[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[House]
[Pages 26089-26096]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       30-SOMETHING WORKING GROUP

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Connecticut (Mr. Murphy) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. MURPHY of Connecticut. Mr. Speaker, I am glad to join my 
colleagues on the floor this afternoon to talk about the final stages 
of our push to complete what has been a very long journey to bring 
health care to the millions of Americans that don't have it, to lower 
the cost of care for the millions of small businesses and families that 
can't afford it, and to start finally doing something about the great 
burden to taxpayers in this entire economy of the cost of a system that 
outpaces all of our competitive neighbors across the globe by a two-
fold margin. We will hopefully be joined here on the floor by some 
other Members who are just as interested in reform this afternoon.
  Let me start out by saying that this really should be a bipartisan 
issue. Health care reform, which touches individuals no matter whether 
they are a Republican or a Democrat, whether they are a liberal or a 
conservative, should be a bipartisan issue. We should be sitting here 
working together to try to pass reform. Because when it comes down to 
it, there is, I think, broad bipartisan agreement, both in this House 
and out in the public, about what the problems are out there.
  We have too many people that are playing by the rules, doing 
everything we ask, getting the job, being employed, putting food on 
their table for their family and their kids but they can't get health 
care insurance. Five out of six of the uninsured in this country are 
part of a family that have at least one full-time worker.
  We agree that it doesn't make sense that there are so many people who 
are doing everything we ask and simply can't afford to have health care 
insurance. We also agree that it doesn't make too much sense that 
doctors have seen a lot of the joy be taken out of the practice of 
medicine as they spend more and more of their time filling out 
paperwork, hiring claims managers and fighting with insurance 
companies.

                              {time}  1500

  We need to get physicians back to the practice of medicine and get 
the practice of medicine away from the practice of arguing over 
reimbursement.
  We agree that the cost of our current system cannot be sustained, 
whether it is for an individual business that has seen its health care 
insurance premiums increase by 120 percent over the past 10 years or 
whether it is for the employees, the families that make up that small 
business or that large business who have seen their share of health 
care insurance costs increase by a similar percentage.
  We all should agree that the current trajectory of costs for this 
government is unsustainable as well. The reason that Medicare is on a 
path towards bankruptcy is not just because you have an enormous amount 
of individuals, the baby boomer generation, entering Medicare age. It 
is also because we have constructed a system which pays far too often 
for volume of care that has nothing to do with quality of care, and we 
are paying for a lot of medicine out there, billions of dollars worth 
of medicine, that isn't adding any actual value to the health care that 
people get.
  I bet you if we got together a random sample of Republican and 
Democrat Members of Congress or Republican and Democratic voters or 
liberal and conservative voters, I bet you there wouldn't be too much 
disagreement that we as a society and as a government should step up to 
the plate and do something about the fact that we have got too many 
people playing by the

[[Page 26090]]

