[Congressional Record (Bound Edition), Volume 155 (2009), Part 20]
[Senate]
[Pages 26638-26643]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. BROWN. Mr. President, when I listen to my colleagues today from 
the Republican side of the aisle, part of me is incredulous. Part of me 
says: I can't believe what I am hearing. The other part says: Of course 
I can believe what I am hearing, because I have heard it since 1995, 
when the Republicans tried to privatize Medicare when I was a Member of 
the House of Representatives and heard it; when I read books about what 
happened in 1965, when Medicare started; and I heard about it in stuff 
I read from the 1930s when F.D.R. first tried to create something like 
Medicare. My Republican colleagues have become the party of no. They 
generally opposed the minimum wage, generally opposed the creation of 
Social Security in the 1930s, generally opposed the creation of 
Medicare in 1965, generally opposed SCHIP to help poor children and 
often not the poorest children, children whose parents had jobs but 
didn't have insurance. The party of no generally opposed most of those 
things. So why should we be surprised that they are opposing health 
care reform?
  What makes me incredulous is to hear them say now that the Democrats 
are going to cut Medicare and that we are going to use the Medicare 
cuts to pay for health care reform. Nice try. For the party of no, the 
party that was against the creation of Medicare, the party that fought 
health insurance forever, the party that, when they got their chance, 
the first time Republicans had a chance, when they had a Republican 
Congress and a Republican President--that was the first time they had 
had that in many years--as soon as they got a chance, they tried to 
privatize Medicare.
  I hear my colleagues come to the floor, at least five of them come to 
the floor and talk about Democrats cutting Medicare. They are the party 
that didn't like Medicare. They are the party that wanted to privatize 
Medicare throughout the 1990s, what President Bush partially succeeded 
in doing.
  We know the history of Medicare is the history of interest groups, 
mostly insurance groups, teamed up with Republicans to try to stop 
Medicare's creation, then the interest groups, led by

[[Page 26639]]

the insurance industry, teaming up with Republicans to try to privatize 
Medicare. And now it is the interest groups, led by the insurance 
companies, teaming up with Republicans to try to kill our health care 
reform, then wrapping themselves in the flag of Medicare, saying: We 
are protecting Medicare. Look what the Democrats are doing. The 
Democrats are going to cut Medicare and pay for health care reform.
  It is such an exaggeration. It is the same arguments, the same 
distortions, the same exaggerations, the same scare tactics we are used 
to. It should not surprise us at all. I see Senator Durbin who is 
familiar with many of these things.
  Mr. DURBIN. Mr. President, I wish to ask the Senator from Ohio if he 
has missed the latest criticism of health care reform. The Senator from 
Tennessee comes to the floor every day and the focus of his attention 
is the length of the bill, how many pages are in the health care reform 
bill. I am not making this up. He has come to the floor, even though 
the Senate health care reform bill is still in process--it has not been 
written; it will be written, posted on the Internet, as promised--the 
Senator from Tennessee comes to the floor and each day the number of 
pages gets inflated. Today he is claiming 2,000 pages in health care 
reform. Then he puts his alternative up and says: I can do it in 200 
pages. It reminds me of the old show ``Name That Tune.'' How many notes 
do you need to hear to name that tune. The Senator from Tennessee says 
he can name that tune for health care reform in 200 pages. Therefore, 
he has a better proposal.
  I wish to ask the Senator from Ohio, how much importance should we 
attach to the number of pages in a bill, and ask the Senator if he 
remembers when the previous President, President Bush, under a 
Republican administration, brought to Congress a 3-page bill to create 
the Troubled Assets Relief Program that cost $800 billion and did it in 
3 pages. Does that tell us there was wisdom in this idea of spending 
billions of dollars to bail out the banks? In Ohio, as you travel 
around, how many people have stopped you and said: Wait a minute. I 
will not support any health care reform bill that goes over 200 pages? 
If it is 201 pages, I want you to vote against it. If it is 2,000, I 
hope you will filibuster it. Has the Senator run into that?
