[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[Senate]
[Pages 25633-25635]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. DURBIN. Mr. President, I think we ought to step back and take a 
look at this health care debate. The Senator from Tennessee has raised 
some interesting questions that we should consider and discuss.
  The reality in America today is that the cost of health care is out 
of control. We know it as individuals because the health care premiums 
keep going up. In fact, the health insurance industry not only 
announced but threatened 2 weeks ago that if we pass health care 
reform, premiums are going to go up again. Businesses are now reporting 
they anticipate the cost of health insurance premiums to cover their 
employees to go up at least 15 percent next year.
  This is not new. Unfortunately it has become a pattern, a pattern 
that continues to raise the cost of health insurance across America. 
Fewer businesses offer protection, fewer individuals can afford to buy 
health insurance, and that is the reality, where we are today.
  We have put forward now five different proposals, and the sixth is 
coming, to deal with health care reform. President Obama challenged 
this Congress to work together on a bipartisan basis to solve this 
problem, to bring costs under control. During the course of our debate 
on it, we identified some other serious problems in our health care 
system. We know what the health insurance companies do to people across 
America. They hire literally hundreds if not thousands of employees to 
sit in front of computer terminals with a sign above them that says 
just say no, so when the doctor calls and says I wish to admit Mrs. 
Smith for surgery or I wish to keep her in the hospital an extra 2 
days, the answer is no and the battle is on. I know this because I have 
been in the hospitals of my hometown of Springfield, IL, standing with 
doctors at the nurses desk as they call the health insurance clerks in 
faraway States and beg them to allow a person to stay in the hospital 
so she will be there the night before her surgery. They were turned 
down and one doctor turned to me and said, ``I cannot in good 
conscience send this woman home. I am going to have her stay and we 
will fight them later on.'' I said, ``Does this happen often?'' And he 
said, ``All the time.''
  Fighting health insurance for coverage when you need it the most, as 
they go through your application and find out that you did not put in 
some minor medical experience that you had--you know, it is not a 
fanciful story. In fact, it is a sad story. People have been turned 
down for coverage for health insurance when they need it the most for 
surgery because they failed to disclose they had acne when they were 
teenagers. It sounds as though I am making that up, but I am not. That 
is a fact. When they want to turn you down, any excuse will do. We know 
this is happening. People, because of preexisting conditions, are being 
denied coverage. When they need their health insurance the most, after 
paying into it year after year, here comes that diagnosis that is going 
to require expensive treatment or a surgery or hospitalization or 
missing work, they find out the coverage is not going to be there or 
there is going to be a cap on the coverage.

[[Page 25634]]

