The Importance of Enacting Health Care Reform

Mr. Merkley:

Mr. President, in the coming weeks we are going to be taking
up what probably is one of the most vexing policy challenges of the last 50
years: How to reform our health care system and provide affordable, accessible
health care to every single American.  The
goal couldn’t be more straightforward, guarantee access for every
American.  And the stakes couldn’t be
higher.  Our small businesses are
collapsing under the weight of health insurance premiums.  Just last month, Oregon’s largest insurer
announced the small business premium was going up 14.7%.  That’s on top of a 26% increase just the
previous year.  Now, large employers have
the challenge as well.  In a global
economy, our broken health care system is a major competitive
disadvantage.  A greater share of the
price of each car in the United States goes to health care than goes to steel.  $1,500 of the cost of the car goes to health
care while across the border in Canada that price is zero.

If we’re going to compete in the world we need a competitive
cost effective health care system.  And,
of course, the biggest impact of our expensive, ineffective health care is most
acutely felt around the kitchen table by our working families.  With unemployment skyrocketing, virtually
every family is reminded of how tenuous its connection is to health care.  Just one pink slip away from losing health
care for their family.  Even those with
insurance find health costs out of reach. 
Nearly half of the personal bankruptcies are by folks who have health
insurance but still couldn’t manage all the health care costs when they became

This is what it boils down to: working families in America,
if they have health care, they’re concerned about the co-pays, concerned about
being under-insured and concerned about losing their insurance with the loss of
a job.  Those working families without
health care are worried about getting sick and how they’re going to get well if
they’re already sick.  This doesn’t have
to be the case.

Mr. President, health care is already devouring a large
portion of our economy, 18% of our gross domestic product.  Driving long-term federal deficits and
crowding out important state investments in education, in infrastructure, in
social services, and pretty much everything else.  And it’s only projected to get worse as our
population ages and health care inflation runs rampant year after year.

Put simply: if we do not reform our health care, our economy
will not thrive.  That’s a stark
choice.  Our economy and health care are
tied together.  Now, Mr. President, I
know that none of this is news to you. 
Nor to any members of this esteemed chamber.  And, in fact, since President Truman, 60
years ago called for health care for every working American as a national
priority, we’ve been struggling to achieve that goal and we have not yet gotten
there.  We’ve been periodically trying to
fix up a fragmented, expensive, unfair system. 
But the fear of change has always overtaken the sense of
possibility.  Those stakes and that
history make it all the more critical that we seize this moment to meet the
challenge that President Obama has laid out for us and that we deliver on
health care reform.

This is the year, 2009 is the year.  This is the year to deliver on the promise,
to give every American access to affordable health coverage, to ensure out
economy has the same potential, the engine of prosperity, the opportunity of
employment in this century that it was in the last century.  To make this happen, we have to find ways to
make our health care system more affordable.

We need to spend our health care dollar in smarter ways so
we can put money back in the pockets of Americans and make our businesses more
competitive.  The good news is we have
lots of examples of how to do this right now. 
Extensive research has documented that the regions in our country that
spend the most per person on Medicare – that’s 60% more than the regions with
the lowest expenditures on health care – they don’t end up with better health
care.  The lowest-spending regions
actually have the same or better health care outcomes after you adjust for
health history and ages and occupations. 
Plus, the beneficiaries are more satisfied.  So if we could take the practices and change
them in the high-cost regions to match the low-cost regions, we would save in
Medicare alone hundreds of billions of dollars. 
Our job in the health care reform effort is to change the rules of the
road so they encourage and enable all providers to act more like the
high-performers, those providing and delivering high quality, lower cost health

That’s why this legislation needs to get us to start
spending our health care dollars more wisely, investing more in prevention,
investing in chronic disease management, building a research base about what
works and what financial incentives are necessary to utilize those
practices.  Rewarding care delivery built
around coordination and efficiency rather than fragmentation and volume.  We know these things work.  And we need to make them the norm, not the

Mr. President, we cannot stop the bleeding in our health
care system costs without also doing something about the convoluted and broken
health insurance marketplace.  The first
thing we need to do is end the insurance company practices that penalize you if
you’re old, or you’re sick, or you have ever been sick.  I’m outraged when I hear stories from
Oregonians about being turned away because of their pre-existing conditions or
their potential propensity towards certain diseases.  The folks who need health care the most are
being turned away the most.  And that is
not a health care system. 

