The 30-Something Working Group: Health Care

Floor Speech

Mr. MURPHY of Connecticut. Madam Speaker, I thank you and Speaker of the House Pelosi for allowing the 30-Something Working Group, which has been empowered by the Speaker's office, to come down to the House floor every so often and share with our colleagues here in the House really some of the burning questions of our constituents out there, especially those that affect younger individuals and younger families, and to talk about how this House, under new leadership with a new face in the White House, is rising to answer those questions and meet those challenges.

We'll put this poster up at the end of the hour as well, but we are always eager to hear feedback from people who want to know more about the 30-Something Working Group. Madam Speaker, thanks to members of your class, we have a number of new members of the 30-Something Working Group and they've been coming down and joining us occasionally in these hours. We're glad to have Mr. Altmire with us and hopefully some guests to join us this evening as we try to focus our discussion this evening on an issue of just incredible importance to our constituents. That is the issue of health care for all Americans.

We sit at a moment of great economic peril for this country and the people that we represent. There is not an hour or minute, frankly, that goes by when we are back in our districts where we're not talking to a family or to a shop owner, to a factory worker, to a small business man about the difficulty that they face in this economy. It's getting harder and harder to keep businesses open. It's getting harder and harder to hold onto your job. And for the now 9 1/2 percent of Americans that are out of work, it's getting hard to find a way back into the workforce.

For those of us who believe that now is the time to pass not incremental health care reform but major structural health care reform, we support that not just because we think that it's a moral imperative, as the richest Nation in the world, that we shouldn't be the outlier in the global health care system by which we still stand as the only country in the industrialized world that has such a high percentage of our citizens without access to our health care system; not just that, as the country which claims to be the leader of the free world, we still sit in a country where children go to bed at night sick because their parents can't afford a doctor; but because we believe that it's part and parcel of how we start to get this economy back on firm footing again.

For families out there that have seen their wages remain flat over the last 5 years and have seen the percentage of their income dedicated to health care costs grow exponentially, they didn't figure out that this economy was in trouble last fall when the banks collapsed. They knew it long ago. For our auto companies that have been struggling for a very long time to compete competitively on a global stage when $1,500 of every car that they sell is attributable to health care costs, $1,500 more than their competitors in Japan or Germany, they knew that the health care system was dragging this economy down long before last fall. And for small- and medium-sized businesses across this country who have seen their premiums dedicated to keep their employees insured grow by 10 or 12 or 14 percent a year, far outpacing the similar increase in revenues coming into their coffers, they knew that health care was weighing this economy down long before the newspapers discovered that this economy was in crisis and in trouble last fall.

If we really want to emerge from this recession stronger than ever, if we really want to be competitive in the global stage, if we really want to recognize the strength of this economy lying in the hundreds of thousands of 2- and 5- and 10- and 20-person businesses out there in each and every one of our districts, then we have got to fix our health care this year. And we can't just do it with a Band-Aid here or there, pardon the pun. We've got to do it with real reform that at the same time lowers the cost of care and expands access to more people. I happen to think that it should be a right as a matter of being a citizen of the United States that you should get health care, but I recognize that the only way that you do that is by lowering the cost of care across the board.

We spend twice as much as all of the other industrialized nations on health care, essentially, maybe a little bit less than twice as much, for a system that still leaves 50 million people uninsured. We can get access for everybody out there as long as we start spending less or, at the very least, that we start controlling the rate of growth.

So I think we are going to talk about all these things tonight as the 30-Somethings come to the floor. We are going to talk about health care, health care reform as a moral imperative, as a matter of conscience for this Nation. We're going to talk about it as an economic imperative, and we're going to talk about it both from the context and the perspective of getting care to people that don't have it today and trying to lower the cost of care so that all of us, whether or not we have it or don't have it, don't continue to pay for a system that far too often provides very expensive care without having accompanying results.

So I'm glad to be here on the floor today with a good friend who has joined here for a number of Special Order hours, Mr. Altmire. Ms. Baldwin has joined us as well.

I'm glad to yield the floor to Mr. Altmire.

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Mr. MURPHY of Connecticut. I want to just put an example to one of the points you made here, which is this cost shift that happens. You talk about the folks who don't have insurance or who are underinsured. They get it, right? We have universal health care in this country. You've just got to wait until you're so sick that you end up in the emergency room until you get it.

In fact, President Bush, while he stalled on health care for 8 years, famously remarked, you know, don't worry about the uninsured--I'm paraphrasing--because they'll get health care when they need it. They just have to show up to emergency rooms.