  Mr. BROWN. I know the question in part is in jest, but it is pretty 
interesting, when you contrast this bill with the TARP bill. President 
Bush, Secretary Paulson, and Chairman Bernanke came to us and said: 
Pass this 3-page bill, and we will all be better off. Obviously, that 
didn't quite work the way they wanted. I come to the floor regularly 
and read letters from people around my State, from Zaynesville, Toledo, 
Bowling Green, Athens, Oxford, and Dayton. I guess the Senator is 
right. I don't see anybody saying: Please vote yes for the short bill 
and no for the long bill. I wish we could talk less around here and 
write a little more concisely. The letters I get that I read on the 
floor are letters generally from people who a year ago, if you had 
asked them, would have said: I have really good health insurance or at 
least I think it is good. But then they got sick and found out that the 
insurance company practiced rescission which is insurance company speak 
for taking your policy away or canceling your policy, or they had a 
child. One of my letters is from a woman who had a child and thought 
she had good insurance. The child had a preexisting condition. She had 
her insurance canceled. Others come from people who graduate from 
college. They are 22 years old. They are taken off their parents' 
insurance policy, and they are struggling because they are not making 
enough money. They don't have a job that has insurance at that stage in 
their lives. They would like to stay on their parents' policy for 
another 4 or 5 years, as our bill allows them to do.
  I guess when I hear the assistant majority leader ask that question 
about the length of the bill--and he is right, that is what Senator 
Alexander was talking about mostly, the length of the bill. Part of 
their criticism is the length of the bill. Their other criticism is to 
try to scare people. How long have they been trying to scare people?
  Mr. DURBIN. If I may I ask the Senator another question through the 
Chair, I also understand that the major force opposing health care 
reform is the health insurance companies, the private, for-profit 
health insurance companies that, incidentally, are declaring some of 
the largest profits in their history, even in the midst of this 
recession. This week Humana announced record-breaking profits primarily 
from Medicare Advantage. Medicare Advantage was the health insurance 
companies' challenge to the Federal Government. The private insurance 
companies said: The Federal Government has been running Medicare for 40 
years and has done a rotten job. We can do better. We can cover seniors 
with the benefits promised in Medicare at a lower cost because we are 
the private sector. We know efficiency. We are not a bureaucracy. We 
are the private sector.
  They were given that chance. A few years ago they started offering 
the Medicare Advantage plan to compete with traditional government-run 
Medicare. At the end of the day, after years of evaluation, what we 
found was the private companies were charging 14 percent more, many of 
them, than government-run Medicare, which meant that the Medicare 
Program was paying them more for the basic benefits than what the 
government was asking to provide the same benefits.
  These health insurance companies have gotten rich on it. Humana this 
week announced a record-breaking profit primarily based on their 
Medicare Advantage plan which was supposed to save us money. In fact, 
it cost us more money.
  I say to the Senator from Ohio, when we write a bill that deals with 
health insurance reform to stop these major companies from denying 
coverage to people for preexisting conditions, putting a cap on the 
amount of money that they will give them if they have a serious 
illness, you can count on these health insurance companies hiring their 
law firms, teams of lawyers to fight us. If it takes another 50 pages 
or 100 pages to make sure we state clearly in the law the rights of 
American families and consumers and businesses when it comes to health 
insurance reform, that is paper well spent. That is time well spent.
  I ask the Senator from Ohio, he has listened to the Republicans on 
the other side of the aisle. I have yet to hear the first Republican 
Senator come forward in favor of health insurance reform. They have not 
come out for the consumer protections which are fundamental to our 
bill. I ask the Senator from Ohio if he has heard that?
  Mr. BROWN. No, I haven't. Again, who are the major opponents to this 
bill? It is two groups. It is the insurance industry, and it is the 
Republican Party. Not Republicans who live in Springfield, IL or 
Springfield, OH, not Republicans who live Urbana, IL or Urbana, Oh. 
They are Republican Members of Congress. They are very closely aligned 
with the insurance industry. Of course, they are not going to support 
this legislation because the insurance industry didn't write it. In 
fact, it is legislation that the insurance companies obviously don't 
much like. We have seen these battles before. They did it with the 
creation of Medicare, the same arguments and scare tactics, the same 
distortions and the same exaggerations. And we are seeing it again.
  The Senator mentioned Humana. Look at this, Humana profits, while 47 
million Americans are uninsured and tens of millions more underinsured, 
premiums double in 9 years, small business premiums increase by 15 
percent or more in 2010. Small business always gets hit harder than 
larger companies, because they can't spread their risk quite as much, 
because the companies can charge smaller businesses more for their 
insurance than they can charge larger companies.
  You go back to their business plan. Look at what insurance companies 
do. The private sector says the government has these big bureaucracies. 
