Unemployment Compensation Extension Act Of 2009--Motion To Proceed

Floor Speech

UNEMPLOYMENT COMPENSATION EXTENSION ACT OF 2009--MOTION TO PROCEED -- (Senate - October 28, 2009)

BREAK IN TRANSCRIPT

Mr. UDALL of New Mexico. Madam President, I ask unanimous consent to speak as in morning business for 1 hour. I also ask unanimous consent to engage in a colloquy with other Senators who may join me.

The PRESIDING OFFICER. Without objection, it is so ordered.

Mr. UDALL of New Mexico. Madam President, first, let me speak on the issue that Senator JEANNE SHAHEEN spoke about before me just briefly. I wish to compliment her for being such a champion for extending unemployment compensation. We are talking about people who, in many cases, through no fault of their own, lost employment. They may well be the only provider for their family. They don't have the wherewithal to support their family.

We have in this recession, this deep recession we are in the middle of, several times for people like that, extended unemployment benefits. Senator Shaheen and Senator Dodd and others who have spoken have described the personal circumstances people are in. We can't believe we can't move this legislation along to extend unemployment compensation benefits. These people need help in the recession and most likely they are the dollars that will be spent in the economy.

I wish to describe the procedure that has occurred. We had 87 Senators vote on a motion to proceed. The first thing we did to get on to a piece of legislation such as this unemployment benefits compensation legislation was we filed a motion to proceed because we didn't have the consent of the Republican leadership. We were then required to let that motion for cloture ripen over a 2-day period. So as many have watched, there hasn't been necessarily a lot of debate. It has ripened. We had the vote after 2 days--87 votes. Then, after 87 said we should move forward on the motion to proceed, there was a 30-hour postcloture period.

Well, what has happened with that is we also haven't had that much debate occurring on the Senate floor, but the time continues to run. So these delay tactics--they are called filibuster tactics, but in a way it isn't a filibuster. There is nobody here filibustering most of the time. So it is a delay tactic to do something the Nation needs.

So I compliment all of the Senators who are standing up for this legislation. I know Senator Whitehouse is also one who believes we should pass unemployment compensation legislation very quickly.

HEALTH CARE REFORM

Madam President, we are here again this evening as a group of Senators--Senator Whitehouse has joined me--to strongly support the inclusion of a public option in health care reform legislation. I encourage other Senators who support the public option to come down and join us.

We were heartened earlier this week when majority leader Harry Reid announced that he would include a public option in the bill he is merging from the Senate Finance and HELP Committees. Senator Reid showed real leadership in developing a compromise that includes the public option, something that a wide majority of Americans support and want included in this reform.

This is another step in the direction of meaningful reform, but we are by no means finished with this debate. We expect defenders of the status quo, as well as those who continue to put insurance company profits over people, to step up their attacks and step up their misinformation campaign. The bottom line is that a public option is the best proposal on the table to help keep the insurance companies honest. It will insert much needed competition into the insurance market, and it will give Americans another affordable, quality choice for their health insurance needs.

So with all of that said tonight, I want to continue by highlighting a story out of New Mexico. It is a letter I received from a woman from Placitas, NM. She is a small business owner who wrote to tell me about a rate increase notice she got from her health insurer. She was told to expect a 9- or 10-percent increase next year. For two people, that will mean $2,300 a month in premiums she will have to pay. Here is what she wrote:

We can't afford it. I am now faced with the likelihood of having to drop insurance which for two cancer survivors is not the right answer.

I know I speak for many of my colleagues here tonight when I say our offices get dozens and dozens of e-mails and letters like this each and every week. Americans are struggling, and they are looking to us for relief from an impossible situation they cannot fight or win.

There was a story in the newspaper over the weekend that I think illustrates how urgent this situation has become. It illustrates why a public option must be a part of this reform. In the newspaper it was reported that many small businesses are facing the steepest rises in insurance premiums they have seen in years. That is saying a lot considering that insurance premiums have already more than doubled over the past 9 years.

In this news story, insurance brokers and benefits consultants said their small business clients are seeing premiums go up an average of about 15 percent for next year and in some places as high as 23 percent. That is double the rate of last year's increases which were already unacceptably high. Do you know why these small businesses are seeing such big increases? This report said it is because insurers are trying to raise their premiums ahead of anything we do legislatively that might reduce their profits.

Health insurance companies are only looking out for themselves and their own profits. It is up to us to look out for hard-working Americans. It is up to us to look out for America's entrepreneurs, those small business men and women whose companies employ some 40 percent of American workers.

