30-Something Working Group On Health Care

Floor Speech

BREAK IN TRANSCRIPT

Mr. MURPHY of Connecticut. I just was in a meeting with some of my hospital CEOs, and they are talking about having a tough year this year. And they said that they were hopeful, though, that they might see some increases from their private providers, from their private insurance companies that send them obviously a lot of money. And they said that because they were making the case to their private insurers right now, Mr. Ryan and Mr. Altmire, that because they had had so many more people coming in without insurance because the number of people that no longer have coverage has increased, and the number of people coming through their doors that don't have any source of payments has gone up, they are hopeful that they will be able to convince the private insurance companies to raise their rates by 5 percent or so to compensate for all those people that are coming in the door without insurance.

That happens every day out there in the negotiations between hospitals and doctors and private insurers. The pressure is on private insurance companies to make up for all the people that show up without insurance. The insurance companies don't eat that money. They pass that along in higher premiums. So everybody out there who is on private insurance today, the 70 percent of individuals who are happy with their current coverage, need to know that your premiums are higher so that those insurance companies can help compensate and keep in business the hospitals and physicians that are caring for all the people that don't have insurance.

Now to your point, Mr. Ryan, about how Medicare is taking on the cost of all these folks that are uninsured from age 55 to 65 and then show up at the door of Medicare with all sorts of problems--let me share this story. In Connecticut, our major insurer, Blue Cross Blue Shield, is walking around with a chart trying to sort of push back, as far as I can tell, on health care reform. And their chart shows, as they claim, that the cost of taking care of a Medicare or Medicaid patient is comparable or a little bit more than the cost of taking care of somebody that has no insurance today.

Apparently, the reason they're showing that chart is to make an argument that you should just leave these people uninsured, because if you put them on insurance, it will actually cost you more.

We know that's not true. We know that by giving insurance to people, by allowing them access to their primary care physician to get them preventative care, that's going to cost less than leaving them uninsured. But they make a totally unfair comparison. They're comparing the cost of someone who is uninsured to the cost of the Medicare and Medicaid system which have the sickest, the most expensive people on their rolls.

And so I think it's a caution for all of our colleagues who look at our current government health care program, Medicare and Medicaid, and say, ooh, if you really look at the per patient cost there, those are pretty expensive programs. Well, they're pretty expensive programs because Medicare and Medicaid insure the most expensive people out there, insure the sickest of the sick, the old and the frail and the elderly. All of the end-of-life care is paid for by that.

Mr. RYAN of Ohio. And why do the programs even exist? Because you can't make money off of sick people. I mean, how disingenuous to walk around saying, boy, look how expensive Medicare is. No kidding. Everybody is 65 and older. Yes, that's expensive, but no one was doing it. So we decided as a country that it may be a good idea to protect those senior citizens and provide them a little bit of dignity.

Mr. MURPHY of Connecticut. And you know what the insurance companies call the money that they spend on health care? They call it medical loss. Medical loss, that's what it is to an insurance company. To you, it's a medical benefit. It is care that you get that keeps you alive. To an insurance company, it is called medical loss. It is a bad thing to spend money on you.

That doesn't mean that there are bad people running insurance companies. It just means that in the end, if the motivation is profit, if the motivation is to return as much money to your shareholders as you can, then every dollar that you're spending on care is less money that you're getting as a return on your investment, which is why so many of us believe that there is just an inherent conflict between good business and good medicine. It doesn't mean that the two can't coexist. It means that government has to step in and try to set a set of rules to make sure that in every instance good business doesn't trump good medicine, and let me give you example of why that is.

Every insurance company executive will tell you, yeah, listen, if it was up to me, I wouldn't deny care for all these people that have preexisting conditions. But if I stop doing that, then I'm going to be at a disadvantage against all my competitors. If I start accepting in all of these patients with cancer and hypertension and lupus and whatever it may be, well, then I'm going to get all the sick people, my premiums are going to go up, and I'm not going to be able to compete with everybody else.

And so they tell you, listen, if it was up to me, I would do it, but you need to set the playing field even between all of us. Insurance companies, listen, we might be fighting them on a lot of things, but they'll actually come in and tell you that if the government comes in and says that we should all take patients with preexisting conditions and we're all living by the same rules, well, then that's fair; we can live with that in the end.

The fact is that I listen over and over again to our Republican friends say that, yeah, we're for that, too. We think that we should stop people with preexisting conditions from being excluded from insurance. Well, they had control of this Congress for 12 years. They had the House. They had the Senate. They had the Presidency. They had everything. They didn't do it. They didn't do it. They would have had insurers with them on that. They would have the public with them on that, but they didn't do it.

So it just is beyond me how we can listen to so many of our colleagues on the Republican side of the aisle come down here and tell us that they were for this all along, that they were for trying to stop these discriminations against people with preexisting conditions, because they could have done something about it. They could have done something about it.