Medicare administrative expenses are

[[Page 26640]]

significantly under 5 percent. Private insurance administrative 
expenses are anywhere between 15 and 30 percent. Look at their business 
plan. The insurance industry hires a bunch of bureaucrats to figure out 
how to deny care. They hire bureaucrats to say: Sorry, you have a 
preexisting condition. We won't insure you. They hire bureaucrats to 
discriminate against people because of a disability or gender or 
something else. They hire people so they can sift through and get the 
``right customers.'' Then they hire a bunch of other bureaucrats on the 
other end to deny claims that people submit. They hire this huge 
bureaucracy in order to keep people from buying insurance, if they are 
not a good risk. And they hire this huge bureaucracy to deny your 
claims.
  Something like 30 percent of insurance claims are denied the first 
time around. If you get sick, you send it in to Wellpoint or Aetna or 
Cigna, they deny your claim. What do you have to do? Instead of taking 
care of your sick wife or your mother, helping her, if you are on your 
own, you spend your time fighting with the insurance company instead of 
taking care of them. That is the good news, if you win on those. So 
often they turn you down and you still don't win if you appeal.
  Mr. DURBIN. I wish to give the Senator a specific example. Several 
years ago the Illinois State Medical Society invited Members of 
Congress to spend a day with a doctor. I wasn't sure I wanted to do it 
because I thought doctors and patients, will this work? It didn't sound 
right to me, but I said: Only if each time I am about to see a patient, 
you tell them, watch out, there is a politician in the room. And make 
sure they give permission. Lo and behold, we did rounds with the 
doctor, and many folks in their hospital rooms were bored enough that 
they wanted to see not only their doctor but this trailing Congressman. 
I was in St. John's Hospital in Springfield, IL as we went into this 
woman's room. She was living by herself at home. She was suffering from 
vertigo and dizziness. As a consequence, she had stumbled down the 
stairs. She had not hurt herself too badly, but the doctor admitted 
her. After an examination, he said: We will have to do brain surgery. 
You have an imbalance caused by a brain tumor, and the operation will 
be on Monday. This was a Friday. So he said: I am going to want to keep 
her in the hospital until the brain surgery on Monday. I can't send her 
home. She lives alone. She will fall down again. She could hurt 
herself. I want to make sure she is ready for the surgery, which was 
very important for her.
  Then he found out that the insurance company said: No, send her home, 
bring her back Monday morning for the brain surgery. This doctor said: 
That is an outrage.
  I watched him as he went to the nurses' station, picks up the phone 
and gets into a debate with the clerk at an insurance company who is 
saying: Send her home. Finally, he slams down the phone, after spending 
15 minutes arguing with no benefit to this clerk, and says: I don't 
care what they say. I am leaving her in the hospital. Either I will pay 
for it or we are going to fight it out later on.
  Think about that for a minute. This is a medical doctor, a surgeon 
getting ready to prepare this woman for surgery, fighting with a clerk 
at an insurance company who says: Send her home. We don't want to pay 
for 2 extra days.
  Mr. BROWN. These are not government bureaucrats. Medicare doesn't 
exclude people for preexisting conditions; right?
  Mr. DURBIN. That is right.
  Mr. BROWN. But insurance companies will use their bureaucracy to deny 
care that way.
  Mr. DURBIN. Deny care. This is the reality of what we are up against. 
So when the Republicans come to the floor and do not want to support 
our efforts toward health care reform, they are saying the current 
system is just fine.
  I saw, incidentally, the Senator from Tennessee come to the Senate 
floor and say: You ought to be able to buy health insurance across 
State lines. Well, there is some appeal to that. You would not think 
much of going from Ohio--I would not encourage this--to go to an 
adjoining State to buy a car. You know, it is the same car, and so 
forth.
  But isn't it a fact that as you go State by State, the standards for 
health insurance change? Some States have very high standards of the 
kinds of health insurance we can expect to buy in our States; others, 
very low standards. Some States are much better at looking at the books 
of insurance companies to make sure they can pay off as promised. If 
you go moving around State by State shopping, you may end up with 
something that looks like good insurance until you really need it.
  So our bills--at least the ones considered in the HELP Committee and 
in other committees--try to establish a basic standard of care so no 
matter where you live in America, you are going to have the same kind 
of basic protection when it comes to what your family needs. And, 
believe me, I have had personal examples in my family and as a lawyer 
where you need it.
