[Congressional Record (Bound Edition), Volume 155 (2009), Part 3]
[House]
[Pages 3868-3874]
[From the U.S. Government Publishing Office, www.gpo.gov]




                    COMPREHENSIVE HEALTH CARE REFORM

  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. Thank you very much, Madam Speaker, for 
allowing us to have the time this evening.
  I am very glad to be joined by a number of colleagues over the next 
hour as we start what we hope will be a fairly regular Special Order 
hour here on the floor of the House of Representatives to talk about 
the great need for comprehensive health care reform this year in the 
United States Congress.
  I think it is very appropriate that we kick off this Special Order 
hour in the midst of an incredibly important and critical debate about 
the economic future of this country, both in the short term and in the 
long term, because one of the things we're going to talk about in this 
Special Order hour is the very fact that, for millions of families out 
there and businesses--small and large--this economy did not just lurch 
into crisis this past summer. It happened long before that.
  One of the biggest contributing factors to the economic crisis that 
businesses and families have been feeling for years is the mounting 
cost of health care. Businesses have not been able to expand because 
they cannot afford to pay the increasing health care premiums. Our 
domestic manufacturers are hamstrung by a system that burdens them with 
health care costs that aren't shared by their foreign competitors, and 
families who are being asked to pick up more and more of the tab of 
health care simply cannot do everything they would like to do. For 
potential entrepreneurs who want to go out and start those new 
businesses, who have great ideas but cannot leave their current places 
of employment because their health care benefits tie them to those 
jobs, they cannot take the risk to go out and start those new endeavors 
because they cannot take the risk that their families will not have 
health care.
  This economy has been held back for too many years by our current 
health care system, and one of the things that I hope we will get to 
talk about here is the increasing burden on our economy by our current 
health care system. We have an opportunity in this economic crisis to 
learn from our mistakes. One of those will be our efforts to try to fix 
this very broken health care system.
  We have a number of people here who may have to leave before our hour 
is up, so I do want to yield some time right off the bat. 
Representative Baldwin, who started doing health care hours before I 
came to Congress, is going to share some letters from our constituents 
over the course of the next hour.
  Before we get into that, I want to yield some time to, really, one of 
the great leaders for those of us who have come here to Congress in the 
past several years. He has been fighting the general fight for health 
care reform, but he has done yeoman's work in the

[[Page 3869]]

past several years on the issue of mental health care. He is my good 
friend, Mr. Kennedy, from Rhode Island.
  Mr. KENNEDY. Thank you, Mr. Murphy from Connecticut. Let me just say 
what a tremendous honor it is for me to join you on what, I think, is 
the moral question of our time.
  We have gone through historic times. We have just had a swearing-in 
that has galvanized this Nation, and now people are asking us: What has 
the country yet to challenge us? This country is now challenged with 
the most profound economic crisis that we have seen in over a century. 
We are coming to terms with the very basic system of government and 
what it should provide its people.
  Every other single major industrial power in this country provides 
its people with health care. The exception is the United States of 
America even though in the United States of America, per capita, we 
spend twice what every other industrialized nation in the world spends 
on health care. As for our infant mortality rates, our health care 
statistics fall well below that of all of our industrial competitors.
  If our Nation were a patient, we would be a sick patient. Tragically, 
for millions of families, this comes home to them ever so frequently 
when they have a member of their family get sick, and they come to 
realize that the insurance they purchased is not enough to cover the 
basic health care that they need to rest comfortably at night, knowing 
that their loved one is going to be cared for without bankrupting them. 
Health care in this country is the single leading cause of bankruptcies 
in this country. We have to change this.
  It is immoral that everyone in this country has their health and no 
discrimination until they get sick. Then what happens? Then they are 
discriminated against because then the insurance companies start 
saying, ``You can get health care, and you cannot. You are too costly 
to cover, but we can cover you because you aren't as costly to cover. 
We are going to provide coverage for this healthy set of people but not 
for this group of people because they may be disabled; they might be 
older people; they might not be a people that we want to insure.''
  This is not what America is about. We have come too far to include 
people in our society in order for us to continue to have a system that 
excludes people in our society, and our insurance system is really 
based upon the notion of exclusion, not inclusion.
  So we need to demand of this Congress and of this President that they 
follow through on the commitment to include all Americans in health 
care and not just those who are privileged enough to have access to the 
best in health insurance. Certainly, that includes those of us who 
serve in Congress. If it is good enough for Members of Congress, it 
certainly should be good enough for all of the constituents whom we 
represent.
  To my colleagues in government, I want to thank you for including me 
in this debate. Let me say this is a moral issue, but it is an economic 
issue, as you said. Far be it for us to think that we are going to pass 
this stimulus package and then a banking bill but not address health 
care. If we do not address health care, this economy is never going to 
come out of the doldrums because double-digit interest rates and 
increases of inflation every year are going to continue to drag our 
economy down.
  This is the time for us to address health care from not only a moral 
point of view but from an economic point of view. So I am glad to join 
my colleagues in this hour of debate.