rules who don't have insurance, that we have too many businesses that 
are bearing the cost of an unsustainably high system, that we have too 
many physicians that are spending too much time arguing for 
reimbursement and not on providing care, and this government is 
spending too much money on medicine that doesn't add value.
  The difference, though, comes in our commitment to doing something 
about the problem. That is where the rubber hits the road. It is one 
thing to go out into the public as an elected official and say that you 
understand people's problems, that you feel their pain when it comes to 
health care. It is another thing to have the courage to come down to 
this House floor and put your vote and put your advocacy where your 
mouth is.
  That is the problem that we have in the House of Representatives 
right now, that it is only one side of the aisle that is proposing 
real, sustainable, transformational reform to our health care system 
which provides answers to those businesses, those families and those 
taxpayers who know in their hearts that the status quo is 
unsustainable. It is unfortunately the Republican minority here in the 
House of Representatives and in the Senate which has decided to be the 
Party of No, which has decided to stand in the way of health care 
reform.
  Now, I want to take my Republican friends at their word. I want to 
believe them when they say that they are for reform as well. But it has 
been about 135 days since the Republican leadership announced that they 
were going to put a plan with real words and text and ideas behind it 
so that the people out there could compare the proposal for health care 
reform that has been proposed by President Obama and the proposal put 
before the American people by the Republican minority. Well, it is 133 
days later, over 4 months later since this declaration was made, and we 
are still waiting. We are still waiting.
  Now, I don't know why that is. There are some out there that will say 
that the objective of the Republicans is to stop reform from happening 
for political reasons; that they think they can do damage to the 
Speaker or to the Senate President or to the President by stopping 
health care reform from happening. And those critics look back to the 
years when President Clinton tried to address this issue, and it was 
widely understood that then-Minority Leader Gingrich decided that his 
path to the speakership laid in destroying the President's plans to try 
to reform our health care system.
  I hope that is not the case. I hope that our Republican colleagues 
here are not opposing health care just because they see political gain 
in it.
  There are some out there that say that the opponents of health care 
reform are allied with the status quo, are allied with the insurance 
companies and drug companies and other industries that may not have an 
interest in reform. That is certainly the emerging case, that the major 
health care industries that certainly have a lot to lose from a system 
that transfers the profits they are making and turns it into help for 
middle class families are going to try to stop reform from happening.
  I will say I think a lot of people have been pleasantly surprised 
that there has not been as much opposition to this debate as maybe one 
would have expected from the insurance and drug industries. Frankly, I 
congratulate them on making an honest attempt to be part of this 
process. But, as we have seen over the last few weeks, those industries 
are starting to inch away from the table, potentially starting to 
prepare to bring the full weight of their money and influence down on 
stopping health care reform.
  I hope that my Republican colleagues aren't stopping health care 
reform from happening because of their alliance with some of those 
industries. But if it is not because they have something to gain 
politically, if it is not because the Republicans have an alliance with 
the status quo industries, then we are sort of left at a loss to figure 
out why, if we agree on the problem, if we agree that something has to 
be done, why we can't come together on trying to fix it. We are now 
entering the final stages of this debate, but it is not too late for us 
to be able to come together here and get behind some common solutions 
to what is undeniably a common problem.
  So we are going to continue to come down to this floor and call out 
our Republican colleagues who seem to be out there saying they are for 
reform, but when it comes to the actual process of coming up with a 
bill are nowhere to be found, and when they say they are going to come 
up with their own bill, leave us waiting for over 4 months to find it.
  We are going to continue then, in absence of real alternate solutions 
or cooperation from the Republicans, to press our ideas forward, to 
talk about how we can bring together this Nation around some basic 
principles of fairness; that insurance companies shouldn't be able to 
kick you off your insurance when you get sick; that insurance should 
actually go back to being insurance so you don't have to be charged 5 
times, 10 times as much just because you have cancer; that we should be 
able to pool together the purchasing power of individuals and small 
businesses so that they no longer are negotiating with the insurance 
companies just based on behalf of their one family or their 10 
employees; that we can still base reform off of the free market, but we 
can try to structure the free market in a way to give a little leg up 
to all the people getting the short end of the stick in the existing 
market, small businesses and individuals.
  We can reach out a helping hand to those people that I mentioned at 
the outset who are playing by the rules, who are doing everything we 
asked them to do, and help them buy insurance. Not by buying it for 
them, not by handing them a government-run insurance program, but by 
helping individuals with tax credits that will partner with their own 