  We had, in Illinois--before we changed the law--companies that were 
selling health insurance to new mothers covering their obstetric care 
and then would not cover the newborn baby until it was 30 days old. You 
know what that is all about. Brandnew babies sometimes are very sick 
and very expensive. So this health insurance company was excluding 
newborn infants from coverage for 30 days. We changed the law in 
Illinois and said: You cannot do that. If you want to cover the mother 
and the baby, you cover that baby from the very moment of birth. So 
there are laws to protect them.
  Other States may not have this law. Their premiums may be cheaper. 
Then what happens when you have a sick baby?
  Mr. BROWN. Well, we know from these letters I have brought to the 
Senate floor from Ravenna and Gallipolis and Galion and Mansfield--
these letters are examples of how people thought their insurance policy 
had some consumer protections in it. It was a fine policy as long as 
they did not use it. Once somebody got sick, they found out the State 
laws were too weak in some States.
  In my State, they are not bad, but they are not as strong as they 
should be. In most States, the consumer protections are not nearly 
strong enough. That is why our legislation says no more preexisting 
condition. Our legislation says, no more discrimination based on gender 
or geography or disability. Our legislation says no more annual caps or 
lifetime caps, so if you get really sick and your care is really 
expensive, they will not cancel your insurance.
  That is why we are building these consumer protections into our bill. 
That is why the insurance industry and the Republicans do not much like 
our bill: it makes the insurance companies do some things they do not 
want to do. That is why the public option is so important. Not only do 
we change the rules for the insurance companies for consumer protection 
on preexisting condition--it is outlawed--and there are no more caps, 
no more discrimination, but we need the public option to enforce that.
  I would like to talk about something else Senator Durbin touched on. 
The Republican opponents to this, in their opposition and some of their 
exaggerations--again, I make the very clear distinction between what 
Republicans in Lima and Middletown, OH, think about this health care 
bill and what Republicans who are elected to office, who have very 
close ties to the insurance industry, think about this bill.
  As Senator Durbin suggested, I do not hear anyone on the street--I do 
not ask their party affiliation, but if I am in a Republican part of 
the State, I probably assume they may be a Republican. It does not 
matter. They may be an Independent or a Democrat. But I do not hear 
them say: The bill is too long or hear them say: I want the insurance 
companies to continue to be able to discriminate or be able to use a 
preexisting condition to exclude people.
  It might be Republicans here who say that who are elected to office, 
who are

[[Page 26641]]

close to the insurance company lobby and the pharmaceutical drug 
companies' lobby. But regular people in Mansfield, OH, and Shelby, OH, 
and Zanesville, OH, and Cambridge, OH, do not think that way.
  Last week, as shown on this chart, a constituent shared this mailing 
with me from Homerville, OH, Medina County. It is an official-looking 
notice, complete with a Pennsylvania Avenue address. As you can see, 
this shown here is the envelope: ``325 Pennsylvania Avenue, Southeast, 
Washington, DC.'' ``IMPORTANT: PROJECTED MEDICARE CHANGES.'' 
``Presorted, United States Postage.'' It has some identifying numbers 
that suggest perhaps it is a government mailing. This is not a mailing 
from the U.S. Government. This is not a mailing from the Center for 
Medicare & Medicaid Services. This is not a mailing sanctioned by 
anybody in our government. But it sure looks like it with ``325 
Pennsylvania Avenue, Southeast, Washington, DC.'' They did not send 
this from Columbus, OH, or Troy, OH. They sent it from Washington, DC, 
with a Pennsylvania Avenue address.
  This official-looking notice declares:

       Proposed cuts to existing government programs include a 
     significant reduction in the federal Medicare program, 
     resulting in an increase in premiums and fees that you must 
     pay . . . and a decrease in some benefits.

  It goes on to state:

       This new cutback in the federal Medicare program means that 
     you will become responsible for an even greater portion of 
     your health care expenses . . . expenses that were previously 
     paid by Medicare.

  Again, this is made to look like a government mailing. Clearly, that 
was their intent. Clearly, their intent is to deceive. Clearly, their 
purpose was to obfuscate and to confuse and to exaggerate. These are 
the same accusations we hear from insurance companies, the same 
accusations we hear, not from Republicans in Columbus or Zanesville or 
Saint Clairsville, OH, but from Republicans who dress like this and who 
were elected to represent us around the country who are very tied in 
with the insurance industry.
  Look at the facts. Health care reform will not increase the premiums 
paid by seniors for regular Medicare by a dime--no increase, zero. 