                              {time}  1800

  Mr. MURPHY of Connecticut. Thank you very much, Mr. Kennedy.
  There is no more forceful advocate for the moral authority that we 
lack as a Nation as we try to go out and broker compromises around the 
world to try to preach to other countries about their rights and 
wrongs. It's very hard to do that when they look at us as the most 
affluent Nation in the world, and in our midst are 45 million people 
who can't afford health care insurance, children going to bed at night 
sick simply because their parents can't afford to get them to a doctor. 
That, I think, cheapens our ability to go around this world and try to 
set the kind of example that we would like.
  Mr. KENNEDY. And very many more Americans who have insurance that is 
inadequate such that they fear getting health care because the 
deductible is so high that they don't go for the necessary preventative 
services. And then what happens? They get even sicker. And then once 
they get so sick, then they come in when it's so costly to take care of 
them; when if we had a health care system rather than a sick care 
system, we could have taken care of them, and it costs a fraction as 
much as what we end up ultimately paying for taking care of them at the 
end of the line, which is what we end up doing in paying for our 
current health care system is a sick care system where we pay for it at 
the end of the line.
  Mr. MURPHY of Connecticut. That is the genius of health care reform 
is that you are going to get a system that covers everyone for less 
money, that we can do the right thing morally and the right thing 
financially at the same time, Mr. Kennedy.
  We're joined here by a number of Members, but I'd love to yield the 
floor at this point to Mr. Boccieri for a few moments, a new Member of 
Congress.
  You know, I think we want to talk about the importance of health care 
reform. But in our current system, the way that you get health care 
reform most often is through a job. And this stimulus bill that we're 
debating right now can be looked at overall not only as a jobs' package 
but as a health care package. Because if we can get more people 
employed, we can get them jobs.
  And so I know Mr. Boccieri wants to talk about our efforts to get 
health care reform generally, but also the importance of this stimulus 
bill for millions of families out there who are at risk of losing their 
jobs.
  Mr. BOCCIERI. I thank the gentleman from Connecticut for his efforts, 
as well as Congressman Kennedy for his stalwart work for making sure 
that we do the right thing for Americans.
  And my friends, Ohio is struggling. Ohioans have lost their jobs over 
the last 8 years in record numbers. In fact, we have not crawled out of 
the recession from 2001. And so many, so many Ohioans--just like so 
many Americans--are one accident, one medical emergency, one diagnosis 
away from complete and utter bankruptcy.
  Yet we spend here in America, like Mr. Kennedy said, more than any 
other industrialized country in the world on health care. More than any 
other industrialized country. Yet, our life expectancy is on par with 
Cuba. We, as a Nation, spend nearly $12,000 for family coverage; 
$12,000 of disposable income is going for health care insurance.
  My friends, this not only makes moral sense and makes sense in terms 
of the right thing to do, but makes sense in economic terms.
  Let me tell you this. We have to cover every American. We have to 
have a system that covers every American. We need to emphasize 
prevention, and we have to make sure that health care is portable 
between jobs, something that has been played out so often in Ohio as 
Ohioans transfer from job to job because of the downturn in our 
economy. And we need to end the discrimination that's based on pre-
existing conditions.
  And I tell you, Mr. Speaker, there is no issue more important than 
this one because this issue alone is costing millions of jobs and 
costing thousands of people from seeking preventative care. We spend 75 
percent of all that health care money, nearly $7,000 per person, we 
spend 75 percent responding to chronic illnesses, illnesses that could 
be treated if we just saw routine visits to the doctor. Chronic 
diseases like diabetes, asthma, and heart disease.
  And we see that only 4 cents on every dollar, Mr. Speaker, 4 cents on 
every dollar is spent to promote healthy lifestyles. There is a huge 
disconnect.
  And when we see the fact that big insurance companies block and 
prevent people from going to see routine visits to their doctor, we are 
actually costing

[[Page 3870]]

