[Congressional Record (Bound Edition), Volume 155 (2009), Part 9]
[Senate]
[Pages 11915-11917]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. WYDEN. Mr. President, the Senate Finance Committee, on which I 
serve, is about to take up the toughest issue in the debate about 
health care reform; that is, the question of how to pay for it.
  To be credible, that means showing that you are not going to sit 
around and wait for years and years to start cutting costs but, in 
fact, you are going to start generating savings, in the $2.5 trillion 
our country spends on health care, quickly. And you must do it in a 
bipartisan fashion that is acceptable to our people.
  So, today, I offer the four pillars of immediate health care cost 
containment. Each one of these pillars is an idea that is supported by 
influential Democratic Senators and influential Republican Senators in 
the Senate.
  The first pillar of immediate health care cost containment requires 
that there be tax relief for the middle class but no more tax subsidies 
for designer smiles. It sounds incredible, but today hard-working 
middle-class folks who are uninsured or underinsured--every day--watch 
their taxes go to subsidize designer smiles for the most affluent that 
would be worthy of Hollywood.
  The first pillar of health care cost containment starts saving 
billions of dollars immediately by taking away unneeded tax breaks and 
beefing up health care tax relief for middle-class workers and their 
families.
  The second pillar of immediate health care cost containment means 
taking an axe to health care administrative costs. Americans are 
drowning in health care rules and administrative hassles. Now you can 
junk the health care bureaucracy by doing everything just once: signing 
up for the health care you want; paying for it through the withholding 
system you use with every paycheck; keeping what you have, if you leave 
your job, or your job leaves you; and easily finding out about the 
costs and quality of health care services that are near you, and doing 
it on line.
  The third principle of immediate health care cost containment is 
everybody is in, and everyone has to be personally responsible. You 
cannot lower health care costs in this country without good, quality, 
affordable coverage for all. If you do not cover everyone, there is too 
much cost shifting and not enough prevention.
  Personal responsibility is just as important. Americans cannot fix 
health care unless everyone secures basic coverage, with extra help for 
folks who would have difficulty affording that. More than 11 million 
people with incomes of well over $60,000 do not buy basic health 
insurance, and that is part of the reason hospital emergency rooms are 
so busy in America. Cutting health care costs means getting everybody 
in the system, and it means everyone would be personally responsible.
  Finally, the fourth principle of immediate health care cost 
containment is a revolution in health insurance. Today, health 
insurance is about cherrypicking. The private insurance companies scour 
your health history, and they want you if you are healthy and wealthy. 
Sick people, on the other hand, are sent to Government programs more 
fragile than they are.
  Holding down costs soon means changing this, prohibiting the 
insurance companies from discriminating against those with illnesses 
and requiring a system that features real competition--real competition 
where the insurance industry does not compete to see who is the best at 
leaving out those who have health problems but competition that is 
based on benefit and quality and price. That is not Government-run 
health care. That is old-fashioned competition--the kind of bedrock 
principles of competition our country understands.
  When insurance companies compete on the basis of price, benefit, and 
quality, that is about as pure a kind of competition as you could have 
in our country, and it would revolutionize the health insurance 
business in our country.
  Each one of these four pillars of immediate health care cost 
containment is supported by influential Democrats and Republicans in 
the Senate. If these four principles were adopted, the Senate could go 
to the country and show our people that on the health issue they care 
about the most--which is containing costs--the Senate has a plan for 
cost containment that will kick in quickly, in the next few years--

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not something for which you have to wait 10, 15, 20 years from now. And 
certainly there are a lot of changes in the health care system that 
ought to be made now because they will save money in 10 or 15 years.
  But the four pillars of immediate health care cost containment I 
outlined this afternoon--tax relief for the middle class and no more 
tax breaks for designer smiles; taking an axe to health care 
administrative costs; everybody in the system, and everyone personally 
responsible; and a revolution in the health insurance business--those 
are ideas that are now sponsored by Democrats and Republicans in the 
Senate and will soon save health care costs. They will reduce health 
care costs, and do it quickly, so that the Senate can be credible with 
the country on this issue of health care reform.
  There are other important principles to this question of getting 
health care on track. Chairman Baucus, in my view, has done yeoman work 
in terms of his sessions to look at the various issues--delivery and 
coverage.
  I have made the case, with considerable passion, on the coverage 
question that I think Americans want on the coverage issue--coverage 
that is at least as good as Members of Congress have--and the 
Congressional Budget Office has said it is possible to pay for that, 
again, with the kinds of principles of cost containment I have 
outlined. Other colleagues, I am sure, will have other views with 
respect to what the basic benefit package ought to be about.
  I also think it is going to be very important to send a 
straightforward message to those who have coverage that there are 
considerable benefits for them in reform as well. We have talked on 
this floor before--Democrats and Republicans--about making sure 
everybody can keep the coverage they have. That is something Senators 
hear about at every meeting they have when they discuss health care, 
and I think there are going to be 100 Senators voting in favor of the 
principle that all our people ought to be able to keep the coverage 
they have.