Health care reform will not reduce Medicare benefits, which are 
guaranteed by law. They will not reduce benefits.
  If health care reform affects the additional benefits some seniors in 
Medicare Advantage receive, if it affects the premiums seniors pay for 
that coverage, it will not be because of any action on the part of 
Medicare. It will be because private insurers, the private insurance 
industry has decided to use health care reform as an excuse to squeeze 
more money out of seniors.
  All you have to do--again, as Senator Durbin suggested--is look at 
what has happened. In the last 7 or 8 years, the profits of private 
insurance companies have gone up 400 percent. Humana profits went up 65 
percent in the third quarter--$301 million. How can they make that kind 
of money? How can they pay their executives what they do? Aetna pays 
its CEO $24 million. For the 10 largest insurance companies in America, 
the average CEO pay at those 10 companies is $11 million. How can they 
do that? They do that because they double the premiums in 9 years.
  They do that because they increase premiums, especially on small 
businesses. They are able to do that because they have squeezed people. 
They do that because they use preexisting conditions to deny care. They 
do that because they hire bureaucrats who refuse to pay legitimate 
claims people submit to their insurance companies.
  Taxpayers and seniors will continue to pay these private plans tens 
of billions of dollars each year to provide coverage to seniors, enough 
to keep premiums where they are, and, according to the industry itself, 
enough to offer the same benefit packages as they do today.
  How is that? Medicare Advantage plans are required by law to provide 
the same benefits as Medicare. If they offer extra benefits, those 
benefits are supposed to be paid for out of efficiencies, not extra tax 
dollars.
  So the insurance companies, 10 years ago, said: Let us in on Medicare 
and we will save taxpayer dollars because we are the insurance 
industry. We are the private sector. We can do it more efficiently than 
the government can. So let us into this and we will save you money. We 
will actually give taxpayers back 5 percent of what you now pay per 
person for Medicare.
  Well, that is how it started. But then the insurance lobby went to 
work. The insurance lobby worked on Newt Gingrich successfully. The 
insurance lobby went to work on the Republican majority in both Houses 
successfully. The insurance lobby went to work on George Bush and Dick 
Cheney very successfully. All of a sudden, instead of discounting and 
paying the taxpayers back 5 percent, they have raided the Federal 
Treasury and have gotten 12 or 13 percent more dollars than we spend on 
regular Medicare, which more than 80 percent of the American people are 
in.
  They have always claimed they operate so much more efficiently than 
regular Medicare that they can offer basic Medicare benefits, plus 
extra benefits, and not spend a penny more than Medicare spends on 
basic benefits only. Unfortunately, 10 years ago, some in Congress 
believed them. Even more tragically, some in Congress continue to 
believe them, as they shovel dollars out of the Federal Treasury into 
insurance company coffers--people who put things like this out, as 
shown on this chart.
  So here is the question: Are Medicare Advantage plans no more 
efficient than Medicare? Do they require a government handout to keep 
their promises to seniors or is all the propaganda being fed to the 
public simply a ploy to pump up profits?
  I find it so interesting--as the country overwhelmingly supports the 
public option, as doctors, in survey after survey, overwhelmingly 
support the public option--I hear conservatives say: The government 
can't do anything right. The government just messes everything up. Why? 
It is a big bureaucracy. It can't do anything right. Those same 
conservatives say: But if we have a public option, it is going to be so 
efficient, it is going to drive the insurance industry out of business.
  Which is it? Is it they are so wasteful and bureaucratic they cannot 
do anything right or are they so efficient they are going to drive the 
insurance industry out of business? They always want to have it both 
ways. They want to have it both ways in Medicare Advantage. They get 
these government subsidies. They raid the Federal Treasury. They shovel 
the money off to their buddies in the insurance industry. And look what 
happens. Taxpayers are paying way too much, and seniors are not getting 
what they ought to get.
  Then this mailing comes along, which is outrageously misleading, not 
only by what it says but by what it does not say. It does not say that 
health care reform legislation will actually increase Medicare benefits 
and decrease Medicare costs; that health care reform legislation will 
decrease--not increase--the amount of money that the more than 8 
million seniors have to pay out of pocket for prescription drugs once 
they hit the doughnut hole. Remember the doughnut hole?
