Wednesday, June 10, 2009

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 ill.

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 care.

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 exception.

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.