the American taxpayer, small businesses, and larger businesses that 
have huge legacy costs more money.
  In fact, a recent study--my colleague from Connecticut, I'm sure he 
knows this one--a recent study suggests that $84 billion a year is 
spent by big insurance companies to block and deny claims. From you 
going to see your doctor, whether it's for a diabetes treatment, 
whether it's for asthma, or for heart condition; and that same study 
pointed out that nearly 77 billion is all that it would cost to cover 
the nearly 50 million uninsured or underinsured Americans in this great 
country.
  We must take action now, because let me give you two scenarios before 
I yield back my time that has been played out in Ohio over the last 8 
years.
  That factory worker that worked at Rubbermaid where the plant closed 
and the job went overseas, now they've got to find new work and they 
also have to find new health care insurance. And when you see those 
individuals struggling, those families trying to send their kids to a 
dental appointment or try to send their young family to go see their 
physician because they have some sort of ailment--maybe the worker 
themselves, Mr. Speaker, has diabetes and they can't go see routine 
visits to their physician now. So they get an ulcer on their foot. It 
goes to a point where they now have to go to an emergency room to seek 
care.
  And it costs all of us paying into the system, four, if not five 
times more by seeking emergency room care versus seeking care from a 
primary care physician.
  So we are actually losing money, costing ourselves more money by not 
ensuring everyone. We need a robust system that allows an employer-
based system that is portable that they can take from job to job and 
the like.
  So if that person now who worked at Rubbermaid is working at 
Wal*Mart, they should have a portable health care plan that allows them 
that transition period.
  But what we do now is we have to pass an extension of COBRA benefits 
because the Congress--and especially our former President--did not 
address this issue and take it head on. Small businesses are asking for 
relief, American families are asking for relief, and it's about time we 
deliver that to them.
  Mr. MURPHY of Connecticut. Mr. Boccieri, thank you very much for 
joining us.
  You know the statistics. You just look at the auto industry. And that 
statistic that we've heard over and over again, that $1,500 of every 
automobile produced in the United States goes to pay health care costs. 
The comparable number to our domestic auto manufacturers for their 
competitors in Japan or all over the word is nearly zero because they 
don't bear the full burden of paying health care costs. They pay it a 
different way. They pay it through taxes to the government for a 
different system, but they're paying for systems that cost 11 or 10 
percent of their GDP where we're paying for a system that costs 16 to 
17 to 18 percent of our GDP. It's a tremendous competitive disadvantage 
for small businesses that are trying to pay those premiums and also for 
those large manufacturers, Mr. Boccieri.
  Mr. BOCCIERI. I would submit to my colleague from Connecticut, who 
has taken on this issue headstrong--and we appreciate that--that a 
recent poll in Ohio from the University of Cincinnati showed that 
nearly 20 percent of all Ohioans--11\1/2\ people in Ohio--nearly 20 
percent, 1.4 million Ohioans from age 18 to 64 lacked health care 
insurance.
  So that person who is transitioning from job to job who can't provide 
the health care insurance they need, it makes economic sense that we 
cover them to make sure that they can seek treatment because it's going 
to cost us more down at the end, four, if not five times if they have 
to take their child to a hospital emergency room to seek routine care 
that they could have done if they just went to their physician. It not 
only makes moral sense, it makes sense for all of Americans.
  And I have to tell you this. We hear the diatribe and the arguments 
from the other side of the aisle, but my colleagues and the Speaker 
need to know this: that in 2004, George Bush's Secretary of Health and 
Human Services, Tommy Thompson, flew to Iraq with one of many billion 
dollar checks in hand to make sure that every man, woman, and child in 
Iraq had universal health care coverage. And what he said is that Iraqi 
families and their children deserve health care, but you do not. And 
we're going to spend American taxpayer dollars to make sure Iraqis can 
go and seek routine care with their physicians but not American 
families.
  And I think that is a huge disconnect. And we need to talk about that 
because we are building brand new roads and bridges and hospitals and 
waste water treatment facilities over in Iraq. But when it comes time 
to put Americans back to work and to ensure that Americans can seek 
routine care with their physicians and with their family doctors, we 
hear nothing but blocking.
  And I tell you, Mr. Speaker, if we were to give a Heisman award, we 
would give it today to some of the dialogue that I heard today on this 
floor.
  This is about putting America first, putting Americans first, putting 
Americans back into their doctors' offices so that they can have 
valuable health care and they can seek routine care. It's about the 
American family and putting Americans first.
  That's what the stimulus and economic recovery package is all about, 
and that's what providing health care insurance to every American is 
about.
  Mr. MURPHY of Connecticut. I thank the gentleman.
  We've heard the numbers on how much we've spent on this war in Iraq. 
We're approaching $3 trillion if you factor everything together. We're 
talking about spending a fraction of that money to put people to work 
here, to give people jobs in this country to start spending our 
taxpayer dollars on investing in American jobs and in American health 
care.
  Representative Baldwin has done just an amazing job of personalizing 
this issue for years on the House floor, and I really, taking from her 
example, have brought down with me a few letter to really try to tell 
the stories of people from my district who are struggling with this 
very issue from both a human perspective and from an economic 
perspective.
  And Representative Baldwin, I'd love to read one letter to start it 
off and then kick it over to you.
  We all have these letters piling up, they are coming in, 
unfortunately, more and more often every day, every week, and every 
month because as the number of unemployed grows, the number of people 
without insurance grows. And in fact, more and more employers as a 
means of keeping their doors open are passing on more and more costs to 
their employees even if they do keep their jobs.
  Let me share one letter that came from a constituent of mine, and I 
will read an excerpt of it.
  She talks about her inability to find a good job in Connecticut, that 
she can find a job but she can't find a job with health care insurance.
  She says, ``Because I cannot get a good job in Connecticut, I have no 
insurance. I went to get my teeth cleaned the other day, and I had to 
pay $173 out of my pocket. A few weeks ago, I was sick and I went to 
the doctor, and it cost me $120. Making minimum wage, I'm getting $7 or 
$8 an hour.
  ``These bills that are mounting are going to take a long, long time 
to pay off. I shudder to think what would happen if I got seriously ill 
or got in an accident.
  ``My family has invested so much time and energy and spirit in making 
this country and this State a great place. But it's increasingly 
becoming a place that I can no longer afford to live.''
  Representative Kennedy talked about the largest number of 
bankruptcies coming from medical costs. This is a woman doing 
everything we ask. She's working a minimum wage job, dignity in the 
labor she provides, and yet she knows that she is just around the 
corner--one illness or one accident--from losing everything, from