  The doughnut hole--for people who are not seniors, they probably are 
not too aware of this, but the doughnut hole was created because when 
President Bush and the Republicans in the House and Senate wrote the 
Medicare drug bill 6, 7 years ago, they allowed the drug industry and 
the insurance companies to have a little too much influence on that 
bill. So they created this doughnut bill, this desert, if you will, 
where people still had to continue to pay their premiums month after 
month after month, but they did not get anything for it. They did not 
get any payment for their drugs.
  So our legislation, first of all, begins to close that doughnut hole 
where seniors will not have to continue to reach into their pockets and 
pay that.
  Health care reform legislation, in other words, will reduce, by half, 
the amount of money that Medicare beneficiaries must pay for needed 
prescription drugs. By 2019, our legislation will totally eliminate 
that doughnut hole. That is good news for seniors, especially those who 
have high prescription drug costs.

[[Page 26642]]

  In addition, health care reform legislation will eliminate the copays 
that Medicare beneficiaries must pay for such crucial diagnostic 
services as mammograms and colonoscopies. Seniors in Medicare now 
typically pay 20 percent of the cost of their preventive services.
  So a man who goes in for a colonoscopy--$700, if you can get it for 
that--has to pay $140 out of pocket. What does that mean for a lot of 
seniors? It means they probably don't get a colonoscopy. They just 
cross their fingers and hope they are not going to get sick, that they 
are not going to get colon cancer. Most of them will not, but some of 
them will, and some of them will have colon cancer that could have been 
detected early, diagnosed early, and saved both a lot of pain and 
perhaps their lives and saved a lot of money for the health care 
system.
  What our bill does is very simple. It will say that preventive care 
will be paid for entirely by Medicare. There will be free annual 
checkups. Our health care reform legislation will provide a new 
Medicare benefit: free annual checkups for seniors. So once a year, a 
senior will get a checkup for free, and that can make all the 
difference in the world.
  None of us should be surprised that opponents of health care reform 
are sending out these deceptive mailings. Of all the offensive aspects 
of this mailing, I am most appalled at the very visible writing in the 
lower left corner, which states down here--I did not see this when I 
saw it. Somebody in Ohio from Medina County handed me this little 
mailing, and we obviously blew it up. I never saw it until it was 
pointed out by Jessica McNiece in our office. The language says: ``Not 
Affiliated With Any Government Agency.'' But you sure would not see 
that when you look at everything else that is on this mailing. But that 
is the game they play.
  One can sure notice the large, bolded writing at the top, though, 
where it says: ``IMPORTANT: PROJECTED MEDICARE CHANGES.'' Projected by 
whom? Projected by the insurance industry? This isn't clear because the 
mailing conveniently doesn't tell you who is sending it.
  We are trying to get to the bottom of where this mailing originated 
because we know the best way to defeat legislation in this body is to 
scare people. The best way is to exaggerate and distort, to turn the 
very young against the very old. When I hear my colleagues in this body 
say the Democrats are going to cut Medicare to pay for insurance for 
the rest of the population, they are trying to turn older people 
against their kids and against their grandkids. It is pretty despicable 
to play that game, to scare people, trying to get seniors upset because 
they are going to cut our Medicare to pay for insurance for these other 
two populations.
  A similar mailing in 2004 led Texas to sue the American Seniors 
Alliance, the front group that masterminded that scam. When we think 
about all this, we need to ask ourselves, what does health care reform 
mean for seniors? What does it mean for taxpayers? Be careful whom you 
believe.
  When the insurance industry attacks health care reform, it is not out 
of altruism, it is out of greed. Usually, anybody who has been around 
here very long knows that when the insurance industry and the drug 
industry are trying to defeat legislation such as this--and, of course, 
they don't like this legislation; the CEO of Aetna is not going to make 
$24 million anymore if our bill passes, the CEO who in 1 year made $24 
million. Their profits aren't going to keep going up and up and up and 
up, so they put everything they have into this. But what we see around 
here is, when the drug industry and the insurance industry oppose a 
bill, they don't send out a mailing coming from CIGNA or Aetna. They 
don't send out a mailing coming from Pfizer or Merck. They send out a 
mailing from a group they have created called--not precise names but 
names such as Americans For Better Patient Health Care or Americans For 
Safe Drugs or associations or trade names; they make them up on paper 
and then the drug companies and the insurance companies funnel money 
in. This one is not even identified that well. We don't know who sent 
this one out, but we are finding out.
  If they had your best interests at heart, they would tell the truth. 
