August 3, 2009 CONGRESSIONAL RECORD — SENATE S8663 Americans do not want a single-payer But among the most troublesome as- The bill was reported by the Appro- system. The leadership of both parties, pects of this so-called reform is the en- priations Committee more than 3 House and Senate, understands this actment of a public plan which will in- weeks ago on a bipartisan basis with fact. The American public does not evitably lead to a single-payer system all members voting in support of the want a wholesale government takeover Americans don’t want and don’t need. measure. of one-sixth of our economy. We do not Don’t take my word for it on the As my colleagues are aware, as the want waiting lists such as in Canada. cost, on the loss of choice, and on the new chairman of the Appropriations We do not want rationing such as in effect on small business job creators. Committee this year one of my goals the United Kingdom. Just read the words of the nonpartisan was to increase transparency and ac- Realizing where public opinion is on Congressional Budget Office. On the countability in the appropriations this pivotal issue, the advocates of issue of massive, unsustainable cost process. In many respects I have fol- these congressional Democratic plans shifting to State governments, don’t lowed the lead of former Chairman have gone to great lengths to assure take my word for it. Listen to the ex- Senator BYRD in this regard. To this people they do not want a single-payer perienced Democratic Governors plead- end, the Agriculture bill and report option either. These reassurances have ing with us not to go down this road. have been available on the Internet and come from as high as the White House And when it comes to whether the goal in printed form for several weeks. All itself. Just last week in North Caro- of this whole exercise is to move us to Members have had ample time to re- lina, President Obama said: a European single-payer plan, it is no view the material in this bill. Nobody is talking about some government longer necessary to heed the warnings As the Senate considers this measure takeover of health care. . . .These folks need of the political conservatives. When it will find a bill that will meet our Na- to stop scaring everybody. you listen closely, the leading advo- tion’s critical requirements to support I wish that were true. But with due cates of the House and Senate legisla- agriculture and related programs respect to our Chief Executive, there is tion, in their unguarded moments, are which are vital to our economy and, a reason people are frightened. They willing to admit that a single-payer frankly, our Nation’s livelihood. Our Nation has been blessed with a are paying attention, and they see that government takeover is their ultimate wealth of natural resources which al- sponsors of this legislation are, in fact, dream. I hope we do not go down that lows us to be the world’s leader in agri- advocating a government takeover. road. I found it interesting that just 1 day Madam President, I yield the floor. culture. This bill offered by Senators after the President’s remarks, I turned The PRESIDING OFFICER. The Sen- KOHL and BROWNBACK will help to en- sure that we maintain that position. on the news to see one of the most sen- ator from Connecticut. There is a total funding of $123.9 bil- ior Democratic chairmen in the House Mr. DODD. I yield to my colleague lion included in this bill, of which from Vermont. of Representatives seem to contradict $23.05 billion is for discretionary pro- the President. Here is the exact quote AMENDMENTS NOS. 2276 AND 2271 TO AMENDMENT grams, the same as the 302(b) alloca- NO. 1908 from this leading Member of the House tion. While this represents an 11-per- Mr. SANDERS. Madam President, I on the consequences of a public option. cent increase in funding when com- He said: seek unanimous consent to set aside pared with fiscal year 2009, not includ- I think if we get a good public option, it the pending amendment so that I may ing supplemental spending, my col- could lead to a single payer and that is the call up my amendments Nos. 2276 and leagues should recognize that for too best way to reach single payer. 2271. long funding for our Agriculture and The PRESIDING OFFICER. Without I wonder what the Federal Trade Rural Development Subcommittee has objection, it is so ordered. The clerk Commission would say about that type been severely constrained. of advertisement. To me, it says: Let’s will report. Even with this level of funding, the lure people into going along with a The legislative clerk read as follows: subcommittee has had to find savings public plan when we know it will even- The Senator from Vermont [Mr. SANDERS] in farm programs to live within this al- tually lead to a single payer down the proposes amendments numbered 2276 and location. 2271, en bloc, to amendment No. 1908. road. I don’t want to take that risk. I very much thank our two managers Another leading House advocate of The amendments are as follows: for their work in preparing this bill. the public option had this to say about AMENDMENT NO. 2276 The Committee on Appropriations has a path to a single-payer system: (Purpose: To modify the amount made offered its unanimous support. I believe This is a fight about strategy about get- available for the Farm Service Agency) the full Senate should do the same. ting there—— On page 24, line 12, strike ‘‘$1,253,777,000’’ f Meaning the single-payer option—— and insert ‘‘$1,603,777,000’’. and I believe we will. AMENDMENT NO. 2271 MORNING BUSINESS I think most folks would call this a (Purpose: To provide funds for the school Mr. DODD. Madam President, I ask classic legislative bait and switch. community garden pilot program, with an unanimous consent that there now be a I recently ran across a blog from Dr. offset) period for the transaction of morning Michael Swickard of New Mexico, cau- On page 52, lines 22 and (23), strike business, with Senators permitted to tioning about this very tactic. Here is ‘‘$16,799,584,000, to remain available through speak for up to 10 minutes each. September 30, 2011,’’ and insert what Dr. Swickard said: The PRESIDING OFFICER. Without ‘‘$16,802,084,000, to remain available through objection, it is so ordered. Given the track record of our government September 30, 2011, of which $2,500,000 shall in bait and switch, all of the promises of na- be used to carry out the school community f tional health care are just that—promises to garden pilot program established under sec- HEALTH CARE REFORM be broken. Maybe there will be a few years tion 18(g)(3) of the Richard B. Russell Na- before the full impact of the bait and switch tional School Lunch Act (42 U.S.C. 1769(g)(3)) Mr. DODD. Madam President, I is felt by citizens. But given the past actions and shall be derived by transfer of the thank my colleagues this evening. I am of our government when implementing pro- amount made available under the heading going to momentarily turn to my col- grams, our future is clear. ‘ANIMAL AND PLANT HEALTH INSPECTION leagues from Iowa, Ohio, Vermont, and I hope we can avoid that future for SERVICE’ of title I for the National Animal Rhode Island—all of whom participated our country, but the writer’s point is Identification program’’. with us nearly 3 weeks ago in the this: It may take a while, but the pat- Mr. INOUYE. Madam President, the markup of our bill, the Affordable tern is there. The future he fears in- Senate is considering the fiscal year Health Choices Act, which took up an cludes a single-payer takeover that 2010 appropriations bill for the Depart- inordinate amount of time, longer than very few Americans would vote for ment of Agriculture, rural develop- I think any markup certainly in the today. ment, the Food and Drug Administra- history of our committee, maybe the I say to my colleagues, there is much tion, and related agencies. I thank our longest in the history of this body. We to be said about the ill effects of the two managers, Senators KOHL and actually spent about 56 hours, 23 ses- health care proposals being put forward BROWNBACK, for their hard work on this sions, and 13 days on this bill. We con- by the House and Senate committees. measure. sidered just shy of 300 amendments, of

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All we are missing is some folks end, unfortunately, but any definition Before I turn to my colleague from willing to come to the table and help of ‘‘bipartisan’’ would have to include Iowa and my other colleagues, as well, us resolve these matters in a way that whether or not their ideas were incor- to share some thoughts with us, I made will allow us to have some votes and porated in any significant degree in an announcement last Friday which decide whether to go forward with ac- this bill, and they were. I am appre- has become quite well known—the fact cessible, affordable, quality health ciative of their efforts. that I have been diagnosed with pros- care. I am particularly grateful to Sen- tate cancer. It is in the very early No one is talking about socialized ators HARKIN, MURRAY, WHITEHOUSE, stages. I am confident the outcomes medicine or talking about big govern- and BROWN for their contributions, are going to be great and all is going to ment-run plans. They use those words along with others on the committee: work out well. I have known about this over and over and over again. You Senator SANDERS, who is here; Senator since June when I was diagnosed with ought to be suspicious when they have MIKULSKI played such an important it and did what I could to learn all nothing else to say about health care role; Senator CASEY, Senator MERKLEY, about prostate cancer and what treat- but scare tactics and fear. That is what Senator BINGAMAN, Senator REED, Sen- ments and options will be available to they have done day after day in this ator HAGAN—all of whom contributed me. debate, and it is a disservice to the to the outcome of that legislation. The point I want to make is this: American people to suggest that after We thought it might be worthwhile When I discovered in June that I had 70 years, with millions of our fellow this evening to talk about exactly prostate cancer, I didn’t lose a mo- citizens uninsured or underinsured to- what is in this bill. We will be adjourn- ment’s sleep over whether I had the night, the only answer they have to our ing in a few days. We will be gone for coverage to pay for it. I didn’t lose a health care problems is to wait longer, a month. Unfortunately, during that moment’s sleep as to whether I have do nothing, and be scared. month, nothing will happen on this quality care. I am a Member of Con- What is more, if they were more seri- bill. But I think it is an important gress. I have a great health care plan. ous about some of these issues, we month to educate our constituents and I have great coverage. I never lost a might be engaged in more of a signifi- people across this country as to what is moment’s sleep over whether or not I cant debate. As I said, that is not true in this bill, what we are trying to ac- would be able to access that coverage. for the 47 million without health insur- complish with our reform efforts. What bothers me is it should not just ance, the 30 million underinsured in Senator HARKIN led the effort on pre- be me or Members like me in this body. our Nation or the 14,000 in America vention in our committee. The Senator If every Member in this body had to go who lost their health insurance today. was asked by our chairman, TED KEN- through what millions of Americans do Every day we wait, another 14,000 peo- NEDY—who, as we all know, is strug- every day, and that is wonder whether ple lose health coverage. Since we gling with his own illness, a brain the quality is going to be there, the marked up our bill—and we finished tumor. We pray and hope he will be care is going to be there, maybe they marking up our bill in that committee back to work with us and to chair his would worry. But that is not the case. back 3 weeks ago this Wednesday— committee. But the distinguished Sen- Our efforts over these days have been 266,000 people in the United States, ator from Iowa, along with Senators to try to bring, at long last, that sense more than a quarter of a million peo- MIKULSKI, BINGAMAN, and MURRAY, of stability and certainty to our fellow ple, have lost their health insurance. worked on various ideas. Prevention citizens that we have in this body and That is what has happened in less than was the matter in which Senator HAR- that the other body has and that thou- 3 weeks. KIN became an expert. He developed sands and thousands of Federal em- My hope would be that while we are very sound ideas in our legislation to ployees and others who have good going to debate this issue at home over promote the improvement of preven- health care coverage have. the month of August, we would come tion ideas as part of our health care re- I am confident everything is going to back with a renewed sense of commit- form efforts. Senator MIKULSKI worked be fine. That is not the point of bring- ment to getting this job done. But to- on quality. Senator BINGAMAN worked ing this up. The reason I bring it up is night, my colleagues and I would like on coverage. Senator MURRAY worked because too many of our fellow citizens to spend a few minutes talking about on workforce issues, which are all so lack the kind of security and stability what is in our bill, what we tried to do critically important. Senator HARKIN that those of us who are here have. I with this, how we tried to increase ac- brought to the committee his more hear my colleagues—some of them— cess, quality, as well as affordability. than three decades’ long commitment say: Well, we ought to wait a while I have heard my distinguished col- to prevention and wellness. He is no longer. We can’t afford to do this. league from Iowa say on so many occa- newcomer to this issue. In a minute, I We can’t afford not to do this. The sions—and I am confident he will prob- am going to ask him, if he would, to go cost to the average American is rising ably say it tonight—we don’t have a into detail about the prevention as- by the hour. health care system, we have a sick care pects of this bill and what is included. I had one insurance company in my system. I think he coined the phrase in People ought to know what we have State of Connecticut, a few weeks ago, talking about it. I have heard him say done. I am so sick and tired of hearing announce a 32-percent increase in pre- it so many years in this body, talking about socialized medicine, government miums. They announced it right in the about what we need to do to develop takeover—nothing but absolute false- middle of this debate, to jack up those sound health care programs. So I wish hoods about what is in this legislation prices. Of course, it goes on all across to thank my colleague and ask if he and what we are promoting. the country. We have working families would share with us his thoughts on I say at the outset, if you like what who are losing their jobs, losing their this. you have, you get to keep it, choose homes, and we find that 62 percent of Is it not the case that chronic disease your doctor, hospital, choose the insur- people who are in bankruptcy are there accounts for about 75 percent of our ance program you have. What people because of a health care crisis. We find health care costs, and these are pre- don’t have is a sense of stability and 50 percent of the foreclosures that are ventable diseases in our country, such certainty that they are going to have occurring are occurring because of a as diabetes and heart disease, among the coverage they deserve if a crisis health care crisis. other things? I wonder if my colleague hits them in health care and that they So my interest in raising this is to from Iowa could take a moment or two will get the care they need. That is bring home the point that we have an to talk about the cost savings achiev- what people are uncertain about today. obligation, it seems to me, in this able through increased prevention, not So many millions of our fellow citizens body, to address this issue; to do it to mention what it means to individ- worry every night that the coverage carefully, do it well but to get the job uals. It can lead to a longer life and a

