[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[Senate]
[Pages 25420-25425]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. UDALL of New Mexico. Mr. President, first, I wish to say to the 
Presiding Officer, I know Senator Sherrod Brown from Ohio and a number 
of us are going to be down here from the 6 to 7 o'clock period, and I 
am starting out here for the first 10 minutes before 6 to talk a little 
bit about health care reform and this whole issue that many of us have 
been addressing on the floor. We did this several weeks ago and we did 
it last week. What we are doing is talking about the whole issue of the 
public option and how important it is to have a public option.
  The Presiding Officer from Rhode Island, Senator Whitehouse, has been 
down here with us. He has pointed out,

[[Page 25421]]

on a number of occasions, how important it is to have a public option. 
But I think one of the things I would like to do today is talk a little 
bit about what these insurance companies are doing and where they are 
coming from.
  Insurance companies made a point of playing nice over the first 
couple months of this reform process, but they revealed their true 
colors earlier this month when they released a series of biased, 
misleading reports to scare people about the impact of reform. The 
truth is insurance companies aren't worried about how reform will 
impact consumers--far from it. What they are worried about is the 
impact of reform on their profits.
  The insurance industry has shown where it stands when it comes to 
health care reform. In the process, they have given us yet another 
reminder of why we must have a robust public option included in the 
final legislation. A public option is one of the only ways still on the 
table to keep the insurance companies honest. It will allow us to 
restore competition back into the market and hold companies accountable 
for their abusive practices. If you need further proof that insurance 
companies are putting profits above people, let's look at this chart 
and look at some of the statistics and numbers here.
  Over 7 years, publicly traded health insurance companies saw a 428-
percent increase in profits--again, a 428-percent increase in profits. 
The 10 CEOs of those companies made $118 million in 2007. That is why 
47 million Americans went without coverage. The premiums more than 
doubled over 9 years, three times faster than wage increases.
  Going to chart No. 2, insurance companies are afraid of competition 
and want to protect their strangleholds in most State markets. Ninety-
four percent of the commercial health insurance market is highly 
concentrated. In 21 States, 1 carrier dominates more than half the 
market. In 39 States, 2 carriers control more than half the market. 
This is the case in New Mexico, where 2 companies control 65 percent of 
the market.
  What does this mean for individuals and families in New Mexico and 
across America? Nearly one in four Americans under the age of 65--some 
64 million people--will spend more than 10 percent of their family 
income on health care in 2009. This means families often have to choose 
between paying health insurance premiums and putting food on the table. 
Outrageous health insurance premiums are a heavy burden for working 
families who already are dealing with tight budgets. This can often 
lead to significant medical debt, bankruptcy, and home foreclosure.
  I wish to talk a little bit about some of the New Mexico families who 
have called me and written me and told incredible stories. I know the 
Presiding Officer, the good Senator from Rhode Island, Mr. Whitehouse, 
has been down here talking about his stories in Rhode Island, and we 
have the Senator from Ohio here right now whom I spoke about earlier.
  Mr. BROWN. Mr. President, if the Senator will yield for a moment.
  Mr. UDALL of New Mexico. Let's ask unanimous consent to carry this on 
as a colloquy.
  The PRESIDING OFFICER (Mr. Kaufman). Without objection, it is so 
ordered.
  Mr. UDALL of New Mexico. Please, go ahead.
  Mr. BROWN. I thank the Presiding Officer, Senator Whitehouse.
  I saw the Senator show that map, if we could put that map back up. 
The current chart shows the number of uninsured New Mexicans, and that 
is, of course, significant. But when we look at this map, we can look 
at any number of States where in some States--about a dozen States--two 
insurance companies have more than 75 percent of the market, some 
pretty good-sized States with some pretty decent populations, including 
Minnesota, Missouri. But no matter how many people live there, when you 
have two companies that have more than 75 percent of the market and you 
look at the next level of States, which includes yours, New Mexico; 
mine; as well as Rhode Island, where two companies have between 50 and 
75 percent of the market, what does that mean in your mind in terms of 
what the public option will do? We were all taught in school, whether 
you were a business major or a French major, that if there was almost a 
monopoly, where two or three companies had most of the market, prices 
went up.