money to try to buy insurance for themselves and giving them the option 
to buy into the same type of plan that every Member of Congress, every 
veteran, every soldier, every Medicare beneficiary has, a government-
sponsored health care insurance plan.
  We are going to talk about those ideas, because those are unifying 
ideas that bring together businesses, individuals, families and 
taxpayers, to try to get insurance to people that don't have it, to try 
to lower the cost of insurance for businesses that are being crippled 
by our current system, and to try to put back some fairness into the 
insurance markets for American families.
  I hope we are in the final stages. I hope it is not too late to get 
bipartisan cooperation on this. But we can't wait any longer.
  I am so glad to be joined on the floor by my good friend from Ohio, 
Mr. Tim Ryan.
  Mr. RYAN of Ohio. Just to continue on as you were saying, one of the 
key components of this legislation is to help small business people, 
and I think in the long term this is going to be part of long-term 
strategies in the United States. We are working on the stimulus package 
and other job-type programs, but if we don't have and put in place 
long-term, systemic changes to health care, we are going to continue to 
impede long-term growth in the United States.
  What we are saying here is, why are all of these small businesses 
putting so much of their budgets into health care when that money 
should be going back into buying new machines, hiring new employees, 
paying their employees more? It is because the cost of insurance keeps 
eating up more and more of their budget, so wages have been stagnant. 
So what we need to do is continue to reinvest back into these 
companies, and that is what this bill is all about.
  Over the course of the last couple of days, we heard our friends on 
the other side, Mr. Speaker, time and time again continue to talk about 
we are removing choice. That couldn't be further from the truth. We are 
trying to increase choice. The idea of the public option is to increase 
choice.
  Our friends on the other side, boy, if it came to a trade agreement, 
if you would pull up the Congressional

[[Page 26091]]

Record and you would listen to these folks talk about trade, choice, 
increased competition, lower prices, it will have all these great 
effects throughout the market. But now when we say we want to introduce 
choice into the health insurance reform package, giving more options, 
maybe even a public option, a Medicare-style option for people to be 
able to go into and buy into, all of a sudden they are against it, Mr. 
Murphy. They are against choice.
  The fact of the matter is that this bill in the long term has a human 
rights component to it, as you stated, with eliminating preexisting 
conditions, making sure that people don't go bankrupt. I think those 
two in and of themselves would be transformational reforms to the 
health insurance program.
  Our friends yesterday in their long line of speakers, they were all 
talking about being scared. I think at the end of the day, our friends 
on the other side are going to be most scared when in November or maybe 
even early December we have a vote on health care for America, and when 
they are really going to be scared is when they vote against health 
insurance reform and they wake up the next morning and they look in the 
mirror and they say, I just voted against eliminating preexisting 
conditions; I just voted against having a cap on how much an American 
can spend per year as a percent of their income so they don't go 
bankrupt. I voted against it. I voted against subsidies to make sure 
that people could afford health insurance.
  That is not going to be a good holiday season for a lot of folks, 
waking up realizing they did that. I think it sounds good now to be 
against this and appeal to the radical fringe of the Republican Party, 
to appeal to the tea baggers, to appeal to those people who are 
completely anti-government. It may sound good. It may be comfortable 
right now to be in that position. But at the end of the day, history 
will look back and say who was pushing this reform to make health care 
more affordable and to address these human issues, and there are going 
to be folks on the wrong side of that.
  Mr. MURPHY of Connecticut. Mr. Ryan, what comes with that is a 
defense of the current system, and whether it is part of their 1-minute 
remarks when they come down to the floor or not, for the party who had 
control of this House for 12 years, who for eight of those years had 
the White House at their disposal as well, they had plenty of time when 
they had control of the House, the Senate and the presidency to do 
something about health care, and they didn't do it. So you combine that 
inaction along with their opposition to this reform effort and you get 
a party which is the party now that is defending the existing health 
care system as it stands today.
  Listen, we don't govern by polls here, but I think some polls give 
you a little idea on where the American people are coming down on this 
fight. All the polls that I have seen that ask this question, if health 
care reform fails, who will you blame, make it pretty clear that they 
know that if health care reform falls apart, which I don't think it 
will, that it will be the Republicans who sent it down.
  That is not what people want, because they know the status quo 
doesn't work. They understand that this mythology of competition just 
isn't for real; that in half the States in this country there is one 
insurer that controls 50 percent or more of the business, and in three-
quarters of the States there are two insurers that control almost two-
thirds of the business. If you are a small businessman right now, 
because you are only bargaining on behalf of a few of your employees, 
you are paying about 120 percent or more than what some of your bigger 
competitors are paying.