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00024 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE August 3, 2009 CONGRESSIONAL RECORD — SENATE S8665 better quality of life. I thank him for like what we have, we can go to some- less we start focusing on keeping peo- his thoughts on the subject matter. thing else. Why shouldn’t the rest of ple healthy in the first place. Is there Mr. HARKIN. I thank our chairman, the American people have that kind of support for that out there? Sure. The the leader on this issue. Would the Sen- access? American people get it. They under- ator yield? I spoke with a small businessman in stand this. They were asked: Should we Mr. DODD. I yield to my colleague Iowa last week. He has 12 employees invest more or not invest more in pre- from Iowa. and spends 15 percent of his gross rev- vention and wellness? Well, you can see Mr. HARKIN. First, I say to Senator enue on health care. He has 12 employ- that 76 percent of the American people DODD, I heard all this talk about so- ees, and one of his employees had a said we had to invest somewhat or cialized medicine. Socialized medicine. kidney transplant. Another came down strongly; invest more, 53 percent; in- These are scare tactics. There are a lot with cancer. In 2 years, his insurance vest somewhat, 76 percent; not invest of scare tactics going on. premiums went up 100 percent. In 2 any more, 10 to 16 percent. I was in my State over the weekend, years. He has a $5,000 deductible, and The American people get it. They get and people were talking about eutha- he said he needs some work done. He it. You can talk to anyone you want nasia in the bill. We hear all this crazy wanted to go in for a colonoscopy be- about health care and ask them: Would stuff going on out there, and I got to cause he turned 50, but a colonoscopy you rather just have something that thinking about this. There is a lot of costs $3,000. Well, that is out of pocket takes care of you when you get sick or money on the table. We spend $2.3 tril- because he has a $5,000 deductible. would you rather have more focus on lion a year, if I am not mistaken. I am trying to get to my point of pre- keeping you healthy? I will tell you the There is a lot of money, and a lot of vention. Because we know if he has a response will be: I want to stay people have a vested interest in not colonoscopy and something happens, healthy. People want to stay healthy. changing the system because they are they can stop it. It is one of the most But in a lot of cases, they don’t know making a lot of money. Obviously, preventable forms of cancer, this colon how. There are not the support systems what they are trying to do is scare peo- cancer, but it is one of the most deadly there to do that. ple. if you don’t get it in time. So I asked Again, on saving some money; a lot People elected us—and I think elect- Art: Why don’t you get a different of times we hear that: Oh, this won’t ed President Obama—to make some plan? He said: I can’t. We only have one save money, and the CBO—Congres- changes in the way we do things, but in rural Iowa I can go to. sional Budget Office—doesn’t score it. there are a lot of vested interests out What we are trying to do is get more But we asked voters. The poll question there that don’t want to change. There plans for people out there in small was: Will prevention and wellness save are a lot of scare tactics going on out towns in Iowa, in Connecticut, and ev- us money? Seventy-seven percent said there. They are unduly scaring people erywhere else so they do not have to be yes. Yes, it will save us money. Again, and obviously by people who don’t stuck with one plan; they can shop the American people get it, that we want to change the system. They want around and get other plans. have to focus more on prevention and the status quo. He asked me if he could get on the health. The other thing I might say, as to all public option plan that we have in our We have some problems with CBO. this talk about socialized medicine, bill. I said: Sure. Small businesses such That is the Congressional Budget Of- historically, when President Harry as you? Absolutely. That means he can fice, for those who don’t understand Truman first proposed a kind of na- get in a pool with everybody else the jargon around here. The Congres- tional health insurance program, that around the country and reduce his sional Budget Office doesn’t score us is the issue that was raised in 1951, I costs. I just remembered that, and I re- very well. Score means they do not think it was. I could be off a year. membered him talking about trying to give us much savings when we invest in Maybe 1950 or 1951 it was raised, when get a colonoscopy. This kind of gets to prevention and wellness. Well, I have he was proposing this. The origins go the nexus of what I wanted to talk gone over that with the Congressional back to an individual whose name I for- about, briefly, which is the focus on Budget Office, and the problem is they get right now, but he was an adver- keeping people healthy. do not give a savings because they do tising executive hired by the AMA at President Obama said very clearly, not give savings on what they call sec- that time to stop Harry Truman’s pro- when he addressed a joint session of ondary savings. Secondary savings is gram. So he came up and he coined this Congress earlier this year, that we what prevention provides. It saves you whole phrase ‘‘socialized medicine.’’ It have to make a major investment in money from going to the hospital or was picked up by then-Senator Robert prevention and wellness because that is getting sick. But they do not give us a Taft, and he kept harping on the Tru- the only way we are going to keep peo- good score for that on savings. But do man program was socialized medicine. ple healthy and reduce medical costs. we have data on that? Do we know if it Well, that was in 1949–1950, I think it Well, President Obama gets it. He un- saves money? Sure, we do. was, and here we are, all these many derstands we have to make a major This is from the Trust for America’s years later, and we hear the same argu- new investment. That is what we have Health. They did a big survey of com- ments coming up again. It wasn’t so- done in our bill—our Affordable Health munity-based interventions and for $10 cialized medicine then and it is not so- Choices Act—which Senator DODD so per person, in 1 to 2 years, they save cialized medicine now. greatly led through our committee. We $2.8 billion; 5 years, $16.5 billion; 10 What we are trying to get is a system make a major investment in preven- years, $18.5 billion. That is just $10 per that is stable, that people can rely on, tion and keeping people healthy. person, and that is just community that they know is going to be there for My colleague is right. I started out programs. So we address the whole them and that is affordable and gives saying we have a sick care system in- gamut. We address the community- them a quality health program—as my stead of health care. I started saying based programs and the clinical-based colleague, Senator DODD, said—as we that in 1992; that we have a sick care programs. have. What we are trying to get for the system, not a health care system. If For example, what we do in our bill American people is the same kind of you get sick, you get care, one way or is we set up an investment fund to do system all Federal employees have. We the other. But there is not much there a number of different things. Let me are on the same system as your local to try to keep you healthy in the first give one example. We are going to postal employee in a small town in place and to focus on prevention. train health professionals in how to Connecticut or a small town in Iowa or Again, our bill has a very strong pre- work with prediabetic individuals, peo- somebody who works for the Farm vention provision in there. ple who have tested high, who look like Service Agency in the Federal Govern- Some ideas on what we have tried to they are prediabetic. We will train ment. We are all on the same plan. We do. The real health reform starts with them to work with them to manage have a lot of choices, don’t we? Every prevention, it does. If we don’t do pre- their condition, to get them on the year, I think we get 20-some plans to vention and wellness, you can jiggle proper diet, to manage them as they go pick from. We sort of have an exchange the payment system all you want and along. What is so important about out there, where every year, if we don’t you are not going to save a dime, un- that? Well, what is important about

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00025 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S8666 CONGRESSIONAL RECORD — SENATE August 3, 2009 that is that right now, for example in prostate cancer. Thirty thousand peo- I thank our chairman, I thank Sen- Medicare, Medicare will pay $30,000 to ple a year die of prostate cancer, be- ator DODD for his great leadership. amputate your foot if you have diabe- cause they never caught it. That is That is what people have to under- tes. They will not reimburse one cent what screening does. That is why what stand. In our bill, we have defined what for nutrition counseling before so you you are saying has such value. we want to do on prevention and don’t get diabetes. But they will pay (Mr. MERKLEY assumed the chair.) wellness. Frankly, I think we had good for nutrition counseling after you get Mr. HARKIN. I appreciate the Sen- support on both sides of the aisle for diabetes. That doesn’t make any sense. ator saying that, and that is why we that. I think the American people sup- Right now, the cost of diabetes in our have to have more focus on this pre- port putting more emphasis on keeping society is $174 billion a year. That is vention and getting people in for early people healthy. $174 billion a year on diabetes. Well, it screenings. If you get it early, you are Andrew Weil, Dr. Andrew Weil has doesn’t take a genius to figure out that cured. We know that. So we want to re- come out with a new book, ‘‘Why Our if we can get hold of people who test move any of the obstacles people have Health Matters.’’ One of the things An- prediabetic and get them on a well- going in and getting screening. drew Weil pointed out to me a while managed program so they do not come Again, the Congressional Budget Of- ago—he said the natural state of the down with diabetes, we will save fice says they cannot figure out the human body is to be healthy. It is in money. But the Congressional Budget savings. I said: Why don’t you go look our DNA. Our body wants to be Office doesn’t score that as any sav- at Pitney Bowes. It is a big company, healthy. Yet everything we do lends ings. 200-some thousand employees, scat- itself to be unhealthy. We have to do So at the clinical level we will do tered all over the United States— things to make it easier to be healthy that. We will reimburse, for example. Mr. DODD. Headquartered in Con- and harder to be unhealthy. Right now There will be a reimbursement for can- necticut. we do the opposite. It is easy to be cer screenings, for smoking cessation, Mr. HARKIN. I didn’t know that. unhealthy and hard to be healthy—es- nutrition counseling, colorectal screen- Pitney Bowes, and their CEO, Mike pecially after you find you have to ing. There will be reimbursements for Critelli, went on a big program of make all these copays and deductibles. that, and you will not have to pay any wellness and prevention for all their There is not much out there if you are deductibles or copays. So for my friend employees. I think they called it prediabetic. Where do you go to get the who is now facing $3,000 for a colorectal Health Care University or something kind of counseling and help you need so screening, this will not cost him any- such as that. Here is what they found. you don’t get diabetes? I suppose if you thing. No copays, no deductibles, and They found, through their wellness have a lot of money you can probably do it, but for the average person, they the insurance company has to reim- and prevention program, they reduced have no idea where to go. burse for that. their number of hospitalizations for all The last thing I might mention, I say Again, if we catch these things early, their people by 38 percent—38 percent. to Senator DODD, also in our appropria- it is just like mammogram screening. Think of the savings. They reduced tions we have, and we hope we get We know if we get breast cancer early, their disability payments and claims some more in other bills, but: work- it is curable. Again, let me say some- by 50 percent, just through their place wellness programs, to buttress thing that is public. The mayor of wellness and prevention programs. what Pitney Bowes and Safeway and Cedar Rapids is a woman. I was in Iowa Again, this will save us money. It others have done in that area. this weekend, and it was announced will make people healthier. Not only For this bill, it is key to reducing she has breast cancer. She went in that, I say to my friend, just the pro- costs and changing the structure of today for a small surgery, and she will ductivity level—people will work hard- health care in America. I am grateful be back to work tomorrow because er, they will work better when they are for my colleague’s leadership in pulling they got it early. healthy and they are well. this together and making sure in this Mr. DODD. If my colleague will yield One other thing I wish to mention. bill we have a very strong investment at this point, again, because I am ex- We have a fund in the prevention title in prevention and wellness. hibit A. I had an annual physical this of the bill that will increase over the Mr. DODD. I thank my colleague, Mr. year. At my annual physical, my PSA years to a significant amount of President. Before I turn to Senator score spiked—shot up. That was a sig- money. People say: What are you going BROWN and Senator WHITEHOUSE—and nal to the doctors that maybe some- to use that money for? there are a lot of things to talk about thing more serious was happening. Right now at the Centers for Disease in the work Senator HARKIN and the They decided a biopsy was appro- Control and Prevention, for cardio- committee did on prevention—one of priate. A biopsy showed I had cancer. vascular disease prevention and heart the great successes in this bill is a But I had the annual physical, which disease prevention, the current funding matter he worked out with our friend my health care plan pays for. If you is $50 million for all States. That is and colleague from New Hampshire, don’t have a health care plan, that barely enough to even print a pamphlet JUDD GREGG. You mentioned Pitney physical can be very expensive, so peo- to get information out to people—$50 Bowes and Safeway. The Presiding Offi- ple don’t get their annual physical. million for cardiovascular disease. Yet cer is, of course, a member of our com- Prostate cancer is the slowest growing angioplasties alone and bypasses, we mittee as well and will recall this con- form of cancer, it is the easiest to man- spend over $90 billion a year—just on versation. But the amendment we age. If you have to have cancer, it is those two items. But if they are caught worked out will allow for companies to the best one to have. If you have to early and if there are prevention pro- reduce by as much as 50 percent the have one, that is the best one—if you grams out there, we can cut those premium costs of employees who de- catch it early. A number of our col- down. cide to take personal responsibility for leagues have had prostate cancer. But You mentioned diabetes. Right now improving their health care: getting in- the important thing, as my colleague diabetes costs us $174 billion a year— volved in smoking cessation programs; pointed out, is to have an annual phys- for diabetes. So the current funding is those who can lose weight will go on ical, get the screening, and detect it $62 million a year for diabetes preven- programs to take that poundage off. early. I will be able to deal with this, tion and control in the entire United I will never forget Steve Burd, the and I am told I will have a very States. CEO of Safeway, telling us that for healthy life for many more years to Arthritis, the current funding is $13 every pound a person who could lose come. million. For nutrition, physical activ- weight loses in a year, it is a $50 sav- If I had gone years without detecting ity and obesity, right now $42 million ings in premium costs—for every 1 this and it migrated or metastasized is all we spend through the Centers for pound. Think about what that can into my lymph nodes or bones, I could Disease Control and Prevention—$42 mean in terms of not only a healthier be in serious trouble. Spark Matsu- million a year. employee but also bringing down that naga, our former colleague from Ha- You get my point. My point is, we are cost of health care, not to mention, of waii, died of prostate cancer. John not focusing enough on prevention and course, that person is less likely to Kerry, our colleague, his dad died of wellness. That is what this bill does. contract diabetes or related problems.

