[Congressional Record (Bound Edition), Volume 156 (2010), Part 3]
[House]
[Pages 3299-3302]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              {time}  1345
                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentlewoman from Nevada (Ms. Titus) is recognized 
for 60 minutes as the designee of the majority leader.
  Ms. TITUS. Mr. Speaker, we've heard a lot about health care today and 
for the past month and, actually, for the past year as this issue has 
been debated as one of the most important things facing this country 
and the people in all our districts. We know that we need better access 
to health care. We need more affordable health care. We need to protect 
Medicare as we move forward with meaningful reforms. These reforms need 
to include issues involving the insurance companies, the insurance 
companies that are today advertising on television against reform, are 
sending their lobbyists to the Hill against reform, who are resisting 
any kind of meaningful reform in hopes of protecting their bottom line. 
I welcome additional comments from some of my colleagues.
  I will reserve my time for a few minutes.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentlewoman from California (Ms. Watson) is 
recognized for 54 minutes as the designee of the majority leader.


                         Parliamentary Inquiry

  Mr. KING of Iowa. Mr. Speaker, I have a parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will state his inquiry.
  Mr. KING of Iowa. Mr. Speaker, under the rules of the House on a 
Special Order, is it appropriate for a Member to yield to someone else 
when they've been recognized for 60 minutes?
  The SPEAKER pro tempore. The Speaker's announced policy allows for 
the leadership hour to be subdivided among designees.
  Mr. KING of Iowa. I thank the Speaker.
  The SPEAKER pro tempore. The Chair recognizes the gentlewoman from 
California.
  Ms. WATSON. Mr. Speaker, I would like to extend our time to 1 hour. 
Do I have 54 minutes?
  The SPEAKER pro tempore. The gentlewoman has 54 minutes.
  Ms. WATSON. Fifty-four. Thank you.
  Madam Speaker, I would like to yield time to Congressman Garamendi 
from California.
  Mr. GARAMENDI. Thank you very much, Congresswoman. As you recall, you 
and I have had a long, long history of dealing with health care issues. 
In the late 1970s, I was chairman of the California State senate health 
committee, and when I left that post, you took it over. And over those 
many, many years that you and I worked on health care, we are now 
approaching the final moment in which this Nation will take up an 
extraordinarily important task, and that is moving towards providing 
health insurance and health care for all of the citizens in this 
country.
  It's going to be a very, very busy week next week. Over the last hour 
or so, I've heard from our esteemed colleagues on the Republican side 
talk about a rush to judgment. It was not a rush to judgment if you 
consider the 30 years that you and I have been spending, trying to 
provide health care services for all the people in California, and now 
we have this opportunity to deal with this issue here for the entire 
Nation.
  It certainly wasn't a work to rush to judgment in the early part of 
the 20th century when, in California and across the Nation, men and 
women were being injured on the job, and to deal with that, the 
Workers' Compensation programs were created. Even Teddy Roosevelt back 
in those periods said that we needed to have a health care system for 
all. It didn't happen then. During the World War II period and before 
it, the Blue Cross-Blue Shield programs were developed by the medical 
community to provide services. But again, it wasn't universal, and it 
wasn't available to all.
  Later during World War II, I remember in California and on the west 
coast, Kaiser Industries found that their workers were getting sick. 
Actually, it was during the Depression when they were building the dam 
on the Colorado River. And so they started what has become known as 
Kaiser Permanente to provide health care to their workers beyond just 
the Workers' Compensation program. In the 1960s, we made a major step 
forward here in America with Medicare and then following it with 
Medicaid. An enormous debate erupted, but progress was made, and a 
universal program was made available to every person--every legal 
citizen, legal person in this Nation who attained the age of 65.
  And I noted with some humor that at the President's summit, just I 
think about 10 days ago, men and women were sitting around the table, 
nearly all of whom--excluding the President and I think just two 
others--actually belong to a single-payer universal health care program 
called Medicare. Yet many of those people said they wouldn't want 
anything to do with a single-payer universal health care system, but 
yet they were participating in such a system.
  So we have been at this a long, long time, and in this House, the 
debate on how to finish the process began 1 year ago. So there's no 
rush to judgment here, nor is there a rush to judgment. I yield to the 
gentlewoman.
  Ms. WATSON. One of the things I would like to make perfectly clear in 
this debate. I was listening to the former hour from my office, and I 
heard over and over and over again how we are cramming the unknown 
through. Now prior to this whole new concept of reconciliation, I 
remember the other side coming down with 2,700 pages and talking about 
what was in those pages and also mentioning to us, Madam Speaker, that 
they had their