  What does that mean with the public option and injecting competition 
into this whole market?
  Mr. UDALL of New Mexico. I thank the Senator from Ohio. I know 
tonight he is leading this effort, this hour we now have on the floor, 
and I thank him for being down here and leading the effort and showing 
incredible leadership on the public option.
  What I think it means is, when we talk about the lack of competition, 
this is a concentrated market, that they can basically do whatever they 
want and drive up the premiums and drive up these incredible profits.
  I don't know if the Senator was on the floor when we showed this 
chart, but publicly traded insurance companies saw a 428-percent 
increase in profits over 7 years. So the lack of competition drives 
those profits. We are not against people making profits; it is just 
this is profit in terms of health care. So let's compare it.
  To answer the Senator's question, one of the things that I think is 
important to compare is the high-tech industry. They have six, seven, 
eight companies all competing against each other, driving the prices 
down, lowering costs. What the public option does is exactly that: It 
drives the premiums--it puts competition into the market; it drives the 
costs down.
  Mr. BROWN. When we have seen the increase in profits of these 
companies, the publicly traded health insurance companies--and I don't 
mind that they have an increase in profits if they aren't doing it by 
using preexisting conditions to deny care to people whom the Senator 
reads letters from, from Santa Fe and Albuquerque and Truth or 
Consequences and all over the Senator's State. I wouldn't mind if it 
was not on the backs of people whose insurance companies put caps on 
their coverage so that even though they didn't know it when they bought 
their insurance--they get very sick, spent a lot of money, and all of a 
sudden they lost their insurance.
  Then you also see on the bottom there, the top 10 CEOs made $118 
million in 2007. I remember talking the other night about the CEO of 
Aetna who, I believe, made $24 million; the CEOs of--do the math there: 
10 CEOs, that is $11.8 million each. Obviously, the Aetna guy drives up 
the average a little, but they are all making $6, $8, $10, $12 million. 
I assume that what has happened in the last decade--and part of the 
reason for that huge increase is that there are fewer and fewer of 
these companies dominating the market. I assume--I am asking, I guess--
10 years ago there was probably more competition in this market than 
there is now. So we are seeing the number of companies shrink, their 
market share increase, and that is an even stronger case for the public 
option.
  I guess the even stronger case for the public option is, frankly, how 
much the insurance companies hate it. There is nothing they are 
opposing more strongly in this bill than the public option. As unhappy 
as insurance companies are with any change--because they love the 
system the way it works now. They love having preexisting condition 
denials, they love their caps, they love to be able to discriminate. 
Their whole business model, it seems to me, is to keep people who are 
sick from getting insurance and then hire a whole bunch of bureaucrats 
to try to spend time on the phone denying care, denying reimbursements 
or denying claims for people who get sick who are their customers.
  So what does public option do for all of that?
  Mr. UDALL of New Mexico. Well, Senator Brown makes a very good point. 
I think, first of all, when you have a public option, it is a nonprofit 
that is dedicated entirely to health care, and you are not going to see 
these outrageous kinds of CEO salaries. The purpose of a public option 
nonprofit is to put moneys that come in above the goal of providing 
health care back into

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the overall system. So what we are talking about is dedicating 
ourselves on that basis to providing the very best quality care.
  So if you take out the profits and you take out these salaries, you 
are going to have a very competitive--
  Mr. BROWN. You are taking out another big group of people. You are 
taking out two groups. You are taking out marketers and the money they 
spend trying to get people to buy their insurance and making sure they 
exclude those who are sick. That takes some skill, it takes some 
computer programming, it takes some aggressive salespeople, 
discriminating aggressive salespeople. Then you have the bureaucrats--
--
  Mr. UDALL of New Mexico. As the Senator pointed out, it happens at 
two points in the process, right?
  Mr. BROWN. Then you have the bureaucrats denying coverage on the 
other end. The public option will not spend a lot of money marketing 
and will not have people denying care, right?
  Mr. UDALL of New Mexico. Absolutely. Those two things occurring drive 
up the costs, so the comparison--let me make this one more point.
  The comparison on administrative costs--let's look at a government-
run program such as Medicare that has 3 percent administrative costs. 