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00026 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE August 3, 2009 CONGRESSIONAL RECORD — SENATE S8667 You get a cost savings, you get a but have a plan on how they are going options. You can go with Aetna or with healthier person, you get a more pro- to die. Some of the things they are say- an Ohio medical mutual fund, mutual ductive worker. That language exists ing are absolutely amazing. company, or you can go with the public in this bill because of what TOM HAR- I wish to kind of cut through that for option. Nobody forces you to do any- KIN did with JUDD GREGG on a bipar- a moment because I know we tend to thing, but providing you a wide range tisan basis to make this a better and use words—we talk about exclusivity of options will give you much better in- stronger bill. I commend the Senator and single payer and the gateway and surance than you might now have if and thank him for it. the exchange, all these words we use you are dissatisfied. Mr. DODD. Mr. President, I see our around here. I wish to cut through Thomas from Knox County, a Navy colleagues from Ohio and Rhode Island that. I wish to share tonight, as I have veteran—that is about 25 miles from are here. every night we have been in session for where I grew up, in Mansfield: Mr. BROWN. I yield to Senator the last week or so, some letters I have I would like to urge you to support health WHITEHOUSE. gotten from people in Ohio. I know the care reform that includes a public insurance Mr. WHITEHOUSE. I ask my distin- Presiding Officer gets these from Port- option. While private insurance is adequate guished colleague from Iowa a question land, OR, and Eugene and Senator in many cases— about prevention because it strikes me, DODD gets these from West Hartford Thomas, the Navy veteran, writes— if you are a community health center and New London and New Haven and I there are far too many instances where pri- vate insurance is denied or is inadequate to and you want to invest in a health pre- know Senator WHITEHOUSE and Senator meet the needs of the insured. vention strategy that will help the HARKIN get letters such as these from A neighbor of mine, a retired minister, was community you serve have healthier their States. But this is the reason we forced to sell his home and move in with his lives and therefore lower the costs to are doing this health care bill. This is son after battling cancer and having tremen- the system for everyone—you put out the reason we have worked hard, doing dous debt as a result. And he was insured. the money for that program if you are our jobs, as we should, to pass legisla- We know how often that has hap- the community health center, you have tion that will protect what works in pened. As Chairman DODD has pointed to staff it, you take all the risks, you our health care system and fix what is out, people who so often have declared do all the work, and yet the benefit of broken. bankruptcy because of their illness what you have done doesn’t come back We know many people want to keep often had insurance, but their insur- to you. It goes to private insurers, it their health care plans that they have. ance had lifetime caps. One of our con- goes to the Federal Government, it If they are satisfied and want to keep sumer protections we are building into goes to patients and better health. But them, we want to help them keep the health care system with this bill is it makes it a very unfortunate business them, but we want to build some con- no more lifetime caps so people can get proposition for anybody who is doing sumer protections so they cannot be the insurance they thought they had, this on their own, which suggests this denied care when they call their in- can get the coverage they thought they is an important place for the Federal surer when they need a health care had. Government to invest because the mar- treatment; so they can’t be discrimi- Why we would allow, in this country, ket, by itself, will not take care of this nated against; they can’t have a com- that a retired minister has to sell his because you invest and you don’t get it munity rating system gamed. That is house and has to move in with his son back. You invest and it goes to the in- what people have seen. So if you have because the insurance he had when he surance company. You invest and it your own health insurance and are got seriously ill would not cover his ill- goes to Medicare. happy with it, we want you to keep ness? I know Senator BROWN wishes to that, but we want some consumer pro- What does that say about our failures make some statement. I wish to make tections around it. in the past in enacting health reform? that point because Senator HARKIN’s This bill is full of assistance for Thomas from Knox County, a Navy work has been so important on this, small business that works so very hard veteran, says: and I think that is an important to help people, small businesses that Please do not vote for any plan that would thread. want to insure their employees but only fatten the wallets of the insurance and Mr. HARKIN. I thank my colleague. I often cannot afford it. This bill will drug industry without significantly fixing think that is a very good point. work so well to encourage and assist the problem for the average American cit- izen. Mr. BROWN. I appreciate the leader- people who want health insurance to ship of Chairman DODD and Senator get that health insurance. What Thomas is talking about is HARKIN on the whole bill. Senator HAR- Let me stop talking, except to read a what has happened in this body and KIN has led the way on prevention. Sen- few of these letters I have received in what happened in the other body, ator WHITEHOUSE and I worked to- the last few days. where I was a Member, 5 years ago gether on writing the public option Jon, from Franklin County—central when the Bush administration pushed which provides a choice—not any gov- Ohio, Columbus area—writes: through a Medicare plan that betrayed ernment mandates, not as the other I am a self-employed 28-year-old with Type the middle class. It was a plan that the side would like to create, this fear in I diabetes. After being denied coverage by drug companies wrote, the insurance the public that it is going to lead to many health insurance companies, the only companies wrote. It was a Medicare single payer. plan I could find charged outrageous month- plan that simply did not work for the Also, I thank the Presiding Officer ly premiums. middle class. It worked very well to for his work on tobacco and other After having a policy for 5 months, the in- fatten the wallets, as Thomas said, of issues on the HELP Committee too. surance company increased my monthly pre- the drug and insurance companies. mium by another $100. I listened as we began this evening. Let me share a couple more. It is vital I have health insurance. I was di- Lia from Miami County writes: Before Senator DODD spoke, we heard agnosed with Type I diabetes at age 12, and from a colleague, a Republican col- I have taken very good care of my health Recently our daughter graduated with her league from the South, from Mis- with diet and exercise. masters degree and was ready to join the workforce. Last summer between semesters sissippi, I believe. We heard over and As Senator HARKIN talks about. she had major back surgery. We are so proud over all these scare tactics, all the I didn’t ask for this disease but ask you to that along with her recovery, she managed kinds of words they use about single vote for reform—especially the public insur- to carry her full curriculum with great payer, about government takeover, ance option. grades. But she developed complications and about socialized medicine. It just We need realistic premiums and choices subsequently endured three surgeries and 2 serves to scare the public, to confuse without penalties. weeks in the hospital. the public. That is what the public option does. Her student health insurance expires at What they have done especially is If you don’t have health insurance or the end of July. During her recovery, she was not able to search for a job and has been de- trying to scare senior citizens into you have inadequate insurance or in- nied from multiple insurance carriers due to thinking we are going to do something surance you are dissatisfied with, you her preexisting conditions. We are now faced to their Medicare, require them to can go into what is called this ex- with additional medical expenses and no in- come in and not just have a living will change. You have a choice, a menu of surance coverage.

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00027 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S8668 CONGRESSIONAL RECORD — SENATE August 3, 2009 I fully understand the need for healthcare MERKLEY—the legislation we wrote that all of us embrace the free enter- reform to assist those who are facing the will take care of this. It will protect prise system as providing the best re- same issues that we are with our daughter. what works in our system. It will fix sults for our country throughout 200 Please stand up for those in Ohio and other what is broken. It will give people who years of history. Why in the 21st cen- states that are doing their best to create a tury should that be any different from better life. Please support healthcare insur- already have their insurance and are ance reform with a public and a private op- satisfied with it more consumer protec- the 20th or the 19th century, where tion. tion so they can keep their insurance competition helped produce the great- She understands we want both. A they are satisfied with. It will give ness of this country? I appreciate the Senator from Ohio public option will, frankly, make pri- those who do not have insurance an op- portunity to buy decent health insur- today raising the point about the value vate insurance companies more honest. of injecting some competition. We all Private options help make the public ance, with a public option, if they so choose, or to go to a private insurance know ultimately that could have the option work better too. It will make it desired effect of bringing down those more flexible, and it will make it re- career. I yield the floor. costs and making insurance or health spond better to market conditions. care coverage more affordable. At some Having them compete with each other Mr. DODD. I thank my colleague and thank him for making that contribu- point, I hope someone might explain to will work for Lia from Miami County, me why competition is a bad idea. I from Piqua, or Troy, that area of the tion on so many points, particularly on the public option. As our colleague though quite the contrary, and it is al- State north of Dayton. most un-American to suggest that we The last letter I would like to share from Ohio has pointed out, and some may find it somewhat alarming—but ought to make this a noncompetitive is from Mary from Cuyahoga, from the environment, that everything else Cleveland area: the whole idea of competition is about as basic in America as any I can think ought to be competitive but not health Please, please, please, do whatever you can care. It seems to me that quite the op- to get the healthcare reform bill through of. The idea that people can have choices out there is something we cher- posite ought to be the case. Congress this year, and stop the insanity we I see my colleague from Rhode Island ish in this country. are experiencing now. My husband and I are here, who made a significant contribu- retired. He has had diabetes for the past 28 In fact, what exists today in so many years. Thank God for Medicare. But he is case is the lack of choice. I listened to tion in crafting the public option and part of the doughnut hole generation. my colleague from Iowa talk about the very public option that was praised by the so-called Blue Dogs in the What that means is, again, what hap- western Iowa, rural Iowa, where you House, the more conservative Demo- pened 5 years ago when the Bush ad- only get one or two choices. In the crats in the House who were reluctant ministration pushed their partial pri- State of Virginia, almost 70 percent of to be supportive of that specific health vatization of Medicare through the all insurance is written by two compa- care package. But to their great credit, House and through the Senate, the bill nies in the entire State—two compa- they took a good look at what we had that was written by the drug compa- nies in the entire State of Virginia. created in our bill on the public option, nies for the drug companies, the bill That is not untrue in most places. I and they were so impressed by the cannot speak specifically State by that was written by the insurance com- work done by our committee—specifi- State, but it is not uncommon that in panies for the insurance companies, it cally, our colleagues from North Caro- simply did not provide senior citizens many areas the choices are very lim- lina, Senator HAGAN, Senator BROWN who had high drug expenses with their ited. So today, for most Americans, the from Ohio, and Senator WHITEHOUSE drug benefits. There was something ability to shop for the best health care from Rhode Island, who were the prin- called a doughnut hole where people plan that serves their needs and the cipal authors of this provision in our simply lost the coverage for which they needs of their families is very limited. bill—that the House Blue Dogs insisted What is being discussed here is not a were paying. that this language be incorporated in subsidized plan, not taxpayer sub- My husband has now reached the limit of part of their health care effort in the sidized in any way, but a plan that the payments that Medicare will make on House. I thank my colleagues from his medications. Now he has to spend thou- would offer an option, a safety net in Rhode Island and Ohio and Senator sands of dollars out of his pocket to stay many cases, probably for some kind of healthy. Why would you pay for only a half KAY HAGAN from North Carolina for illness that can afflict someone, which their work in this regard. year of his medications? What is he supposed most people worry most about that to do the rest of the year? Hope for the best? Possibly my colleague from Rhode Is- My husband had taken charge of his health could ruin them financially. It is a land would like to talk about that or through better diet and exercise. Yes, we pretty straightforward kind of a plan some other aspect of this bill. need to take responsibility for our health, that would provide some basic cov- Mr. WHITEHOUSE. I would be de- especially a disease such as diabetes, but we erage, at a competitive price, a non- lighted to talk about that. But the need healthcare that will help when all of profit operation that would take the first thing I would like to do is react to our efforts fall short and illnesses take over. element of profit out. I know that may a point the distinguished chairman has Please vote for healthcare reform. be intimidating to people, to have just made regarding how ironic it is All of us get letters like this every someone out there competing with an that some of our friends on the other day. Thousands of these letters are idea. If it is not a good plan and people side are so opposed to increasing com- sent to the Capitol every single day don’t like it, they will not go to it, in petition in the insurance industry. One from people who are struggling. Most which case it will not work very well. of the things that is particularly ironic of these letters, I have found, come If it is a well-drafted plan that does is that a great number of our col- from people who have had health insur- what many would like it to do, it leagues on the other side go home to ance, they have lost it because of a pre- might just have the effect of bringing their home States to a health insur- existing condition, they have seen it down the cost in a competitive envi- ance system that already is a public fall far short of what they were prom- ronment. option for their business community, ised because they had a very expensive I mean, under a capitalistic system, their workers’ compensation system. illness, or they have sometimes seen competition is what contributes to The two places you get health care their health insurance go away because price fairness. If one company controls are from the general health insurance they have lost their job. the whole game, or two do, you get a marketplace and from the workers’ In every one of these cases I have predictable result—price fixing—and compensation marketplace. You can read tonight, in every letter I have you pay an awful price as a consumer, get workers’ compensation coverage, read, the dozen or so, couple dozen let- whether you are buying shoes or auto- and it will cover small workplace inju- ters I have read here on the floor of the mobiles or any other product or serv- ries, it will cover catastrophic work- Senate, in every single one of these ice. place injuries, it will cover temporary cases the legislation that those of us— So the idea of injecting a level of conditions, and it will cover lifetime Senator WHITEHOUSE and Senators competition—I find it somewhat ironic chronic conditions. It has all of the ele- HARKIN and DODD and the Presiding Of- that our Republican friends are fright- ments of health insurance coverage and ficer, the Senator from Oregon, Mr. ened of this idea. I traditionally think the need for it.

