Employee Free Choice Act Of 2007--Motion to Proceed--Continued

Floor Speech

EMPLOYEE FREE CHOICE ACT OF 2007--MOTION TO PROCEED--Continued -- (Senate - June 25, 2007)

BREAK IN TRANSCRIPT

HEALTHY AMERICANS ACT

Mr. WYDEN. Mr. President and colleagues, there will be a great deal of activity in the Senate this week, and I want to take a few minutes to talk about the fact that this is going to be a big week in American health care as well.

There will be considerable effort devoted to the State Children's Health Insurance program. I see our friend Senator Hatch on the floor of the Senate. I commend Senator Hatch for his work on this program. The effort on the State Children's Health Insurance Program, in particular, has been a bipartisan one, involving Senator Baucus, Senator Grassley, Senator Rockefeller, and Senator Hatch. I commend their efforts on this legislation. Senator Hatch and I have talked about this in the context of health care reform many times. It is a moral blot on our country that so many youngsters do not have quality, affordable health care, do not have good coverage
like the children of Members of Congress.

So I want it understood that I am in strong support of the bipartisan efforts on the State Children's Health Insurance program that are ongoing in the Senate Finance Committee on which Senator Hatch and I serve. I particularly commend Senator Baucus, Senator Grassley, Senator Rockefeller, and Senator Hatch for the leadership they have shown.

Also, this week there will be several other significant activities in health care. Tomorrow, the Senate Budget Committee will open hearings on comprehensive proposals to fix American health care. They will start by looking at the bipartisan legislation I have worked on with Senator Bennett of Utah. It is the first bipartisan proposal to overhaul American health care in almost 15 years. That and other approaches will be talked about in the Senate Budget Committee with the chair of our committee, Senator Conrad, and Senator Gregg, having a longstanding interest on the question of health care reform, realizing you cannot get on top of big budgetary challenges in the United States if you do not address health care.

Then, finally, at the end of the week, my guess is there are going to be a lot of Americans flocking to the movie theaters to look at Mr. Michael Moore's movie. I will say, for purposes of the discussion this afternoon, since I am not in the movie business, I will spend my time this afternoon talking about health care legislation that is bipartisan in the Senate. Since I have mentioned the question of SCHIP, and how important it is, and how important it is that it be addressed quickly, let me turn now to the question of the Healthy Americans Act.

After 60 years of debate, going back to the days of Harry Truman, I believe the cure for America's ailing health care system is now within reach. My view is we are seeing encouraging signs pop up everywhere.

For example, the business community has done an about-face on the issue of health care reform. For example, in 1993--the last time Congress tackled this issue, during the Clinton administration--the business community said: We cannot afford health care reform. Now the business community is saying: We cannot afford the status quo. Previous adversaries, particularly business and labor, are now coming together to work for reform.

As the distinguished Presiding Officer knows, from our discussions when I introduced my legislation, the bipartisan Healthy Americans Act, we had Andy Stern, the president of the Service Employees International Union, standing right next to Steve Burd, the president of Safeway Company, and mid-size employers and small employers. So we are seeing the business community that so often has been at odds with labor and others coming together with them saying: We cannot afford the status quo.

Finally, it seems to me we have had a coming together of Democrats and Republicans on this issue. I am very pleased, under the leadership of my lead co-sponsor, Senator Bennett, many Republicans have said they will go to a place they have had questions about in the past; that is, covering everybody. You say those words, ``covering everybody,'' and, of course, to some people that implies you are going to have a government-run plan, it is somehow going to be a socialistic kind of plan. Well, many conservatives, many Republicans have come to agree with Senator Bennett and me that you cannot fix American health care unless you cover everybody because if you do not cover everybody, what you have is people who are uninsured shifting their bills over to those who are insured.

Families USA has done an analysis indicating, in their view, that those who have insurance may pay in the vicinity of $1,000 worth of their premium to cover people who do not have insurance. So my view is, with Republicans and Democrats coming together in an area saying, ``Let's make sure everybody is covered,'' we do have positive signs for reform.