  But there are two other words I think those people with coverage are 
looking for. I say to the Presiding Officer, you and I have had some 
discussion on this issue before. Those folks with coverage want to hear 
about how they are going to be wealthier and healthier with the health 
care reform legislation that would be passed in the Congress. On this 
issue, the fundamental question is going to be about increasing the 
choices that individuals have for their coverage.
  I have not spoken about this on the floor of the Senate in the past, 
but I was flabbergasted to learn that those who are lucky enough to 
have employer-based coverage in this country--of that group, 85 percent 
of them get no choice at all. They get one package, and that is it. So 
you have 85 percent of the people in this country who are lucky enough 
to have health care coverage who do not get what their elected 
officials from Colorado and Oregon and everywhere get.
  We get a full menu of health care choices. Of course, that is a big 
factor in holding down health care costs for all because then you have 
some competition. And if one company does not do well in 2009, 
everybody is off in 2010 and choosing somebody else.
  So it is going to be very important to show those with coverage--
people who want to be healthier and wealthier after health care reform 
is passed--that one of the ways to get some additional money in your 
pocket is to have more choices. Because when you have only one choice, 
of course, there are not the kind of competitive juices at work in your 
health care system that even Members of Congress have.
  So what I have been interested in is saying that if you want to stay 
with your employer's package--absolutely--Democrats and Republicans in 
the Senate are committed to doing that. But if you, for example, want 
to choose one of the private alternatives that would be established in 
health reform legislation, and would be certified by your State as 
protecting consumers, you ought to be able to make that choice. And if 
in making that choice you save money relative to what it might cost for 
your employer's package, you get to get those savings and--without 
offense to Colorado--you can use the money to go fishing in Oregon 
because we have created a marketplace.
  So I wanted to come today and lay out the four immediate principles 
of health care cost containment. I think there will be other central 
questions, such as the issue of coverage and the question of how to 
make sure the Senate keeps faith with the 160 million people--it is 
about 160 million people, on any given day, who have employer-based 
coverage and wish to keep what they have--who would like to be 
healthier and wealthier, and, finally, if they want to leave their job 
or their job leaves them, their coverage ought to be portable and they 
can take it with them.
  Finally, let me note that I think Chairman Baucus and Senator 
Grassley, the leaders on the Finance Committee, are doing an 
exceptionally good and an exceptionally fair job in terms of tackling 
this issue. The fact is, health care reform, particularly financing it, 
is not a subject for the fainthearted. There is a reason this issue has 
been tough to tackle since the days of Harry Truman of 60 years ago. 
But under the leadership of Chairman Baucus and Senator Grassley and 
the Finance Committee--and I think I can speak for Senators on both 
sides of the aisle that we are very appreciative of what Chairman 
Kennedy and Senator Enzi are doing in the HELP Committee. The four of 
them are our committee leaders, our chairs and our ranking minority 
members. I believe that this time, after 60 years of working on this 
issue, it can get done.
  The fact is, for health reformers, the history of trying to fix 
health care is almost the story of unrequited love. If you look back on 
this issue, almost every 15 years reformers say: This is the time. I 
finally found the one. I am going to be able to have my dreams 
realized.
  Of course, it has been exactly 15 years since the last effort in 
1994, during the Clinton years. Harry and Louise pretty much soured 
that romance in 1993 and 1994. But I do think, largely because of the 
good work being done by Chairman Baucus and Senator Grassley and 
Chairman Kennedy and Senator Enzi, this year is different. A lot of 
colleagues on both sides of the aisle have moved toward an approach 
that I believe will allow us to come together.
  There is a recognition that Democrats have been right on the 
proposition that if you fix this, you have to cover everybody. If you 
don't get all Americans high-quality, affordable coverage, you have 
that cost-shifting I spoke about and inadequate attention to 
prevention. I think there is a recognition that colleagues on the other 
side of the aisle in the Republican Party are making valid points as 
well. There ought to be private choices. It is important not to freeze 
innovation. We ought to stay clear of price controls. So there is an 
opportunity now, with the Senate being led by two very fine chairs and 
ranking minority members, to get this done.
  I will close with an observation from a number of economists. Our 
country clearly is concerned about the cost of these bailouts and 
financial obligations in the banking and housing sector. Most of those 
folks believe that the astounding sums being spent on financial 
bailouts--they are going to look like a rounding error if health care 
is not fixed. So the stakes are very high. Fixing the economy means 
fixing health care.
  With the principles I have outlined here today, the four immediate 
principles of health care and cost containment, I think the Senate can 
get off on the most important and most difficult issue of health care--
containing costs--and do it in a bipartisan way.
  Mr. President, I yield the floor, and I note the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. NELSON of Florida. Mr. President, I ask unanimous consent that 
the order for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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