[[Page 3871]]

having her entire life changed both from a health standpoint and from a 
financial standpoint. And these are the letters that are piling up in 
our office.
  The uninsured sometimes get cast as people who brought it on 
themselves, that they should just go out and find a job, just go out 
and seek out health care insurance. Well, we know that whether the 
number is four out of six or five out of six, the vast majority of 
people who don't have insurance come from families with full-time 
workers who have a job but just simply don't have health care for 
themselves or don't have it for their families or dependents.
  So at this time, I would be happy to have my friend and the leader on 
this effort of bringing the human side of the story to the House, Ms. 
Baldwin, to join us.
  Ms. BALDWIN. Thank you.
  I want to start by thanking you for your leadership. It is so 
important that you bring us together to highlight the issue, and I 
think it is powerful to hear what our constituents have to say in their 
own words.
  We all travel back and forth between Washington, D.C., and our home 
districts. I represent an extraordinary constituency in south central 
Wisconsin, and there is nowhere I travel in my district that I don't 
hear these stories that tug on your heartstrings and tell us in no 
uncertain terms that we must take action, and we must take action in 
this session of Congress.
  I want to share with you a sampling--and we could probably have 
endless special orders and not get to all of the communications that we 
receive.
  Michael in Poynette, Wisconsin, in my district says, ``I am a 
[Federal employee] and a member of the Wisconsin WI Air National Guard. 
This past year we were granted a wage increase of roughly 2.3 percent. 
At the same time, the cost of our FEHBP plan benefit increased by up to 
44 percent.'' For he and his coworkers.
  Michael writes, ``Along with this, many of the co-pays also 
increased. This has put a tremendous strain on my colleagues in the Air 
National Guard, many who have been deployed three and four times in 
support of operations throughout the Middle East region.''
  Ed in Monroe, Wisconsin, writes to me, ``My wife and I live in the 
gap. Between our Social Security and a disability policy she had, we 
get too much money to qualify for help, but not really enough to get 
by. With the donut hole in Medicare D, we would only be able to get my 
wife's meds for 3 months if it were not for the samples provided by one 
of her doctors.''

                              {time}  1815

  ``Four of her 10 meds would take 65 percent of our total income if it 
were not for the help of that doctor. I live with chronic pain because 
of a cancer treatment, but as the years go by, it helps less and I have 
other medical problems that are gradually getting worse.''
  Ed continues: ``I have a wife and a son that I have to take care of 
because neither can do it all for themselves. I am the one who battles 
with Social Security and the insurance companies. I have to deal with 
problems that arise with their medications, their finances and many 
day-to-day things.''
  Ed continues: ``Every time I hear a politician talking about cutting 
Medicare and other programs for the elderly and disabled, it scares me 
to death because I am just hanging on by a thread.''
  Sue in Beloit writes about her situation. Sue writes: ``My husband 
was diagnosed with lung cancer. After treatment began, we found out 
that the insurance company had a small loophole for the treatment of 
cancer. Under our insurance, they have a $13,000 limit per year on 
radiation and chemotherapy. That amount did not even cover the first 
treatment of either the radiation or chemo. I was not going to have my 
husband die for lack of treatment, so we started to use our savings and 
available credit to pay for medical expenses. My husband later died,'' 
Sue wrote. ``After having completely depleted our savings and facing 
insurmountable credit card debt, I had no choice but to file bankruptcy 
last year.''
  Greg in Verona, Wisconsin, who owns a small business writes: ``Since 
1998, we've been providing health care to our employees. Every year, 
we've had double digit increases in our costs. This year, the insurance 
company has informed us we'll be paying 42 percent more next year, 
which will lead to one of several eventualities:
  ``One. We'll have to reduce what we cover as a benefit for our 
employees and hopefully retain them. Reality is, many will leave and 
we'll have trouble replacing them.
  ``Two. We'll eat the increase but offer no employee raises for the 
next 3 years.
  ``Three. We'll raise our prices and force customers to look elsewhere 
for the services we currently provide them.
  ``The very real possibility is we'll end up with some element of all 
the scenarios and end up not being able to keep the doors open. Very 
scary thought when one considers that my business has been around for 
55 years.''
  Michael in Burlington, Wisconsin, writes: ``My late daughter was 
diagnosed with lymphangiomatosis and Gorham's Vanishing Bone disease in 
March 2005. We found out how much a child with a terminal illness costs 
a person. My wife and I used every amount of credit and refinanced our 
house three times just to take care of her. Since her death, the bills 
mounted so bad that now we will have to file bankruptcy and we already 
have been foreclosed on our home.
  ``Secondly, my wife was born with a hole in her heart. In 1972, the 
doctors repaired the hole. In doing so, through the blood transfusion 
they gave her hepatitis C. Now she is preexisting at 37 and can't get 
life insurance and has been repeatedly denied health care coverage. Her 
mental breakdown because of the death of our daughter left the 
insurance companies another reason to not let her have health care. 
This needs to change.''
  Carol from Madison, Wisconsin, writes: ``As someone who has had no 
health insurance at all for 3 years, I can tell you that it was pretty 
miserable being one of the millions of people in this country without 
health insurance. Not long ago, my best friend died at age 42 because 
of ovarian cancer because she did not have health insurance and waited 
too long to see what was causing all of her symptoms. Yes, people in 
America actually die from not having health insurance.''
  Susan in Baraboo, Wisconsin, writes: ``I am writing you today 
regarding health insurance coverage for single people with no children. 
As of this time, I feel that I am left out of the loop in regards to 
this topic. I am 42, and last September I was diagnosed with breast 
cancer. In January of this year, the company that I worked for informed 
us that they would be closing down. I was laid off in December while I 
was out due to my cancer treatment. I have been searching for health 
care everywhere because my COBRA will be going up and I am on 
unemployment and barely able to pay the $244.76 for the coverage now. I 
cannot get insurance because of the breast cancer. HIRSP, which is the 
Wisconsin State High Risk Program, is too expensive for me to get 
coverage since they want 4 months of premiums up front, and as they 
only cover some things.
  ``What are single people supposed to do? We don't qualify for any 
government assistance because we are single. We cannot go without 
insurance. There are no programs to help us out. So when you are 
working on health care in the House of Representatives, please remember 
that there are single people out there also in my shoes. I am at a 
crossroad because I have no avenue for assistance when it comes to 
health care. Come November, I will be unable to get coverage when I 
need it at this point in my life.''
  I hope, Mr. Speaker, that my colleagues will join me, and on behalf 
of those constituents whose stories I've shared, in recognizing the 
absolute critical nature of our efforts to enact national health care 
that covers all Americans. The crisis is only worsening at this 
particular moment, and I invite my colleagues to join me in working on 
this most pressing issue.
  I again thank the gentleman from Connecticut, my friend, Chris 
Murphy, for bringing us together this evening to

