Health Care

Floor Speech

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--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.

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