Then we go over to the insurance industry, and we are talking 30 
percent. It is those people in the process who are denying the claims 
and all of that activity.
  Mr. BROWN. So it is the CEO salaries, the profits, the marketers, and 
it is the bureaucrats denying your claims when you thought you had good 
insurance. They say about 30 percent of claims are initially denied.
  I have read a lot of these constituent letters. So many of these 
letters come from people who are sick and thought they had good 
insurance, who then ended up getting very sick or having a new child 
who had a preexisting condition, and they ended up fighting the 
insurance company, and they were already suffering from an illness. 
Think about the stress one must already have from having breast cancer 
or from having a sick child, and then they have to spend time on the 
phone fighting with insurance companies or bureaucrats who are saying 
no, no, no.
  Instead, with the public option, they will not have those bureaucrats 
to fight, correct?
  Mr. UDALL of New Mexico. Correct. Would Senator Whitehouse like to 
speak?
  Mr. WHITEHOUSE. I am delighted to join the discussion. One other 
point merits mention about a public option. The current business model 
for health care in America is not a good one. The insurance companies 
try to--if you are not healthy--make sure you never get insurance in 
the first place. If they give you insurance and then you get sick, they 
will look for loopholes and try to throw you out. Then they will try to 
control the way you get treated by your doctors. So your doctors have 
to spend as much as half of their time on the phone trying to fight and 
get you the treatment they know is right for you, but they have to 
clear it with the insurance company, which has a vested interest in 
taking as long as it can and causing as much trouble as it possibly can 
because some doctors and patients will just give up.
  On the other side, in terms of the quality of care, with all that 
stuff going on, we have a country in which the quality of care is far 
below our competitors by innumerable measures. Part of it has to do 
with the way the system works.
  We had an intensive care unit reform that we fought through in Rhode 
Island that was modeled on the keystone project in Michigan. In 
Michigan, they went into intensive care units and said: We are going to 
eliminate hospital-acquired infections, get rid of those. In 15 months, 
they saved 1,500 lives, $150 million, and 81,000 days that patients 
would have spent in the hospital with those infections, but they didn't 
have to because they got out without them. They invested in that.
  That is the kind of thing a public option can invest in because it 
will be around, it is not profit motivated, and it wants to do the 
right thing for people.
  Mr. BROWN. How does that work? In the Michigan hospital, they used a 
checklist and all this to try to cut down on infections. How does 
public option interface with the hospital to try to get them to do 
that?
  Mr. WHITEHOUSE. It will be willing to take the long view and say: You 
know what. This is the right thing to do.
  Mr. BROWN. Invest the money now, and the insurance companies will not 
do that.
  Mr. WHITEHOUSE. Insurance companies have had a long time to do this, 
but they have not done it. If you want to believe that by passage of 
this legislation, all of their motivation and their business model, the 
way they work, is going to spontaneously change, and they will start 
doing things they have never done before, is one thing to believe. I 
think prudence and experience and a practical and serious appreciation 
of how urgent our situation is all counsel against believing a sudden 
epiphany happening in the halls of the big insurance companies and, 
instead, put a new entity on the field, which would be easier to start 
up and bring a new business model in with it. It is not going to have 
all that tradition and history. You know, you get in a rut. The only 
way to change the business model in health care is to have a new 
entrance--a public entrance and a nonprofit entrance and one that has a 
dispersed interest in the health of the American people rather than the 
wealth of the insurance company shareholders.
  Would the Senator from Oregon like to jump in?
  Mr. MERKLEY. Mr. President, I am happy to jump in. Last weekend, I 
was over in central Oregon--in Bend--and I was reading local clips. One 
of the articles that came across was about a lawsuit that had been 
filed. The article said that a year before an individual had passed 
away because they had repeatedly asked for an MRI to address a pain he 
had in his back. It turned out to be a tumor, and it killed the 
individual. But they could never get the MRI approved. The doctor 
requested it, but it wasn't approved. Another doctor requested it--a 
consulting doctor--and it wasn't approved. Eventually, the tumor was 
beyond the point of being able to be operated on. The individual passed 
away.