                              {time}  1515

  The competition just doesn't work today.
  So, listen, if you want to talk about what to be scared of, the real 
thing to be scared of is doing nothing, is allowing for the cost of 
this system to continue to explode for families and for small 
businesses to get the short end of the stick when it comes to their 
inability to bargain with insurance companies. What we really should be 
scared about is for politics to drive a wedge into the heart of doing 
what's right for this economy and our families, Mr. Ryan.
  Mr. RYAN of Ohio. I love when our friends on the other side, oh, my 
God, they're going to start rationing care. Like, are you breathing in 
2009 and hearing and seeing what's going on with the current private 
insurance market? It's unbelievable the rationing that's going on. And 
what we're saying to the insurance companies is no longer will you be 
able to tell an American citizen you can't cover them because they have 
a preexisting condition. Now, that is a transformational step in the 
private insurance markets. But right now we have our friends on the 
other side of the aisle and across the dome saying that somehow this 
system is okay.
  And you know what? This will be a Democratic bill when it passes, and 
we're all going to have to live with the consequences. But I will tell 
you, I'd much rather be in Niles, Ohio, in December telling my 
constituents that they will never be denied because of a preexisting 
condition, the 1,600 families that went bankrupt in the 17th 
Congressional District in Ohio, that that won't happen anymore. That's 
a pretty good holiday gift, a pretty good Christmas gift for a lot of 
people in my district. And to go to a small business person and look 
them dead in the eye and say, You know what? Last year your insurance 
went up 15 percent and now they're projected to go up another 15 or 20 
percent as far as the eye can see. And that's the thing we forget to 
talk about is this isn't, Oh, my insurance went up 15 percent in the 
last 5 years. No. It went up 15 percent a year every year for the last 
5 years, or whatever the case may be, and the projections are, in 30 
years, $1 of every $3 in the United States of America will be spent on 
health care. Now, to me, we have a responsibility to do something.
  And when folks say, well, you're going to bust the budget, we're not 
going to do anything. The budget is on its way to getting busted. We're 
trying to fix it. That's what this is all about. And when you have 45 
million people a year without health insurance, and the numbers can be 
disputed, 10 million, 15, 20, 30, 40, we all hear, there are millions 
of people in the United States of America who go into an emergency room 
and call that their health care plan. And then you follow in after with 
your insurance card and you wonder why you're paying $10 for an 
aspirin. Well, because three people just walked in and didn't pay 
anything for an aspirin, so you've got to pay for it, and the people 
with insurance. So those costs get pushed off. That is unsustainable.
  Let's get these people in the tent, get them preventative coverage. 
We can give them a $20 prescription, Mr. Altmire, instead of letting 
them 2 weeks later show up in the emergency room and spend a week in 
the hospital costing us $10,000 or $15,000. Now, this is not rocket 
science, but the trick is taking on the special interests that have 
controlled this town over the past 8 years and trying to wrestle 
control away from them and trying to give it back to the American 
people.
  Now, just think about it. Since the Democrats have taken over, we've 
taken on the oil industry. We've taken on the banking industry and got 
them out of the student loan business. Now we're taking on the 
insurance industry. Whose side are you on? These are the people we're 
taking on, and the American people, I think, once they hear the story, 
are on our team, recognizing we're taking on these big interests.
  Mr. MURPHY of Connecticut. I yield to Mr. Altmire.
  Mr. ALTMIRE. I appreciate the opportunity to be here to talk about 
the importance of why we need to do health care reform. And the 
gentleman from Connecticut has heard me talk many times about an 
experience that I had which alludes exactly to what the gentleman was 
talking about, where a woman in my district came to me and she said all 
the reasons that she was unhappy with the Democrats in Congress, she 
was unhappy with the President. And she said to me, Don't you