  We know these stories. We live with these stories. People are calling 
us, saying the health insurance company says no, they won't pay for it. 
And the battle is on. So part of health care reform is to deal with 
this health insurance reform too.
  I have to say in all candor to my Republican colleagues, they have 
yet to come forward with any proposal for health care reform. They just 
say no. Whenever we come up with a proposal, it is not good enough, it 
doesn't reach the goals they want to reach. But when we ask them what 
would you do, they have nothing. When the HELP Committee, which is the 
Health, Education, Labor, and Pensions Committee of the Senate, now 
under the chairmanship of Senator Harkin and then under the temporary 
chairmanship of Senator Chris Dodd of Connecticut while Senator Kennedy 
was going through his cancer therapy--when they considered this bill 
they had literally hundreds of amendments, 500 amendments in open 
hearing as they went through this bill.
  It is not a surprise. This is a big undertaking. Health care reform 
is the biggest domestic issue we have ever faced in this country--ever. 
It comprises one-sixth of our economy. There were 500-plus amendments, 
day after day, hour after hour, debating back and forth. At the end of 
the day, the bill was finished. The committee had adopted over 150 
Republican amendments they had offered to the bill. Senator Dodd 
believed it had a fair hearing--it is a bipartisan bill with input from 
both sides--and he called the roll in the committee to see if we could 
move the bill forward to the floor. Not one single Republican Senator 
would vote for it. Even after adding all those amendments they would 
not stand up and vote for the bill to move forward to the floor. Again, 
faced with the challenge of writing a bill, it is easier to stand back 
and say here is what is wrong with what you are doing. But in good 
faith they should step forward and be part of it.
  Senator Max Baucus in the Senate Finance Committee had one of the 
toughest assignments. He had to deal not only with policy but also with 
paying for it. That is what the Senate Finance Committee is all about. 
So what Senator Baucus did, for months, was to engage three Republican 
Senators on his committee: Senator Grassley of Iowa, Senator Enzi of 
Wyoming, Senator Snowe of Maine. Three Democratic Senators sat down 
with three Republican Senators and said let's come up with a bipartisan 
bill. Let's try to reach agreement among ourselves as to how to do this 
in a bipartisan fashion. Eventually, after literally months of trying, 
two of the Republican Senators left, leaving only Senator Snowe of 
Maine, who ultimately supported the committee bill that came forward.
  She is an unusual profile in courage in the Senate. She is the only 
Republican in the House or Senate who has ever voted in committee as a 
Republican to bring a bill forward on health care reform. It showed 
extraordinary courage on her part. But it also showed that despite the 
best efforts in both of these committees in open session and in closed 
meetings, we could not get Republican buy-in for health care reform. 
They are opposed to everything.
  Unfortunately, to be opposed to everything is not a way to solve a 
problem. The current health care system in America is unsustainable. It 
costs too much. The costs are going up too fast--not just for 
individuals, families, and businesses, but for government as well. The 
health insurance companies are running roughshod over people who, when 
they need it the most, cannot count on the health insurance protection 
they thought they had purchased. It is a reality that in the bankruptcy 
courts across America today, two out of three people filing for 
bankruptcy in America are filing because of medical bills. It has grown 
over the last few years from one out of three to two out of three. 
Sadly, that percentage is going to continue to grow because you know 
what happens--a person goes in after an accident, a diagnosis, goes 
into the hospital for what appeared to be a brief stay and the next 
thing you know a bill comes rolling through for $80,000 or $100,000 or 
more. These bills pile up in an amazing fashion and you have no control 
over them. You are there at the instruction of your doctor, receiving 
the care the doctor said you should receive. You don't stop before the 
nurse leaves the room and say how much do those pills cost? It is the 
reality that we are helpless, defenseless, when we are in that 
position.
  So people have these medical bills stack up in an attempt to find a 
cure or to save a life. At the end of the day, the health insurance 
doesn't cover them. They file for bankruptcy. But here is the statistic 
you should remember. In addition to 2 out of 3 people in bankruptcy 
because of medical bills, 74 percent of those people filing for 
bankruptcy because of medical bills have health insurance. They are not 
uninsured. They have health insurance that was not there when they 
needed it; health insurance that cut them off when they thought they 
had coverage; health insurance that had a limit on how much it would 
pay and they were left in a position where they were about to lose 
everything. They may be able to hang onto a truck or a toolkit or maybe 
even a small home, but their savings are gone, wiped out, because of a 
diagnosis or an accident.
  That is the reality of where we are today and why we continue to 
engage this issue, despite the controversy that surrounds it.
  Senator Harry Reid is the majority leader in the Senate and he has a 
tough job. He is in the process of taking the two bills prepared by the 
Senate committees, bringing them together into something that can pass 
the Senate. It is hard. There are a lot of policy questions and a lot 
of strong feelings. Within the Senate Democratic caucus are members who 
are very conservative, moderate, and liberal. We have it all, a wide 
range. We agree on some things but there is disagreement when it comes 
to other things. One of the questions that came up, one of the issues 
of controversy, was about the so-called public option. In shorthand, 
the public option is an attempt to create some form of health insurance 
protection that is a not-for-profit plan--it doesn't have to worry 
about paying profits to shareholders; isn't going to buy a fortune's 
worth of advertising; doesn't have to hire a lot of clerks to say no 
but tries to keep costs under control and compete with private health 
insurance companies.
  We should be concerned about this because, without a public option--
and it is only an option--without a public option, these health 
insurance companies have virtually no restrictions on what they can 
charge us. I say that because health insurance--insurance in general 
but health insurance companies--enjoy special treatment under American 
law. There are only two businesses in America that are exempt from 
antitrust law. One happens to be organized baseball; the other, the 
insurance industry. You say: What does that mean? It means that back 
110 years ago when they took a look at the insurance industry, they 
argued that because it was subject to State regulation in every State, 
it was not interstate business. Students of the Constitution know there 
is an interstate commerce clause there that gives the Federal 
Government authority when we are dealing with interstate business. So 
health insurance companies and insurance companies in general were 
judged to be State businesses and exempt from antitrust law.
  Then fast forward about 50 years. The Supreme Court took a look at 
insurance companies and said this has changed. These are no longer 
small insurance companies regulated State by State. They are now doing 
business nationwide, and so the Court decided in the 1940s that the 
exemption from antitrust law would no longer apply. A Senator from 
Nevada serving at that time, Senator McCarran, offered the McCarran-
Ferguson bill, which became law and exempted insurance companies from 
antitrust laws.
  That is a long lead-in to where we are today. What it means is that 
the insurance companies, unlike any other businesses in America, can 
literally meet in a closed room and decide to fix their prices. They 
will decide what premiums they will charge for insurance policies all 
across America. They can