[[Page 3300]]

staff reading through every single word. Now I heard them say, 
Congressman Garamendi, that we're cramming the unknown through. This is 
highly, highly unreasonable and a misstatement. We intended and we set 
out to address the 38 million uninsured. If you have insurance--and I 
want the public to hear this--the original intent was to cover the 38 
million uninsured. And by the way, Congressman Garamendi, 8 million of 
that 38 million is in California, our State, and 6 million of those are 
children. Would we not want to cover health care for our children?
  Mr. GARAMENDI. If I might for a moment, Congresswoman Watson--
absolutely. It would seem to be the fundamental compassion of a human 
being to make sure that their children and the community's children, 
indeed our Nation's children, have health care. And we should extend 
that well beyond to all of us. It is not in our interest as human 
beings who presumably have compassion to leave people without health 
care.

                              {time}  1400

  We are not rushing to judgment here. We have been at this in America 
for more than a century. And this House has been at it for a year, 
heavily debated. I was just elected to Congress back in November, came 
here 3 days later, and voted on a bill that you and others had worked 
on for the previous 10 months.
  So here we are with the House having passed its bill, the Senate 
having passed a bill back Christmas Eve, I think 72 days ago. That bill 
has been available. It is my understanding that next week we may have 
an opportunity to vote on the Senate bill and send that to the 
President and then follow up with corrections to the Senate bill that 
are desired by both Houses, such things as eliminating that little 
advantage that was given to Nebraska and other corrections to the bill.
  So this is not something that is being rushed to judgment. In fact, 
it has been debated for a century. It has been debated in this House. 
Back in the Clinton period, there was a major debate going on during 
that period of time.
  Ms. WATSON. This is not mystery content. What we are going to be 
considering are the issues that both sides can agree on. We should have 
health insurance that is affordable, health insurance that is 
accessible, and with the great expanse of land in California, where you 
go to get your health care needs to be accessible to you, and not in 
another town like it is in so many areas of our districts.
  Mr. GARAMENDI. One of the things that was in both the Senate bill and 
the House bill was an effort to expand access to care, not just with an 
insurance policy, but also with facilities. There were major 
improvements and significant sums of money available to expand 
community clinics, where most poor people, where many young children 
and people that are moving from one town to another are able to get 
their care. That is an enormous expansion of services. So what is wrong 
with providing a facility, community care? It happens to be good care, 
and it happens to be very well priced.
  Ms. WATSON. I think of your district, over an expanse of land. I have 
gone to other districts in Colorado with Diana DeGette, and we drove 
for miles all within her district, town to town. So the community 
clinics will be accessible to people who live in remote areas. Then we 
all agreed that we wanted to cover preexisting conditions.
  Mr. GARAMENDI. Let's talk about that. I was the insurance 
commissioner in California 1991 to 1995, 4 years, and then again in 
2003 to 2008. And in that 8-year period I saw horrible things being 
done by the health insurance industry in the way in which they 
discriminated. There are many lessons I learned, but one of the 
principal ones is for the private health insurance companies it is 
profit before people; do whatever you need to do to enhance your 
profits. And you just mentioned one of the ways, which is various 
mechanisms to discriminate, preexisting conditions.
  Let me give you an example. I know of a young woman that had been on 
her family's health insurance program for 23 years. She turned 23, and 