  That article talked about a second parallel situation that is 
unfolding right now. The individual is still alive but also is seeking 
an MRI and is being turned down by the same company. I thought, that is 
how an insurance company makes those profits--by turning down requests 
for coverage. Hopefully, it doesn't come to the point that a diagnostic 
exam is denied to the degree that someone is going to die, but it 
happens. It happened in this particular case.
  The motivating factor of the management of the company was to 
maximize profit, not to maximize healing. The Senator from Rhode Island 
served as insurance commissioner. I am sure he saw examples of this. If 
I heard him right, he is saying that in a public option the motivation 
is healing, not profit, and therefore has a long-term perspective. 
Therefore, it can invest in prevention, in disease management. A 
private company will not assume that its customer, the policyholder, 
will still be a customer in 10, 15 years. They take a short-term 
perspective. That is to minimize the amount you spend on health care. 
But the longer term perspective would be much better for the quality of 
life of our citizens, and certainly investment in prevention and 
disease management might have tremendous rewards in bending the cost 
curve.
  Mr. WHITEHOUSE. That is precisely accurate. If you are a for-profit 
insurance company and your motivation is to make money, and if you 
assume your customers are going to stay with you--how long does 
somebody stay with a company before they change jobs or move to a 
different State? Five to ten years? You put down 100 cents on the 
dollar of a prevention strategy or a wellness strategy and help that 
individual, and if it is an illness, it is going to show up 8, 9, or 10 
years later

[[Page 25423]]

and you haven't saved yourself any money. You have done the right thing 
for the customer but haven't saved yourself any money. So you have a 
huge built-in bias to underinvest in wellness and prevention.
  Sure enough, we are a country that underinvests dramatically in 
wellness and prevention. It is impossible not to connect the dots and 
see that the reason we are so underinvested in wellness and prevention 
has to do with the motivation of the for-profit insurance sector.
  (Mr. UDALL of New Mexico assumed the chair.)
  Mr. KAUFMAN. Mr. President, one of the things that concerns me about 
this is we hear about the fact that we should not have a public option 
because it is the government doing this and that. When I was in 
business school, I learned that the beauty of the private sector is 
competition. If you don't have competition, you will not get the 
advantage in the private sector. I don't care how you structure things. 
I want to read off some States.
  The problem is, in so many States we have no competition. The only 
way we are going to get competition is through some kind of a public 
option.
  In Hawaii, 98 percent are with two insurers. In Rhode Island, it is 
95 percent. In Alaska, it is 95 percent. Vermont, it is 90 percent. 
Alabama, it is 88 percent. In Maine, it is 88 percent. In Montana, it 
is 85 percent. In Wyoming, it is 85. You can go down the list to 
Florida, which is No. 42, and 45 percent of all the health care is with 
two firms. The next one is No. 43, California, and it is 44 percent.
  You cannot get the advantage of free enterprise if you do not have 
the competition. What this is about--the whole reason to have a public 
option and the only way you are going to bend the cost curve and get 
this turned around is to have competition. In most of the States, you 
are not going to have competition if you don't have the public option. 
So the public option is turned on its head.
  When I hear people on the Senate floor and on television talk about 
government, government, the one thing government by itself cannot 
provide is competition. In some cases, it is the only way we can 
provide competition.
  Mr. WHITEHOUSE. It is a little ironic to have the insurance industry 
complaining about government entering into the role as a competitor to 
the insurance industry, which is the best possible way government could 
enter into this equation, when, for years, they have fought for and 
protected a government role in the health insurance industry, which is 
to protect them, the insurance industry, from the antitrust laws. 
Government has been involved in health insurance for a long time in the 
worst possible way--protecting these insurance companies from being 
subject to antitrust laws, like every other business in America except, 
I guess, Major League Baseball.
  Mr. KAUFMAN. It is hard to believe when you hear it on the floor--and 
how do they get the ads straight? First, they say government cannot do 
anything right. The next ad says we cannot just have government because 
government is going to take away our business. Either government is 
efficient and organized or it is not.
  So what you begin to see is that there isn't much continuity to the 
arguments against a public option. They bring out the same old 
arguments we heard in 1994 about the public option--and then the public 
option was not like what we talked about before. First, it is an 
option. People don't have to do it if they don't want to.