[[Page 3872]]

give voice to the American people who are suffering so much in the 
current circumstance.
  Mr. MURPHY of Connecticut. I thank the gentlelady. You have some 
pretty articulate constituents. We hope to come down here and do this 
fairly regularly, and the unfortunate nature is that there are enough 
letters that come in every week to be able to fill at least an hour 
every week or every 2 weeks with their stories. So I thank the 
gentlelady for joining us and being part of this and hopefully keeping 
this message going forward, which is that these stories are endless, 
the crisis is real, and we have an opportunity to do something about it 
and do something about it now. We can't wait any longer. Our economy 
can't wait. Our families can't wait. Our businesses can't wait.
  This year, this session, we have an opportunity to do real health 
care reform, and the ultimate consequence of that is hopefully that the 
number of those letters that Ms. Baldwin read aloud will reduce over 
time as people see real health care come to them and their family and 
the businesses they work for.
  Mr. Altmire, we normally join each other down here for a more wide-
ranging conversation amongst the 30-somethings, but I'm thrilled you 
were able to come down and join us this evening.
  Mr. ALTMIRE. I want to thank the gentleman from Connecticut. There's 
no one in this House--a lot of us care and work hard for health care--
but that works on health care more and cares more than Mr. Murphy, and 
I appreciate you putting this together.
  And the reason this is an important issue is because it affects 
everybody. It affects every individual. It affects every family. It 
affects every business in America. Health care is something that we all 
need, and health care is something that we all have a right to.
  Now, there's differences of opinion on what reform should look like, 
but there's no difference of opinion that our system is broken. And if 
you look at the facts, we as a Nation spend almost $2.5 trillion on 
health care as a country, far more than any other country in the world; 
yet we still get mediocre results when compared to other countries in 
some things like life expectancies and infant mortality, and Mr. 
Kennedy talked a little bit about that earlier. Now, we're the not in 
the middle of the pack. We're in the bottom of the pack in some of 
those when compared to other countries.
  Now, if you can afford to get in and if you have access to the system 
and if you're one of the fortunate that has a quality health plan and 
you don't have any preexisting conditions, then you might say, well, we 
have the finest health care system anywhere in the world. And that's 
true, too, for that segment that's able to access our health care 
system.
  The problem that we have is we have 50 million Americans, approaching 
that number, that lack any health insurance at all; 50 million people 
with no health care. As the gentleman from Connecticut talked about 
earlier, it's a common misconception to say those are people that it's 
their own fault, they should have health care, they should get a job. 
Three-quarters of those people have a job or they live in a household 
where the head of the household has a job. They don't have health care.
  We passed an expansion of SCHIP in this Congress in the past 2 weeks 
here, signed into law by President Obama, that extends 4 million 
children access to the SCHIP program. Those are working families. Those 
are kids that didn't have health care. They live in families that work 
hard and play by the rules, but they can't afford health care for their 
kids. Is there anything more important that we could be doing for our 
children than making sure they have access to quality health care?
  And if you look at our country, a big issue that we talked about in 
the stimulus was the information technology system in this country. And 
I just think it's crazy that you can go--I live in Pittsburgh. So 
somebody who lives in San Diego, they might not think this is so crazy. 
But if you live in Pittsburgh and you go to San Diego and you put your 
bank card in the ATM machine, you can pull up all your records in a 
safe and secure way, all your financial documents, get your balance. 
You don't worry about it. You don't think about privacy.
  But if on that same trip you show up in the emergency room in San 
Diego and you need services, they can't pull up your record. They don't 
have your family medical history. They don't have your allergies. They 
don't have your imaging, your X-rays. They don't know anything about 
you, and you start from scratch, and they're going to ask you half a 
dozen times when you're there, what are you allergic to.
  It's crazy that health care is the only industry in the country that 
doesn't have an interconnected information technology system. You would 
think that would be the most important one to have it. We don't have 
it.
  Now, there are some health systems in this country, including the VA, 
that has done a pretty good job of putting together an information 
technology system, but what we can't allow happen is that we develop a 
nationwide network of small information systems that are incompatible 
with each other because that doesn't solve the problem at all.
  So, what we tried to do in the discussion of the stimulus package was 
put together a roadmap for the future with information technology 
systems so that anywhere you go in this country, if you need health 
care, you can pull up your records in a safe and secure way. And with 
health care changing the way that it is and treatment protocols 
changing, the patient will have access to that, and in some cases, in a 
safe and secure way, the patient who is a diabetic from home that does 
their own self-tests can update their own record in conjunction with 
their physician.
  So these are things that we need to aspire to in the future. We 
cannot allow our health care system to continue to languish behind the 
times of technology, and we certainly cannot continue to allow 50 
million Americans and growing every day to go without health care. 
Because it's been said many times in this hour and many times before, 
we have people that do have health care outside of that 50 million that 
are one accident or injury or illness away from losing everything. The 
gentleman said it a moment ago. Those are the people that are lucky 
enough to have health insurance.
  I hear from small businesses in my district all the time, with say 10 
employees. They will say if one of their employee's kids, not the 
employee, the employee's kid gets sick or injured, they get a phone 
call from the insurance company, and they say, well, you're too big of 
a risk, we have to drop you. What's the point of having health 
insurance if you only have it until you need it, until somebody needs 
to use it? That's not what health insurance is supposed to be about.
  We need to find a way to allow small businesses to pool their 
employees, either through their States or their regions or metropolitan 
statistical areas or, moving forward, the entire Nation. Put them all 
in the same community-rated risk pool and say that your individual 
health status doesn't matter when setting your rates. You can still 
have the same choices in the market. You can still, as an employer, 
choose what coverage you're going to offer your employees. And you as 
an employee have the same choice, but the insurance company can't use 
your individual health status to set your rates.