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00028 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE August 3, 2009 CONGRESSIONAL RECORD — SENATE S8669 Well, when our colleague from Wyo- health insurance system is such a The insurance companies are bigger ming, the distinguished ranking mem- nightmare for a family in that situa- and smarter, and they set the rules. So ber of the HELP Committee, goes home tion, they have lost their son, they you can bet that the doctors’ side of re- to Wyoming, he goes home to a single- have lost their savings, and they are sponding to that costs more than 15 payer public option for workers’ com- about to lose their home. They are percent. pensation health insurance. So it can about to be put out of the house that In fact, the Lewin Group has esti- hardly by anathema to have a choice has all of the memories of their son. mated that 36 percent of a provider’s public option. You know, there are people for whom overhead cost goes to fighting with the The distinguished gentleman, Sen- this is very real, and we have to keep insurance industry. Everybody in this ator MCCAIN, who was the Republican our eye on that ball and not on all of place has had the experience or some- candidate for President, goes home to the smoke and all of the fear body they know or love has had the ex- Arizona to a competitive public plan mongering that is happening around perience of trying to get a claim paid, providing workers’ compensation here. A lot of that smoke and fear having it be denied, submitting a bill, health insurance in his home State. mongering is happening around our having it be denied, having to wait for The Republican leader himself, Sen- public plan. treatment that you need while your ator MCCONNELL, goes home to Ken- Well, it is not that complicated. It is doctor tries to get prior authorization tucky, to a State where there is a pub- competitive. It is fair. It has no special from the insurance company that says: lic plan that delivers health insurance, subsidies for people who are in that No, we need more papers. All of that is a competitive public plan. And I sus- plan versus in competing private plans. expensive. None of it provides any pect his employers like it and the peo- It has no special advantage. And it health care value, zero. It is all admin- ple are comfortable with it. honors President Obama’s programs istrative overhead and nonsense. In some cases it is big. I was at the Our colleague, KAY BAILEY and the promise of all of the Presi- Cranston, RI community health center. HUTCHISON, is shortly to go home to dential candidates that if you like the It is not a big organization. Rhode Is- Texas to run for Governor. When she plan you have, you get to keep it. You land is not a big State. Cranston is not does, she will go home to a State that are not forced out of anything. our capital city, not our biggest town. has a competitive public plan that de- So if it has no special advantages, if Its community health center does not livers health care through the worker’s it has no special subsidies, why do we have an enormous budget. They spend support a public option? Why is it bet- compensation system. $300,000 every year on the consultants Our distinguished friends in Utah, ter? Well, I would say that there are who help them try to negotiate this Senator BENNETT and Senator HATCH, three reasons we can have some con- payment claims war they are stuck who have done so much work on health fidence that a public option will make in—$300,000 a year. On top of that, 50 insurance issues over the years, go a difference for the kind of people Sen- percent of their personnel time, half of home to Utah, where their business ator BROWN was talking about, the their personnel time, goes to fighting community has a competitive public family I was talking about, people who with insurance companies. So you take plan for delivering health insurance. suffer through our existing health care a little place such as the Cranston So, in addition to the irony of being system. community health center and you can against competition, their business The first is, a public plan does not tell them: Half of your personnel costs communities, I believe, are highly fa- need to take profit out of the system. can go away or can be devoted to pre- In 2007, in Rhode Island, one of our vorable to a public plan that competes vention, as the Senator from Iowa has insurers, United Health Care, asked in the market to deliver health insur- suggested, instead of fighting with the permission to remove $37 million as its ance that the business community insurance industry. That is an im- funds, the workers’ compensation profit in that year from Rhode Island proved model. That is something the health insurance market. So I guess back to its home headquarters. My public option can pursue. ironies abound here. State isn’t as big as Ohio. It is not as You don’t have to fight the providers I would also like to compliment Sen- big as Iowa or Connecticut. It is a that way, and the amount of waste ator BROWN for keeping it real here on small State. It has a million people. In that is burned up on all of that warfare the Senate floor and reading those let- one year to take $37 million out of that for no health care value whatsoever is ters and reminding us that when push State, when they only had a 16-percent an opportunity for this public option to comes to shove around here, it is not market share, think of that. A 16-per- achieve. the nametags and the labels that mat- cent market share in a State of a mil- The third area is to more broadly ter, it is not ‘‘socialized medicine,’’ it lion people is about 160,000 folks they change the busines model. There is a is not ‘‘government takeover,’’ it is cover, assuming that everybody had failed private insurance business model people who have real problems. coverage; $37 million out of those right now. It is pretty simple to sum- I was struck by a letter that was 160,000 people in 1 year gone for profits. marize. No. 1, if they think you are brought to my attention today. I do Stop doing that. Stop paying exorbi- going to get sick, they deny you insur- not know exactly what day it came in, tant salaries such as United Health ance. You don’t even get in the door. but I saw it today. A working couple Care’s chief executive who got $124 mil- No. 2, if they make a terrible mistake with a son, sort of the ideal American lion in salary. That is a lot of money and let you in the door and then you family, doing nothing wrong, doing ev- that could go back into other things in have the temerity to get sick, they erything right, playing by the rules, health care. That could help families look for a way to deny coverage. They working hard. The son becomes griev- either get better coverage or pay lower go through the form and look for a ously ill, has a very grave illness. Over premiums. So there is one thing—no mistake you might have made so they the years, his condition worsens, and profit, no excess cost. can throw it out. They find something ultimately his disease takes his life. The second is, you could have better that might have been a preexisting They were insured through this whole dealings between insurers and pro- condition. They look for a loophole. If period, but the insurance was not viders and hospitals than we have right they are stuck, if they can’t find a enough. There were copays, there were now. Fifteen percent of our health care loophole, then they deny payment. limits, there was cost sharing. As a re- costs from the insurance side goes to They tell you that the coverage you sult of all of this, they are deeply in overhead and administration. Most of need isn’t what you need or they refuse debt. They had to take time off work that goes to denying claims and mak- to honor the doctor’s bill when it and spend time caring for him, and so ing life difficult for providers, doctors, comes through the door. But a business they have had employment issues. and hospitals, when they submit their model for an entire industry of denying Now, this is, again, sort of the ideal bills. There is a war, a claims war insurance to the people who they think American family. They are both work- going on right now between the insur- will get sick and then denying coverage ing hard. They have a son whom they ance industry and doctors and hos- to the people who actually do get sick love. They are doing everything right, pitals. And 15 percent of what we pay and, when they can’t dodge their cov- and they are playing by the rules. And for health care gets burned up on the erage responsibilities, denying pay- because he got sick and because our insurance company side of that war. ment to doctors or hospitals or trying