under the current law a 23-year-old can no longer be on their parents' 
care. Under the bills that will be before us for final review hopefully 
next week is a proposal to extend that to 26 years.
  But for her that wasn't yet law, so she went out searching for 
insurance. It turns out she went back to the company that had insured 
her for 23 years. And the company said, oh, we can't insure you. She 
asked why. You have a preexisting condition. It turns out the condition 
was acne. The list of conditions that would exclude you from coverage 
called preexisting conditions is about three pages long for most 
insurance companies, which basically say if you are a woman in the 
child-bearing age group you are not going to get coverage. Why? Because 
you might actually have a child. My goodness, that is expensive. We are 
not talking about family friendly policies here, are we? But that is 
reality. For this young woman she was excluded on the excuse of a 
preexisting condition.
  Now, I happen to have been familiar with this woman and I said let me 
see, let me get on the computer and see what this is all about. So I 
entered her name, came out she was excluded. I went back and entered 
her name as a male, and she got coverage. Something seriously wrong. 
And the bills before us next week will eliminate that kind of 
discrimination, preexisting conditions, as well as discrimination 
because you happen to be a woman. Those days will be over.
  Ms. WATSON. I am so appreciative of your knowledge. You live in an 
area that is a valley in Sacramento, California. I went up to 
Sacramento, and I spent 20 years there; and I inherited the health 
committee, as you have already mentioned, from you. I had it for 17 
years. And I found out that I had allergies. I spent years and years 
trying to find out why I had these allergies. Then I found that in this 
valley the allergens collect. And I found out that I was allergic to 
grass, tree bark, cat hair, the CBCs, that material on the wall.
  Mr. GARAMENDI. I am sorry, Congresswoman, but you are uninsurable. 
You cannot get a health care policy.
  Ms. WATSON. Exactly. Exactly.
  Mr. GARAMENDI. Unless you happen to live until you are 65. When you 
are 65, you will automatically be eligible for a single-payer universal 
health care program called Medicare. People want to live long enough to 
get into that system. And at that White House meeting most of the 
graybeards there were 65, and they belonged to that system.
  Ms. WATSON. Well, I finally made 65 and went beyond.
  Mr. GARAMENDI. I don't believe it.
  Ms. WATSON. I did. Way beyond. But the point I am trying to make here 
is that Americans deserve health care. If you have an insurance company 
that covers you and your family and you like it, you keep it. And I 
want to make this perfectly clear to the public that many meetings were 
held.
  Many meetings were held here in Congress. No bill gets out of 
committee that has not been voted on. And a majority vote will get the 
bill out of committee. We hold our meetings in front of the public. 
When a bill goes to a committee, it is held, and it is spoken to, it is 
marked up in front of the public. So I want to make that perfectly 
clear to the viewing audience and the listening audience out there.
  We did nothing in a closed smokey room. We don't really smoke in all 
of our rooms. Some people do. In California, we have a policy that you 
cannot smoke in any enclosure or outside. You can smoke in your own 
homes, however.
  So everything that was in the bill that we are going to consider has 
been discussed in the public. You were not here for all of those 
discussions, but you follow policymaking because you served with 
distinction in the California legislature. You served as a statewide 
officer, and you know something about this. And thank you for tuning in 
to what we were doing here.
  But our premise was we ought to have a single-payer so that every 
American can feel that they are covered. If we want to keep costs down, 
we are going to keep people healthy. And