[[Page 26092]]

dare take my money to pay for those people who don't have health 
insurance.
  And I said to her, Well, the problem is you're already paying for 
them. As the gentleman articulately said, if you go to the hospital and 
you don't have insurance, you get treated. They cover you; right? You 
get whatever the health care you need. It's the least efficient, most 
costly setting. But they're going to transfer those costs to the next 
person who comes through the door that has insurance.
  And this woman said to me, It's interesting that you say that, 
because I just had a procedure done at the hospital and I had to pay 
$18,000 out of pocket because the insurance denied part of my claim, 
and I asked the hospital, she said, why does everything cost more than 
it should? Why does an aspirin cost $10? Why does everything cost five 
times more than you would think it costs? And she was told, as the 
gentleman talked about, well, that's because of the cost shift that 
takes place to pay for the people who don't have coverage, a cost shift 
to the people who do have insurance. And that's the crux of the whole 
thing.
  I hear all the time you guys agree on 80 percent of this; right? 
Everyone agrees we should do the insurance reforms, no preexisting 
exclusions, no caps on out-of-pocket expenses, lifetime or annual caps. 
The insurance companies will have to take all comers. They won't be 
able to drop you if you get sick or injured. They won't be able to deny 
you coverage for any reason. And everyone does agree on that. Yes, we 
should do that. The problem is we can't do that by itself.
  And the reason health care reform has never happened before is 
because of the hard decisions that have to be made, the decisions that 
we're going to make in this Congress and the decisions that for a 
hundred years since Theodore Roosevelt, literally a century ago, first 
started talking about health care reform we've failed to do as both 
Congresses and administrations, both Republican and Democrat. And those 
decisions include: How do you get people into the system who aren't 
insured? How do you do that?
  The only way that works, the only way that you can tell the insurance 
companies you have to take everybody no matter how sick they are and 
you can't use their health status to set their rates, the only way that 
works is if you get the young and healthy people into the system, the 
24-year-olds who are currently offered insurance by their employers but 
they turn it down because they think there's something they can do 
better with the $200 monthly premium than buy health insurance. And 
they say, Well, I'm young. I'm healthy. I feel good today. I'd rather 
do something else with that money.
  Well, we have to find a way to get the young and healthy people into 
the system. If you're going to require people to have health insurance, 
you have to find a way to help them afford it as individuals and as 
businesses. Because if you're a small business--and almost half of 
small businesses are unable to offer health insurance now because it 
costs too much. If you're a small business that can't do that, it's not 
because you don't want to. It's not because you're a bad person. It's 
because you can't afford it. And this bill is going to help small 
businesses find a way to offer health insurance to their employees. 
It's going to offer tax credits, if we do this right, and small 
businesses will be able to offer health insurance. Individuals who are 
required to have insurance that can't afford it are going to receive 
some assistance to help them do that. And what that does is it offsets 
the risk pool. It balances out what we all know needs to be done on the 
insurance side with the preexisting conditions and the exclusions.
  So that's what we've never done. We've never made the hard decisions 
on the 20 percent that we all know needs to be done but we can't agree 
on how to do it. But there is 80 percent that is easy. But you can't do 
one without the other. So that's what we're going to try to do is do 
both.
  Mr. MURPHY of Connecticut. Reclaiming my time, I think, Mr. Altmire, 
that our Republican friends know that, because there's a reason they 
didn't do the 80 percent while they were here and in control of the 
House and in control of the Presidency, because it does necessitate the 
other 20 percent being done at the same time.
  We all agree that preexisting conditions shouldn't be a reason for 
exclusion from health care, but as you said, you have to make a tough 
decision to get there, and that's that we have to ask all individuals 
to participate in health care. And then you have to be prepared to do 
the things necessary for those that don't have the means to be able to 
comply with that mandate. Those are the hard things that have prevented 
health care reform from happening.
  But you know what? If this job was just about the easy things, there 
would be a lot more people that would want to be Members of Congress. 
But this job is about doing the hard stuff. This job is about making 
some decisions that aren't easy regarding how you get to universal 
coverage, regarding how you expand the life expectancy of Medicare.
  I mean it's worth talking about that for a moment, Mr. Ryan. We get 
all sorts of Republican Members coming down here decrying the fact that 
this bill starts to slow the rate of growth of Medicare, but they're 
the same exact people who come down here and talk about how Medicare is 
so broken and how it's going to go bankrupt and how Congress has to 
come and do something about it. Well, guess what? There are only two 
ways that you can fix Medicare. You've either got to send less money 
out of Medicare or you've got to bring more money in.
  So our solution is, before we ask workers and employers to pay more 
in Medicare taxes, let's make Medicare efficient first. Let's get rid 
of the waste and the fraud and the abuse that's in Medicare today so 
that we don't have to ask more people to pay into the system or that we 
don't have to raise the age of eligibility.
  Yet we have people out there trying to scare seniors, telling them 
Medicare is going to be cut without telling them that all that's being 
cut are the payments to insurance companies and the drug companies and 
the money that goes to health care systems that are performing a lot of 
extra treatments and procedures without any extra value and that their 
benefits actually get better, Mr. Ryan.
  Mr. RYAN of Ohio. And the idea with Medicare, as well, is now we have 
in many areas across the country where people are 55 or 60 years old. 
They lose their job. They don't have health insurance, or they don't 
have very good health insurance. So I hear a lot from people in 
northeast Ohio that say, Well, I'm going to wait until I get into 
Medicare. I'm not going to get anything now. I will get some real basic 
coverage, if anything at all. I'll wait until I get into Medicare.
  So we have people who now basically don't have insurance that are 60 
years old and wait years before they go into the Medicare program who 
end up with very small problems not getting addressed and they become 
very big problems, and sometimes chronic problems by the time they get 
into Medicare, which is very, very expensive. But if everybody has 
health insurance, then you will get the kind of preventative care, the 
kind of screenings that you need, the kind of preventative treatments 
that you need to prevent you from going into Medicare and costing a lot 
more money.
  So, overall, when we talk about slowing the rate of growth to 
Medicare, it's because there will be a healthier consumer, a healthier 
patient going into the Medicare program, which is going to have 
significant savings over time. But that's not brain surgery. That's 
just a smart way to run it.
  I mean, I think that if you would ask somebody to draw up the worst 
possible health care system for costs and efficiency, they'd say, Well, 
let's wait until you get really, really, really sick and then you go to 
the emergency room and get in line with everybody else who waited until 
they got really, really sick or had a major accident and you get in 
line with them. That's the worst way to do it. So we're trying to fix 
that.
  Mr. MURPHY of Connecticut. I yield to the gentleman from Maryland.