They would come to the table and play a productive role instead of a 
destructive one, not in their various front groups. Insurance companies 
are in the business of businesses. If they thought health care reform 
was going to help their bottom line, they would be for it. But 
Republicans here have consistently opposed health care legislation, at 
the behest of the insurance companies and the drug companies that have 
consistently opposed it.
  I see Senator Leahy, who wishes to speak, so I will close with this: 
We know these tricks. In 1965, the insurance companies teamed up with 
the Republicans to try to defeat the creation of Medicare. In the 
1990s, the insurance companies and their allies in the drug industry, 
with Republicans, teamed up to try to privatize Medicare. In the first 
part of this decade, they succeeded, teaming up--the drug companies and 
the insurance companies teamed up with Republicans for a privatized 
prescription drug benefit that meant tens of billions of dollars for 
the insurance companies, tens of billions of dollars for the drug 
companies. But it doesn't work for the American people. That is why our 
health insurance legislation is so important. That is why we need to 
move forward and do the right thing. So dismiss mailings such as this, 
when they are not identified, when you don't know who sends them. When 
they try to be something they are not, ignore them.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. LEAHY. Mr. President, what is the parliamentary situation?
  The PRESIDING OFFICER. The Senate is in a period of morning business.
  Mr. LEAHY. Mr. President, I am delighted to follow the Senator from 
Ohio, who has been such a leader in this area. Of course, I am 
delighted to see my distinguished friend from Massachusetts in the 
chair, a friend of probably more years than either one of us is willing 
to count.
  Today, we as Members of Congress have the opportunity to complete an 
effort that actually began decades ago. The status quo has a powerful 
lobby, and the centuries of status quo have killed health insurance 
reform before. They are pouring all their energy not into offering 
constructive solutions but into erecting new pillars of obstruction at 
every turn.
  Each of the various reform plans that have been brought forward by 
now have their strengths and their weaknesses. We all know that. But 
one other thing we should know: Radical reforms they are not.
  As President Obama asked, these proposals are based on the existing 
system of employer-based private insurance. But in the absence of 
comprehensive national reform, several States have helped fill the void 
by crafting some of their own solutions. I am proud my home State of 
Vermont has been a leader and an innovator on several issues that are 
now being wrapped into the reform package. One such provision mirrors a 
pilot program in Vermont, the Blueprint for Health. This coordinates 
care among patients and does it in a way to prevent costly 
hospitalizations and procedures. Patients who participate in the 
program have their care monitored to ensure they are receiving the 
kinds of preventive services and disease management they need. The 
blueprint rewards physicians who keep their patients healthy. The 
program has already slowed costs. Of course, it has reduced emergency 
room visits.
  Vermont has also coordinated patient care as one of the States at the 
forefront of the movement toward electronic medical records. That is a 
reform I have long promoted. Recently, I visited Montpelier Pharmacy in 
our capital city, a small city of 8,500. I had the privilege of being 
born there. But I visited Montpelier Pharmacy to announce a grant I 
secured to help small pharmacies across Vermont adopt a system for 
electronic prescriptions. With electronic prescribing, you can have all 
kinds of computer safeguards to prevent dosages from being too large

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or also prescribing a medication which may conflict with another 
medication that has already been prescribed. The system gives the 
physicians--but also the pharmacists--a concrete medication history 
that doesn't rely just on a patient's memory alone. In fact, if you 
have a patient who cannot or does not remember what medication they 
have been taking, this can be lifesaving. It is a little bit better 
than a patient saying: Well, I have that small white pill, and I think 
it is something for heart or something like that; they can press the 
button and know exactly what medications they have and what the 
contraindications are for other medications.
  Vermont has also been a national leader in children's health care and 
in expanding coverage for low-income Vermonters to the Medicaid 
Program. All this in a little State of 650,000 people. But because of 
our early action, more than 96 percent of Vermont's children have 
health insurance. In our little State--not a wealthy State, but 96 
percent of Vermont's children have health insurance. We have one of the 
lowest rates for uninsured adults in the country. It makes Vermont a 
leader and model for the rest of the Nation.
  The proof is in the pudding. We have 96 percent of the children with 
health insurance, the lowest rates for uninsured adults, so it should 
be no surprise that Vermont has been ranked the healthiest State in the 
Nation by the American Public Health Association and the Partnership 
for Prevention and ranked No. 1 in health care by the Commonwealth 
Fund. We can talk about things to do, but when you actually do them, it 
works.