                              {time}  1830

  And that would make the system more fair. But the larger issue moving 
forward, as the gentleman said, and I'll conclude, is we have to find a 
way to ensure the highest quality care that is available to some parts 
of our society is available to everyone, to all 300-plus million 
Americans in this country, has access to the highest quality care, and 
they have health care not just when they do need it, but when they do 
need it. That's the key.
  Again, we're going to have a long discussion about what does reform 
look like. We've talked about it before. And that's an issue that this 
Nation needs to come to terms with. But there can be no disagreement on 
the need for health care reform which, once we get

[[Page 3873]]

past this economic situation that we're in now, has to be the number 
one course of action for this Congress.
  I thank the gentleman.
  Mr. MURPHY of Connecticut. I thank you, Mr. Altmire, and I think by 
focusing in on that question of quality, you really talk about the 
third leg of the stool--is about coverage, is about prices, is about 
quality.
  I think, although all of us come from a little bit different 
perspective on the ultimate path forward on the parameters of that 
health care reform effort, we know that it can advance all three legs. 
We can get a more affordable system that covers more people for better 
quality than we have now. And I don't think it's too ambitious to 
suggest that we're going to get a system of coverage that covers 
everybody for less money than we're spending today.
  If you shift the money from crisis care to preventative care, if you 
start pooling the purchasing ability of the people that are paying, you 
can drive down the cost and expand out the number of people. And that 
sounds impossible. I mean, how do you get more for less? But every 
other country has shown a way to do that. We're not going to copy other 
countries' systems. We're going to create our own, taking already from 
the best that we have. But we can do both, Mr. Altmire.
  We're joined as well today by my colleague from Connecticut, 
Representative Courtney. Representative Courtney and I got the chance 
to chair the Public Health Committee in our respective State 
legislature, and we both know firsthand how hard it's been for States 
to toil under the system, as 50 different States try to cobble together 
50 different systems of health care to insure their citizens in the 
absence of any national strategy.
  Mr. Courtney, I thank you for joining us here this evening.
  Mr. COURTNEY. Thank you, Mr. Murphy. As you said, we both sat on the 
Public Health Committee in Hartford, Connecticut, in the State 
legislature. You did an absolutely outstanding job for the people of 
the State. You were the guy that was there to implement SCHIP. We call 
it HUSKY in Connecticut, for obvious reasons--because we have the best 
men's and women's basketball teams in the country right now in the 
NCAA.
  You also did, again, a lot of other path breaking legislation during 
your time there. It's very exciting to see you now on the Energy and 
Commerce Committee to continue that work at the national level.
  I wanted to follow up actually on a couple of comments that our 
colleague from Pennsylvania brought up regarding the fact that, A, in 
the short time that President Obama has been in office, he followed 
through on a campaign promise to extend health insurance to 4 million 
more children in this country. As the three of us know, this was an 
issue that people clawed at each for 2 solid years. And then, within 2 
weeks of coming into office, we were able to accomplish that historic 
expansion and strengthen coverage for things like dental care and 
mental health care, which anybody out there talking to the pediatric 
community knows, was a real weakness in the SCHIP program that has now 
been in effect for the last 10 years.
  His stimulus plan, the American Recovery and Reinvestment Act, 
recognizes the fact that we have lost 3 million jobs in this country 
and, unfortunately, in America, when people lose their jobs, they also 
lose their health care in many instances because we have an employment-
based system. And his proposal which creates a COBRA subsidy, providing 
65 percent of the premium costs for unemployed individuals, is really 
just a major change in the health care landscape in this country.
