Health Care Reform

Floor Speech

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Mr. MERKLEY. Mr. President, we stand at a critical juncture today as we grapple with how to fix our broken health care system. Rapidly escalating health care costs are compounding the current economic crisis in America. Families and businesses across the country are struggling to afford increased premiums, copayments, and deductibles. Premium increases are taking an increasing portion of workers' wages, and more firms are under pressure to reduce or possibly eliminate health care coverage for their workers.

Helping middle-class families and small businesses afford health care coverage is a critical component of improving the Nation's economy. Families and business owners in Oregon have told me at length how concerned they are about the rising costs of health care. Those families who have health care are concerned about losing it, and they are concerned about the rising cost of premiums and the copays. And those citizens without health care--nearly 47 million Americans are unable to afford the cost of health care--those citizens are worried about getting sick or they are sick and they are worried about how to pay for the drugs and treatments to get well. Under this system, our small businesses that are working hard to provide health care coverage for their employees are worried they will not be able to continue, that they will have to raise the share of the costs the workers carry or maybe they will have to eliminate the health care plan altogether.

I wish to share with my colleagues the experience of one of my constituents, Jeanette Hall of Milwaukee, OR. She was employed, but she could not afford health insurance. Jeanette had a mole on her arm. It was a mole she thought should be looked at. Her friends and family urged her to have it looked at. Finally, she went to the emergency room to have it examined. The diagnosis was melanoma, but Jeanette could not afford to have the surgery to address it.

Sometimes one gets a fortunate turn in life, and Jeanette just got such an example. She was interviewed by a local news station that was doing a story about the plight of the uninsured. Jeanette says she is only alive today because of that moment when a news station covered her story because after that story aired, she received a call from a local hospital that offered to help. They basically said that in exchange for being the subject of an observational surgery for medical students, the hospital would cover the cost of the surgery. Jeanette is now cancer free, and she feels very blessed about that. What is more, she now has a job where she has health insurance, and that certainly puts a brighter horizon in place for her. But while she is pleased about her personal health and her personal health insurance, she is worried about health insurance for families and friends and health insurance for all Americans in this broken health care system.

Her brother is very ill. Her brother does not have health insurance. Her brother needs an operation to save his life, but he is not getting that operation. She anticipates that his life expectancy is very short now as a result. She sees it very personally, very directly.

Just as she hopes for health care for her and her family and for American citizens, so do citizens across this Nation. Citizens such as Jeanette are not looking for a government handout. They don't expect something for free. But what they do want is access, choice, quality health coverage, affordable health coverage for their families and their workers.

We need to offer citizens such as Jeanette a lifeline in these hard economic times. As a member of the Senate Health, Education, Labor, and Pensions Committee, I am very proud of the bill we passed 2 weeks ago which puts us a significant stride closer to providing affordable, quality health care for every American. It is a plan that will lower costs, provide consumers with more choices, and increase competition.

That act, the Affordable Health Choices Act, is a landmark bill. It gives every American a full range of health insurance options, including a community health plan. It ensures that those who like their current health care coverage can keep it. And it guarantees that no American will be denied coverage because of preexisting conditions. That act makes sound investments in disease prevention, in health promotion, and it strengthens the health care workforce.

The Affordable Health Choices Act gives small businesses better choices for high-value health insurance by creating a new health insurance marketplace, or gateway as it is called, which will help lower costs and increase competition. In fact, let me explain this a little bit more.

Right now in America, if you are an individual trying to get health care, you have to pay an extraordinary premium because you don't bring any market share clout to the negotiating table. And right now in America, if you are a small business, you don't get a good deal because you don't bring any market clout to the negotiation. This health care bill at its heart addresses this problem. It creates an exchange where you would purchase health care, not as an individual but as a group of hundreds of thousands of fellow citizens. That health care plan would bring the combined negotiating clout of those hundreds of thousands or even millions of individuals, so you get a much better deal as an individual and you get a much better deal as a small business. I know that every individual and small business in America that has gone through this process of trying to get a fair, decent health care plan knows exactly what I am talking about. And that is the heart of this reform.

But even as we make historic progress on guaranteeing affordable quality health care for all, there are powerful forces underway to halt this effort. There are those who favor the status quo, and they are working on their talking points, they are rallying their special interests, they are doing polls to see what phrase will most scare Americans from changing. They want to defeat this historic march toward quality, affordable health care for every single citizen.

One thing is clear: We cannot afford to fail. Maintaining the status quo is not an option. The last time we attempted to tackle the problem in 1992, health care spending was $849 billion. Today, health care spending in America is $2.2 trillion and growing by over 10 percent a year. March it forward next year, and it will be over $2.4 trillion; the year after that, $2.7 trillion; the year after that, $3 trillion, and so forth. We will be spending nearly $40 trillion under the status quo over the next 10 years.

Premiums in the early 1990s were 7 percent of a family's income. Today, premiums eat up 17 percent of a family's budget. In 1996, employers paid about $3,700 toward a family plan. Now that is well over $10,000 and growing, and workers are picking up an increasing share of the costs.

Today, under the status quo, 60 percent of bankruptcies are due to health care costs--more than half. More than half of personal bankruptcies are due to health care. What is more, more than half those personal bankruptcies due to health care are with folks who have health care insurance, but their health care insurance simply was not adequate to cover the extraordinary costs of a medical emergency. Indeed, 75 percent of those individuals who are going through bankruptcy due to health care costs had health insurance.

If we look to the future, the consequences of inaction are even more dire. But, despite all that, every day we hear from special interests, we hear from their allies who are standing up, using their poll-tested phrase such as ``government takeover'' in order to scare the American people into rejecting health reform.

