Energy And Water Development And Related Agencies Appropriations Act, 2010

Floor Speech

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Mr. WYDEN. Mr. President, I wish to spend a few minutes this morning talking about some of the positive developments that are taking place right now on this issue of health care reform. For example, this morning, the President is out talking to workers who already have insurance about how health care reform will work for them. He is spending his political capital. He is using the bully pulpit that is the White House. It is clear that this is a priority for the President of the United States.

A second positive development is in the Senate Finance Committee. We have a bipartisan group of six Senators. They are putting in killer hours at this point. I have been kidding them that I suspect they are being fed intravenously, but they are trying to put together a bipartisan health reform effort, and I appreciate what they are doing.

Third, I note my good friend from Utah on the floor of the Senate this morning. He and I have made it clear that the sponsors of the Healthy Americans Act, a bipartisan group of 15 of senators, are very open to working with Chairman Baucus, Chairman Dodd, and the President of the United States in a bipartisan fashion to fix health care.

So the question that is front and center in all of these discussions with the President, with the bipartisan group in the Finance Committee, with the bipartisan group of Healthy Americans Act sponsors that Senator Bennett and I are part of, is how we control costs in health care. What are we going to do to make health care more affordable?

It is our judgment that the key to making health care more affordable is to make sure people have bargaining power and people have choice--the same choice that Members of Congress have. The distinguished Senator from New Mexico, the Senator from Utah, and myself actually belong to something that is pretty much an exchange, which is like a farmers market for health insurance. But essentially what we in the Senate have is the opportunity to choose from a menu of private health policies. We get rewarded for making an economical selection to save on our premiums, and we get rewarded when we choose a program that puts more emphasis on prevention and health. So when Senators shop wisely, they end up being wealthier and healthier as a result of being able to participate in a big exchange.

What Senator Bennett and I wish to do today is extend that kind of bargaining power to everybody in our country. After a period of time, a phase-in over a few years, everybody in our country ought to have a chance to have the kind of bargaining power and the kind of clout that Members of Congress have. Everybody in our country ought to be in a position to choose a policy that works for them. And when they make a good choice, when they
shop wisely, the extra money should go into their own pockets. That is the kind of approach Senator Bennett and I have advocated. It is a way to focus on these exchanges, these farmers markets which, in my view, are the key to getting health reform right.

What these exchanges do, if we set it up right, is they give all the middle-class people who are insured today in New Mexico, Utah, and Oregon a chance to come out winners under health reform at the get-go. And if you are already insured, the President has said he is going to let you keep the coverage you have. Now that makes a lot of sense. We senators hear that at every meeting back in our states.

But if, for example, in Utah, Oregon, or New Mexico, you don't like the coverage you have and you can get a better deal at the exchange, something that puts more money in your pocket, something that helps you and your family, let's let people do that under Free Choice.

Under the Free Choice proposal Senator Bennett and I have advocated, that we have presented to Chairman Baucus, Chairman Dodd, and the President of the United States, this is something we can do for the insured that helps them save money right at the get-go.

Regrettably, a number of the bills that have been considered in the Congress do not give people those kinds of choices. And when we look at how these bills are set up, there are what are called ``firewalls'' that restrict people from getting these choices. A lot of the people who are advocating for a public option are not even going to get the choice to enroll in one.

The key to helping people who already have insurance, the 160 million who get coverage through their employer today, is to get these exchanges right and to make sure that everybody has bargaining power within these exchanges as part of a big group.

I have a private policy as a Member of Congress. The people in Oregon, in effect, are my employer. They pay a portion of it. We have a million people in our group. That is the way to spread a lot of cost and risk through a group so you can get real value. Let's set these exchanges up at least so they contain big groups through a regional approach. Senator Bennett and I said we are open to a variety of ways of doing this. But let's make sure that everybody has some clout in the marketplace. If you are a small business in New Mexico today, you get strangled by the administrative costs of health care. You don't have much clout in the marketplace. As a small employer, you may be paying 30 percent of your health care dollar for administration. It should not be that way. We should be giving those small businesses relief.

