Health Care Reform
Floor Speech
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Mr. DURBIN. Mr. President, as we meet on the floor of the Senate, we are deliberating a bill about promoting tourism in America, which turns out to be a way to increase economic activity, create some business activity, keep people in their jobs, and maybe attract folks from overseas to see this beautiful land of ours. We are now in a procedural holding pattern. The minority party has asked us to wait 30 hours before we talk about it. It is unfortunate because we are prepared to go and are ready and we have a lot of things to do, but the rules of the Senate are available for them as for us, and they are utilizing them now to delay and stop action on this bill which is very routine, bipartisan, and enjoyed the support of over 90 Senators when it was called yesterday on a procedural vote.
In the meantime, as we are waiting on the floor for the Republicans to give us permission to go forward, the committees are at work. I left the Judiciary Committee where the Presiding Officer is also a member, with the Attorney General, where we spoke about some critical issues.
Right across the hall from us is the Finance Committee, and they are debating the future of health care in America, and that is a debate which we are all following very closely.
It is clearly time for us to acknowledge the obvious. Although we have some of the best hospitals and doctors in the world, the fact is the cost of health care in America is spinning out of control and if we do not have the political will and courage to step up at this moment in time and address that, it is going to get much worse. People will find that there will be more uninsured people, people with health insurance that is not worth much, and that the cost of what you can buy will be so expensive that average people cannot afford it. You will find, if we do not do something, that health insurance companies will continue to exclude people because of preexisting conditions, continue to argue incessantly with doctors over what the right procedure will be. We will find unfortunately that there will be a situation where we do not have the chance to utilize the very best health care in this country for needed procedures.
Many Senators say: I have listened to that but count me out. I have a great health insurance plan. I don't need to be part of your debate.
What President Obama has said and what we have said in Congress is: OK, we accept that. If you have health insurance that you like, that you want to keep, you can keep it. There will not be any change. But if you happen to be one of those Americans who think they can do better for something more affordable or, sadly, if you are one of the 48 million Americans with no health insurance, for you, we think we have to change some of the ways we do business in this country.
One of the key elements here, as I mentioned already, is what to do with 48 million uninsured. If these uninsured people had their own health insurance, it would be a benefit to all the rest of us who happen to have health insurance.
Some of these political commentators like to write that Members of the Senate have some special health insurance plans. We are fortunate to have one of the best in the world, but it is the same plan Federal employees have across America. Eight million Federal employees and their families, and Members of Congress who opt to buy into it, have a wonderful plan. I am lucky; my wife and I are very fortunate to have that kind of coverage. But for a lot of people, they don't have that kind of luxury. Once each year, I can choose from nine different health insurance plans that sell to Federal employees who live in the State of Illinois. That is quite a good deal. If I don't like the way I was treated last year by my health insurance company, I can change. It is like buying a car; I have a lot of places to shop and look. But most Americans don't have that. Most Americans do not have the option of looking for health insurance, and if they do, they cannot afford it. If you have to pay for it out of pocket, you may find yourself unable, and small businesses which want to provide health insurance, not only for the owners but the workers, say: It is just too darned expensive, we cannot afford to do it.
That is why 48 million Americans--not the poorest because we cover them with Medicaid, and not those lucky enough to have health insurance, but those smack-dab in the middle who get up and work every day at businesses, maybe businesses they own, and do not have health insurance. One out of four realtors in America has no health insurance. You don't think of that, but it is a fact. So we work with them to try to come up with an approach--that is now being debated by the Finance Committee--to have small businesses and self-employed people have a chance to buy health insurance just like Federal employees can buy health insurance.
But we really have to get to the bottom line of this issue. It is not enough to just say we are going to cover 48 million Americans currently not covered. That is important because uninsured people who show up at the hospital in America today are not turned away, they are treated. Who pays for them if they cannot pay for themselves? The rest of us--taxpayers and people with health insurance. It is estimated that the average family pays an additional $1,000 a year--almost $100 a month--for coverage for uninsured people. We are picking up their health expenses because they do not have health insurance. That is a hidden tax. So when we talk about the cost of health care reform, there is a real cost of doing nothing--about $1,000 a year out-of-pocket for most American families.
We need to move on to the tougher issue, and this is the one debated at length here on the floor. The bottom line here is the cost of medical care. We spend twice as much as any other nation on Earth for medical care for our citizens. Sadly, we do not have the results to show for it. If you look at the basic health indicators, many countries that spend far less per person than the United States have much better outcomes. You wonder, why is that the case? We have the best hospitals, we have the best doctors, we have all the technology, all the drug companies. Why are we not the healthiest people in the world?
Some of it is our own fault. When you look at the chronic conditions that cost so much in our health care system, it is the choice of the person who decides, I am going to keep smoking cigarettes. That is a terrible choice. It can lead to sickness and disease and even death, and that is a lifestyle choice people should not make, and they do and we pay dearly for it.