Here are citizens who know firsthand the challenge and the stress of health care. But they are being manipulated. There is an effort to manipulate them by powerful special interests that want to scare them, to turn them against reform and change. The opponents of reform have a health strategy. Their strategy is the status quo. Why do they like the status quo so much? Because the special interests are making so much money with the current health care system--huge profits for insurance companies, huge profit for other health care players. But here is the problem. Soaring profits for health care companies equate to out-of-control, unaffordable premiums for America's working families.

Let's examine the status quo plan put forward by the opponents of reform. Under the opponents' status quo strategy, the premiums that are paid by a family would go from about $13,000 a year now to, just 8 years into the future, $24,000--nearly double in a short period of time. If you want out-of-control premiums, then support the opponents' status quo efforts.

Second, under the opponents' status quo plan, the cost of health care for a small business would more than double. The cumulative costs are extraordinary. We see the costs here, in billions of dollars, start in 2009 at $156 billion--the cost imposed on small businesses--and soaring to $2.4 trillion by 2018--cumulative costs. So over a 10-year period, small businesses carrying a multitrillion-dollar burden under the status quo.

Third, under the opponents' status quo plan, the number of uninsured Americans increases. Why is that? It is very simple: Families cannot afford these premiums, small businesses can't afford these premiums, even large businesses may not be able to afford this more than 10-percent-a-year increase in premiums. Indeed, under one study, the number of uninsured Americans, under the status quo, the opponents' plan, would reach 66 million Americans over the next 10 years, up from about 47 million right now. That is a huge increase.

Fourth, under the opponents' status quo plan, our community hospitals would see uncompensated care go through the roof. Why is that? Because we have more uninsured. They have to go to the emergency room to get their care. So the hospitals end up carrying that burden. What does that do? That results in a cost shift from those who do not have insurance and go to the emergency room--those costs get shifted to those with insurance. It continues the death spiral in soaring insurance premiums that we have right now in America.

What is more, under the opponents' status-quo approach, we get the same failure to invest in prevention and disease management. Insurance companies do not have an incentive to invest in disease management that might make you healthier 10 years from now or 20 years from now because they assume you probably will not be their customer 10 or 20 years from now. We get the same investment in a fee system, in a cost-plus system, that is driving up the cost of health care.

Let me make this very clear. If you have any form of expense in which the compensation is cost-plus, the person providing those services is going to provide as many services as possible. If you are building a fighter and you say: We will pay your costs plus 10 percent, you are going to make sure that fighter plane is as expensive as possible. The same is true in health care. Yet that model of compensation is the dominant model in health care today.

We need to invest in an integrated approach, such as the Mayo Clinic does, where the doctors are not motivated by profits but by providing health care to their patients. They have no incentive to run you through that MRI machine four or five times. Their only incentive is to help you get well. That is a very different approach, an approach we need to expand on in America, an approach that says we need an integrated health care system, not a cost-plus fee system.

When the opponents of reform try to scare you and say we don't need to change anything, remember how scary their plan is. I know you understand what I am talking about because you see it every day. The opponents are saying it is OK if insurance companies routinely deny necessary medical care and cancel policies in order to increase their profits. The opponents are saying they prefer an America where parents will lie awake at night, worried if they can afford health care their children need because they do not have health insurance for their children. The opponents want an America where workers are just one pink slip away from losing their job and their health care. That is a double calamity that strikes millions of families in America every year.

The opponents are arguing for an America where a would-be entrepreneur who works hard and wants to start a business may not do so because he or she cannot afford health coverage in a volatile, expensive small business market. The opponents want an America where small businesses that do offer insurance are faced with double-digit, budget-straining premiums that threaten the economic viability of that small business.

I wish to see our small businesses thrive. Our small businesses are incredibly creative, with far more patents per capita than large businesses. Our small businesses expand and grow and absorb more workers. We want them to expand and thrive, and a major challenge they have today to their thriving is our broken health care system.

I do not accept that vision for America, the vision put forward by opponents of health care reform. We need to create a simple health care exchange, where individuals and small businesses can go and be part of a large pool so they can negotiate a fair deal. Today we do not have that fair deal. Tomorrow we will.

We need a health care system that invests in prevention and disease management. We need a health care system that works to expand the health care workforce, because we have a big challenge. Many of our health care workers in America, our doctors and our nurses, are retiring. They are baby boomers. They are reaching retirement age. We will have increasing demand for more of their services as baby boomers retire. The bill we put forward works to address that discrepancy; otherwise, greater demand and lower supply will drive up the cost of health care.

We need to create a system that eliminates insurance that doesn't cover preconditions. What kind of health care do you have if you have a bad back but your bad back is not covered? What kind of health care system do we have if you have melanoma, such as Jeanette did before her operation, and you cannot get it covered because it is a preexisting condition?

This bill changes that. I believe we need to create a health care system that expands citizens' choices instead of constraining them as in our current system. We have many markets in America that only have a single dominant provider. We need to create a Community Health Care Plan to hold the feet of insurance companies to the fire. Competition in the marketplace--a 100-percent apple pie, American concept--is needed in health care to help control costs.

Americans across the country are counting on us to work together to find a solution, to help ease the burden of health care costs on family and business budgets and create more affordable health care options. I urge my colleagues to set their partisanship aside, set aside the goal of trying to torpedo America's future because you want to torpedo the Presidency of Barack Obama. Think about the quality of health care for our working families and what we in this Chamber could do to make that quality of life far better. The costs of inaction, the costs of our broken status quo system, are too great to allow their solution to fall to petty, bitter partisan bickering.

Let's come together. Let's fight for a brighter future for America's families.

I suggest the absence of a quorum.

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