Well, I've told this story maybe even on this House floor before. I told it 100 times back in Connecticut. When we were debating health care reform in the State legislature, I'll never forget a woman who came and testified before us. She told this story:

She said, you know, I was working. I was employed, but my employer didn't provide health care, and I didn't make enough to go and get it on my own. I think she might have had some kids, and she had gotten them insured, but she hadn't had insurance herself. She started noticing over the course of a couple of weeks that she had a real pain in her foot. The pain would sort of get worse, and then it would get better. She knew that she should go see a doctor, but she knew that a couple of things were going to happen: one, she was going to be billed a pretty exorbitant amount for the visit; two, she was going to have to go into the pharmacy and have to probably pay for some antibiotic to treat it. She was savvy enough to understand that, when she did that, she was going to pay the highest cost in the whole system. If you were uninsured, you were going to pay top dollar for that visit, and you were going to pay top dollar for that drug. You don't get the benefit of the bulk purchasing that the Federal government gets through Medicaid or through Medicare or that the insurance companies get through similar programs.

So, one night, she finally decides the pain is just so unbelievable that she can't stand it anymore, and so she goes to the emergency room. She gets to the emergency room too late to save her foot. She has a foot infection that has gotten so bad that she has to have it amputated. For her, that is a life-changing event. Her life is never going to be the same. She is never going to be the same person or the same mother. She is going to have to deal with the disability for the rest of her life just because she didn't have the money or the coverage to get some simple antibiotics that would have treated that foot infection. That just doesn't make sense in the richest country in the world.

Think about it from just a cost perspective. I don't know how much that surgery cost, but it was in the thousands of dollars, I am sure. She didn't have the money to pay for it. Maybe she got billed for it, but probably, more than likely, it just sort of got sucked into the unreimbursable cost by that hospital and got picked up, essentially, by the taxpayers in subsidies for that hospital or by those people who had the insurance, through higher insurance rates, in order to help the hospital to compensate for the people like that woman who didn't have care.

So we paid for that surgery. You and I paid for a surgery that didn't have to happen. There is a woman walking around now with her life fundamentally altered simply because she didn't have access to insurance. Sometimes people need to hear these examples, Mr. Altmire, of what it really means when somebody only has health care when they get so badly sick or ill that they show up in emergency rooms.

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Mr. MURPHY of Connecticut. Thank you very much, Ms. Baldwin. I'm always amazed at how articulate your constituents are. It really is amazing to hear the stories firsthand because, as Mr. Altmire mentioned and as one of your constituents mentioned, there is an entire industry out there that is dedicated to trying to stop people from getting care. That's what you get when you build in the type of profit motivation that we have and the pressure on shareholder return. We treat health care and the economy around it just like we treat, basically, every other industry out there. I think there are a lot of us here who believe that there is something fundamentally different about health care than the auto industry or the cereal industry or the widget industry and that, when the consequences of somebody's not being able to get that product is life or death, maybe we should have some different rules that govern it. Maybe there is no problem with having some incentive built in for innovation, for success and for all the rest. Maybe there should be a limit to that, and there should be some constraints on the system.

So I thank you for joining us, and please stick around for a little while.

Mr. Altmire, you are talking about the three pedestals here of access, cost and quality. I think it's just important for us to talk for a second about how we sort of have an assumption in this country that the more money you spend, the better care you're going to get, right? And what we have found, as we sort of surveyed one particular segment of the country to the next, is that isn't necessarily the case, that spending more money and just having more health care doesn't necessarily deliver better health care. There are great surveys from Dartmouth University and other places that show that, actually, if you can better coordinate care, if you can get physicians talking to each other, if you can get primary care doctors doing more work up front, you can spend more money on preventive health care, as you talked about, that you can get better health care out there. So one of the things when we talk about controlling cost is trying to actually get people to have a decrease rather than an increase in utilization. I think it will be a big central part of our discussion here about how we do that.

There are very interesting ideas about how you try to encourage providers to work together, about how you invest more in primary care. But a subject that we have talked about on this House floor, which is going to be fundamental to this discussion, is giving those physicians and hospitals the tools to do that. The only way that you can try to get doctors talking to each other about complicated patients, the only way that you can try to really empower the consumers themselves to take more ownership over their own health care is to make sure that they have the ability, as physicians or providers, to track those patients through the system or, as a consumer of health care yourself, to track your care as you move through the system. Technology is really the key to that, and we have already taken a great step forward on that issue through the stimulus bill. There is $19 billion in the stimulus bill dedicated to building out the world's best, most connected, most highly technologically advanced health care information system so that as an individual walks into the emergency room, that that treating physician can immediately figure out what his medical history is, what tests he's already had, what's been ruled in, been ruled out relative to the illness that they present with. We can save billions of dollars just by having better information in the system. I am so glad that our President had the foresight to see those savings down the line by investing money in the stimulus bill to get that technology out as quickly as possible so that it can be a platform for those savings. There are going to be a thousand different ways that we talk about to save money in this system, and we know that that's how we get access. But I don't think any of it is going to be possible, Mr. Altmire, without that investment in technology, something that you talk a lot about.