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00029 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S8670 CONGRESSIONAL RECORD — SENATE August 3, 2009 to have some person who is not even a tients are, the more you get paid; the ited from dropping or watering down doctor second-guess the coverage that more you do, the more you get paid. insurance coverage for those who be- your doctor tells you you need, that is There is enormous hope for the whole come seriously ill. No gender discrimi- a terrible business model. It has caused system. In fact, it may be the only nation. There has been a problem of immense pain across the country, and hope for our whole system is to change tremendous discrimination in the cost it has been a disaster. There is a better that business model to a model that of coverage based on gender. Under our business model. A public option can works on quality improvement, preven- legislation, insurance companies would pursue it. tion, investment, payment reform, and be prohibited from charging you more Mr. DODD. If my colleague will yield electronic health record infrastructure because of your gender. No annual or on that point, those very fact situa- for everybody. A public option will lead lifetime caps on coverage. Again, you tions the Senator describes would be us in that way. have coverage. You have never had to totally prohibited under the bill we Perhaps you can trust the private in- use it. All of a sudden you get that cri- marked up in our committee nearly 3 surance industry to do this, although sis in your family, and then you start weeks ago. Every one of those fact sit- they never have so far. But perhaps reading the fine print and discover all uations would be prohibited under the now suddenly something will change you get are two hospital visits or three legislation we sent to the body for its and you can trust them to start doing doctor visits. You have a serious prob- consideration. this for the first time, when they never lem on your hands. That coverage you Mr. WHITEHOUSE. Yes, it would. did before. But I don’t think it is a wise have been paying for month after And it is an important piece of this leg- bet to put all of our eggs in that one month, year after year, all of a sudden islation that has received far too little basket. Give us a public option and let might as well not exist at all. Under attention so far in the debate. It has them compete. I think they can help our bill, the industry would be pre- caused an immense amount of personal transform this world. vented from placing annual and life- pain, human anguish, and suffering The last thing I will say it is cost time caps on coverage that you receive. that our health care system causes. control. We have heard a lot about cost Extended coverage for young adults: The distinguished Senator from Ohio, control on this subject. There is no bet- Children would continue to be eligible Senator BROWN, and I wrote an article ter way to have cost control than to for family coverage, not stopping at about this. We wrote: Your health in- get a public option out there doing all age 21 but up to 26. That is a huge gap, surer should be your advocate, not these things—stripping the excess prof- 21 to 26. Then we have young adult your adversary. The community health it out of the system, lowering the ad- plans that would allow another option. insurance option will invest in preven- ministrative costs, ending the warfare Young people often think they will live tion so that when you are healthy, you with providers that provides no value, forever and never have any problems. stay that way. It will invest in care and working to a business model found- We are trying to help out this age management coordination, if you have ed on quality, prevention, electronic group that too often slips through the a chronic condition, and it will fight infrastructure, and clearer payment cracks. This group often doesn’t think for you, not with you, to get you the signals. That is where we need to go. coverage is that important and, as a re- best possible care with the least pos- The public option takes us there. sult, suffers when they are faced with Nobody cares more about this than sible hassle. illnesses or accidents. That is what this is all about. The the distinguished chairman and par- Lastly, guaranteed insurance renewal new business model can look in these ticularly the people he has heard from is the point I wanted to raise—when areas: Quality improvement. We know in Connecticut. I would revert back to you discover all of a sudden that you the chairman to discuss the personal that improvement in the quality of are no longer covered. Under our legis- aspects of this on the part of the people care in this country can save dollars. lation, the industry would be required But as we were saying earlier in our he serves. Mr. DODD. I thank my colleague. to renew any policy as long as the pol- colloquy, it doesn’t save money for the There will be many more opportunities icyholder pays premiums in full. The person investing in the quality. It for us to go over this, but I want to companies wouldn’t be allowed to saves it for the system. A public option make some points that are important refuse renewal because someone be- will have the public purpose necessary and are part of the legislation that came sick. Every one of these provi- to pursue those quality improvements came out of our committee and that sions is now written into our legisla- that will drive down cost. are now available for colleagues and tion. Our bill absolutely makes major Health information infrastructure. others to consider. reforms that will make a difference on We have the worst health information Under our legislation, you can never behalf of the citizenry who are count- infrastructure in this country of any discriminate again for a preexisting ing on a program that would not de- industry. The only industry that has condition. So when someone comes in prive them of the coverage they de- worse information infrastructure is the and says, I am sorry but that condition serve. mining industry. It is pathetic. But the precludes you from getting coverage, I see our colleague from Oregon is same principle applies. The doctor in- under our legislation, drafted and ap- here. I want to say that RON WYDEN vesting in that equipment on their proved by our committee, that would has been a tremendous advocate of desk puts out all the money, takes all not happen. Never again can a pre- health care reform for so long. He has the risk, absorbs all the hassle, and the existing condition be used to deprive written a bill that has attracted a lot savings go to the insurance companies. coverage. of bipartisan support. He and I have So we are underinvested. A public op- No exorbitant out-of-pocket ex- had long conversations about some of tion can make those investments in penses, deductibles, or copays. Insur- his ideas. I have asked him to take a our electronic health record infrastruc- ance companies will have to abide by look at what we have done as well. I ture. yearly caps on how much they can am confident we will end up with Prevention strategies. I won’t dwell charge for out-of-pocket expenses. health care reform. And I want to on that because the Senator from Iowa There will be minimal or no cost shar- thank RON WYDEN for his energy and has done such a good job already. Same ing for preventive care. The insurance passion about this issue and the very principle: A public option can pursue industry would fully cover regular creative ideas he has brought to the the public purpose of protecting public checkups and tests that help prevent table. health through prevention in a way illness such as mammograms or eye Mr. WYDEN. Mr. President, I wanted that insurers never will because they and foot exams for diabetes, the kind of to come tonight as a member of the Fi- don’t have the financial interest at thing Senator HARKIN talked about. It nance Committee and particularly stake. Finally, you can develop new doesn’t make sense to pay $30,000 to highlight the extraordinary contribu- models of payment to make all those amputate your leg instead of paying tions that those on the HELP Com- happen, because the way we pay for it for the coverage to determine if you mittee have made in the prevention now is piecework. Procedure by proce- are susceptible to the illness. area. This is going to be a landmark dure, the more you do, the more you No dropping coverage for the seri- bill. This is going to be an absolute get paid. Not the healthier your pa- ously ill. Companies would be prohib- turning point in American history

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00030 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE August 3, 2009 CONGRESSIONAL RECORD — SENATE S8671 when we finally say that instead of One of the things that is troubling sulted with him often on this issue. I spending loads of money on various about this debate is if we do not get look forward to his work on the Fi- health care services, we will start the choice issue right, a lot of Ameri- nance Committee. keeping people healthy. You look, for cans are not going to be able to choose Of course, on workplace wellness, we example, at the Medicare Program. those kinds of packages. I think, under have to make sure small businesses are Medicare Part A will pay thousands the Senator’s leadership, we will be able to help their employees in and thousands of dollars on senior citi- able to do it. wellness programs. We know from zens’ hospital bills. And then Medicare The last point I would make is—and other businesses and what they have Part B, the outpatient portion, can’t I thank the Senator for all the time— done—some larger businesses but some do anything to reward somebody for I think working together over the next smaller ones that have done good staying healthy. Along comes Senator few months we can close the sale with workplace wellness programs—it pays HARKIN, who has consulted very exten- folks who have insurance. This is going off immensely in savings but also in sively with the private sector, worked to be the key to getting health reform productivity. Of course, that is some- on a bipartisan effort. Senator ENZI passed. thing the CBO does not look at—in- and Senator GREGG were very involved. Mr. President, 150 million-plus people creased productivity. They do not look And you found the sweet spot. Preven- say: Not only do I want to make sure I at that. tion. am not worse off, I want to be better But I say to Senator WYDEN, he is ab- What you all were able to do in the off. Well, we want to make sure they solutely right. What we have done, preventive area is to show that you are going to be able to choose a pack- what we anticipate will be coming now could give very dramatic incentives to age such as Senator HARKIN has been from the Finance Committee, and in reward people for staying healthy, low- able to advance in the HELP Com- putting these together, we will have a ering their cholesterol, lowering their mittee, where they get rewarded for whole new—what is that fancy word blood pressure, picking up on some of prevention. We want to make sure they called Paradigm—a new paradigm in the good work that is being done in the can choose a package where they can health care in this country, where peo- private sector but not getting into get lower premiums. We want to make ple will have a lot of choices. They will where one could, in effect, be said to be sure everybody can keep what they be able to shop. They will not be like discriminating against an individual have, but if they do not like what they my friend Art in Storm Lake, IA, who who would have a lot of health prob- have they can go somewhere else, only has one place to go with a $5,000 lems and would have difficulty just which is what we can do as Members of deductible. with an incentive-based system. Congress. Now we will be able to take a lot of That is a very thoughtful approach, So I think tonight’s program, par- these small businesses and they will be in my view, to moving this country for- ticularly focusing on prevention and able to go on these exchanges and they ward. I hope we will be able to pick up the incentives you all have laid out— can be in a pool with a lot of other peo- on it in the Senate Finance Com- and as Senator WHITEHOUSE has talked ple all over the country. We know a mittee. There is a lot of bipartisan sup- about, changing this insurance model, principle of insurance—I say to Sen- port for it. I came to the floor tonight which in many respects is inhumane to ator WYDEN, he knows this very well— to particularly highlight that. reward all this cherry-picking and, in one of the basic principles of insurance There is time, perhaps, for one other effect, sending the sick people over to is: The more people in the pool, the thought. I was struck—as we talk government programs more fragile cheaper it is for everybody. about the lack of choice in this coun- than they are—you all have done some So we set up the bigger pools with try—the distinguished Presiding Offi- very good work, particularly in preven- our small businesses, my farmers and cer and I woke up this morning to our tion and making sure the consumer farm families to get into bigger pools, statewide newspaper, the Oregonian, gets a fair shake with the insurance in- and not just these small pools that cost which described, in great detail, our dustry. them so much money. But the idea be- health insurance as Members of Con- Working together, particularly by hind it, of course, the one big para- gress. Senator HARKIN and I have adding choices, we are going to be able, digm, is to start focusing on wellness talked about this, Chairman DODD as over the next few months, to show we and health promotion, keeping people well. It described how Senator can close the sale with those who have healthy. We have to put more incen- MERKLEY and I have access to 23 health insurance in this country and come tives in there for people. care packages, which, by the way, un- back in the fall and win bipartisan sup- derstand the HELP lesson. They can- port to go where this country has not You talk to anyone. Go out and talk not discriminate against you if you been able to go for 60 years; that is, to anyone and ask them would they have a preexisting condition. You go quality, affordable coverage for all like to be healthier or would they like into a big group so you can play Americans. to be sick. That answer is easy. They hardball with the insurance companies. We have already made it clear that in want to be healthy. What kind of help What is striking about this—and Sen- any legislative effort we are a part of, do you get? When you go to your doc- ate MERKLEY and I heard about this on we will mandate good health for the tor, when you talk to your doctor and the front page of our newspaper—is Dodd household because we are all stuff, do they tell you how to be most of the country thinks this is some thinking about you, and we want you healthy? Well, I do not know. I do not kind of ‘‘Cadillac,’’ gold-plated oper- to know how much affection we have think so. When is the last time you ation. But, as the newspaper pointed for you and how much support both went to a doctor and walked out with- out today, that is what somebody who personally and professionally we have out getting a prescription? So the doc- works for the Forest Service gets in for you from all of us in the Senate. tor gave you a prescription. Go get a central Oregon, that is what somebody Mr. DODD. I thank the Senator. drug. We have to change this. In our who is a janitor, for example, the paper Mr. WYDEN. I thank the Senator for bill, we do. said, gets at the Bureau of Engraving. giving me all this time. Again, part of our prevention pack- I very much look forward to working (Mr. WHITEHOUSE assumed the age is to focus on medical schools and with all of you on the HELP Com- chair.) how we get more people in general mittee, as Chairman DODD and I have Mr. DODD. I thank my colleague. practices and family practices and talked about, to make sure everybody Mr. HARKIN. Mr. President, I wish to residencies in prevention and wellness can have a wide array of choices, have thank my friend from Oregon, with so they begin to understand how they a lot of clout to take on the insurance whom I have had numerous conversa- can start working with people to keep companies, get reduced administrative tions, going back over years, on the them healthy. costs, which is what you get with the whole wellness ethic and how we can So this is a way we are going to try big groups, and, by the way, have a fi- kind of get this big ship of health care to shift this so the person can say: Yes, nancial incentive to choose one of moving in a different direction. Sen- I want to be healthy. And do you know these Harkin-type packages that re- ator WYDEN has been one of the great what, I went to my health care practi- ward prevention. leaders in this area, and I have con- tioner—maybe a doctor, maybe a nurse