[[Page 26093]]


  Mr. SARBANES. I appreciate it.
  I want to just echo what my colleagues are saying in terms of 
strengthening the Medicare program.
  The savings that we're going to get out of the current program which 
come from being smarter--one way to do it is to be smarter on about how 
we deliver care and how we manage care, and we can realize savings that 
way.
  The other way, and I'm sure this has been addressed in part already, 
is to go after some of the fraud and waste and abuses there. I mean, 
``60 Minutes'' did a story recently where they talked about that. Well, 
you've got to put some resources in to crack down with enforcement.
  There was an article a few weeks back about the producer of these 
motorized wheelchairs that cost them $1,000 to make these things. 
They're selling them to the Medicare program for $4,000. Well, that 
doesn't make any sense. That recalls the imagery of the $600 toilet 
seat that the Pentagon used to buy before we cracked down on that kind 
of thing.
  So there are things that we can do, very legitimate things we can do 
to find savings in the Medicare program.
  But what's important to understand, and seniors need to understand 
this, is that much of the savings we're taking, we're not taking that 
and putting it somewhere else. We're actually reinvesting it back into 
the Medicare program. So, in other words, the savings we get from these 
important steps that we take, we can take the benefit of that and we 
can invest it in things like closing the doughnut hole. We can invest 
it in things like more preventative services on the front end so people 
stay healthy instead of getting sick and then it costs more to treat 
them later in the process.

                              {time}  1530

  There is plenty of research that shows that if you cover preventive 
services, if you get rid of that copayment, which we plan to do for 
things like the initial exam, for glaucoma screening, and for other 
preventive services, and you provide that to our seniors, it is going 
to benefit them and it is also going to save a lot of money in terms of 
the system in the long run.
  So it is very important for our seniors to understand that when we go 
looking for savings in the Medicare program, we do that with the goal 
of taking those savings and reinvesting them back into the Medicare 
program to make it stronger. And why wouldn't we want to make it 
stronger at a time when we have this baby boomer demographic wave that 
is coming into the country. Every 11.5 seconds, somebody turns 60 in 
this country. So we know that infrastructure has to be strong, and we 
have to do everything we can to invest in it going forward. That is 
what this bill does. That is why if you are a senior, you ought to be 
behind it 100 percent because it does all of the things that make sense 
for our seniors out there.
  Let me yield to my colleague from Florida.
  Ms. WASSERMAN SCHULTZ. Thank you so much.
  Mr. Speaker, I am glad to be able to be here with my colleagues, both 
of whom are members of the 30-Something Working Group.
  Mr. Murphy, one of the things that has really stricken me when it 
comes to thinking about some of the devastating statistics that are out 
there in terms of describing what our uninsured population looks like 
are our older Americans. Not senior citizens; they are obviously 
covered by Medicare. But there was a 36 percent increase in the number 
of older Americans without health insurance between 2000 and 2009. We 
are literally at 7.1 million uninsured people as of just 2007, which 
means you know now there are more than that who are between 50 and 64 
years old. It is really startling to me that there are that many. That 
is a gap in coverage.
  I know my own mom, who has a preexisting condition, if she didn't 
have a job, would be in that same category. She is 63 years old. She is 
not Medicare eligible yet. The job that she has provides health 
insurance, but she is a cancer survivor. As a cancer survivor, she is 
absolutely uninsurable. I have tried to get her insurance. She needs to 
be winding down her working years; but, unfortunately, there is no 
insurance company on the individual market or anywhere else that will 
insure her if she is trying to buy insurance privately. That is what 
health care reform will solve, for someone like my mom, for the more 
than 7 million people who are older in this country, who are either 
working Americans or who need to be winding down their working years, 
it will provide them with insurance that they don't have to worry about 
losing, that they don't have to worry about it being taken away because 
they have a preexisting condition, that will be tied to them and not 
their job.
  Those are essential reforms. And it just continues to boggle my mind 
that our friends on the other side of the aisle who promised 133 days 
ago that they would have a health care proposal, a health care plan, an 
alternative to ours, the one that they are out there trashing every 
day, and yet they still don't have one. They point to this bill and 
that bill that is maybe pieces of reform. I don't know. When I look at 
my children's puzzles that they have, the only time I think of it as 
whole is when all the pieces are together. You can't call a plan 40 
different pieces of the puzzle and say, Oh, there's our plan. We've 
thrown out some suggestions. That's our version of reform.
  That is not reform. That is just a whole bunch of broken pieces 
laying all over the floor. That is not leadership. Not only have they 
not exercised leadership, they have simply been an obstacle. The 
American people see through it. It is transparent. That is why every 
week that goes by, we pick up more and more support for health care 
reform. That is why 57 percent of the American people, when asked, 
support a public option, support a competitive option to provide more 
choice and more competition with the private market.
  I will stop for now by just giving you my frustration from personal 
experience, because I have to tell you, over the last few months I have 
had an opportunity to talk about my own personal health care 
experience. In doing that, I felt very fortunate after going through 
breast cancer last year, that I had insurance. I had coverage through 
my job here as a Member of Congress. But I am 43 years old, and if I 
left employment with the Federal Government, I would be uninsurable 
because I had cancer. And this is what breast cancer survivors go 
through for the rest of their lives after a diagnosis, no matter how 
unlikely it is that we would have a recurrence.
  For me, as a breast cancer survivor, I took steps to make it less 
likely even than the average woman to have a recurrence. So I am at 
like 96 or 98 percent likely to never have to deal with breast cancer 
again; but I would be uninsurable. That is wrong. Health care should be 
a right, not a privilege. It is just unconscionable. They are lacking 
in conscience, our opponents, and that is all you can call them right 
now is opponents. The opponents of reform have no conscience. They 
clearly don't care about making sure that people like me, people like 
my mom, people like the constituents that I represent who don't have 
insurance but deserve to have it, that they can get it.
  Mr. MURPHY of Connecticut. Ms. Wasserman Schultz, the awe and esteem 
you were already held in before the announcement that over the last 
year and a half you have been battling with this has only increased 
knowing that you were able to keep up the pace of your work schedule 
while going through that ordeal.
  Ms. WASSERMAN SCHULTZ. Thank you.
  Mr. MURPHY of Connecticut. You also know there are a lot of people 
out there who when they get sick can't continue working.
  Ms. WASSERMAN SCHULTZ. Right.
  Mr. MURPHY of Connecticut. I have told the story on this floor at 
least once or twice before about a gentleman who I met not more than a 
few weeks ago who contracted gallbladder cancer. He was an hourly 
worker at a factory in New Briton, and he was going to have to miss a 
number of weeks of