Now, of course, bumping up against these positive signs is the popular wisdom. The popular wisdom, of course, is: Oh, Government cannot possibly put something together. People say: Oh, Government cannot organize a two-car parade, let alone fix something that will be a seventh of the American economy: American health care. People say there are too many lobbyists--too many lobbyists--many more than legislators. They are going to block it.

They say, of course, touching on the point I made earlier, that people who have coverage, they are going to say: Gosh, I would rather stay with the devil I know rather than that other guy, that other devil. But I will tell my colleagues, I think the public understands the system is broken, and if now the Congress comes forward with a step-by-step strategy to fix American health care, I think the public will be receptive.

So let me outline, for purposes of a brief discussion, what goes into the diagnosis with respect to what is ailing American health care. I think, for the most part, people understand what is ailing our health care system, so I am going to make this diagnosis brief. First, for the amount of money we are spending in this country annually--$2.3 trillion--you could go out and hire a doctor for every seven families in the United States. So let's talk about what that means for folks in Arkansas and what it means for folks in Utah. If you divide the number of people in this country--300 million--into $2.3 trillion, which is what we will be spending on health care this year, you could go out and hire a doctor for every seven families in the State of Arkansas, pay the doctor $200,000 for the year and say, Doc, that is your job. You are going to take care of seven families. Whenever I am out and about speaking to physician groups, they always come up to me and say: Ron, where do I go to get my seven families? Because I like that idea of being able to be a physician again, to actually be an advocate for patients. So we are spending enough money.

Now, despite these enormous sums and the fact that we have thousands of dedicated, caring, and talented health care professionals, the collective value we get for our health care dollar in America is shockingly small. For example, we are 31st in the world in life expectancy, having recently surged ahead of Albania but still lagging behind Jordan. On infant mortality, we are beating out Belarus, but we are still lagging behind Cuba.

Part of our challenge is we don't have a lot of health care; we have mostly sick care. Medicare Part A and Part B show this better than anything else. In the State of Arkansas, under Part A of Medicare--or Utah or Oregon or anywhere else--Medicare will pay thousands of dollars for senior citizens' bills. It goes right from Medicare to a hospital in Arkansas and Oregon. Medicare Part B, however, the outpatient part of Medicare in our States, pays hardly anything for prevention, hardly anything to keep people well, and keep them from landing in the hospital and racking up those huge expenses in terms of health care. We ought to change that. We ought to change it, and I am going to talk a bit about how the Healthy Americans Act does it and does it with incentives.

In addition to this bias against wellness and against preventive health care, we have a system where the biggest expenditure, which is the tax breaks for employer-based coverage, goes disproportionately to the wealthiest of us and encourages inefficiency to boot. Under the Tax Code today, if you are a high-flying CEO, you write off on your taxes the costs of getting a designer smile. But if you are a poor woman working at the corner furniture store, you get virtually nothing. The biggest reductions now in employer-based coverage--the biggest reductions, according to a new study by the Robert Wood Johnson Foundation--comes in the area of low-income workers.

So that is a bit about the diagnosis, and I already mentioned the fact that people who have insurance pay about $1,000 from their premium for folks who are uninsured.

Now I wish to talk about what we are going to do about it. What is it we are actually going to do about the big challenges with respect to health care? When I have gone home and had town meetings, we have always had kind of a back and forth early on between folks who say they want a government-run health care system of some sort and folks who want a private sector-oriented system. The discussion goes back and forth, and I am sure my colleagues have had similar experiences when they are home talking about health care. But finally, after a little bit of back and forth, somebody in the audience stands up and says: Ron, we want health care like you people in Congress have. We want coverage like you people and your families have. Then everybody starts cheering. Everybody is cheering for that. Nobody knows exactly what it involves or what it constitutes, but they figure if Members of Congress have it, that is what they want as well. So I very often, at that point, reach into my back pocket and take out my wallet, take out my Blue Cross card and ask people if that is what they want. It is private insurance. It covers me. It covers the Wyden family. People say, yes, that is what they want.

