
       So now, a 22-year-old with no history of any illness--

  A young man, 4 or 5 years older than the pages who sit in front of 
us--

     but who at some point in the future might need medical 
     support, can't get health insurance.
       Instead of creating a system that provides him incentives 
     and proactive monitoring of his condition--

  To keep him as healthy as we can--

     we have a system that drives him away, doesn't encourage 
     preventive measures, and ends up costing everyone more. I 
     encourage you to take every action possible to put an end to 
     health insurance companies denying coverage for preexisting 
     conditions. We need a system that puts an emphasis on 
     preventive care.

  Robin is right about her son. Under our health care bill, as the 
Presiding Officer from Alaska understands, anyone who chooses to can 
stay on his mother's or father's health insurance until reaching the 
age of 26. So her son would have 4 more years on their health care plan 
under our bill that we are going to debate on this floor in the next 
few weeks. Robin's son would be able to keep his insurance until he was 
able, down the line, to get a better job with insurance. Obviously, 
under our bill, he is going to have access to insurance anyway. But one 
of the things to help young people as they go into the workforce--maybe 
they are living at home, just moved out of the house, finishing college 
or coming home from the military, but so many young people lose 
insurance because they are working at often low-paying jobs that don't 
provide insurance for their employees.
  Beatrice from Summit County, the Akron area, writes:

       As a recent retiree due to economic downsizing, I am left 
     to purchase an expensive insurance plan. But I am not sure 
     how much longer I will be able to pay for the premiums. I 
     only recently got a temporary contractor job that can end at 
     any time.
       After 37 years of employment with the same company, it is 
     sad to think that after all those years, I am unable to 
     afford to pay my insurance premiums and unable to collect my 
     Social Security since I retired early.
       As my anxiety and stress increase, additional health 
     problems have surfaced. I am not old enough to qualify for 
     Medicare and unable to afford private insurance or COBRA.
       I'm asking for your help in supporting health reform that 
     benefits all Americans.

  Beatrice is another example. She has worked for a company--as did 
Wilkins from Youngstown, who worked for some 30-plus years, 38 years. 
Beatrice from the Akron area has worked at the same place for 37 years. 
Both lost their jobs. Both can't afford COBRA. Both can't get 
insurance. Both are seeing their health compromised.
  If you have worked someplace for 30 years and you are in your 50s and 
you are hoping you can stay alive and stay more or less healthy until 
you are 65, think of the stress that comes with that; the stress of 
trying to find insurance; the stress of fighting with insurance 
companies if you do have a preexisting condition or they put a cap on 
their coverage and what that does to people's health care. No place in 
the world, no developed, wealthy nation such as ours puts their 
citizens through these constant battles with insurance companies, these 
unending fights when insurance companies do all they can to take 
coverage away from people who thought they had coverage.
  I spoke to the Fendlay Rotary today in a community in northwest Ohio 
which experienced terrible flooding a couple of years ago and I am 
working with them to help with the Army Corps of Engineers to get a 
flood mitigation project put together so these floods don't continue to 
happen on the Blanchard River. We were talking about the insurance 
industry.
  I don't dislike the insurance industry. I think they do what they 
have to do because they compete with one another and each does these 
same business practices. But understand, first, they don't want to 
cover you if you are not healthy. They would rather not write an 
insurance policy if you are not healthy, so they hire all kinds of 
people to make sure they don't take you if you have a preexisting 
condition or if they think you are going to be an expensive risk. That 
is on the one hand. Then on the other hand, if you have already been 
insured by this company, if you already have insurance, they have a 
whole battery of employees who are there to try to deny coverage. I 
read the other day that close to 30 percent of claims are initially 
denied by insurance companies--30 percent. So the insurance industry 
spends all this money to keep people out who are sick, whom they don't 
want to insure, to find out if there is any preexisting condition or 
other reasons not to insure them; and then they hire a whole battery of 
people to try to deny payment, to deny claims if you have an expensive 
claim against the insurance company.
  Again, no other country in the world does that. A lot of countries 
rely on private insurance, but they are private not-for-profit 
insurance companies. They are not companies that try to exclude you 
from getting coverage, and then if you have coverage and you get really 
sick, try to cut you off so you don't get your costs paid for, you 
don't get your claims paid for. It is simply a business model that 
works for the insurance industry, but it sure doesn't work for the 
American public. It doesn't work for people who thought they had decent 
insurance.
  The last letter I will read comes from James. James writes:

       I've paid all of my life for health insurance and now I 
     can't afford it because I'm unemployed. Because I had no 
     insurance, I've had to go to the emergency room, which cost 
     me over $1,300. I've worked and had health care all my life 
     and now I'm told it could cost me $100 up front to even be 
     seen by a doctor. We need a health care system that works for 
     all of us.

  One story, one letter after another. I know when the Presiding 
Officer is in Fairbanks or Anchorage or anywhere around Alaska, he is 
hearing the same thing from people, through letters and individual 
conversations from so many people who thought they had good insurance, 
only to find out they don't when they get sick; people who are just 
hanging on until they can get a good government plan, Medicare, when 
they turn 65; people who have worked hard all of their lives and played 
by the rules and feel like a discarded old shoe, as the gentleman from 
Youngstown wrote.
  I think about what our health care plan will do and how we are going 
to change the system and make it work for these four people in Ohio and 
for hundreds of millions of people around the country, where anyone who 
is satisfied with their health insurance under our plan will be able to 
keep it, and at the same time we are going to build consumer 
protections around those plans. We are going to ban certain practices, 
including no more preexisting condition exclusions, no more 
discrimination based on disability and gender and geography and age and 
race or anything else. No more saying to women, You can't get coverage 
because you were a victim of domestic violence and that is a 
preexisting condition. Believe it or not, insurance companies do that 
sometimes. No more saying to a woman who had a C-section, Sorry, you 
can't get insurance, that is a preexisting condition because the next 
baby will have to be a C-Section again and that is too expensive for 
us.
  The second thing the bill will do with consumer protections built 
around it is it will assist small business, giving incentives to small 
businesses to cover employees.
  Third, this legislation will provide insurance for people who don't 
have coverage or who are dissatisfied with their coverage.
  Fourth, this legislation will provide a public option so that anyone 
who chooses can go into the public plan, not necessarily go to CIGNA or 
Aetna or United or Medical Mutual in my State, or one of the private 
insurance companies. That means when people have the public option, it 
will keep the insurance industry honest because they won't get away 
with gaming the system because they have a competitor

[[Page 25088]]

such as the public option that will compete directly with them. It will 
mean the public option will help to drive prices down because it will 
make private insurance more affordable, more efficient. Private 
insurance companies will no longer be able, because of the competition, 
to pay $24 million CEO salaries such as Aetna does and so many other 
private insurance companies do. It will mean that people have more 
choice in southwest Ohio.
  In the Cincinnati-Dayton area, there are two insurance companies that 
provide 85 percent of the insurance and that is simply not competitive. 
That is why these monopolistic practices that insurance companies 
engage in so often run counter to the public interests. That is why the 
public option is so important: to get people choice, to discipline the 
insurance companies, to bring in competition, to keep prices down, and 
it will matter as we move forward.
  I thank the Presiding Officer for the time on the Senate floor. This 
legislation will be debated over the next couple of weeks. We know that 
70 percent or two-thirds of the American public want a public option. 
We know a poll by the Robert Wood Johnson Foundation says more than 70 
percent of doctors want a public option. We know an overwhelming number 
of Democrats of both the Senate and House, 90 percent, support a public 
option. As I said, almost two-thirds of the public, through consistent 
polling for the last month, and month after month after month, shows 
that two-thirds of the public support the public option. It makes 
sense. It makes a good health care bill that much better. It makes the 
system work that much better for people who have insurance now and 
people who don't have insurance, but especially all of us who worry so 
much about the health care costs in this country and how they have 
spiraled out of control.
  I thank the President and yield the floor and suggest the absence of 
a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BROWN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________