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00031 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S8672 CONGRESSIONAL RECORD — SENATE August 3, 2009 practitioner, maybe a physician’s as- able to provide health insurance for his the Senator from Rhode Island pointed sistant, and it could be a host of dif- people, and it bothered him deeply be- out. ferent people; it could be a chiro- cause he did not have enough business, But I wished to point out Kevin practor—and, do you know what, they and health care coverage, even years Galvin. Today we met in his shop in spent a lot of time with me, and they ago, was more expensive than he could Hartford, CT. The Secretary of Health gave me a program to follow to stay afford. and Human Services, Kathleen healthy. And guess what. They check Students sometimes ask: Can one Sebelius, was there. The new Adminis- up on me and they find out: Are you person make a difference? This per- trator for the Small Business Adminis- following your program? Come in. You son—I suppose the legislative leaders tration, Karen Mills, was there. Con- come in here in 6 months. I am giving in my State would acknowledge this as gresswoman ROSA DELAURO was there. you this program to show you how to well—this one person, on his own, over The speaker of the State house was stay healthy. And they call me up after 2 years, organized 19,000 small busi- there. The president of the State sen- a month. Someone in the office called nesses in my small State to lobby my ate was there. The head of the small me up, asking: Are you doing this? In 6 State legislature about doing some- business community was there. They months, I have to come back in to thing at long last to make a difference were there to say thank you to Kevin make sure I am doing it. for small businesses on health care. Galvin for what he had done. No one has ever done that before. But They achieved it about a week ago, in If one person like that can make a in our bill, you see—in our bill—they no small measure because one guy, who difference, we ought to listen to them. will be able to get reimbursed for that. employs about 13 people, got fed up. When the Kevin Galvins of this coun- They will be able to get reimbursed for The average small business pays 18 try—he is a small business guy with 13 keeping someone healthy and not just percent more for health care than larg- employees, struggling every day. He taking care of you when you are sick. er businesses and gets a lot less cov- decided he was going to do something I wish to thank my friend from Or- erage than others do as well for the about it, and we ought to listen to him. egon. He has been a great leader in this very reason Senator HARKIN pointed He made a difference in my State. But area for so many years. I look forward out: pooling, the idea of being able to if we listen to him, we can make a dif- to working with the Senator to get us work together, get together. They can ference with small businesspeople all over that finish line sometime this hardly lift up their heads. In a small across this country. If we will take the year. business, you are struggling every day language we wrote in our bill that can I thank Senator DODD again for all to survive. make a difference with small busi- Seventy-five percent of our employ- his great leadership. I say to the Pre- ness—13 million people in this country ers employ fewer than 25 people in our siding Officer, the Senator from Rhode who work for small business every day country. The majority of people in our Island—talking about the public op- don’t have health insurance. Of that 47 Nation get a job in a small business. tion, to digress for 1 second away from million, 13 million—being able to make Yet they work so hard every day trying prevention—here is one of the reasons a difference in their lives, giving them to keep that business afloat, particu- we need a public option: From 2003 to the kind of coverage, the accessibility larly in times such as these. 2007, the combined profits of the five and the affordability to health care, It bothered Kevin Galvin so much, largest health insurance companies can make a huge difference. went up 170 percent. Their profits went that employees of his, in some cases, One thing we don’t mention enough: up 170 percent. The CEO compensation had to leave him. They did not want to This week is the 44th birthday of Medi- for the top seven health insurance com- leave but had to because their spouse care—this week. It is a great program. panies right now: $14.2 million a year. lost their job, which is what they were Well, that is why we need a public op- relying on for health insurance. He told It took the poorest sector of our soci- tion out there, to kind of put some us about one fellow today, who I think ety out of poverty, the elderly. It also brakes on that, to give some competi- was with him 20-some-odd years, who did something else. How many of us in tion out there so these health insur- had to go off and find a job that paid 30 our generation were able to do other ance companies know they have to be a percent less in income but because things and make investments in other little bit more stringent on maybe they had a health care plan. He left the things because in 1965, this Congress, what they pay their CEOs, and maybe job he loved to take a 30-percent pay the men and women sitting in this the profits will not be so high because cut so his family could have health Chamber—mostly men in those days— they will have a public option out care. passed Medicare? All of a sudden, that there that will act as a check both on A young man whom we talked to financial burden children had to look their profits but also a check on the today, an employee, a Hispanic Amer- at—the cost of pharmaceutical drugs quality of care they provide. That is ican, in Hartford, CT, is raising a fam- their parents needed, going to the doc- why the public option is so vital and ily on his own and has a child with a tor with their parents—all of a sudden, necessary. severe disability and his parents have a lot of it got taken care of. It was a fi- Well, again, I say thank you to Sen- Alzheimer’s and there is no coverage nancial benefit to their children. ator DODD for having us here tonight, under this guy’s plan, Kevin Galvin’s I don’t know if there are any eco- and I thank him again for his great plan, in his workplace. But they are nomic models that look around and leadership on this health care bill. doing everything. Kevin does whatever say: How much did that program not I say to my friend from Oregon, we he can to help that family out because only benefit the elderly who got Medi- are going to get it done. We are going he loves that young man who has care, but how did it benefit their chil- to make this a wellness society, not a worked with him. He cares about him. dren who were then able to make in- sick society. But he cannot afford to do it forever. vestments in their own children’s edu- Mr. DODD. Mr. President, I thank He cannot survive as a businessperson cation and in that better home and our colleague from Iowa, and I thank, that way. that better neighborhood, buying that again, RON WYDEN for his contribu- So we need to pay attention. Our bill second car? How much did our economy tions. does. We talked about prevention. But actually grow and improve because we I wish to reintroduce a constituent of one of the things I am most proud of in invested in Medicare? We always talk mine, Kevin Galvin. I spent the morn- our bill is providing those credits to about what it did for those who receive ing with Kevin today. He is a true small businesses so they can afford Medicare, but how about those who American hero, in many ways. He did coverage, giving them the option of didn’t receive Medicare but had re- not want to become an American hero. going to those alternative plans out moved from them—or at least partially Kevin employs, I think, 13 people. He there that may suit their needs the removed—the burden of those costs has a small business in Hartford, CT. best, which they do not have today, al- they would otherwise pay? He started out in a hardware business lowing them to come together, so they How many people today, because of about 27 years ago and changed his have an opportunity to drive down the uncertainty about their health in- business model to meet the needs and those costs when they bargain together surance, are not making the kinds of times of our country. He was never for the best cost for their employees, as investments in other things because

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00032 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE August 3, 2009 CONGRESSIONAL RECORD — SENATE S8673 they are trying to protect themselves probably know, but the younger gen- dreds of thousands of individuals rath- against that crisis that could befall eration may not realize it. Prior to er than having to go as a small busi- them? We don’t talk about that. 1965, the poorest population of our ness of 5 or so or 25 employees to the All I hear about is how expensive this country were our elderly. It was a health care market, because when you is. It is going to be expensive, but if we great tragedy—the generation that go by yourself with 5 or 10 or 25 em- don’t do something about it, it will be grew up and then contributed so much. ployees, it is like leading a lamb to lot more expensive—expensive to our The 20th century—of course, by 1965, slaughter. Now they will be able to go economy, expensive to individuals, and those were the veterans of World War I. to the health care marketplace where expensive to our Nation. They were the people who had lived they will be able to be a part of a larg- So when we talk about these issues, through the Depression and held us to- er pool and negotiate a much better it isn’t just those who benefit as a re- gether as a nation time after time, and deal. sult of having access; it also is the re- here they were reaching their retire- The second is, they will have so lief, it is the sense of comfort, that ment years, and, as we all know, when many options when they get to that sense of confidence that, Lord forbid, health care problems become pretty health care marketplace, whereas now something happens to me and my fam- routine. there may be only one company that ily, I am protected against cata- A generation that came before us sit- will hear them out and give them a strophic ruin—catastrophic ruin that ting in this very Chamber decided we possible plan, and then they will have can happen. I don’t think we talk could do better than that, and so craft- many more to choose from. about that enough here. One of the rea- ed Medicare. The leadership again So I think those pieces are a tremen- sons is because none of us here—none began with President Kennedy and cul- dous improvement to what I think has of us here—have to worry for one single minated with the work of Lyndon been a long neglected part of the second about that. None of us are going Baines Johnson putting a package to- health care puzzle. to be economically ruined as Members gether with Hubert Humphrey and oth- Mr. DODD. Again, I thank my col- of the U.S. Congress if a health care ers, putting together that Medicare league for mentioning that. He is abso- crisis befalls us. Not one of us. Yet the Program and taking a substantial por- lutely correct. As I mentioned earlier, millions of people we represent worry tion of our population and giving them the average small business pays a lot about it every single day. the assurance and the confidence that more for insurance than larger busi- That is at the heart of all of this, to as they grow older and face health care nesses do, and they get far less cov- be able to establish a system in our problems, the Nation would be there to erage than others do as well. That is country which protects our Nation— back them up and to say thank you as why we provide new credits in this bill: the greatest, the wealthiest Nation in a gesture of gratitude for the contribu- $2,000 per employee, family coverage; the history of mankind—from the abso- $1,500 for couples; and $1,000 for individ- lute and very predictable knowledge tion they made. Also, there was a note of selfishness uals. That may not satisfy all of their that you have either been sick, you are in that it relieved that younger genera- health care costs, but it is a major sick, or you are going to get sick. I tion from the burden of financially car- break and an assistance to small busi- guarantee you, if you are a human ing for parents beyond their economic nesses and guys such as Kevin Galvin being living in this country, that is means, in many cases. So it freed up who would like to be able to buy that going to happen to you. To what extent coverage for his employees out of loy- does that occasion, that event put you their children to provide for that gen- eration’s grandchildren. In so many alty to their family. and your family in financial ruin? It One thing about small business is it happens to millions in this country. So ways we have benefited from that. So while we talk about the recipients becomes a family. Everybody knows that as much as anything else ought to of Medicare—and that is extremely everybody. You know about what their motivate us to get back here and do worthwhile—we all benefited from kids are doing. You know what is going the job. on in their homes. There is a far great- I see my colleague from Oregon is that. It was a great economic relief to er deal of flexibility in trying to meet here, Senator MERKLEY of our com- an entire Nation, not just the recipi- the needs because it is a family in so mittee, who has done a great job as ents of Medicare’s assistance and sup- well. port. many ways. So being able to jump in Mr. MERKLEY. Mr. President, I Mr. MERKLEY. Mr. President, if I and help them provide, as Kevin has thank the Senator very much for his could carry on a second point related tried to do with his own employees presentation and leadership on health to the Senator’s comments, and that is over the years, we open up the insur- care. simply as you address small business ance gateway to all small businesses to The Senator was just talking about and Kevin Galvin, your constituent, to give affordable insurance options to Medicare, and when our HELP Com- help organize small business, whereas employers. mittee was meeting, I heard a very in- we did a tremendous job in regard to This gives small businesses the same teresting statistic; that is, while Amer- our seniors 65 and older, we haven’t bargaining leverage as I mentioned icans spend 17 to 18 percent of our GDP done such a good job for our small busi- earlier, protection from hiking up rates on health care—more than any other nesses. on small businesses, watering down country on the planet—our health out- I know that over the past many coverage, or denying coverage alto- comes overall are significantly less years, small business owners have been gether just because one worker gets than several dozen other nations in the coming to me and saying: JEFF, we just really sick—and you heard cases of world. That is part of the puzzle we are can’t afford these double-digit in- that. I think Senator HARKIN talked addressing. But then I heard another creases we are getting every year in about that small business where one piece of the puzzle; that is, for Amer- health care premiums, and we are hav- employee contracted a very serious ill- ican citizens who are 65, their health ing to shift some of the cost to our em- ness and the industry then jacked up prospects are among the best in the ployees. We are having to consider the premiums for everyone, thus mak- world. The question was posed before shutting down our insurance program ing it impossible for other employees the committee: What is the difference? completely. We as small businesses to get coverage. Our bill, as our col- The difference is very simple, as the can’t get the same good deal the large league from Oregon, Senator MERKLEY, Senator from Connecticut has so de- businesses are able to get. Can’t you do mentioned, bans that case. scribed, and that was the creation of something about that? We exempt businesses from having to the Medicare Program. All of our citi- I think with the bill the Senator pay any penalty if you employ 25 or zens 65 and older have health care. If from Connecticut has steered through fewer employees, and that is a great we can take it and make it a nation committee, he has done such great asset. Again, 75 percent of all employ- where all of our citizens 65 and under work in laying out a plan that will help ers employ 25 or fewer in our country. have health care, wouldn’t it make a our small businesses in several dif- We don’t count seasonal workers. Our tremendous difference? ferent ways. colleague Senator KAY HAGAN offered Mr. DODD. My colleague is abso- First is to create a pool where they that amendment in our committee to lutely correct. This is the point. People will have the negotiating power of hun- exclude seasonal workers toward the