So I wrote a piece of legislation, the Healthy Americans Act, that gives folks across the country--in Oregon and Arkansas and Utah, across the country--guaranteed coverage such as Members of Congress get, delivered in a manner such as Members of Congress have, with choices and benefits such as Member of Congress have. Folks can get all the details about how this works at my Web site: Wyden.senate.gov.

Now, the Lewin Group--they are an independent, nonpartisan health care consulting group; kind of the gold standard for health policy analysis--says you can make that pledge, the pledge that I made for coverage at least as good as Members of Congress get, for all Americans for the $2.3 trillion that is spent annually, and, according to the Lewin Group, you would reduce health care spending by almost $1.5 trillion over the next decade.

Here is a bit of how the Healthy Americans Act works. Our country has about 300 million people, as I have mentioned. I don't alter the basic structure of care for Medicare, the military, and the small Government programs. The reforms I make to the Medicare program keep the basic structure of Medicare as is, but we do tackle the two biggest challenges facing the program.

The first is we are seeing a huge increase--a huge increase--in chronic illness. These are folks with heart and stroke and diabetes, a variety of problems that are chronic in nature. In fact, the estimate is about 5 percent of those on Medicare use up about 60 percent of the Medicare expenses. So we create efficiencies for how to better manage the chronic care that this large group of people incur. I think it will help generate savings for the long term. As we do that, we attack the underlying reason so many Americans need chronic care; that is, prevention has been given short shrift. So under our legislation, we create incentives for parents to enroll children and their family in preventive programs. They get lower premiums if they do. With respect to Medicare specifically, for the first time we authorize the Government to lower Medicare Part B premiums, the outpatient premiums, so that if seniors lower their blood pressure, lower their cholesterol, and engage in sensible, preventive medicine, they would experience lower premiums.

So we make improvements to Medicare, and Government programs clearly can be refined. But I am of the view that in the area of Medicare and the VA and some of the smaller Government health care programs, we basically ought to focus on keeping the basic structure as it is and making improvements as I have outlined in the chronic care and prevention care within that basic structure. So if you do that, if you set aside Medicare and the VA, you are left with about 250 million people. About 170 million of those folks get their coverage through employer-based health care. About 48 million are uninsured. They are often without any coverage at all. They may have some very modest coverage--charity care--and then we have folks in the individual market and Medicaid.

So let me describe what we do for folks in that area where there are 250 million people, folks who aren't covered by Medicare or the VA. If a citizen does have employer coverage, the employer is required by law to cash out the worker. We do it in a way so that with the very first paychecks, the first paychecks issued under the Healthy Americans Act, the worker will win and the employer will win.

Let's say, hypothetically, in Arkansas or Oregon, you have a worker who has a salary of $50,000, and the employer is purchasing $12,000 worth of health care benefits for them as well. Under the legislation, the employer is required by law to give the worker $62,000 in compensation--salary plus the value of their health care benefits. Then, we adjust the workers' tax bracket so they don't pay any additional tax on the additional compensation. That is important because, for all practical purposes, Senator Bennett and I have legislated the biggest pay raise in the country's history by putting that extra cash in the workers' pockets. So when the worker sees it--we spent a lot of time talking about it--the worker says: That is pretty cool getting all this extra money. What is the catch? There has to be a catch if I am getting all this extra compensation. There is a catch. The worker, under the Healthy Americans Act, has to buy a basic health insurance policy, including prevention, outpatient, inpatient, and catastrophic--a basic policy. The first thing the worker is going to say is: How in the world do I do that? How am I going to be able to buy my own coverage? So we set up something called Health Help to make it easy for people, and people could do it online, to purchase their own coverage. We fixed the private marketplace to make it easier. Private insurance companies can't cherry-pick. They can't take just the healthy people and send sick folks over to Government programs more fragile than they are. There is community rating. People go into big pools so you can spread the cost of the risk. There is guaranteed issue so you can't be turned down. We also prevent people from being hammered because they have a preexisting illness.