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Mr. MURPHY of Connecticut. Mr. Altmire, scale it down. There are thousands of hospitals, some of which are in the State of Connecticut, that have competing systems, even within their own hospitals, that don't talk to each other. There are hospitals that have one electronic records system for their emergency room and then one electronic medical records system for their in-patient unit. So the same thing that happens as you move from active service out to be part of the veterans

health care system works within a matter of days in a hospital setting. When you come in and present to the ED, you then aren't on the same record system when you move over to the inpatient unit. Now that is because we do not have a sort of nationally agreed-upon platform for how systems communicate with each other. And a lot of hospitals say to themselves, well, I have got one really good system for emergency rooms, and then I want to buy this other really good system for in-patient care. We have got to have some national standards that basically say to any hospital or physician's office that's buying into a records system that you can be guaranteed that you are going to get a system that presents you with all the data and tools that you need and will be able to communicate with everybody else. In fact, there's no way that we're going to spend that stimulus money without some national standards to guarantee that that happens. But as a sort of preview as to how politicized and how politically charged this debate can become, when we were debating that portion of the stimulus bill, which really is a commonsense investment in information technology, something that there should be no reason why Republicans and Democrats should disagree. I don't want to put words in Mr. Burgess mouth. He is a Republican Member from Texas. He comes down to the floor very often to talk about the crisis in our health care system, and he talks in a very articulate way about the need to upgrade our information system. So there's a lot of potential agreement on this issue between Republicans and Democrats. But it didn't stop the sort of right wing in this country from going out and spreading lies that this investment in information technology was the Federal Government's attempt to have a Big Brother takeover of health care, and this was the Federal Government reaching in and controlling all of your health care information and knowing everything about every illness that you've had or prescription drug that you're on. It's the furthest thing from the truth. We're just simply trying to standardize private health care investments that have been made by hospitals and doctors across this country. But I think it speaks to how difficult this debate is going to become. There is a group of folks out there who are either just ideologically opposed to having the government have any role in health care, or folks who are part of the status quo who are making their fortunes off of health care today that don't want the rules of the game changed. Even when it comes to what should be fairly noncontroversial issues, like investments in information technology, I mean, my God, you know, it's boring to say, right, but it's so important. It's just not that controversial. We're still going to find a lot of people on the outside that are going to fight us on this issue, as they will on many others, Mr. Altmire.

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Mr. MURPHY of Connecticut. The gentleman knows that I think this is, for me, critical to reform going forward. I really do think that if you empower consumers to have real choice, that that is one of the ways in which we're going to control cost. Right now when you decide you want health care insurance, if you are a business or an individual, it's a real cloudy picture out there. You don't know exactly what you're buying. You don't know the combination of deductibles and premiums that are going to force costs on you. You can't ever be sure exactly what the benefit plan is, whether pre-existing conditions are covered here and not here. So one of the things that we're talking about that is fundamental to this reform is really trying to standardize the market, creating some national standards for health insurance; that you've got to have this basic benefit package that covers preventive services and real catastrophic care; that you can't discriminate against people that have pre-existing conditions; that you can't have lifetime limits; to basically give people some certainty that when they go out and purchase insurance, that they're going to get insurance, that they're going to get something they can actually use.

So, a lot of us say, well, you know, why not give people the option, if they don't like the private insurers who are inevitably going to take a piece of their premium and pay the CEO a big salary or pay back shareholders or turn it into profit, why not give them the option to purchase a nonprofit, government-issued plan?

Now, Mr. Altmire, you are right, that that only works if that government option, that government health care option, has to finance itself; that it doesn't get a subsidy from the Federal Government to help it compete with the private plans. But if that public insurance option has to pay for itself, just like every private insurance company has to, they collect premiums, pay for care and it all has to be self-financing, then you are exactly right, what is the problem?

If the government is so inefficient, then they will end up having an insurance plan that costs more than the private insurers, and nobody is going to buy that. But if our theory is correct, that by not having the profit motivation that the private insurers have, that they can run a more cost-effective product, then why shouldn't consumers have that choice?