  It is inconceivable to me--and we have debated this for a long time--
I am trying to see the first indication of how we have competition in 
these States where the overwhelming amount of business is just in two 
firms. Nobody has come to me and said: How are you going to have 
competition? I believe in competition.
  Mr. WHITEHOUSE. Particularly when those two firms aren't subject to 
the antitrust laws, they are able to price-fix and do things like that. 
For them to complain about competition after having used government to 
wall themselves off from the basic law that protects competition, you 
kind of have to believe the irony department is open late at night at 
insurance companies.
  Mr. BROWN. We know what they say about why they are against the 
public option. We know what conservatives--many of whom have been close 
allies of the insurance industry in their campaigns for years--we know 
what they say: government take-over. The government cannot do anything 
right, and the government will run them out of business.
  We know the real reason the insurance industry is fighting this: they 
have has a 428-percent increase in their profits. As they get bigger 
and bigger and squeeze smaller insurance companies out, they know the 
public option will mean no more huge profits.
  We know the insurance industry will continue to make profits because 
they are smart and sometimes they are well run. They have been around a 
long time. They are going to have marketplace advantages. We know CEOs 
of the 10 largest companies made an average of $11 million. That means 
a lot of vice presidents are making $3 million, $4 million, $5 million, 
and $6 million. They like that gravy train. Of course, the people 
making the decisions at the insurance companies, doing the lobbying, 
hiring the lobbyists, and hiring the PR firms, and making decisions to 
run television ads, these are all people who want this to continue.
  There was an article in the Time Magazine that came out today that 
every Member in Congress in both Houses has an average of 2.3 industry 
lobbies--that may just be the drug companies or insurance companies 
together. There are hundreds of lobbyists around here to protect health 
insurance profits and to make sure the top executives are making $6 
million, $8 million--up to Aetna's CEO, who makes $24 million a year.
  They have a lot at stake in this. But you know what, we have a lot 
more at stake. What we have at stake is we have people--we can read 
letters when we come to the floor. A lot of us day after day read 
letters from people who have preexisting conditions and have lost 
insurance or a 24-year-old who just graduated from college or just came 
back from the military and cannot get insurance because they had 
asthma, as my wife does, when they were 12 years old and cannot get 
insurance or their mother got really sick and the insurance practice 
called, I say to Senator Whitehouse, rescission--that is a fancy word--
we are dumping you off the insurance because you cost us too much 
money.
  It goes back to what you were saying. The business model is, we do 
not want to insure sick people or people who might get sick, and if we 
do insure them, we want to find ways not to honor their claims, not to 
pay their claims. The industry will fight like a dog, in many cases, to 
keep from paying those claims. It is a dysfunctional model in business. 
It is bad for our society. It is really only correctable by a public 
option, injecting that competition and keeping those companies honest.
  Mr. WHITEHOUSE. One of the ironies in all this is that whole scheme 
of the insurance companies is actually increasing the cost of American 
health care. I think from 2000 to 2006 the administrative costs of 
insurance companies went up over 100 percent. So they are loading on 
more and more people whose purpose is to do just what you said, which 
is to interfere with the doctors, to require more and more prior 
approvals before you can get treatment, to do more and more claims 
denial--all of that. And then not only does that add costs to the 
health care system within the insurance company, but then the doctors 
have to fight back.
  In Rhode Island, I go all around to doctors and medical practices and 
community health centers. The standard number that I hear is that 50 
percent of the personnel of a doctor's office or a community health 
center is not dedicated to providing health care but dedicated to 
having to fight back against the insurance industry.
  I visited the Cranston Community Health Center a few months ago, and 
they said that more than 50 percent of their personnel is devoted not 
to the

[[Page 25424]]

health care function but to the ``fighting with the insurance company'' 
function. Plus they have to spend $300,000 a year that could go to 
health care for consultants and computer programmers who help them 
fight with the insurance companies. It is not just half the personnel, 
it is also a $300,000 consulting expense.
  You put the two together, and it is a huge cost and a great 
opportunity for a public option to cut through all of that, to knock 
off the administrative expense on their side, costs on the doctors' 
side, and bring costs down.