So that is the way it works for folks who now have coverage, about 170 million of them. In the case of the worker I described in Oregon and Arkansas, $50,000 in salary, $12,000 in health care, $62,000 in compensation, if they can use that to go out, say, and buy a basic health insurance policy for $11,500 rather than the $12,000 they are now getting for health care, they can be on their way to Oregon for a great fishing trip in Central Oregon, because that is exactly what we are trying to do, is to create marketplace incentives for folks to try to hold their costs down. If the employer doesn't offer the coverage, employers make a contribution on the basis of their revenue per employee.

We had three groups of employers we worked on with this: large employers, medium-sized employers, and small employers, and when we launched the whole effort, there were representatives from each of those three employer groups. So it is a bipartisan bill: Senator Bennett, a Republican, and myself, a Democrat. It is bipartisan, and it has the support of business and labor organizations.

Where does the money come from to pay for the Healthy Americans Act? We can make substantial savings by redirecting the Tax Code away from the system today which disproportionately favors the most affluent and rewards inefficiency. We steer it more to the middle class and the working poor. There are substantial administrative savings. According to the Lewin Group, this consulting group for private insurance, we have the administrative costs down to under 5 percent. That means we are going to systematically drive out a lot of what is being spent on marketing and underwriting and various kinds of inefficiency, which is clearly unneeded. We make substantial savings in what is called the disproportionate share of funding that now goes to the hospitals when they have to pick up the bills for those who are uninsured. It makes so much more sense. Instead of a poor person who has no coverage going to a hospital emergency room in Arkansas or Oregon or Utah, it makes so much more sense to use the scarce dollars so that person can afford a private insurance policy. It would be targeted at outpatient care and inpatient care and prevention rather than frittering away so much of our scarce resources for hospital emergency room services.

This legislation does that. The insurance companies compete not on the basis of cherry-picking but on the basis of price, benefit, and quality. Finally, we make care for the poor much more efficient and humane. Right now, if you are poor in America, you have to go out and try to squeeze yourself into one of perhaps 30 boxes in order to be able to get care as someone who is low
income. I think that is degrading and inefficient. We can do better.

Under the Healthy Americans Act, we say care for those individuals is automatic. They would get covered automatically. Once they are signed up, they are in forever. I know there are many who are saying that fixing health care is not possible in this Congress. I already mentioned the good work of Senator Rockefeller, Senator Hatch, Senator Baucus, and Senator Grassley on the children's health program. I will be with them all the way. They have done very good work. The fact that so many kids don't have decent health care is morally wrong and Congress ought to address it. I am going to do everything I can to help them.

I think this Congress ought to go farther. I don't think we got an election certificate to sit around and wait for another Presidential campaign to get going. Fortunately, under the leadership of Senators Conrad and Gregg, the Senate Budget Committee will get going tomorrow, looking at a variety of options to fix health care. We are going to start with the Healthy Americans Act, but certainly a lot of colleagues have good ideas, and many are bipartisan. Certainly, Senators Feingold and Graham have good ideas. The American people don't want us to wait for 2 more years. They are not going to be tricked into comprehensive reform. The subject is too personal. They want to know what the benefits are going to be, what their costs are going to be; but they are ready. They know the current system cannot be sustained given our rapidly aging population, the huge increase in chronic illness, the disadvantages the employers face, and the tough global markets.

The American people know the current system cannot be sustained. They understand it is broken and we are going to show them there is a better way, a bipartisan way. The hearing that will begin tomorrow, and the bill Senator Bennett and I have, will be the first bipartisan proposal to overhaul American health care in 15 years. I don't think we ought to wait 2 more years. That is not what we got an election certificate to do. Let's pass the SCHIP legislation. One of the key sponsors is on the floor this afternoon. Let us move on to address a new direction in American health care to finally make it possible for all of our citizens to get under the tent for basic, affordable, quality health coverage.

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