The people in this Chamber who are going to say there can be no public insurance option available to individuals are taking choice away from consumers. I would rather have my 700,000 constituents be able to have as many choices as possible. I want them to decide whether they think that private insurance or public insurance is better for them.

Everybody will answer that question differently. But I think that those of us that are going to be favoring a publicly sponsored health care plan as one of the options for individuals and businesses out there are going to be on the side of consumer choice, and I think if we give consumers that choice, it is going to create a really competitive structure that will end up with some people having public insurance, some people having private insurance, but a real competition by which we lower health care costs, Mr. Altmire.

Listen, I get it. The devil is in the details of making sure that you don't give a little competitive advantage to that public option, but I think that it is really a linchpin of health care reform going forward, if we can get it right.

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Mr. MURPHY of Connecticut. Mr. Altmire, we spend so much time with our business community, our chambers of commerce, when we are back home and when they come visit us down here, that we know what the reality is out there.

These folks that right now can't afford to give health care to their employees desperately want to do that. They want to do it first because it is just the right thing. They are members of their community like anybody else is, and they want to be able to provide health care to their employees, whether they have two employees or 40 employees. That is just the kind of people that are out there running small businesses by the skin of their teeth across this country.

But they also need to do it from an economic standpoint. They know that to the extent that they can't offer health care or can't offer the kind of generous plan that they would like to, they are at a disadvantage against their competitors who can offer that type of health care. They are at a disadvantage against the big employers who can steal their employees away.

So this is really an issue that our small businessmen are waiting to be a part of the solution, and if we can offer them, whether it is through a public option or through lower rates on private plans, a more affordable health insurance option, they are going to take it. They are going to grab it.

You are right, we don't want to set up any incentives where they are going to push people off to the public plan. But we know the majority of folks are going to want to be part of the solution out there, just for reasons of conscience, but also for reasons of their own salvation as a particular business.

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Mr. MURPHY of Connecticut. I thank Mr. Altmire and Ms. Baldwin for joining us tonight.

Let's make no mistake about this. This is going to be a fight. This is going to be a fight, because to do this right, you are going to have to take on some folks who have gotten real fat over this health care system. You are going to have to take on some ideologues that just don't believe that the government has any role in trying to get health care to people.

There is a polling memo going around Washington written by Newt Gingrich's pollster essentially outlining in 28 pages how you stop health care reform from happening. That is the agenda of a lot of people in this town, a lot of folks on the other side of the aisle, that they do not want health care reform to happen.

Now, some of it is for good, honest policy reasons. I believe it is an incredibly mistaken belief that the private sector can just fix this on their own. They haven't done it for the last 50 years. How can we expect they are going to do it overnight?

Some of it though is very cynical politics. Some of it is due to people that look back to 1994 and the failure of the Clinton health care plan in the 2 years prior, and believe that if folks can stand in the way of President Obama or this Democratic House passing health care reform, that they will gain some electoral advantage out of that.

Now, I hope that is the minority of people that are standing in the way of this bill. But make no mistake, there are people out there who simply see political advantage against Democrats in general or against the President of the United States in stopping health care reform from happening.

Now, they may have succeeded back in 1993. I wasn't here, Mr. Altmire wasn't here, so we can't speak to all the reasons that happened. But that is not going to happen this time. Not because you have got smarter people in the House of Representatives or you got necessarily a better strategy moving forward, but because the American people are not going to stand for the status quo.

They know this economy is tough and they feel more conscious than ever of the fact that they are just one paycheck away from losing their health care and becoming one of the tens of thousands of individuals out there who have been forced into bankruptcy because of health care costs.

The status quo is not good enough for people out there, and despite 28 pages of polling telling the folks on the other side of the aisle how to stop this from happening, I believe that the will of the majority of Americans is going to bring us together to get a good bill passed.

We are here as 30-somethings in the Democratic Caucus talking about that tonight, but I believe that there is going to be a groundswell of public support that is going to force us, both parties, to come to the table and do something, not small, not minor, not temporary, but something big and permanent to fix all of the underlying problems in this health care system, to make sure that more people have it and less businesses are burdened by it.

So, again I would like to thank Speaker Pelosi for once again giving us the opportunity as the 30-something Working Group to come down here tonight, and remind folks that they can e-mail us at 30somethingdems@mail.house.gov. If you have any questions for us, any feedback on what you have heard this evening, www.speaker.gov/30something is where you find us on the Web.

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