[[Page 26094]]

work to get the initial treatment. That wasn't okay by his employer and 
his employer let him go because of the work that he was going to miss 
and might miss in the future. He is now unemployed because of his 
illness, and he is collecting unemployment benefits, but almost every 
dime of his unemployment is going to pay for the health care costs that 
he still has to bear.
  And so everyone I think out there, now more than ever, as this 
economy puts more people in economic peril, realize that they are not 
just one paycheck away from potentially losing health care, but they 
are one diagnosis away from losing their job and the health care that 
comes with it.
  Ms. WASSERMAN SCHULTZ. If the gentleman would yield, the point you 
are making can't be stressed enough. There are countless individuals in 
this country, countless people. We are talking about people. The 46 
million, when you talk about the 46 million that are not insured, it is 
very easy to glaze over and think about them as an amorphous blob 
rather than 46 million human beings.
  One of those human beings, like your example, the person who went 
through gallbladder cancer, was a woman who came into my office a few 
weeks ago, and she said this to me. She said, I am happy, Debbie, that 
you survived, that you got through your breast cancer. You were very 
fortunate when you were diagnosed. The only thing you had to think 
about was fighting your cancer.
  A day after she was diagnosed for the third time, she lost her job, 
and then she lost as a result her insurance. So at the same time as 
getting a third diagnosis of breast cancer, she also had to battle for 
coverage and has not been able to get the access to care that she 
should have been able to get. That happens to breast cancer survivors 
and people who are victims of disease every single day in this country 
because their insurance is tied to their job. If they don't have a job, 
very often they don't have insurance and they can't get insurance. That 
is just, in this country, in the wealthiest country in the world, in 
the country that people always throw around the comment, we have the 
best health care in the world, no, we don't. We are 29th in infant 
mortality, and 37th in life expectancy. The statistics that Americans 
are dealing with in terms of their likely survival and their health is 
just abominable, because we have a sick-care system, like the gentleman 
from Ohio said, not a preventative-based system, not a well system.
  I yield to my friend.
  Mr. SARBANES. I want to just pick up because when we talk about the 
uninsured, we are talking about 1 out of 7 Americans, and their plight 
is more obvious than the plight of the underinsured, which is another 
whole group of Americans. These are people who have purchased an 
insurance policy. They have been paying their premiums, month in and 
month out. Then they get sick, and it is at that point that they 
discover that the policy they have doesn't come anywhere near covering 
the treatment that they need because there may be a cap on how much the 
insurance company is willing to pay in terms of the medical expenses. 
Or it has high copayments and deductibles associated with it. So there 
you have a situation where people actually purchase coverage. They 
thought that they were in pretty good shape if an illness came into 
their family. But then when that situation confronts them, they 
discover that they are still at severe economic risk. And there are 
thousands of examples of families out there who had insurance and then 
somebody got sick and they have to go into personal bankruptcy because 
they can't afford to make the payments.
  Now, if you were to add together the people who are underinsured with 
the people who have no insurance at all in this country, you are 
starting to get up to about one out of three people in America who are 
at risk in this way. So that means close to 100 million people are 
getting up every morning and they have a knot in their stomach because 
they don't know whether some illness is going to hit them in a way that 
will pitch them over the economic brink. You can't function as a 
society that way.
  What I marvel at is look at how much we have achieved as a Nation, 
even while carrying around this broken health care system on our back. 
Think about what we could accomplish in terms of productivity and other 
things if we could fix this system once and for all. That is what this 
reform effort is all about. There is an industry out there that has got 
to be pushed to do the right thing. The health insurance industry has 
asserted that voluntarily they will change their practices when it 
comes to preexisting conditions and coverage exclusions for that, when 
it comes to rescinding policies based on some technicality that 
occurred at the time somebody was applying, when it comes to making 
their rates more reasonable and pocketing less profits by recognizing 
that they should put more into the medical expenses on behalf of their 
enrollees than they should into their own profits.
  They have told us time and time again, we can fix this problem on our 
own.
  Ms. WASSERMAN SCHULTZ. But they don't.
  Mr. SARBANES. But we have seen, and coming in every day is evidence 
that they can't restrain themselves, they can't really discipline 
themselves. At precisely the moment in this debate when you would think 
they would want to demonstrate restraint and show that they can forgo 
some of those sizable profits, I'm going around my district and hearing 
from businesses and employers who just now have gotten the notices on 
what next year's premium increases are going to be. They are looking at 
premium hikes of 20 percent, 25 percent, 30 percent. Now if a company 
that is only spending 75 cents of the enrollees' dollar on medical 
expense is turning around and sending out a premium notice that says we 
are going to raise your rates by 25, 30 percent next year, something is 
wrong with the picture.
  This shows that left to their own devices, they cannot help 
themselves. That is why we have to move forward and put in place these 
best practices and put competition in place for that industry.
  I have said a number of times, and I will repeat it again today, to 
me this is all about whether we are going to go on living in the health 
insurance industry's world, by their rules, or whether they are going 
to start living in our world by our rules--and they will live in our 
world, they'll do just fine--because we need health insurance in this 
country.