Mr. President, we have fifty million Americans without
health care.  That’s what this
conversation is about.  Taking that 18%
of our gross domestic product we spend currently and finding a way to provide
good quality coverage to every single American, not leaving out 50 million
Americans.  Those are reforms that anyone
can get behind.

But I understand when we talk about other changes to health
insurance, folks can get nervous and worry about the system changing in ways
that are not beneficial to them and that’s why I keep coming back to this
point: We’re going to provide the health care system we have for the people who
have it, we’re going to improve.  We’re going
to improve it to make it more cost-effective so we can provide health care to
the 50 million who don’t have coverage. 
With the reforms our citizens will have more choice and choice in health
care options is a good thing.  Instead of
leaving individuals and small groups at the mercy of insurance companies
providing expensive plans with very high administrative costs, those
individuals and those small businesses will be able to participate in a
marketplace that groups them together with millions of other Americans so they
can benefit from the larger pool of health care participants. 

Now this marketplace will resemble something very close to
the list of options that federal employees have.  When you become a federal employee you have an
option of this plan or this plan or this plan. 
That’s what we’re going to do. 
We’re going to provide a list of plans that citizens can choose from to
be part of a larger pool.  We’re going to
provide a list of plans that small businesses can choose from and benefit from
being part of a larger pool of insured. 
Now, this is a structure that we’re familiar with as members of
Congress.  What works for members of
Congress, what works for U.S. Senators, will work for working Americans.  These plans give apples to apples comparisons
so that citizens can pick the plan that fits their family the best.  It will ensure minimum standards so that our
workers are not ripped off.  And the
access to the marketplace will come with premium assistance so that strapped
consumers can get help affording the premiums to obtain health care.

Now, given the track record of inefficiencies and cherry
picking by private insurers, I think it’s imperative that consumers have
multiple choices including a public option. 
That public option is simply a way to describe what we’re already
providing to our seniors throughout this nation.  A public organized plan, a very efficient
plan, the administrative costs of Medicare are around 2%, while the
administrative cost for our individual applicants to the health care system,
for our small businesses is 30%.  Why not
let our individuals – why not let our small businesses benefit from a 30%
improvement in the use of the health care dollar?  Now this public option would compete on a
level playing field with private plans and further expand choices for consumers
and it would be a tool for keeping costs low. 
And it should be part of any package we put forward.  Now, you would think that all of us here in
this room hearing from our constituents in every corner of our state would
understand that this whole conversation is about addressing one of the highest
stress factors for working families in every part of this nation.

But there are opponents of this reform.  My colleagues
across the aisle hired a consultant, Frank Luntz, to prepare a plan to torpedo
health care.  This plan came out in April.  This 25-page document
about how to kill any plan that’s put forward.  And this goes on to say it
doesn’t matter what the specifics of the plan are, just adopt language that
attacks it and frames it the opposite of what it really is.  Because what
this document says is that Americans want this health care reform so you can’t
fight it head-on, you have to recharacterize it, reframe it.  So what does
this plan that’s been put out to kill health care say?

It says time is on our side.  If we can slow the
process down, we can kill it.  Well, you know, windows of opportunity are
open for a certain period of time and then they close.  So I suppose
that’s smart advice if you want to kill health care.  But if you want to
do something for the 50 million Americans without health care, then we need to
move quickly forward with health care reform.  Now, this document – this
Republican document about how to kill health care, it says: say that the plan
is centered around politicians.  Say that it’s that it is about
bureaucrats.  Say that it’s about Washington, D.C.  Well, I’m not sure what there is about
providing health care options to 50 million working Americans who struggle
every day to address the cost of health care and often end up in personal
bankruptcy and forego all kinds of other opportunities so that their child can
go to the doctor.  That has nothing to do with bureaucrats.  That has
nothing to do with Washington.  That has everything to do with family
values, strengthening the foundation of our families.