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00033 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S8674 CONGRESSIONAL RECORD — SENATE August 3, 2009 total size of a small business, which is Mr. HARKIN. I thank the Senator. that matters for the issue they are important in small agricultural com- Mr. MERKLEY. I thank the Senator wrestling with. munities where seasonal workers be- very much. So in so many ways, the plan the come absolutely critical. But if you The distinguished chair, Senator committee has put together profoundly start adding them all up, it would drive DODD, mentioned earlier that this bill improves on our broken health care that small business into a larger num- is not just for the uninsured; this is for system for those who have insurance ber category. I assume in Oregon that the insured because we have a broken today in America. could be a major problem, I know in health care system for the insured. My Mr. DODD. I thank my colleague. the agricultural sector of your State, colleague from Oregon made this point, There is so much to talk about, and and it helps self-employed workers by that we need to close the deal for in- there are so many pieces of this. I was allowing them to purchase health in- surance in this country. listening to Secretary Sebelius today, surance through the gateways. I can tell you that folks with insur- and I am sure all of us have mentioned So a lot of businesses are single em- ance have been telling us lots of stories this in our own States, and we hear ployers. They employ themselves. That about the challenges they face under colleagues talk about this ‘‘tax’’ being could be tremendously costly, and by our current broken status quo health imposed as a result of this bill. There is pooling, it makes it possible for those care system. The first is that right no tax being imposed by this bill. How- people to drive down those costs. now, their insurance is largely tied to ever, there is a tax that exists today, So a major part of our bill, as Sen- their job, so if they should lose their which is $1,100 for the average family, ator MERKLEY has pointed out, is fo- job, it is a huge calamity—not just be- and that is the amount the average cused on small business—again, the cause they lost their job but also be- family pays in health care premiums great engine of our economic success in cause they lost their insurance. It is a every year to cover the uncompensated this country, and we pay a lot of atten- double whammy. This bill would care—that is, for those of the 47 mil- tion to their needs in this bill. change that for our families who cur- lion who show up in emergency rooms Mr. MERKLEY. There is just one last rently have insurance. for health care. We take care of them. point I wish to make, but I am happy Second, our families who currently If you show up in a hospital, just to yield to my colleague. have insurance, their costs are being walk in, and you have a problem, there Mr. HARKIN. I thank my friend from driven up, in part because they are cov- is not a hospital in America that Oregon. ering the costs of the emergency room doesn’t take you into that emergency Mr. President, I can’t thank Senator treatment for those who don’t have in- room. They don’t throw you out on the DODD enough for getting the informa- surance. In the last couple of years, we streets and say: I am sorry, you don’t tion out on what our bill does. A lot of have had more and more people with- have any money, so you are going to people don’t know that we have a very out insurance transferring more costs have to suffer. Communities all across the country comprehensive bill. This one dealing in the emergency room and, therefore, do this job every day. We need to un- with small businesses is so important. more costs to the insurer. Therefore, derstand that, of course, it is not free. Now, it is true we excepted busi- more companies—particularly small That care costs. It is the most expen- nesses that employ fewer than 25, as we ones—are saying we cannot afford sive health care in the country that oc- should. However, I just told the story health insurance anymore. curs in an emergency room. The cost of about my friend in Iowa who employs This is a downward cycle, a death that, on average, is $1,100 per family in 12 people, and they buy health insur- cycle in insurance that we break with the United States. If that is not a tax, ance but they only have one plan, and this bill—helping out those who have I don’t know what is. You are not get- this would give them more. insurance by taking away the burden ting anything for it. You are helping to I believe that with the bill we have of paying for the emergency room for pick up the cost of the people who and setting up these exchanges and let- those who don’t. don’t have coverage who are showing ting different insurance companies A third factor is that other pieces are up—usually in a critical state, because come on the exchange, and with a pub- driving up health care more than 10 they have waited until such a point lic option there are a lot of small busi- percent a year of health care pre- that it is catastrophic, and they nesses out there that would like to miums. That means health care is haven’t had any prevention, as Senator cover their employees; they just simply going to double every 7 years. That is HARKIN talked about earlier, and they can’t afford it or the deductible is so unsustainable in this country for those waited forever. high that it is not even worth it. Now of us who are fortunate enough to have Now it has come down to a crisis, and I believe they will be able to take, with insurance. they show up in the emergency room our bill, after it is fully implemented— Then, also, citizens have been recog- with the child at 1 or 2 in the morning. it takes about 3 years to phase in, if I nizing that they would like to have It is not just filled with car accidents am not mistaken—there will be a lot of portability—to be able to take the in- and violence. People walk in every small businesses out there that employ surance they have and, should they night because they have a child or a 10 or 15 people that now will be able to change jobs—as Americans do, on aver- spouse who needs care. They are reach- get an insurance policy for their people age, every 3 years—be able to have the ing out in desperation, and that is ex- that will be a heck of a lot more rea- same insurance plan, the same set of pensive health care. We are paying a sonable than what they can get now, choices, the same doctors, the same tax of $1,100, and the average family and they will be able to shop for that. doctor for themselves and their spouse pays that. So even though we have exempted and their children. That portability be- Mr. WYDEN. If the chairman would them, I think a lot of small businesses comes an inherent feature of the bill, yield on that point, the reason I want- want to cover their employees. They helping those who have insurance. ed to speak at this point is, in fact, live in the same community; they go to The list goes on. Those who currently today there is an entrepreneurship tax the same church; they know one an- have insurance sometimes get it at a in America. What it means is, if you other, and they want to buy some very poor deal. As the chairman point- have a health care problem and you health coverage for their employees. ed out, it is 18 percent more for an indi- work in a small business and you have They can’t now, but I believe under the vidual than a small business. Now they a good idea and you would like to go bill we have through our committee, will be able to be part of a larger pool out and set up your own small busi- once we get it fully implemented, we and get a much better deal. ness, you are not going to be able to do will have that public option out there, Finally, many of those who currently it because you have a preexisting ill- we will have the exchange with all of have insurance don’t have existing con- ness. You are locked into your job. the insurance programs out there, and ditions covered. If they have a bad What your insurance reforms do in the they will be able to now shop around back or a heart condition or cancer or HELP legislation, and what I think a and find one that can fit their needs. diabetes, and they cannot have that lot of Senators want to do, is lift that So we will have a lot more support for fundamental health care issue covered entrepreneurship tax. small businesses that way. by their insurance, then they don’t This is very appropriate that you Mr. DODD. Absolutely. have any form of health care insurance talk about taxes because that is what

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00034 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE August 3, 2009 CONGRESSIONAL RECORD — SENATE S8675 this always comes down to. Your insur- Compare that to going online at— some loved one or ourselves get very ance reforms specifically, as a result of pick one—say, Amazon. You log into sick. People’s viewpoints change when making sure that person who has a Amazon and they say: Welcome, SHEL- they have had that experience. They good idea—perhaps that gentleman’s DON WHITEHOUSE. Good to have you find the limits of their policy. They see business the Senator just described— back. Here are all the books you how fast the copays add up. They see they are going to be able to do what bought in the last year or so. Based on the fine print in what they thought was makes America great, which is use that, we think here are more books you a great policy when times were good their ingenuity and talent because might like. Choose something you and they were healthy, with just a lit- when they go to their next job, they would like, and your billing informa- tle injury here and there, and every- are not going to face insurance dis- tion is here. thing was taken care of fine; but when crimination. Put those experiences side by side they got really sick they found that I appreciate the Senator bringing up and show where our bill can take the policy they thought they could count the entrepreneurship tax. I am looking American health care consumer, and on wasn’t there for them. forward to working with the chairman what that means for quality of care, Now the leading cause of families over the next few weeks. I think there and not just for the convenience of not going into bankruptcy and losing ev- is additional work we can do on the ex- filling out the form, but when you are erything in this country is somebody changes. The Senator from Oregon, Mr. a pharmacy, it is connected to your in the family having a health care dis- MERKLEY, my colleague who is doing laboratory, it is connected to your doc- aster that wiped them out. That should such a good job, talked about some of tor, it is connected to the hospital, and not be. It happens over and over and those options. I think we can get addi- you are the center of it, and all of it is over. It happens to the insured. That is tional people more bargaining power, private and secure. That is a new and not the uninsured. If you are uninsured and in effect build on the good work better world for everybody, including and you have medical bills, you know done in the HELP Committee. those who have insurance. you will have problems, but it is the in- Thanks for all the time tonight. You Who has not had somebody they sured who are caught by surprise. They have done a first-rate job on preven- know go into a hospital and come out have their homes, their stock port- tion. Again, I appreciate lifting that with a hospital-acquired infection? It folios, perhaps, on the side; they have a entrepreneurship tax. That is why I has happened over and over. I have had nest egg, and maybe they help support wanted to take a minute to point that a friend who went in for a simple knee their children a little bit. And, boom, out. surgery, arthroscopic surgery. He was a comes the illness and suddenly they I look forward to working specifi- big athlete in college, and he needed a have all these costs and these bills and cally with my colleagues on the HELP simple surgery on his knee. He got a it is piling up and they cannot keep up Committee. Let’s expand those ex- hospital-acquired infection—a strong, and they start to get behind. Before changes because that makes the sys- big guy—and it nearly killed him. It you know it, they have lost it all, and tem work for us and Members of Con- took him out of work for weeks. Mer- they are in bankruptcy. gress. cifully, he recovered and everything is Americans have that experience I checked the other day. My pool— fine. It was touch and go for a while, every day and every one of us have put on the front page of our paper—is 1 and the cost of all of that was tremen- heard from somebody in our State who million people. That is a lot of folks to dous from that hospital-acquired infec- is right there. So I think the point the spread costs and risk among. Senator tion. He required weeks of medical chairman has been making, and Sen- HARKIN and I have talked about it. It is care. Everybody has had that experi- ator MERKLEY made, about how impor- not possible to replicate that exactly, ence. About 100,000 people every year— tant it is for people who have insur- for a variety of reasons. We can get Americans we represent—die every ance, in terms of improving their lives, close. We can get pretty close because year because of hospital-acquired infec- their quality, and their care and pros- we can build on the good work Sen- tions. pects is very poor. I applaud the Sen- ators have done in the HELP Com- Senator HARKIN tells me that it is ator for having made that point. mittee, expand the exchanges, and give the fourth leading cause of death—hos- Mr. DODD. I thank my colleagues more people choices and more opportu- pital-acquired infections. They don’t from Rhode Island, Iowa, Senators nities to lower their premiums and, in care if you are insured when it comes WYDEN and MERKLEY, and Senator my view, close the sale with the in- to hospital-acquired infections. The in- BROWN who spent a little time talking sured people over the next few months. sured will get one just as quickly as about this. There is a lot more to talk I thank the Chairman for all the the uninsured. The quality provisions about, such as the quality issues that time. of this bill will prevent that and dimin- Senator MIKULSKI of Maryland spent a (Mr. MERKLEY assumed the chair.) ish that. That number should be under long time helping to develop, and Sen- Mr. DODD. I thank my colleague 5,000. It should be a rarity. Instead, it ator MURRAY from Washington on from Oregon, a great advocate. We ap- is a commonality. The system has to workforce and the coverage questions preciate his involvement this evening change for that to happen. that JEFF BINGAMAN worked on, as with us. As a member of the Finance If you have an illness, try to find a well. Committee, it will be critically impor- prevention program. Ask anybody you We hope in the few days we have be- tant that we come together. know where they can go to find some- tween now and adjournment—and we Mr. WHITEHOUSE. I wanted to fol- body who will support them in getting know a good part of the time will be low up on Senator MERKLEY’s discus- an appropriate, sensible, supported pre- taken up with the Sotomayor nomina- sion of the different ways in which vention program for themselves. It is tion—we will have a chance to talk fur- somebody who is watching this, and rare to find. It is almost impossible. As ther about this bill and say to our col- who is insured, can look forward to I said earlier, when I was talking about leagues: We welcome your comments. some benefit from all of this. A simple the person who had a leg removed for There are five committees of Congress one would be to think, in your own ex- $30,000 because there was nobody there charged with the responsibility of perience, how often you have gone into to prevent them from letting that dis- health care. Four of the five have met your doctor’s office and maybe been re- ease get to that stage, there are big and completed their work. Our com- ferred to a specialist or you brought a savings there. It is a human con- mittee, the HELP Committee, has family member in and you had to take sequence. You can have all the insur- completed its work. We know the Fi- a clipboard and fill out on paper for the ance in the world, but if it doesn’t have nance Committee is working to com- umpteenth time your personal health a prevention option, you are not plete its work. I want to make clear insurance, your billing information, helped. that the HELP Committee product will your Social Security information, and The last thing I will say is that so be very much a part of this effort. We whatever it is they want. You have to many of us who feel comfortable right welcome the work of the Finance Com- fill it out over and over again. That is now with our insurance only feel that mittee. But much of health care cov- the experience many people have with way because we have had the good luck erage is the shared purview and respon- our health care system. not to have the experience of having sibility of the Health, Education,