  Like a lot of Members, I have been at unemployment offices over the 
last 3 weeks or so. Connecticut has been hard hit, like other parts of 
the country. And talking to the folks who are in the offices describing 
the individuals coming in, who in many instances have never experienced 
a layoff in their lifetime, and in many instances had very solid, upper 
middle-income salaries, now have all these problems thrust at them.
  But the number one issue that constantly comes up for people who are 
at that desk trying to contend with a blizzard of new programs that 
they have never dealt with before is, How do I keep my health insurance 
for my families? And the cost of COBRA extension is brutal. It averages 
around $700 or $800 a month. If you just do the simple math in terms of 
what an unemployment check will cover, this COBRA extension, which 
President Obama has included in the Recovery and Reinvestment Act, is 
just going to be a tremendous help for working families who are trying 
to get through this very difficult patch.
  There's another issue, though, which Mr. Altmire mentioned, which is 
also in the plan, which is an investment, really an infrastructure 
investment, in health IT. About $19 billion is included in the plan. 
And Jason mentioned earlier that the VA and the military health care 
system is actually kind of ahead of the curve in terms of the civilian 
sector.
  I had a chance actually to personally see that in December when I was 
over in Iraq and Afghanistan. I was at Walter Reed Hospital in 
December, visiting a young soldier from East Lyme, Connecticut, who was 
shot by a sniper in mid November. He was being treated at Walter Reed. 
Talked about the great care that he received at Landstuhl Hospital in 
Germany.
  And on our way back from Iraq and Afghanistan, we stopped at 
Landstuhl Hospital and I was up talking to the nurses on the ward and 
the doctor who actually performed surgery on him. I mentioned his name. 
This was about 6 weeks after the fact. They all knew him right away.
  One of the reasons why, other than the fact they're just great people 
who really care about their patients, is that they have a totally 
interoperable system of health IT within the military hospital system. 
So the doctor can pull up on a computer the treatment files of this 
soldier who's in Washington, D.C., at Walter Reed Hospital, and 
interact with his doctors, answer any questions that may come up in 
terms of his recuperation. It was remarkable.
  And the question Jason asked is, Why can't we have this in the 
regular health care system in this country? Obviously, it's because we 
have a very fragmented system, and we need to overcome these issues of 
interoperability.
  One of the ways it does it is to build on a system that George Bush 
started. He created the Office of National Coordinator of Health Care 
Information Technology. That was a Bush Executive Order. And what the 
recovery plan does is it basically takes that office, which is dealing 
with these issues of interoperability, and pump new funds into the 
program and just moving this country forward much quicker than it 
otherwise might have done under the prior administration's budget.
  Well, there's an urban legend already out there claiming--and it's in 
the blogs and it's on some of the cable TV shows--that somehow this 
National Coordinator of Health Care Information is creating a 
nationalized socialized system of health care and it's going to mandate 
treatments that doctors and hospitals are going to have to administer. 
Nothing could be further from the truth.
  This office, which was created by George W. Bush, is strictly an IT 
office that is dealing, again, with implementation of computer 
technology in this system which, again, as Congressman Altmire said, 
needs a lot of work because it's a very fragmented system, particularly 
when you're trying to bring in doctors and health care providers who 
are outside of the hospital network into the system of health care 
information technologies.
  So, for anybody out there listening who has heard these ridiculous 
claims that somehow this bill is going to create a one-size-fits-all 
system of health care, nothing could be further from the truth. This 
bill is about trying to, again, implement what George Bush started, and 
which makes common sense for anybody. All the stakeholders and health 
care systems agree that health care IT, making the system more 
efficient, coordinating care by