Now this document about how to kill health care, this says,
bring in denial, horror stories from Canada or other parts of the world to
suggest to people they’ll lose their relationship with their doctor.  That
somehow they’ll be jerked out of the arrangements that they found to be so
satisfactory.  Scare them.  Scare the citizens of the United
States.  Well, I can tell you that what is scaring the citizens of the
United States is they can’t afford their health care.  They want us to do
something about it.  Bringing up false horror stories that have no bearing
on the plan before us to scare – to scare our citizens and make them worry even
more, that’s not responsible.

What’s responsible is to do something about a broken health
care system. 

This plan has lots more about how to kill health care. 
It says: take and say that this will destroy the personalized doctor-patient
relationship.  Take and say that this will create waste, fraud, and abuse,
and so on and so forth.  Every poll-tested set of words designed to
decrease support and scare people into foregoing this opportunity, this once in
a decade – or perhaps this once in a generation opportunity that we have to
change in our health care system.

Now, you may think that I’m raising this document before you,
this – this plan for how to kill health care, and that maybe it doesn’t have
any bearing on the real debate here.  But it absolutely does.  These
talking points are being echoed in this very chamber, in this very chamber in
order to kill health care.  Let’s see.  Here we go.  Frank
Luntz’s memo, that’s his memo on how to kill health care, came out in
April.  It says – talking point number five – “Health denial care horror
stories from Canada and other countries do resonate, but you have to humanize
them.  We recommend the phrase ‘government takeover’ rather than ‘government
run’ or ‘government control.’”  Why? Because government takeover sounds
even scarier.

So what did we hear in the chamber from our minority leader
just recently?  I quote – “Americans are concerned about a government
takeover of health care and for good reason.”  And it goes on – so
recognize that that is a point that’s coming from a document about how to kill
health care, not a responsible debate about the plan we have in front of us.

Let’s take a look at another example.  Frank Luntz’s
memo.  His memo, talking points three and four.  “Time is a
government health care killer, nothing else turns people against government
takeover of health care – than the expectation that this plan will result in
delayed and denied treatment.  The arguments against the plan.” I’ll note
that this is about a plan that wasn’t written.  It’s about any plan put
forward.  “The arguments against this plan must center around politicians,
bureaucrats in Washington.”  Note the emphasis on saying that the plan
will result in delays and deny treatment.  And what have we heard on the
floor of this chamber from the minority leader?

We have heard just recently and I quote – “Americans don’t
want to be forced by bureaucrats.”  That comes right out of the talking
points.  “To give up the health care plan to be pushed into a
Washington-run government plan.”  Right out of those talking points. 
“They don’t want to wait two years for surgery. And they don’t want to be told
they’re too old for surgery.”  All of
this straight out of this road map.

My friends, it is irresponsible in the face of 50 million
Americans without health care, with working Americans in every one of our
states going bankrupt as they struggle with health care expenses.  It’s
irresponsible to utilize a road map of rhetoric that comes from polling about
how to scare people.  That’s irresponsible.  What we need to do today
is lay out a plan on how we can create affordable, accessible health care for
every single American.

Addressing one of the biggest factors that degrades the quality
of life for our citizens across this nation.  Now we have a unique
opportunity.  We have an opportunity because small business wants help
with those 26% increases and 14.7% increases in premiums that they’re having to
pay and they’re not able to continue paying them.  And large businesses
are asking for help to become cost competitive so that we can restore
manufacturing in our nation and put people to work and rebuild the middle class
and have successful international corporations operating out of America. 
And families around the kitchen table are asking for help today.  They
know how they struggled.  They know if they have health care they might
lose it next week when they lose their job.  They know if they have health
care, they might not be able to make the co-pays if they have something serious
happen with their child.  And they know that if they don’t have health
care, that they’re going to have to forego virtually everything else or perhaps
forego the treatment itself because they won’t be able to afford those – afford
to make those payments to the doctor or to the hospital.  This is the
moment when families and small businesses and large businesses are coming
together to paint a new vision to improve the quality of life.  To
strengthen the foundation for our families.

Let us seize this moment.