VerDate Nov 24 2008 02:28 Oct 22, 2009 Jkt 079060 PO 00000 Frm 00035 Fmt 0637 Sfmt 0634 E:\RECORD09\RECFILES\S03AU9.REC S03AU9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S8676 CONGRESSIONAL RECORD — SENATE August 3, 2009 Labor, and Pensions Committee, under Let me pick up on one issue Senator ers.senate.gov. I urge people to take a the leadership of Senator KENNEDY of DODD raised. Most Americans do not look at it. If you want to know what is Massachusetts, as well as the Finance understand this, but in the midst of a wrong with health care in America, Committee. Senator KENNEDY has disintegrated health care system, we this booklet will tell you. championed for four decades this ef- have 60 million Americans who do not People are writing from their hearts, fort. Regrettably, he cannot be with us on a regular basis have access to a phy- from their own suffering, describing because of his own struggles with ill- sician—60 million. What happens when the health care crisis. I want to read ness. But he has helped frame this. It those people get sick? If you are in and comment on a few of the state- has been a bipartisan effort over the Vermont and you are kind of stubborn, ments sent to my office. This is from a years. you delay going to the doctor when you fellow in Swanton, VT, a small town in We are determined as we move for- should go, and you wait and you wait. the northern part of Vermont: ward in this debate that the product And 6 months after you first were feel- My younger brother, a combat decorated my colleagues have worked on so dili- ing badly, you go crawling into the veteran of the Vietnam conflict, died three gently over these past number of doctor’s office, and the doctor says: weeks after being diagnosed with colon can- cer. He was laid off from his job and could months is going to be very much a part Why weren’t you in here 6 months ago? not afford COBRA coverage. When he was in of our health care program. And the person says: Well, I felt awk- enough pain to see a doctor, it was too late. I express my gratitude to each mem- ward. I didn’t have any health insur- He left a wife and two teenage sons in the ber of the committee who helped ance. I was embarrassed. prime of his life at 50 years old. The attend- produce this result that took so long. The doctor says: I am getting you to ing doctor said that if he had only sought We have taken this time to explain to the hospital because you are really treatment earlier, he would still be alive. our fellow citizens what we tried to in- sick. People talk about waiting lines in corporate in our bill that will get us to So instead of treating people when Canada or in Great Britain. Let’s talk the point of increased accessibility, in- they are initially ill, what we end up about over 18,000 Americans dying creased quality, and affordable prod- doing for people who do not have access every year because either they do not ucts. That is what we are gaining. That to a doctor on a regular basis or do not have any health insurance or, if they is the purpose we are driving at to get have any health insurance is we wait do, they cannot get access to a doctor. those three goals met. until they become very ill and then we When we talk about the health care I think we achieved a good part of it send them to the hospital and spend crisis in America, it is not just the with this bill. More needs to be done, tens of thousands of dollars, in some pain that millions of Americans are ex- but, obviously, it is a great step in the instances, when we could have treated periencing, the fear, or the tens of mil- right direction. them with much less suffering and at lions of people who stay at their job I see another partner of ours in this much less cost. today. Do you know why they are stay- effort. He played a critical role with There is another point that is not ing at their job? Not because they par- community health care centers. I say widely known, and that is, according to ticularly want to stay at their job, but to my colleague from Vermont, last the Institute of Medicine, in this coun- because they have good health insur- week I was in New Britain, CT. I have try today, we lose about 18,000 Ameri- ance and their wife has an illness that many community health centers in cans every single year who die because needs to be covered. Talk about eco- Connecticut. As a result of the stim- they do not go to a doctor when they nomic nonsense, absurdity—millions of ulus package, several of them received should go to the doctor. That is six people staying at work because they do some real help to expand because they times the number of people who were not want to give up their health insur- are overcrowded. Getting electronic killed on 9/11 every single year. ance. What President Obama says, be- records is critically important. Their What Senator DODD is talking about cause of the economic crisis, we have patients have greater needs, but they and what many of us have worked on is to address health care, is absolutely have a medical home now. significantly expanding the federally right. I have three volunteer clinics in Con- qualified health center program, start- Some of our friends on the other side necticut, one in Norwalk, CT, one in ed by Senator KENNEDY four decades say what they have always said: Let’s Danbury, CT, and one in Bridgeport, ago, widely supported in a bipartisan do nothing. You want to do nothing? CT, under AmeriCares. That program manner. Within 10 years, the amount of money only serves the uninsured. It is com- What studies tell us is, if, in fact, we you are paying for health care today pletely voluntary. can do what is in this legislation and will double. If you are a small business In Norwalk, I have 60 physicians in provide a community health center person today in Vermont or around the the area who volunteer their time to with physicians, with dentists, with country and having a hard time pro- come in and serve the needs of the peo- low-cost prescription drugs, with men- viding health care to your workers or ple of the greater Norwalk area, not to tal health counseling, do you know maybe your family, think about what mention retired doctors, nurse practi- what we would end up doing, amazingly happens when the cost of health care tioners, and others who help. enough? We save money. We save doubles. Think about large corpora- I say to my colleague, that he has money. We invest over a 5-year period tions that have to compete with Euro- been a tremendous voice—in fact, our about $8 billion, and we end up saving pean, Scandinavian countries, and bill increases by 400 percent the com- money because we keep people out of companies where health care becomes mitment to community health centers the emergency rooms, we keep people a right of all people and not something across our country. We can expand out of hospitals, we keep people alive. placed on the employer. community health centers and provide If that is not a good investment, I In this year, amazingly enough, when that medical home for so many people. don’t know what is. we talk about health care and econom- They are a source of prevention, early So the fight to make sure that every ics—and Senator WHITEHOUSE was al- detection, providing for the needs of American has access to a doctor, to a luding to this a moment ago—there are families—all of these things that occur dentist, to low-cost prescription drugs 1 million people this year, it is esti- in these remarkable facilities called is certainly, in my mind, one of the mated, who will go bankrupt because of community health centers. crowning achievements of the Health, medically related illnesses. Most of The best champion, other than TED Education, Labor, and Pensions Com- those people have health insurance—1 KENNEDY, who helped author the idea mittee piece of health care reform. million Americans. And our friends to begin with, is our colleague BERNIE A month ago, I asked people on my e- say: We can’t go forward; now is not SANDERS from Vermont. I thank him mail list, which is not only Vermont, the time to go forward on health care for that effort. but all across the country, to write to reform. Tell that to 1 million American Mr. SANDERS. Mr. President, I me and tell me their relationship, how families who have suffered bankruptcy. thank Senator DODD for his kind words they are dealing with private health in- In my view, the evidence is over- and extraordinary efforts over the last surance companies. Within a week, we whelming that our current system is several months to lead the fight in had over 4,000 responses. The booklet is extraordinarily wasteful and bureau- health care reform. available on my Web site, sand- cratic; that in a very significant way,

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He speaks with prior to the second vote, there be 2 industry—the private insurance compa- that passion I love to hear about these minutes of debate equally divided and nies, the drug companies, the medical issues and talks about real people and controlled in the usual form; and that device suppliers—to make as much what they go through every day. the time for the second vote be limited money as they possibly can. I was thinking as he was talking, I to 10 minutes: McCain amendment No. Amazingly enough, according to the say to Senator SANDERS, there is a 1912 and McCain amendment No. 2030; papers in the last few days, the health wonderful small business guy in Con- that no amendment be in order to ei- care industry has spent over $130 mil- necticut named Penn Ritter. I have ther amendment prior to the vote; and lion in the last quarter on lobbying. known his family a long time. He got that following the second vote, the There are 100 Members in the Senate up and talked about his business and Senate then recess until 2:15 p.m. and 435 Members of the House—to how difficult it has been to buy health The PRESIDING OFFICER. Without spend $130 million? care for his employees. He talked about objection, it is so ordered. Where do they get that money? They one particular case which is very mov- ing. get that money, if they are a drug com- f pany, by charging the American people They were laying people off. The the highest prices in the entire world. economy was down. They didn’t need I was the first Member of Congress to people. One of the people they were COMMENDING NEVADA ASSOCIA- take Americans over the Canadian bor- going to lay off had terminal cancer. TION FOR LATIN AMERICANS, der a number of years ago where He knew if he laid him off, he would INC. women with breast cancer who were have no access to the kind of health Mr. REID. Mr. President, I rise to fighting for their lives were able to care coverage he would need to go call the attention of the Senate to the through the difficult period he was pick up breast cancer medicine at one- 40th anniversary of the Nevada Asso- about to go through. But the verdict tenth the price. The drug companies ciation for Latin Americans, Inc. was clear. This small business decided cannot lower prices in this country— NALA is a Las Vegas-based organiza- this was not going to happen. So they they have to charge us the highest tion that strives to provide low to mod- kept the man on, not because they prices in the world—but somehow they erate income families educational and could afford to keep him on—because do manage to come up with tens and social services to enhance their quality they couldn’t afford it—but in good tens of millions of dollars to try to buy of life. NALA aids the people in the Sil- conscience they couldn’t do that. There Members of the Congress. ver State with exceptional services in are people like that in small businesses While more and more people are los- education, language immersion, health all across our country, in every com- ing their health insurance, we are see- prevention and immigration. ing many of these private insurance munity in which we reside, who make a difference every day. There are wonder- NALA was established as a nonprofit companies seeing huge increases in organization in 1969. As a Hispanic so- their profits. We are seeing the insur- ful providers and hospitals and places that take in people and treat them cial-service organization, NALA ac- ance companies, the drug companies quired a small daycare center in 1978. paying, in some cases, tens of millions every single day. I would like to see us, in this Congress, at least rise to the At the time it was serving mainly Afri- of dollars in compensation packages to can-American families, but now the their CEOs. level of our citizenry who do these things every day—the Penn Ritters of center serves all low-income members For anybody to suggest that this of the community. The Social Services country does not need health care re- America, the doctors who work at Manchester Memorial Hospital in Con- that NALA offers include emergency form is simply not to understand what rental, utility assistance, food vouch- is going on from one end of this coun- necticut, those people who work at AmeriCare, those volunteer doctors ers, and food pantry assistance to indi- try to the other. We are a great nation. viduals who qualify for assistance. Dur- There is no reason in the world why we who show up every day. I could go down a long list, and every one of us ing these difficult economic times should end up spending almost twice as where many families are in dire need, much per person on health care as any can talk about what happens in our communities by caring people who help we are grateful for NALA’s excellent other nation and yet have inferior services and resources. health care outcomes in terms of in- people maneuver and navigate in a dif- fant mortality, in terms of life expect- ficult time during this health care cri- The association’s affordable pre- ancy, in terms of preventable deaths. sis. school/childcare program benefits more We can do better. And right now, de- The least we should be able to do is than 400 children annually. The pre- spite all of the lobbying money coming to figure out how to meet the chal- school program includes an exceptional in from the health care industry, the lenges they meet every single day, and ESL program and meals for the chil- moral imperative is for Members of my colleague from Vermont is as elo- dren. Many of these children become so Congress to think about the folks back quent as any other Member on this well versed in English, that most be- home, the people who have no health subject matter, and I thank him for his come teachers to their limited-English insurance, the people who are under- comments. speaking parents. NALA offers HIV Mr. SANDERS. I thank my colleague insured, the people who are going prevention services and outreach to very much. bankrupt, the people who are staying those living with AIDS through coun- Mr. DODD. Mr. President, I yield the seling, health care, and job training. In at their work, not because they want floor, and I suggest the absence of a to but because they have a decent addition to their educational and quorum. health outreach, NALA offers immigra- health insurance program or the small The PRESIDING OFFICER. The business people who cannot invest in tion services through their targeted clerk will call the roll. program that assists with application their company because they are busy The legislative clerk proceeded to spending all of their money on health processing, naturalization preparation call the roll. and employment referrals. care. We can do better than that. We Mr. DODD. Mr. President, I ask unan- must do better than that. Now is the imous consent that the order for the I praise the Nevada Association for time. quorum call be rescinded. Latin Americans, Inc. for their 40 years I hope the American people work The PRESIDING OFFICER. Without of support to the low-income commu- with us in standing up to very powerful objection, it is so ordered. nity of Nevada. It is through the hard special interests and moving us toward f work of organizations like NALA that real health care reform. low-income families across Nevada and I yield the floor. ORDER OF PROCEDURE—H.R. 2997 the United States will be able to over- Mr. DODD. Mr. President, I want to Mr. DODD. Mr. President, I ask unan- come the challenges of our current briefly, before he leaves the floor, com- imous consent that on Tuesday, August economy.

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