And for all those people out there that say, listen, government should stay out of health care, this is a prime example of where government needs to come in and set fair rules that insurance companies needs to play by, because if you leave it up to the private sector, they're going to push sick people off of their rolls, push sick people off to the side.

I don't want a government takeover of health care, you don't want a government takeover of health care, but there are some places that government needs to step in and fix it.

Mr. RYAN of Ohio. Well, you think about how a game started like basketball or football or just of any sport; right? At some point, you know, Naismith puts up the peach basket and starts throwing a ball and they decide, well, we'll cut a hole and the ball will fall through. That will be good. But then you start getting teams, and at some point someone threw an elbow at somebody's face and hit them with an elbow in the face and they couldn't play anymore. And the people organizing the game said, you know what, that's not really fair. That's not what the game is. So that's illegal because here's the game. You each get five people. You put it in the thing, but whatever the rules are, and then rules consistently evolve to make the game more fair.

And so here we are in the United States, well, we're saying that government is not going in to run anything. What we're going to do is create new rules, and one of the rules is you can't be denied for a preexisting condition because it's unfair. We are all agreeing as a country, and our friends on the other side, we will see how they vote when they have an opportunity to vote for this, because it's unfair. Going bankrupt in the United States for a health care reason is unfair. We want to change that rule. That rule no longer applies. And so what we're trying to do is make the game of health care more fair.

But there's a point that I wanted to just touch on for a minute. One of the points I wanted to touch base on that Mr. Murphy just made is how the insurance industry has acknowledged that this will be a level playing field for all the different insurance companies, and if we do preexisting condition, making sure that no one can pay any more than a certain percentage of their income out of pocket per year to prevent bankruptcies, those kinds of things. There's an important point that I think we need to acknowledge and talk about more.

If insurance companies have to cover everyone, if they can't play the game that they're playing now--the game now is how do I get sick people off of my rolls so they don't cause me a medical loss and how do I not get people on my rolls that I know are going to cost me money, and those people are going to be diabetics and heart disease and cancer patients.

And I had one cancer patient come to a roundtable I had who said, you know, she had cancer and then she lost her job and then was out with another job trying to get insurance on her own. She was denied. Her cancer had been gone for years and years, but it hadn't been gone 10 years, so insurance companies would continue to deny her coverage.

And so what we're saying here, if everybody is covered, if insurance companies can't deny anybody coverage, they will have to take you. There is a new business model that will be created within the insurance industry, because the game of keeping people off your rolls, or getting sick people off your rolls, is over. The new game for the insurance company is going to be how do we keep the people that are in our pool under our coverage healthy.

So you are going to see them investing money into wellness, prevention. They're going to be very interested in what the kids are eating at schools. They're going to be very interested in the pesticides that we're putting on our food that may cause cancer. They're going to be very, very interested in obesity rates. They're going to be very interested in what physical education programs look like in our schools.

We can have a real ally among the insurance industry to partner with us, with nutritionists, with dietitians, with, you know, preventative and wellness groups. We will now have an ally. Instead, the insurance companies are now the enemy because they don't want to make these investments.

Now they're slowly starting to because I think they're reading the tea leaves here is that they're going to be slapped down and they're going to have to cover everybody, and because of that, they are going to be able to make investments, and I think it's going to end up being a very, very good thing.

Mr. MURPHY of Connecticut. I agree, and as I said, I think that's why, on this issue of setting a level playing field amongst insurers, where they're not allowed to keep out people who are sick, where they're also not allowed to price people who get sick at an exorbitantly higher rate than other people, you know, insurers want to be part of that change because it does allow them to get back to trying to be about wellness and about health care rather than trying to be about moderating risk.

So I think in this fight we have allies. Now, listen, insurers may not like other parts of this bill. They may not want the public option to put pressure on their rates to come down, but there are a lot of other pieces here that they're partners on.

I want to just present one other example of where it's appropriate for the government to come in here and set new rules, and you said it right here. You know, if

you don't want the government regulating health care, well, then you've got to dial the clock back about 50 years or so, because the government right now not only is paying about 55 percent of all health care dollars in this country, but we're heavily regulating health care insurance today.

It happens mostly at the State level, but every single State has a pretty well staffed insurance department that's regulating health care today. It just doesn't do it very well, in large part because if you're an individual buying health care insurance or you're a small business purchasing on behalf of you and maybe five others, you're getting a pretty raw deal. It's pretty simple economics. You are negotiating on behalf of one or five versus large employers who can either bear the risk themselves and they just self-insure or they have enough employees so that when they're trying to cut a deal with the insurance company they can get a pretty good deal. But for that one guy out there that's just buying an individual policy, he's paying the highest rate. He's paying the highest rates because he's got no purchasing power.

So we're just trying to change the rules for him. He would still go out and purchase insurance, but he would be able to purchase insurance in an exchange that this legislation sets up, where he would be joined with everybody else in his State or in his region who is looking for an individual policy, and we would join their forces together and negotiate on their behalf. We'd have insurance companies bid into the exchange to bid to have the right to offer coverage to all of those individuals, and we would leverage the purchasing power of thousands of individuals.