[[Page 3874]]

just sharing information in a safe and secure manner, is a way to 
really move the ball forward in this country towards a system of 
universal access and high-quality care.
  So, if people are hearing those rumors--and I have had some seniors 
call the office saying they don't like the idea of this--the fact of 
the matter is that this is a program which the military uses, which the 
VA uses, which is going to be good for care in terms of eliminating 
errors in the system because of just the fact that bad information is 
being shared by different providers.
  It does nothing in terms of changing the doctor-patient relationship, 
the patient-hospital relationship. The government is not getting 
involved in the decision-making of how your health care is going to be 
decided or administered.
  Holding this forum on the night before the vote, Mr. Murphy, I think 
is a great opportunity to clarify, again, some of the really good steps 
forward that President Obama is asking the Congress to vote for.
  Like yourself, I know we believe that, as folks who have worked on 
this issue for an awful long time, that this is a real opportunity in a 
very difficult time of our country to move forward for all Americans.
  So, with that, I will be happy to yield back to you.
  Mr. MURPHY of Connecticut. Thank you very much, Mr. Courtney. I 
preceded him or came after him as the chair of the Health Committee. 
The work that had been done under your leadership to start what really 
was a model program for getting prescription drugs to Connecticut 
citizens, the ConPACE program, was really an amazing piece of work due 
to your great leadership. And I thank you for joining us here.
  I'm glad that you brought up, Mr. Courtney, this issue of what this 
new Office of Health Care Information Technology is going to do. One of 
the things that has held us back as a Nation in trying to create a 
sensible system of health care information technology is that we don't 
have any national standards, that we don't guarantee the ability of one 
system to be interoperable with another system.
  It just makes absolutely no sense that someone that has been treated 
their entire life at a hospital in Torrington, Connecticut, who gets 
brought into the emergency room 20 minutes down the road in New Milford 
Hospital, even if they want that hospital, that emergency room to have 
data about their care, their illnesses, their treatment, their tests, 
that that data can't be transmitted. That those two hospitals who have 
spent millions of dollars building up their own information technology 
and medical records system can't communicate with each other.
  And ultimately as we move forward on some sensible form of 
comprehensive national health care, it's going to have to have at its 
foundation a health care information technology system that 
communicates with each other. It's going to have to be, I think, very 
strong patient protections built into that system. But it is going to 
have to be interoperable. And the only way that that happens is through 
a Federal effort to try to set up some basic standards to guarantee 
that these systems are not just individual silos and they can 
communicate with each other.
  That doesn't mean that we're going to dictate one software program or 
one hardware program. But we're going to have some ability for those 
systems to communicate with each other. And I think of all the pieces 
that many of us are excited about in this stimulus bill, the ability 
for this piece of legislation to move us leaps and bounds forward on 
the issue of health care information technology is just absolutely, 
absolutely critical.
  Representative Courtney also mentioned the issue of the expensive 
COBRA system. Representative Baldwin was reading us some letters 
before. And seeing that you brought it up, I figured I'd read a portion 
of a letter on that very subject.
  George from my district writes, I'm 63 years old and was recently 
laid off from my job. I was told that I would have 30 days of 
additional insurance coverage from the day that I was laid off. But 
when I went in to schedule a minor operation, I was told that I didn't 
have insurance coverage anymore and the operation had to be canceled. I 
was given the option to continue coverage under COBRA, for a price. 
When I looked at the cost of COBRA insurance, it was over $753 a month. 
My unemployment check per week was roughly $498 a week, less taxes and 
any part-time job.
  ``How are we as Americans able to maintain our homes and this when 
things like this happen to us? I think it's a real crisis and you and 
your fellow Congressmen and Senators should really make an effort to 
fix these problems that we're facing.''
  That story can be told over and over and over again in this current 
economy as people are losing their health care insurance. They have 
that option of COBRA, a great decision that this Congress made to allow 
that option. And now, under President Obama's stimulus bill, people 
will actually be able to afford that option. It will be a realistic 
option for people that are losing their jobs as a bridge to reentering 
the workforce.
  I know we have a Special Order hour awaiting us so we will wrap it up 
at this point. I hope that as we come down to the floor and have these 
Special Order hours surrounding health care reform, that we're going to 
be united by a single purpose of getting health care reform done this 
year.
  As Representative Altmire and I were talking about, everyone is going 
to have very different perspectives from both sides of the aisle as to 
what should be the component of that reform legislation. And people's 
ideas may vary greatly, but my hope and I think all of our hope of 
those that joined us here for this hour, is that our unity of purpose 
is in getting a bill done. Getting a comprehensive piece of health care 
reform legislation done this year.
  This Congress and this town has been stymied year after year in that 
effort. But the stars may be aligning this year to get something done. 
And, in particular, I think that this economic crisis that we're going 
through right now should be that final impetus to get us over the hump.
  We have known for a long time that as a moral imperative we have to 
step up to the plate and deal with the fact that there are too many 
people getting sick for no reason except that they can't get care. 
This--it's too expensive. But we now have a much sharper idea of what 
the economic imperative is behind health care reform.
  We can cover more people for less money. We can save jobs by reducing 
health care costs.

                              {time}  1845

  And if we set that as the very realistic goal heading into a health 
care reform debate, I think we will find, despite the cacophony of 
voices that will surround this hall from the outside interest groups 
that have so much concern and stake in the status quo, that there is 
probably much more agreement in this House than there is disagreement.
  I thank my colleagues for joining us here today. I look forward to 
coming down and having this hour several times over the coming weeks 
and months.
  With that, I yield back the balance of my time.

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