                              {time}  1545

  But they have to start getting with the program in terms of what 
ordinary Americans need and deserve with respect to health care.
  Mr. MURPHY of Connecticut. And Mr. Sarbanes, we've got to remember, 
health insurance is a business, it's a for-profit business. There used 
to be a lot of nonprofit insurers out there, including in Connecticut, 
but they're disappearing. In Connecticut, I'm not sure that we have a 
nonprofit health care insurer that's a viable alternative for folks in 
our State.
  And so as a business, I guess you can understand that what we 
perceive as payments for necessary health care insurance companies term 
``medical loss''; that's what they call the money that they pay out for 
health insurance claims, ``medical loss.'' Because to them it's a loss; 
any money that they pay out to pay claims is less money that they can 
keep for profit or as a return on their investment to shareholders.
  Now, it's a business, so I'm not going to begrudge them the fact that 
in the end their motivation is often profit investment return, but it 
speaks to the fact that the interests of the insurance industry are not 
always perfectly aligned with the interests of their beneficiaries and 
of patients out there, and it is up to a fair-minded, commonsense 
government to try to even out that playing field. That is why this 
health care reform bill has to have all of those provisions that you 
talked about.
  Now I want to just talk for one second about the debate here that 
we're

[[Page 26095]]

having because we would like to think that there is consensus around 
these issues. We talked a little already about the fact that the tough 
decisions are the ones that Republicans were unwilling to make for a 
very long time. But there was a 27, 28-page memo that was going around 
Washington about 6 months back written by Frank Luntz, the sort of 
pollster-in-vogue for the Republican Party. It was a 28-page memo on 
how you kill health care reform. It wasn't an analysis of what the bill 
actually was, it wasn't a summary of the proposals the Democrats had 
put forth and a critique of those proposals, it just said, Here are the 
words and the phrases that you need to use in order to kill health care 
reform without evaluating whether it was a good or bad thing to kill 
health care reform. The supposition from the beginning was of course 
we're going to try to kill health care reform.
  It is no coincidence that the phrases in that memo are the phrases 
that you will hear over and over again uttered on the House floor by 
Republicans, by many of their allies in talk radio, ``government-run 
health care,'' ``socialist takeover of health care.'' The same phrases 
that polled well to people who were willing to stop health care reform 
are the same phrases that are used on this House floor--no connection 
to the bill we are actually debating, the bill that the Congressional 
Budget Office actually says over a 10-year period will expand the 
number of people who have private health care insurance, not contract 
it, but will expand the number of people that are insured by private 
insurance companies.
  But this debate doesn't seem for one side of the aisle to be about 
really the merits here; this debate seems to be about certain catch 
phrases and sound bites that will stop reform from happening.
  Ms. Wasserman Schultz, as you mention, every day, as we sort of 
emerge from the heat of August, it seems that more and more people, 
whether it be in the public opinion polls or in the calls to our 
office, are getting behind the idea of health care reform happening. I 
think that is due to the simple uncovering of these distortions and 
sound bites. People are realizing that the phrases they hear on TV--
it's not all from Republican Members of Congress, a lot of it is from 
the folks who are in the news entertainment industry--they're figuring 
out that there is a very big difference between rhetoric and reality.
  Ms. WASSERMAN SCHULTZ. Well, you're absolutely right. As we came out 
of the ``August of fear'' and were progressing through the fall, every 
day that goes by, with every passing day--add the bogus report that was 
released by AHIP, the Association of Health Insurance Plans of America, 
that tried to scare seniors and scare people into believing that their 
costs were going to go up and that government was trying to take over 
their health care. As Mr. Sarbanes alluded to, forgive us if we don't 
trust the health insurance industry to do the right thing on their own; 
they've had many, many years to do that. For at least some of this 
debate they have been helpful--or at least not obstacles, which is 
progress. And we will hitch our star to any progress that we can make 
when it comes to expanding access to health care and making sure we can 
cover everybody.
  But at the end of the day, the fearmongering isn't working anymore. I 
mean, opponents of reform were singularly focused on scaring seniors, 
on scaring people into believing that the health coverage that they had 
now was going away, that they weren't going to be able to get access to 
quality health care, that somehow we were going to begin rationing. And 
you know what? The American people see through that. They can see the 
transparent attempt to derail reform because their real priority is 
politics. Their real priority is that they are unhappy that they are 
not in power, they have been disrobed, revealed to be essentially the 
frauds that they are because they say now that they want reform, but 
they had 12 years, 12 years that they ran this place--they were in 
charge for 12 years and they did nothing. They controlled everything 
and they did nothing about health care reform.
  So that is why the American people are not responding to their 
distortions and their exaggerations and their fearmongering. The 
American people have had it, and they want health care reform.
  I yield to the gentleman from Connecticut.
  Mr. MURPHY of Connecticut. And the consequences of standing in the 
way of reform, as we've talked a little bit earlier in this hour, is 
defending the status quo. I think that there has been an awakening out 
there that that is just unsustainable. Mr. Sarbanes talked about 20 
percent, 30 percent increases in insurance in Maryland, the same thing 
in Connecticut. Our main insurer that covers more than half of the 
individuals in our State announced just this year a 30 percent increase 
in premiums.
  People have woken up to the fact that the status quo cannot work. 
Whatever the objective is of people who are trying to stand in the way 
of reform, if the result of that is another year of double-digit 
increases of premiums, if the result of that is another year of 
millions of Americans being denied care simply because they're sick, if 
the result of that is another year of the Medicare program being on a 
trajectory to bankruptcy, that just doesn't work for people.
  So I think we have seen this momentum towards reform, in part because 
people have discovered that the catch phrases and the slogans out there 
from the opponents of reform don't have much grounding in the text of 
the bill. And the consequence of going with the people who say, do 
nothing, preserve the existing system, is disastrous for families and 
potentially ruinous for this government.
  Mr. Sarbanes.
  Mr. SARBANES. Well, in August, when we had all this noise and 
commotion that was going on, the other side began to predict the demise 
of the health reform effort. But then September came and October came, 
and a funny thing happened on the way to that demise, and that is that 
people started asking the public again, what do you think, and 
discovered that they weren't about to let go of this thing, that 
they've waited too long to see these reforms.
  If you look at what's in the health reform proposal that we have 
developed in the various committees in the Senate and the House, it's 
almost a checklist of all the things that need to be done to address 
decades of grievances on the part of the American people. I mean, it's 
all there--strengthening Medicare, dealing with the problem of those 
who have no insurance coverage or are underinsured, creating a better 
health care delivery system, focusing on our health workforce and 
making sure we're getting people in the pipeline, improving the public 
health system in this country--which we understand oh so well today we 
have to strengthen when we look at the H1N1 outbreak and the 
infrastructure that we need to put in place. These are all things that 
for decades people have been calling about, and we've never been able 
to achieve the reform. Finally, now it is within our grasp.
  When we were that close to it and the story line began, the narrative 
started to be put out there that this isn't going to happen, that's 
when the quiet majority out there, the American people, said, No, no, 
no, wait a second; we're not giving up on this thing. We've come too 
far to turn back.
  That is why you see, as was mentioned by our colleague, you see in 
every single survey that's conducted that the American people want us 
to act. Only 20 percent of Americans when asked say that the Congress 
should not act on health care reform. Only 20 percent say we should 
just leave things the way they are, because they know that it's time to 
be liberated from the current system and to embark on a system that 
looks after people, that keeps people healthy, that doesn't confront 
them at a moment when they least should be thinking about whether they 
can pay, whether it will bankrupt them. At that moment, when they get 
sick and they need the care, that's when they should be able to rely on 
it. And so many millions of Americans can't do that.

[[Page 26096]]

  So when I hear this discussion about, Let's hit the reset button, 
let's start over again--the American people don't want to start this 
process over. We started back in January of this year with hearings, 
and we did hearings in three committees in the House and two committees 
in the Senate. We gave the public a chance to understand what was in 
this bill and get their input. And here we are 10 months later, it's 
within our grasp, and if we keep pushing, we're going to deliver this 
for the American people.
  Mr. MURPHY of Connecticut. If this was easy, Mr. Sarbanes, it would 
have been done under President Bush. If it was easy, it would have been 
done under President Clinton. If it was easy, it would have been done 
under the first President Bush, President Reagan, President Carter. If 
this was easy, it would have been done already. It's not easy. This is 
one of the most complicated, convoluted health care systems in the 
world, which is part of the source of the problem that we find 
ourselves in today. And so the solution is not one sound bite, the 
solution isn't 10 pages; the solution is tough to come to.
  I have faith that the American people are going to get what they've 
been asking for--as we've mentioned here today--for over 100 years, a 
system of health care which guarantees that they get coverage not just 
when they're very sick, but throughout their lives, and gives it to 
them at a price they can afford.
  With that, Mr. Speaker, we thank you so much for granting us the 
time, and we yield back the remaining time.

                          ____________________