Now, health insurance companies would still be regulated, just like they are today, but rather than operating in a market in one State at a time, rather than operating in a market where they are allowed to essentially negotiate with one person and one person and one person, they would now be negotiating with a pool of individuals, which would lower the costs for those people. Just a different way to structure the market. Still a regulated insurance market. It's just a different set of regulations.

It's another example of where government, by setting a more fair set of rules for insurance companies and individuals, can lower prices. That's what this legislation is talking about doing; not taking over the health care system, but establishing a different set of rules that benefits our constituents, individuals, and small businesses who have gotten the short end of the stick so far.

Mr. RYAN of Ohio. And so you go to this exchange that's going to be--there will be an essential benefits package that will be set by the Surgeon General and a group of experts who will decide what the essential benefits package would be, you know, dental, maternity, hospital, all the basics, and every insurance company that goes into this exchange, that will be the bare minimum. So there won't be any of this, I'm paying a lot of money out of pocket but my coverage is terrible, or, I don't have any to begin with. There will be this essential benefits package which will be the baseline coverage for every single private insurer that comes to the exchange.

Then they can build on that with premium plans, Cadillac plans, however high they want to go, so people who have a lot of money, there are still going to be plans up there because insurance companies will be making money.

What we're asking here in the House side now is, in addition to all of these private insurers, we put in, basically, a Medicare program, a Medicare program that will compete with all of the other private insurers. Everyone, 80 percent of the people who have Medicare like it. Sixty-five percent of the American people say this is a good idea. But that Medicare that would be in the exchange with all the other insurance companies would compete with all of them, but they wouldn't have to put money into marketing. They wouldn't have to pay a CEO $100 kajillion a year or, turns out, like $200,000 a minute or an hour, whatever it is nowadays and would compete. And by not having to put all that money into advertising and all those other things could help bring costs down, and everyone else in the exchange would now have to compete with that.

So you want to talk about choice, that public option and the way we're setting up the exchange is all about choice. And if you're a family of four making less than $89,000 a year, you're going to qualify for some health care credits, some subsidies. So you will get the subsidy from the government based on your income, and then you go to the exchange and pick any plan you want. No government bureaucrat's telling you what--no, you've got to pick this plan; no, I mean that one; you pick this one. There's none of that.

You get the credit and then you go to the exchange. And if you want the public option, you could pick it. If you don't want it, you don't have to pick it.

Mr. MURPHY of Connecticut. Mr. Ryan, I think for those of our colleagues who are against this exchange, they've got to go to their constituents and the American people and explain to them why they don't believe that individuals should be able to join together and negotiate for lower rates.

If they're against the public option, they have to make the argument to their constituents why they don't think their constituents should have the choice to choose the same kind of health care that Members of Congress and Medicare beneficiaries and soldiers and veterans and public employees have. This is about banding people together to get lower rates, giving people more choice. And the reason why both of those ideas, Mr. Ryan, and I'll wrap up, have broad public support, every single poll that comes back says 60, 70 percent support the idea of the insurance exchange and a public option within it is because that's what they want. That's what they want, the ability to negotiate together and the ability to have more choice.

Mr. RYAN of Ohio. And how do our friends who talk about freedom and liberty want to deny the ability to basically buy into a Medicare-type program? That seems to me like it's limiting the consumers' choice, limiting freedom. And what we're saying is they have all got to compete. They have all got to be there. We're going to help you pay for it because we know if you don't get insurance you're going to go cost us a heck of a lot more money in the emergency room and this is all about choice.

And you know, if you like what you have, you keep it. That's fine. So you know, this is good. I think about the 1,600 families in my district that go bankrupt because of health care. I think of the people that will have opportunity and options because of what we're trying to set up here and reform this system.

But as we close, Mr. Speaker, I would just like to say, if you look at what we have tried to do and what we have done over the course of the last 7 or 8 months, we've taken on the oil industry; we're taking on the insurance industry. Since we've been here, we've raised the minimum wage, increased money for Pell Grants, taken the banks out of student loans so that people can afford to go to college, make investments back into the middle class, infrastructure money, stimulus money, thousands of teachers are at school right now because of stimulus money that is coming out, invested in the green technologies, green energy.

If you look, issue by issue by issue by issue, everything that we have done has been sticking up for the middle class and taking on the special interests that have been driving down wages, driving up health care costs, making it difficult for small businesses, making it difficult to go to college, cutting every business in on the deal, no matter what; and it's important to recognize that this reform proposal and this reform bill is all about giving the middle class consumer protections, choice, and affordable health care in a system that has justice.

So I want to thank my friend from Connecticut, I want to thank our friend from Pittsburgh, western PA, who was here. And, again, our condolences out to people in the Pacific who are going through a very, very difficult time who shared with us earlier in the hour.

With that, we yield back the balance of our time.

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