What Senator Bennett and I have said with our free choice proposal is if you are an employer in New Mexico or elsewhere in this country, you may want to take your workers to the exchange. This is employer-sponsored insurance. This is an employer taking their workers to the exchange. As an employer, you can go to the exchange in New Mexico and say you want a discount because you are taking your group of workers to the exchange. That is playing hard ball with the private insurance business. That is saying to the insurers in New Mexico you are not doing good enough; you are not giving me a good enough deal, so I am going to have a chance to go to the insurance exchange and get a better one. We call it Free Choice: more options for employers and more options for workers. Options that look like what Members of Congress have.

I fear if we do not set up a system that gets this exchange right so that people have bargaining power--employers and employees--we are not going to be able to get the kind of cost containment the President of the United States has identified correctly as the heart of health care reform. It is about holding down costs. It is about making coverage more affordable.

I urge colleagues to look at the article that was written in this morning's Washington Post by Ezra Klein talking about the importance of the exchange and what it can mean for the bargaining power of middle-class people and businesses if it is set up right.

We know how to set it up right because it resembles the system that all of us enjoy in the Senate. At the beginning of the year, senators have a choice, a menu of options. If you make a good one, the money goes right into your pocket.

One last point with respect to Free Choice. Sometimes the best choices are not the most expensive choices. Senator Bennett knows a lot about this because in Utah they have a system, intermountain, that has illustrated that the best choices are not always the expensive choices. Let's make it easier for people to choose an Intermountain program or a Mayo program or any of the other integrated systems that are regarded as the gold standard in terms of quality.

One of the concerns I have about all of these firewalls in the legislation that is being considered is that Americans around this country, after a big push in the Congress to choose quality, are not even going to have the opportunity to choose a program like Mayo or Intermountain that gets more value for the health care dollar.

There are some positive developments in the health care debate going on today. To highlight some of these developments, the President is out talking to workers; negotiations are going on in the Senate Finance Committee; and there is the very gracious approach that Senator Bennett and a number of Republicans are taking in terms of saying: Look, we want this to be bipartisan, we want to meet the President halfway.

Each of those developments, it seems to me, is very positive. Fixing health care is absolutely key to fixing the economy.

As Ezra Klein pointed out this morning in the Washington Post, the reason people's take-home pay isn't going up is because medical costs are gobbling up everything in sight. So the key to fixing health care is promoting free choice; getting these exchanges right so employers and employees have more opportunities to hold costs down.

I think, in view of these positive developments I have highlighted, there is reason for Senators to stay at it and keep working in a bipartisan way, and real progress is going to be made before this body leaves for the August break.

I yield the floor.

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Mr. WYDEN. Mr. President, let me pick up on the point made by the Senator from North Dakota because he is very accurate in his assessment.

One of the reasons they like so much this idea of trying to set up a model as we have in the Congress, with our exchanges, is because, for example, somebody who is working for the Forest Service in the State of Oregon has essentially the same kinds of choices I have for the Wyden family.

I think Senator Dorgan's point about trying to make clear to the American people that these choices Members of Congress have, somebody, for example, who works for the Forest Service in Oregon, has essentially the same choices, which involve basic health care--what we think of as preventive care, primary care, being able to go see a doctor, being able to get hospital coverage, and a reasonable catastrophic benefit. That is what Members of Congress can essentially choose from, and that is what somebody has an opportunity to get if they work at the Forest Service.

I think Senator Dorgan's point is very valid. The reason I have come back to this is because, under our free choice proposal, people in this country would, in effect, be able to go to one of these exchanges, which is similar to a farmer's market, and choose from a menu of private policies, not unlike what a Member of Congress has and somebody who works for the Forest Service. So I think the Senator from North Dakota has made a good point.

We, of course, have a lot of bargaining power because we go into these big groups, and that bargaining power can hold down administrative costs and get a better deal for somebody who has insurance. I would like to see, as we go forward with this legislation, that these exchanges are set up around a lot of the same principles Members of Congress have. Because if you do that, that is going to hold costs down for people who have insurance, and it is going to make their coverage more affordable. For example, the workers the President is going to see today would have additional choices in the future and save money when they are purchasing quality health care.

With that, I thank the Senator from North Dakota for making an important point.

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