Other people do not watch their diets closely. I am certainly no one to preach on that. But when we suffer from obesity in this country, people end up in the hospital and end up in doctors' offices 10 times more frequently than people who are not obese. Diabetes comes from that, high cholesterol, high blood pressure, heart problems--all these can be managed with lifestyle choices and preventive medicine, which we do not focus on in America today, so we need to do more of that.
But the other element is we need to have buy-in from doctors and hospitals and medical professionals to bring down the cost of health care.
There is a widely read article which has been referred to over and over, worth repeating, published by a doctor who is a surgeon in Boston. His name is Atul Gawande. The article was published in the New Yorker on June 1. I commend it to everyone following this debate because most Members of Congress are reading it closely. Dr. Gawande went to McAllen, TX, and wanted to know why the average cost for a Medicare patient treatment in that town was $15,000 a year while the average cost in El Paso--and Chicago, I might add--was right at $10,000 a year. Why did it cost 50 percent more to treat a Medicare patient in McAllen, TX? He took a look and sat down with doctors, and being a surgeon he knew what questions to ask.
The first response was: Defensive medicine. We have to order extra tests because those lawyers will sue us.
Another Doctor said: You know that is not true, Texas has the toughest medical malpractice law in America, limiting pain and suffering awards to $250,000.
This doctor went on to say: Nobody is suing us around here. It is not about defensive medicine. If it is, it is a tiny part of it.
What it turns out is many of the doctors in that community, and hospitals, are ordering more procedures than are needed. If you are a patient or the parent of a patient, you are not going to question it when a doctor says: I think we need an MRI. Are you going to say: Doctor, are you sure we need an MRI? You trust his judgment, and that judgment, unfortunately, can be very expensive because the doctors in that town are motivated by more procedures, more billing, more money, more profit. That is the wrong motivation. The motivation should be a healthy patient, a good medical outcome.
Dr. Gawande contrasted McAllen, TX, with the Mayo Clinic, a fantastic medical resource in Rochester, MN. It treated members of my family, and it is one of the best in the Nation. The Mayo Clinic hires the best doctors they can find and pays them by salary. They are not paid by patient or how much they bill. So these salaried doctors are looking for good outcomes. They don't want to order anything more than a patient needs. They want to get a good outcome. Think of the difference in motivation between the doctors in McAllen, TX, and the doctors in Rochester, MN.
The Congressional Budget Office sent a report to us yesterday, and it says if you really want to reduce the costs of health care in America, you have to get to the question of reimbursement. When you talk about that, you will get everybody at the American Medical Association on their feet, shaking their fists, saying if you cut back on compensation and reimbursement for doctors, fewer people will go into the profession, you will not be able to get the
best procedures--you understand what they are going to say. I have heard it. Many of us have heard it. But we have to find a good way to approach this. We have to bring down the rising cost of health care in this country.
One of the suggestions is that in addition to private health insurance companies offering health insurance, we have a public option, that we have a plan that really is not motivated by profit, whether it is a government-sponsored plan like Medicare or whether it is some other plan, a cooperative, which Senator Conrad has proposed, that really says: Let's take the profit out of it and see if we can move toward the best health care outcomes and reduce the costs of health insurance so we get a good medical outcome at a reasonable cost.
Some have come to the floor and criticized that idea. I think they are wrong. I think if you look at the Medicare system, 45 years after we enacted it, it has been an unqualified success. Just look at how long seniors are living because they have good medical care after they reach the age of 65. It is not a question of whether you are rich or poor.
I run into people in my State of Illinois--a woman, a Realtor who said to me in Harrisburg, IL: Senator, I want you to meet me. She said: I am 64 years old. I have never had health insurance 1 day in my life.
I could not believe that. But she said: Next year I am 65. I am going to have Medicare. And finally I can breathe a little easier knowing that the savings I have put together are not going to be wiped out with one trip to the doctor.
So we understand that Medicare has worked. And it has created quality care and good outcomes. We also know the Veterans' Administration, another government health insurance approach for the men and women who served our country, whom we honor with a medical system that is there for them, provides some of the best care in our country.
We need to find a way to work out these differences. Believe me, at the end of the day there will always be a reason to do nothing. There will be political risk in doing something. But the American people have to stick with us in this debate and understand that if we do not address the fundamental issue, it is not just a question of whether we will have deficits as far as the eye can see from medical costs or a program going through the roof, it is a question of whether we will all have peace of mind of health insurance protection for ourselves and our families that makes sure we have something we can afford, based on quality that will provide the kind of health care we need. It all comes around. Every family faces it. And when that day comes, we want to make sure we have done our part. This year, President Obama has challenged us, though we are sitting idly on the floor today doing virtually nothing except giving speeches. He has told us: Do not go home this year without health care reform.
He is right. It is time to roll up our sleeves and get that done.
I ask unanimous consent that an article from the New York Times on June 17, this morning, by David Leonhardt entitled ``Health Care Rationing Rhetoric Overlooks Reality'' be printed in the Record.
There being no objection, the material was ordered to be printed in the Record
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