[[Page 3301]]

we even have a provision that allows medical students to be able to get 
grants and scholarships if they then commit to becoming a general 
practitioner so that people can go, particularly to these clinics or to 
their hospitals, their doctors' offices, and stay healthy. That is what 
is going to save money.
  We are not doing this, Mr. Speaker and Congressman Garamendi, to 
increase the deficit. It is just the opposite. We are doing it to save 
Americans money. Because if you don't have good health care and 
coverage and you have a sick child and that child has a fever, what are 
you going to do? You are going to take that child into where you see 
that flashing light, that neon light. That is emergency. That is a 
costly area in a hospital. And if that child is acutely ill, the next 
stop will be in the surgical suite. And that is where the cost goes up.
  Mr. GARAMENDI. Congresswoman Watson, you are very, very aware of all 
of these, having served those many years in the California legislature, 
here, and also as an ambassador. And you understand what apparently our 
colleagues on the other side tend to miss, and that is that the cost is 
in the system. And because there are so many uninsured who do wind up 
in the emergency room, the cost actually goes up.
  Now, for a variety of reasons I was at an emergency room in 
Sacramento over the weekend, and it was plain to see that there were a 
variety of people there. Most of them did not have a true emergency 
from perhaps an auto accident. They were there with a cold, with the 
flu; and they were waiting.
  Now, America has been waiting. And they are in a waiting room that is 
extraordinarily expensive, as you said. The bills, the Senate bill as 
well as the House bill, address this in two ways. First of all, they 
provide the health insurance so that a person can go to the doctor 
before they become seriously ill and go to the clinic, go to the 
doctor's office rather than to the expensive emergency room. That is 
one way they save money. The second way is there are a variety of 
elements in the Senate bill as well as the House bill specifically 
designed to reduce the cost in the system. You mentioned one: stay 
healthy. Smoking: we know that if we can keep people healthy we reduce 
the overall costs.
  There are provisions in the bill to advance wellness. Great. There 
are also provisions in the bill to deal with the extraordinary 
administrative costs in the system. One of them, which I heard our 
colleagues on the other side of the aisle demean, is a national benefit 
package, a uniform benefit package across the Nation.
  Now, I know from my experience as insurance commissioner doctors, 
insurance companies are faced with hundreds of different kinds of 
policies, different deductibles, different copays. The result of that 
is extraordinary administrative cost. One way of dealing with it is to 
have a national benefit available through what are called exchanges, 
which are pools which insurance companies can get involved in, creating 
a large actuarial, a large group so the actuarial cost, the actual cost 
is reduced per person. And also allowing competition to exist, which is 
the other third way. There will be competition within the pools.
  So you have got a uniform benefit, you have competition, you have a 
national nonprofit company operating within those exchanges. So that 
would provide additional competition. So you have got competition 
keeping prices down.
  And on this floor 2 weeks ago we passed a major change in the 
antitrust laws applying the antitrust laws to the health insurance. So 
within this area of legislation that will be voted on next week are 
major efforts to reduce the costs. And I have only begun. I have gone 
through three of what I think are half a dozen different ways to reduce 
the costs in the system. So much so that the Congressional Budget 
Office estimates that the reforms that will be before us will actually 
reduce the national deficit in the decade ahead and in the out-years, 
more than a trillion-dollar reduction in the national deficit as a 
result of these reforms.
  Ms. WATSON. Congressman, we have been waiting for the CBO to then 
give us some idea of what these reforms will cost and how they will 
reduce the costs of health care here in America. We were hoping that we 
would have gotten that information today. We do have to give everyone 
72 hours to look at the bill before we can bring it up. So we are 
waiting to get the cost estimate on this new proposal, and we do expect 
it to come in lower than anticipated. Thank you for giving that 
information.

                              {time}  1415

  Mr. GARAMENDI. The figures I was giving you are based on the Senate 
bill. Now, the additional changes that are going to be made, 
corrections to the Senate bill, will provide, we are quite confident, 
additional reductions in the cost of the total bill and reductions in 
the national deficit in the years ahead.
  The other thing that needs to be understood is that these cost 
reductions will be real, and many will be available in the near term, 
others as we learn how to implement the medical technology so that we 
have records that are readily available. So we will be able to see 
significant reductions in cost, as we have already discussed.
  One of the things that will also be available as a result of this 
legislation is the availability of medical providers. You touched on 
this and hit it hard, and we need to emphasize it once again. There is 
a lot of discussion like the bill has too many pages, some say. Well, 
many of those pages specifically deal with making sure that the medical 
providers are there, extending the availability of loans and programs 
for primary care doctors, for nurses, for nurse practitioners. And I 
recall, years ago you carried the nurse practitioner legislation in 
California.
  Ms. WATSON. One of the misstatements I hear over and over again is 
that government that doesn't do anything right will be running the 
system, and that is a misconcept, and I want everyone to hear me. We do 
cover the conversation between the patient and the doctor to determine 
end-of-life care. It will be covered for the first time. They called it 
death panels. It is just the opposite.
  You know, you ought to have a right to discuss with your 
practitioner, with your doctor, what your quality of life should be.
  Mr. GARAMENDI. How to deal with what will inevitably be the final 
days for all of us. We would want that to be in the interest of the 
individual and the individual's family. Right now, many doctors cannot 
do that.
  Ms. WATSON. We allow you to tell your doctor, and it will be covered, 
who has the durable power of attorney; where your will is; do you want 
to be resuscitated; do you want to have these kinds of treatments or 
not. This is a discussion that will be covered. Government does not 
have this discussion. The patient and the doctor will have that 
discussion.
  Mr. GARAMENDI. That is the way it should be, but the way it often is, 
it is the insurance company that makes the decision. I cannot begin to 
count the number of times when I was insurance commissioner that 
complaints would be brought to me that the insurance company decided 
that this young girl was going to die because she was not going to get 
treatment for her leukemia. This is not unusual.
  In California last year, the statistics collected by the Department 
of Managed Health Care showed that the five largest insurance companies 
that cover most everybody in California, the denial of claims and the 
denial of services ranged from 25 to 40 percent. So it is the insurance 
company, not the doctor or the patient, that is making the decision. It 
is the insurance company.
  Now, on the other side of it, in Medicare and in Medi-Cal, you don't 
see those kinds of denials. There are denials for things that are 
inappropriate.
  So we know in the reforms that are coming before us, we open the door 
for the patient and the medical practitioner, the doctor, the nurse, to 
have that relationship to make the decision on what is the appropriate 
care. That is not the case today. It is the insurance company, all too 
often, that is making the judgment on whether a treatment will be 
available.