  While Vermont has been a model in coordinating care and offering 
wider health coverage through public programs, a provision to expand 
Medicaid coverage nationwide threatens to penalize States such as 
Vermont that have acted early to do the right thing; States, such as 
Vermont, that did not wait but went forward to protect the people in 
their State. Instead of rewarding States that have taken the initiative 
to expand Medicaid Programs early, one of the Senate bills would 
require States that have been leaders in expanding coverage to accept 
less Federal assistance than other States who are offered only the bare 
minimum of coverage. In other words, it penalizes those that have done 
the right thing and rewards those that have done the wrong things. 
Taxpayers in early leader States such as Vermont would be forced to 
sustain programs in States across the country that traditionally 
ignored the needs of their citizens. So to address this disparity, I 
recently joined with 13 other Senators from early leader States to 
offer a proposal that treats all States fairly. We can all share the 
goal of increasing access to essential medical services by expanding 
Medicaid coverage nationwide. I look forward to working with others in 
a way that does not misguidedly harm early leader States.
  Even though Vermont has long recognized the importance of a health 
care system that includes all Vermonters and Americans, individual 
States can't make enough progress without comprehensive health 
insurance reform. We need that. Workers nationwide are losing insurance 
for their families when they change or lose jobs. Insurance companies 
can and do discriminate against sick people. Notwithstanding what the 
hundreds of millions of dollars' worth of ads say, they can and do 
discriminate.
  I hear heartbreaking stories daily from constituents in Vermont. They 
tell me of the trouble they have getting, paying for, and keeping 
health insurance. I hear it when I go to the grocery stores at home. I 
hear it when I am putting gas in my car at home. I hear it when I am 
walking down the street or coming out of church, such as the woman from 
Winhall, VT, who spends $500 a month on prescriptions--$500 a month on 
prescriptions--but she would be uninsured if not for her husband's job. 
She is working two jobs just to make ends meet and afford their health 
care costs.
  Then there is the small business owner in Vermont who has three full-
time employees and one part-time worker and she works 6 and 7 days a 
week, but she can't afford the blood test her doctor recommended. If 
she becomes sick, she will lose her business, she will lose her home, 
her employees will lose their insurance.
  There is the man from central Vermont who told me about his sister-
in-law who lost parts of both feet because she didn't have health 
insurance. She didn't have health insurance, and when she needed 
medical attention, she waited, hoping things would get better. Well, 
they didn't, and she had to be rushed to the emergency room for 
amputation.
  Real-life stories such as these make us ask: Why are we the only 
industrialized Nation in the world that lacks health insurance for its 
citizens? Why does the wealthiest Nation on Earth lack health insurance 
for its citizens? Why does the most powerful Nation on Earth lack 
health insurance for its citizens? It is shameful. We owe it to all 
Americans to pass meaningful reform.
  I strongly believe the best way to meet these goals is to include a 
public health insurance option in health insurance reform. A public 
option would give consumers more choices to purchase an affordable and 
quality health insurance plan. It would bring about competition. It 
will bring down costs. I applaud the majority leader for saying the 
Senate bill will consider this.
  In order to introduce true competition in the insurance industry we 
must also end the exemption from antitrust scrutiny that has been 
carved out of our laws for the benefit of health insurers and medical 
malpractice insurance companies. The antitrust laws exist to protect 
consumers and promote competition, and we should no longer allow the 
insurance industry to hide behind its special, statutory exemption from 
the antitrust laws. During the Senate's debate on health insurance 
reform, I will offer as an amendment the Health Insurance Industry 
Antitrust Enforcement Act, which I introduced last month, to end the 
health insurance industry's exemption from our antitrust laws.
  We know our current health system is unsustainable. It threatens not 
only our health security but also our economic security. Doing nothing 
has been seen as an option before us. It is always easier to do 
nothing, but that is not an option now. We tried doing nothing for 
years and the situation has grown worse. So let's debate and let's pass 
health insurance overhaul in the coming weeks. Let's give Americans the 
competition they need. Most importantly, let's give Americans the 
choice they need.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New York.
  Mr. SCHUMER. Mr. President, first, I wish to compliment my good 
friend from Vermont on his excellent remarks. I am proud to be a 
cosponsor on his legislation on the antitrust exception. I also wish to 
say to my friend that I know he was a little bit under the weather the 
last few days. I called him a couple times to wish him well. I think I 
can speak for every one of the other 99 of us, we are glad the Chairman 
is back and in fighting form.

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