  (Mr. KAUFMAN assumed the chair.)
  Mr. BROWN. They use the term ``medical loss ratio.'' They want to 
keep the medical loss ratio as low as possible. The medical loss ratio 
is often 75 percent. That means that 75 cents on the dollar goes to 
actual health care, doctors, hospitals, physical therapists. The other 
25 percent is insurance company overhead. They call every dollar they 
spend on health care a loss. That is the way they think. That is the 
insurance company model. So if the medical cost ratio goes up to 85 
percent--in other words, they spent 85 percent on medical care--they 
don't like that. They want the medical cost ratio to stay low because 
the rest is marketing, profits, and insurance company salaries. It is a 
curious turn of a phrase. I think they are phasing that term out 
because I think they know ``medical loss ratio'' does not sound good to 
them.
  Mr. UDALL of New Mexico. Something Senator Whitehouse mentioned 
earlier that should be driven home very strongly is the antitrust part 
of this. I am not sure people out there know what we are talking about 
when we say these large insurance companies that are making all these 
profits are exempt from the antitrust laws. We know. We were attorneys 
general. We had to get into antitrust cases as attorneys general.
  What it means is that the antitrust laws say: As you get bigger and 
you get a more concentrated market, the government can weigh in and say 
the market is too concentrated; there is not enough competition. What 
we have done with these insurance companies is we have said: Oh, no, 
no, we are not going to use the antitrust laws; we are going to exempt 
you from the antitrust laws. That is something I think the average 
citizen does not realize. It applies in most of the rest of the economy 
to encourage competition, but it isn't here. I know Senator Brown and 
Senator Merkley also understand this point. This is a very important 
point.
  Mr. WHITEHOUSE. There is an alarm bell. An alarm rings when a market 
is something called heavily concentrated. The Department of Justice has 
standards for when a market is heavily concentrated. When a market is 
heavily concentrated, that means they look particularly closely for 
anticompetitive conduct. Of course, they don't look at the insurance 
industry because they are exempted from the antitrust laws. But 94 
percent of the major metropolitan areas in America--nearly everyplace--
is heavily concentrated. It is in that uncompetitive danger zone.
  The public option is not only a useful alternative, but we are 
dealing with a market where competition is in a very poor state. So it 
is not as if you are adding an extra competitive element to an already 
competitive market. You are adding an extra competitive market to a 
market that is almost virtually certain to be heavily concentrated and 
to show none of the signs of healthy competition that one looks for in 
a healthy marketplace.
  Mr. MERKLEY. So not only do we have little competition because there 
are many markets with only a couple of companies providing services, 
but because of the antitrust provisions, those companies are allowed to 
talk to each other, to collaborate on what rates they charge or what 
deals they make with providers, further reducing competition, even when 
there are a couple companies in the market.
  If we take and flip this notion of competition and look at it through 
the eyes of the individual working American, then what it becomes is 
choice. Lack of competition in the marketplace equals lack of choice 
for individual Americans.
  I read this story in the press last weekend in central Oregon about 
this fellow who could not get an MRI. He had probably very few choices 
about what insurance company he could go to. Would it not be great if 
he would have the ability during an open window each year to be able to 
say: I am not satisfied with the service I am receiving or I am not 
satisfied with the premium I am being charged, and I want to change to 
a different company or a different provider to see if they do a better 
job. That is the heart of the American capitalist system if there is 
competition and, therefore, choice for the individual. These two things 
go hand in hand.
  When folks say that what will happen with a public option is that it 
will reduce choice, I must say, what are they thinking, because we 
don't have choice now. But if you bring in a community health option or 
a public option, then you do have real choice as a citizen. You can 
march with your feet. You can sign up for this program or this program 
or this program.
  We have competition between governmental opportunities and 
nongovernmental in other areas. I don't think I would like to say to 
the citizens in the State of Oregon: You no longer have a choice of 
mailing a letter with the post office. Everything you do regarding the 
mail has to be through a private company. I don't think I would like to 
say to the citizens of Oregon: You no longer have the choice of sending 
your kids to public school. You have to choose between solely private 
options.