[[Page 3302]]


  Ms. WATSON. Congressman Garamendi, you know this, a few weeks ago, 
Anthem Blue Cross, the California Blue Cross program, announced to its 
consumers that they will have a 39, almost a 40 percent raise in their 
fees. If we did nothing in the State of California, it would cost a 
family $1,800 annually for coverage.
  Now, we had a series of community forums.
  Mr. GARAMENDI. I think that is $1,800 a month.
  Ms. WATSON. It would raise their coverage up $1,800.
  Mr. GARAMENDI. Yes, additional cost.
  Ms. WATSON. We had a series of town halls and so on, and I will never 
forget this man. He had a heavy accent, but he was an American citizen. 
He said he worked three jobs, and he said, My 2-year-old became ill, 
and even with my three jobs, I was not able to afford an insurance 
policy and could not get coverage for her, and she died. We should 
never get that testimony in the United States of America.
  Mr. GARAMENDI. That is yet again an example of what is seen every day 
in every community in this Nation. There is a denial of coverage by the 
insurance companies. And for those who have no insurance, they face a 
situation of death, bankruptcy, and the loss of their jobs. It is not 
necessary.
  Now, we have talked about the cost in the system, and perhaps this is 
where we will let this discussion end today. This Nation is spending 
17.5 percent of its total wealth on health care. Our competitors around 
the world, not including China, which is completely different, but the 
other industrialized nations of the world, Japan, Korea, the European 
countries, spend 10 percent or less of their wealth on health care. In 
all of those countries, they have universally available health care, 
different kinds of systems, but it is universally available. We are 
pending 17.5. They are spending 10. You would think with that 
additional expenditure we would be healthier. Unfortunately, we are 
not. We don't live as long. Our children die earlier. Our women die in 
childbirth more often. Our health care statistics rank us in the range 
of the nation of Colombia. This is a tragedy for America, and it is a 
blot on our reputation in America.
  The legislation before us will begin to address that by providing 
better health care services, as we have discussed with the clinics and 
other reforms that are taking place; access to health care, because of 
the expansion of insurance to some 30 million Americans that don't 
presently have it; and control of the insurance companies. So no more 
preexisting conditions, no more game playing and discrimination and 
post-event underwriting, which is you get sick and suddenly your 
insurance is cancelled. Those things are gone.
  We are also, in this legislation, controlling the cost of health care 
in America so that our Nation can once again revive its 
competitiveness, so we spend our money on education and manufacturing 
and the things that create a strong economy and a strong society with 
health care. That is our goal.
  And the great opportunity that you and I have, and all 432 Members of 
this House and the 100 Members of the Senate and the President have, is 
to finally close the gap--finally, after a century of effort--to 
provide a system that covers Americans with a health insurance program 
that has the quality and the benefits that they need.
  I know you have been there. You have been there since I first met you 
in 1976 in California and the years you have been here. So, 
Congresswoman Watson, it is a great privilege to engage in this 
dialogue with you.
  Ms. WATSON. I would just like to conclude by saying I serve on the 
International Relations Committee. We travel the globe. I served as an 
ambassador. I taught school in my twenties in the Far East and over in 
Europe. And so I have been around this world many, many times. Our 
status has dropped among other nations. My intent is to continue to 
lift the status of the most wonderful country in the world, and we are 
only as strong as our weakest link.
  It amazes me to hear the criticism, to hear people rant over 
delivering health care rather than reason over delivering health care, 
when I know that they happily nodded their heads to spending $15 
billion a month on a war that has not really benefited the United 
States much, and that is the war in Iraq. And no one complained about 
adding to the deficit then. And now we come up with a health care 
reform that we want to strengthen America's children, America's adults, 
all Americans. And to think that would be the cause for these tirades 
we hear is beyond reason.
  So I really appreciate you enriching this House with your experience 
and your knowledge. And I am a little prejudiced because you are from 
California, but I think your background helps to give understanding to 
our audience, Americans, that we are doing this for the benefit of all 
Americans.

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