Health Care Reform

Floor Speech

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Mr. MERKLEY. Mr. President, there was a time when our colleagues across the aisle were in favor of competition. Correct me if I am wrong, but in the past, we used to have a highly regulated, noncompetitive airline industry. Was it not our good friends across the aisle who said we need to create competition so consumers have real choice and this will drive the cost of airline tickets down? Am I mixed up on that or is that fairly accurate?

Mr. UDALL of New Mexico. That is an absolutely accurate rendition.

Mr. MERKLEY. We are in a very similar situation here, where we have a noncompetitive industry, costs going through the roof. There is a basic factor at work which is, if we introduce competition in health care, service will improve, costs will come down.

Choice is much more important in this area than just about any other. If you are not satisfied with the cost of your insurance or the service you are receiving, then you should have multiple places to go. That is the underlying point of creating a health care marketplace or exchange, as it is called, so citizens can say: Here are all the plans competing against each other. What are they going to offer? A year later, if you are not happy, you get to switch, which says to every single insurance company, if we don't do well, we are going to lose our customers. That is the marketplace. That is competition. That is what we need in America. It will be helped by having a public option.

Mr. UDALL of New Mexico. Absolutely. No doubt about that.

Mr. MERKLEY. I can tell you a couple stories from Oregon. There was an article in the Bend Bulletin in October about two families.

One individual, Dale Evans, went to his doctor because he was experiencing pain in his chest. His doctor recommended he have an MRI to find out what was going on. The request was made three times. The insurance company turned it down three times. Because he didn't have this test, there was no diagnosis made of the cancerous tumor he had. His tumor proceeded to damage the nerves in his spinal cord and left him unable to walk. Then it became too large to be operated on. Mr. Evans died the following year, in 2008. As a result of the choice made by the insurance company, a for-profit insurance company, the test was not conducted and the individual died.

Richard Paulus of Bend, OR, has a similar case being filed right now. He, fortunately, is still alive. He was denied repeated requests for back surgery. His doctor argued for a second opinion. The request was made, turned down again. One factor is, you want to have an insurance company that is making decisions related to healing, not related to profits. The second factor is, one of the best ways to drive that, if Mr. Evans and Mr. Paulus were not satisfied, if they had a choice, they would be much more likely to create accountability with the company they are with right now.

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Mr. MERKLEY. Your point is well taken. The overhead in the private health care industry is now 25 to 30 percent. That is a whole lot of folks sitting around desks operating with paper rather than nurses and nurse practitioners and doctors practicing the craft of medicine, the craft of healing.

Whereas, if you look at Medicare, instead of 25 to 30 percent overhead, it is somewhere around 3 percent--much less and, therefore, a lot more dollars going into actually assisting folks in getting well. Again, competition is going to drive down that overhead.

Mr. UDALL of New Mexico. I say to Senator Merkley, the thing the American people should know about the health care plan Senator Reid was down here talking about earlier--that we have unveiled here in the Senate--is it has a public option in it. So the public option will be there to provide competition. It will be there to provide the very best care. And it will be there to make sure we keep these insurance companies honest. That is what we are trying to do here: to make sure there is competition in the market, to make sure the insurance companies are honest.

Mr. MERKLEY. Yes. The reason we have lost competition is twofold. One, in many markets, a single company dominates the market. Second, even if you have multiple companies, they are exempt from the antitrust laws and, therefore they can communicate with each other in a way that reduces or even eliminates real competition. That is why this is so important.

There is one feature of this public option that I think is important to recognize. It represents a huge compromise, and that compromise is that many of our Senators said: We are not sure our folks back home are quite sold on this idea, and we do not want to see it ``forced on them.'' Quite frankly, I think it would be good to have competition everywhere in the country, everyone have more choices. But in deference to that Federalist tradition in America, in deference to the laboratory of State experimentation, a provision has been included in Senator Reid's merged bill that says if a State does not want to participate, it can opt out.

So there is no Senator in this Chamber who should have any concern about saying my folks back home do not want this, and they are going to be forced to have it, because no State will be put in that position. Any State can choose to say: We do not wish to participate. I think that means we will have a situation where many States--most States, I believe--perhaps virtually all States will say: We do want to participate. But those States that are not so convinced will have a choice to watch this unfold to decide if they wish to join this movement for competition and choice later on.

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Mr. MERKLEY. I say to the Senator, let me give you an example of how that competition can work in a health insurance marketplace. In Oregon, we have a public option in workers compensation, which is health insurance for injuries that occur on the job. We have had this public option for 80 years. It did not work that well. It was not that well designed, and it was not that well managed.

About 20 years ago, a group of businesses got together, and the businesses said: We need a better insurance policy. We need a better competitive market for on-the-job health insurance. So in a deal that was called the Mahonia Hall deal, Mahonia Hall rewrote and improved the management of our public option. The result is, rates today in workers compensation in Oregon are half of what they were 20 years ago, because competition was introduced, efficiencies occurred, service improved. I can tell you, there is not a business in Oregon to be found campaigning to eliminate the State accident insurance fund, which is a public option in work-based health care.

Our colleague SHELDON WHITEHOUSE was involved in establishing a very similar program in Rhode Island. Their workers comp, he told me--and I think he has told this Chamber--introduced by Rhode Island adopting a work-based health care public option resulted in their rates dropping by half.