  It is a positive thing to have competition, and having a strong, 
robust public option is going to create a real opportunity for our 
citizens to choose and, in so doing, create this competition, improve 
service, and lower costs. If we don't lower costs, then we truly have 
not succeeded in health care reform.
  Mr. WHITEHOUSE. Think how many Americans from Oregon or from Ohio or 
from Rhode Island or from Delaware, the Presiding Officer's home State, 
have been able to achieve their dreams because they were able to go to 
a public university in their home State as opposed to private colleges. 
I have nothing against private colleges and universities. I went to 
one. I think they are wonderful. But I am very proud of the University 
of Rhode Island, and for many Rhode Islanders and many people who come 
to Rhode Island to go to URI, that is a great opportunity for them. The 
notion that it should not be there because it is government run and 
government supported and, therefore, makes Brown University 
noncompetitive is just crazy. The facts belie it.
  If you look even closer--I know the Senator from Oregon has talked 
before about the workers' compensation example--half of the States in 
the country have public options that operate in an insurance market and 
provide workers' compensation. Indeed, some of the strongest advocates 
against a public option in health insurance on the other side of the 
aisle have workers' compensation public plans in their home States.
  Mr. BROWN. If I may ask a question, I remember the Senator from Rhode 
Island mentioned some very prominent members of our Health, Education, 
Labor, and Pensions Committee, on which all three of us sit, that they 
were some of the strongest critics of the public option, but their 
States, if I recall, have, in some cases, a single-payer plan.
  Mr. WHITEHOUSE. The Republican leader, Senator McConnell, has a 
public option in his home State of Kentucky that provides workers' 
compensation insurance in competition with private insurers. It has 
been doing it for years. It has a significant market share. I don't 
recall that he has ever criticized that plan. I think it seems to be 
helpful.
  Mr. BROWN. It probably makes them both work better, public option and 
private work better.
  Mr. WHITEHOUSE. In Arizona, our wonderful colleague, Senator McCain, 
with whom I am very proud to serve, is also very antagonistic toward 
the notion of a public option. But in Arizona,

[[Page 25425]]

if I recall correctly, their public option has been in the workers' 
compensation market for 80 years.
  So the notion that when you have a public option it is going to 
creep, crawl, and take over and force out competition is proven wrong 
by the actual facts and history of some of the States of Senators who 
are here making that very argument.
  Mr. BROWN. Didn't you mention the other night the State of Wyoming, 
which is represented by the ranking Republican on the Health, 
Education, Labor, and Pensions Committee--before I ask about Senator 
Enzi and that committee, one of the things I think is important to 
remember when I hear people say this is a partisan effort, we all 
remember in our committee we did 11 days--there was no hurry on this--
11 days of markup, longer than almost any of us can remember in terms 
of that much time in committee, debating and vetting. We adopted 161 
Republican amendments. I voted for almost all of them. I know Senator 
Whitehouse and Senator Merkley did most of them, too, and there are 
some fundamental questions on which we have ideological differences. We 
made a better bill as a result. But Senator Enzi's State has a public 
option or only a public plan? I cannot remember.
  Mr. WHITEHOUSE. In Wyoming, the workers' compensation system is run 
entirely by the government. It is a single-payer public plan. As far as 
I can tell, all of the business community in Wyoming is perfectly 
comfortable with that plan.
  One of the concerns people raise about a public plan is that it will 
give terrible public service, terrible customer service. It has been 
described as if you take the IRS and a department of motor vehicles and 
put them together, that is the kind of customer service you will get 
from a public plan. I doubt very much that the public plan in Wyoming, 
which is a single-payer, government public plan, gives that kind of 
terrible public service because if it did, I would expect the Wyoming 
business community to be up in arms about the way they are being 
treated by their only choice of workers' compensation insurer. Judging 
from the track record, it seems they are pretty satisfied with it.
  I think when you actually go out into the field and look at examples 
of competition, whether it is the Postal Service, higher education, or 
these public plans that do workers' compensation in half of our States, 
we find that a lot of the concerns the people have raised, a lot of the 
fears that seem to animate this debate actually, in reality, appear not 
to prove out.