[[Page 25635]]

decide to allocate the market. One insurance company X, you take 
Chicago; insurance company Y, you take St. Louis; insurance company Z, 
you get New York. Any other business that tried to do that would be 
sued by the Federal Government for restraint of trade, for killing 
competition. But they are exempt and that is a fact.
  So when the insurance companies, health insurance companies, tell us 
they are going to raise premiums, mark their words; they are going to 
do it and they have the power to do it and they can do it speaking as 
one and we cannot stop them under the current law as it exists. That is 
the reality.
  The public option says there at least will be a choice out there for 
everybody who is in an insurance exchange, looking for a choice. There 
will at least be a choice out there that is not a private health 
insurance company: a not-for-profit company, not subsidized by the 
Federal Government, that is going to deal with providers across America 
to try to bring costs down.
  The Senator from Tennessee said this public option is what Medicaid 
is but he is mistaken. Medicaid is different. Medicaid is a government 
insurance plan. What is the difference in this situation is there would 
be no government subsidy to this public option and the public option 
entity, the insurance company, the not-for-profit insurance company, 
would have to negotiate arm's-length transactions, negotiate with 
doctors and hospitals on the rates they would be paid. There is no 
government mandate on the rates paid. That is not the case in Medicaid 
at all. So the analogy falls apart. When the Senator from Tennessee 
says public option is basically Medicaid, it is not. Medicaid is a 
government plan, public option is not a government plan. Medicaid has 
government command and control when it comes to the amount they are 
paying. This plan has to negotiate arm's-length transactions. It is 
totally different.
  I might say a word about Medicaid. I asked the Senator from 
Tennessee, earlier this year because of the recession, President Obama 
said: We think the States are in trouble. We think the governments are 
in trouble. With the recession, fewer people are working, fewer people 
are paying taxes, and the demand for government services is going up. 
So we need to help them. We came up with $80 billion, $85 billion to 
send back to the States in a rescue fund so they could get through this 
recession. Unfortunately, we didn't have the support from the other 
side of the aisle. So when the Senator from Tennessee comes in and says 
these governments are facing hard times, it is true they are, but the 
times would have been much harder for these governments without 
President Obama's stimulus package, which tried to help these States 
get through this rough period.
  In the stimulus bill, the State of Tennessee received almost $760 
million in FMAP, which is basically Medicaid payments. There are only 
three Republican Senators who voted for it, not including the Senator 
from Tennessee. So when we tried to help the States deal with the 
expenses they face, many of those who are coming to the floor today did 
not vote for it. I think that needs to be part of the record.
  Let me also say the costs are going up for health care in general, 
and that affects the cost of Medicaid. Medicaid is for the poorest 
people in America. Medicaid, by and large, when it comes to those under 
the age of 65, covers children. These are the children of poor 
families. The only compensation to the doctors and hospitals when they 
show up, if there is any, comes from Medicaid.
  Also, it covers those who are elderly and very poor. You find some of 
them living in nursing homes across America. They have lost everything. 
They have nothing left. They have their Medicare and the help of 
Medicaid.
  The argument that Medicaid is a bad system and poor system--it is 
easy to criticize that system, and it should be improved. What would we 
do without it? What would happen to these elderly people who have 
nowhere to turn and no savings, who are living the last months and 
years of their lives because of Medicare and Medicaid?
  The States, of course, say the Federal Government should give them 
more money for Medicaid. I wish we could. In my State, incidentally, it 
is about a 50-50 split in Medicaid. For every dollar in Medicaid, 50 
cents comes from the Federal Government and 50 cents from the State 
government. Other States are more generous with more money coming in.
  The fact is, I know it is tough on governments to keep up with the 
expenses. What is the alternative? Is the alternative to ignore any 
health care for poor people? They will still get sick. As sick as they 
turn out to be, they will still show up at the hospital, and in our 
compassion we will treat them and the cure will be paid for by 
everybody else who has health insurance.
  I might also say I believe the opt-out provision, which is being 
discussed as part of our approach, says we are going to create these 
public options, these not-for-profit health insurance companies in 
States across the Nation. But if a State decides through its Governor 
and its legislature they don't want to be part of it, they can opt out 
of the system.
  I cannot think of a fairer approach. It will be tough for some States 
to do that because the public sentiment is pretty strong, almost 2 to 1 
in favor of a public option. People understand they want to have a low-
cost alternative and not be stuck with the premiums the private health 
insurance companies decide to charge.
  So I say in response to my colleague from Tennessee, whom I respect 
and call a friend, I don't believe characterizing the public option as 
the same as Medicaid is a fair characterization, and I don't think opt 
out is an unfair approach. I think there is fairness to it, allowing 
each State to make the decision what it will do based on the needs of 
the people who live in that State, and the people in the State will 
have the final say at the next election as to whether the legislature 
and the Governor made the best choice.

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