Wouldn't it be great if competition could reduce health care costs in America rather than having 10 to 15 percent increases every single year?

Mr. UDALL of New Mexico. Yes. I say to the Senator, you hit it on the head. I have been here on the floor with Senator Whitehouse--I know Senator Reid was just here--participating in a colloquy.

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Mr. MERKLEY. There are folks who have said: Well, now, hold on. Isn't this a government takeover of health care? Since that has been said so many times on this floor by those who oppose health care reform, I think we should address it directly. Introducing a competitor does not have the government taking over health care. It is an option citizens can choose--if they are not satisfied with the current performance--competing on a level playing field. This is exactly what you need when you have markets that have lost their competition.

It is important to note this phrase ``government takeover'' came out of a study that was contracted for by my colleagues across the aisle to say: How can we defeat health care? They polled folks in America and said: What are the scariest terms we can use--even though we do not know what the plan is; even though we do not know whether the plan is going to invest in prevention; we do not know if the plan is going to invest in disease management; we do not know if the plan is going to have healthy choice incentives that will help improve the quality of life of Americans and decrease health care costs; we do not know if we will have insurance reforms that will get rid of dumping, the practice of throwing people off their health care plan once they get sick; we do not know whether there will be reforms that say there will be guaranteed issue, you cannot be denied the opportunity to have health care because of preexisting conditions. We do not know any of that, but whatever it is, we are going to be against it. So let's do a study now. And they contracted to do the studies. Let's find out how to scare Americans. The result was: Let's call it a government takeover.

I have to tell you, this is too important an issue to the citizens of our Nation. Health care touches every individual, touches every small business trying to succeed. It touches every large business trying to compete around the world, with much more efficient--much more efficient--health care systems in other countries. It is too important than to do studies to try to find words to scare Americans.

How about we try to solve problems in this Chamber? I am going to tell you, I think this bill put forward last night by Majority Leader Reid is about solving a problem absolutely critical to our economy, critical to our small businesses, critical to the quality of life of our families.

Mr. UDALL of New Mexico. I say to Senator Merkley, you are exactly right. Senator Reid has put a merged proposal on the floor, and do you know what the response is we have seen? I like your comments on this. The response we have seen I find amazing, I find absolutely amazing, because here is what we are facing.

The American people want health care reform, so we have announced we are going to put a bill on the floor to reform health care. We have been working on it for months. It is out of two committees. We have brought it together. So what do we have to do in the Senate to move forward? We file a motion to proceed. OK. That is just to proceed. You are not even on the bill.

Do you know what is going to happen? The Republicans are going to step forward, their leadership is going to step forward, and they are going to say: No, no, we are not going to agree to that. We are not going to agree to even proceed to the bill.

So we are going to have to file cloture. When we file a cloture motion today, it is going to take 2 days before that cloture motion ripens. Then we are going to have a cloture vote. Then 30 more hours are going to expire. They are going to require us to use all that time. Even though we may be in a quorum call and not doing any debate, they are going to require that. Then, believe it or not, they are going to require us--these wonderful clerks who work up here--they are going to require them to stand up for 50 hours and read that bill on the floor--50 hours. The normal thing we do to get to something is we waive the reading. But they are going to require it.

What does the Senator think of that approach? I cannot understand that.

Mr. MERKLEY. Many Americans are familiar with the tradition of a filibuster, and they envision it where Senators stand up and speak and speak on an issue of principle. That was used very rarely in the past. In fact, now all that is required is for one Senator to object to unanimous consent, and then you need to have a 60-vote test.

This 60-vote test is most often used at the end of a debate to say: Do we go to a final vote? Are we going to wrap up debate and go to a final vote? But in this case, as the Senator has described it, it is going to be used even to hold a debate on health care in this Chamber.

All my life--I first came to this Chamber when I was an intern for Senator Hatfield in 1976--all my life, I have heard the Senate described as ``the world's greatest deliberative body.'' Well, that is a pretty cool thing. But are you telling me that folks are going to try to block this Chamber from even debating health care?

Mr. UDALL of New Mexico. That is exactly what I am saying. We have worked hard. The majority has worked hard. We put together a bill. We have had hearings--Democrats and Republicans--in those committees. When we file a motion to proceed, we are not even on the bill, we cannot amend the bill. When we file that motion to proceed, they are going to require we take 2 full days, and then another 30 hours, and then demand we read the bill on the Senate floor.

I see Senator Alexander in the Chamber. I know there are good friends of ours on the other side who do not want to see that kind of thing proceed. But a couple of Senators can muck up the whole works here and slow this thing down.

I think the American people want us to move forward with health care. I think they want us to get something done that provides health care for people, that provides choices, that keeps people's doctors, that puts competition in the market--all of those kinds of things.

Senator Merkley.

Mr. MERKLEY. I join the Senator in saying to all my colleagues, do not fear debate on health care. We are here, and it is our job to come and debate. It is our job to come and talk about how important it is to have insurance reforms so people are not barred because of preexisting conditions, people are not dumped after a decade of being provided insurance because they get sick.

It is so important we have this debate, and I look forward to having it, and hope all colleagues will join in saying: Yes, no matter which side of this issue you are on, it is time to debate, as our citizens have sent us here to do.

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