  Mr. BROWN. I would add from what Senator Whitehouse said that you can 
look another place and you can see how in very quantitative and very 
specific, giving example comparisons that Medicare versus private 
insurance--we know the cost of bureaucracy, the cost of marketing, the 
cost of future profits, and the cost of high executive salaries. 
Private insurance means they have a 15-percent absolute minimum, more 
than 20, 25, sometimes 30 percent administrative costs. Medicare has 
somewhere around 3 percent overhead, administrative costs. Medicare is 
a public plan. The private insurance companies really don't compete 
very well with Medicare in terms of measuring them for administrative 
costs.
  Whether you look at workers' comp plans when there is a public option 
or you look at workers' comp plans in Wyoming where it is single-payer 
or you look at Medicare, you can see that this argument they make that 
the government can't do anything right is pretty wrongheaded, 
especially when they are afraid that government does things so 
efficiently, it is going to run them out of business.
  We know public plans can coexist, side by side, with private plans 
and make the private plans a lot better. I argue the private plans will 
make the public plans perhaps more flexible too. It will help both.
  Mr. WHITEHOUSE. That is what competition is all about.
  Mr. BROWN. That is what competition is all about.
  Mr. WHITEHOUSE. I have to depart, and I yield the floor to the 
distinguished Senator from Ohio. But before I go, I want to express my 
appreciation to him for convening us and for his energetic and constant 
advocacy on this subject. I think he has been a wonderful leader of our 
caucus, and I wish I could stay longer, but I have a plane awaiting me.
  So I yield to the Senator from Ohio.
  Mr. BROWN. I thank Senator Whitehouse, and I will wrap up too. I 
think this discussion is much better than a speech, frankly, from any 
one of us. I appreciate the contribution of the Presiding Officer, Mr. 
Kaufman, the Senator from Delaware, to this discussion, more than 
debate, as well as Senator Merkley, who was with us, and Senator Udall 
of New Mexico.
  As I close, let me run through a couple of these posters reflecting 
the monopoly that has caused so much hardship for so many people in 
State after State after State. In my State, two insurance companies 
have a huge part of the market. In parts of southwest Ohio--the 
Cincinnati and Dayton areas--two insurance companies have about 80 
percent of the market. In Senator Udall's State, it is very high. In 
some States it is even higher.
  When you have that lack of competition in States, you can see what it 
brings to us after that. It brings huge profits. Having so little 
competition, it means these insurance companies get larger and larger 
and push out smaller insurance companies and we end up with two or 
three companies. Without competing much with each other, what do you 
end up with? You end up with a 428-percent increase in profits over 7 
years. You end up with the 10 top industry CEOs making $118 million, 
headed by Aetna's CEO making $24 million last year. So what happens? 
Forty-seven million Americans don't have insurance. Insurance premiums 
more than doubled in 9 years. If we do nothing--as many on the other 
side suggest, and certainly the insurance companies would like that--we 
will see insurance premiums double again in the next 7 or 8 years, 
putting such a burden on small businesses and making our big companies 
less and less competitive internationally. We all know what that means 
in terms of jobs for our people, especially in manufacturing.
  Again, what fuels all this? What fuels all this and all these dollars 
they are making is the insurance company business model. The insurance 
company business model is to deny care--to deny insurance, to start 
with--by using very sophisticated sales practices to keep people from 
even buying insurance if they are sick, if they have a preexisting 
condition that might be expensive. That is part of the business plan. 
The other end of the business plan is to deny care as often as they can 
for people who have insurance.
  So we know what we need to do. We know a public option will make a 
huge difference in keeping the insurance industry honest. A public 
option will make a huge difference in providing competition. And a 
public option will make a huge difference in keeping prices down. That 
is why we are here tonight. That is why I appreciate the work of 
Senators Kaufman, Udall, Merkley, and Whitehouse, and why I believe 
come December, when this work is completed on this health insurance 
bill--which, frankly, our government has been working on for 75 years, 
since Franklin Roosevelt tried it--we are going to finish with a good 
strong plan, with a robust public option that will make a huge 
difference in people's lives.
  Mr. President, I yield the floor, I thank my colleagues, and I 
suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Begich). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BROWN. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Franken). Without objection, it is so 
ordered.

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