With that, I will open the floor to my colleagues. Let's talk about what a public option would mean for small businesses and how difficult it is for American entrepreneurs to keep their heads above water as health insurance companies continue to raise their rates, deny them coverage, or drop them completely when they place a claim to be reimbursed.

I see Senator Whitehouse here. He has been a champion throughout this process in terms of the public option. I will yield to him. I also see Senator Durbin here, our majority whip, who I hope will join us, who has also been an incredible champion when he stands up in leadership time and throughout the day on the public option.

The PRESIDING OFFICER. The Senator from Rhode Island is recognized.

Mr. WHITEHOUSE. Madam President, I thank the Senator from New Mexico for organizing this time.

What do we mean by a public option? To begin with, I will explain a little
what our public option is and why it is so important. Then I have some stories from people in Rhode Island who have contacted me and who are exactly the reason we need to do this.

The first thing you will hear is our friends on the other side saying that the public option is a government takeover of the health care system, that it is going to squeeze out private providers and it will be subsidized by taxpayers and all these things. I know something about the public option that came out of the HELP Committee because, along with SHERROD BROWN and KAY HAGAN, I wrote it. So I know a little bit about what it does. Those things are just not true.

The design of the public option is that it exists State by State. In each State, it has to stay solvent. It can't lose money. The government puts up the money any insurance company needs to start with, the initial capital. After that, the public option in each State, from its revenues, the premiums it charges, has to make money and stay solvent. If not, it fails like any other company. Secretary Sebelius of HHS is mandated to make sure each State's operation runs on a solvent basis. So there is no taxpayer bailout. It is head-to-head competition on a level playing field, and the insurance companies, frankly, should not be frightened of it. They are, but the reason they are has a lot to do with their bad practices and very little to do with anything about the design of the public option.

One of the reasons we need it, to give a little background on this, you have to remember where our national health expenditures are going. Look at this chart. This is how much we spend on health care.

I was born in 1955, when we were spending $12.5 billion a year on health care in this country. We probably spend that much a day now. In 1979, just after I graduated from college, by then we had gone from roughly $12 billion a year to $220 billion a year. In 1987, which was about when my daughter was born, we were over $500 billion or $ 1/2 trillion a year. In 1992, we were at $849 billion a year. In 2009, we are at $2.5 trillion a year. You can see the shape of the curve on the chart. It is not going out and leveling off. It is getting steeper and steeper. Costs are going through the roof, and the private insurance industry is driving that.

There are big savings that can be achieved. The President of the United States, President Obama, and his Council of Economic Advisers issued a report in July of this year that said:

Efficiency improvements in the U.S. health care system potentially could free up resources equal to 5 percent of the U.S. GDP.

They continued:

It should be possible to cut total health expenditures by about 30 percent without worsening outcomes ..... which would again suggest that savings on the order of 5 percent of GDP could be feasible.

If you do the math, based on GDP, 5 percent is more than $700 billion a year--that is $700 billion with a ``b''--in excess costs in our health care system. So we have a big target this public option can shoot for.

People say: Well, if there is no subsidy involved, how is it that the public option is going to be able to compete against these private insurers and save costs? Well, three ways:

No. 1, no profits necessary; they will be not-for-profit. In Rhode Island, about a year ago, United Health Care, a big private insurance company which has a 16-percent market share in Rhode Island--and we are a small State; we are not like Illinois or even New Mexico; we are only a million people. So this is a company in a State of a million people with only a 16-percent market share, and they asked to remove $37 million in profits from that 1 year out of the State to go back and pay for salaries of CEOs and shareholders and all that. Think how much $37 million could have been delivered in health care to 16 percent of the insured population of Rhode Island, a State of only a million people, if it didn't have to go out in profit. So that is one thing. Profits don't have to be sucked out of the system.

Second is administrative costs. One of the reasons this cost keeps going up is because the administrative costs of the insurance companies go up. In 2000, while these costs were going up, they were raising their administrative costs by more than 100 percent. What did they do with those administrative costs? They make it more difficult for you to get care and harder for your doctor to get permission to give you the treatment you need.

You hear the other side talking about government bureaucrats standing between you and health care. They don't stand between you and your health care; insurance company bureaucrats stand between you and your health care. And they are getting better at it all the time. The armamentarium they are creating to make it difficult for providers to get paid and get authority to go forward is getting more complex and expensive every year.

In addition to the fact that those costs have doubled, gone up more than 100 percent, what do the doctors and hospitals have to do? They have to fight back or else they will get rolled.

So you have this whole other cost. I went to the Cranston Community Health Center, a wonderful community health center in Cranston, RI. They told me that 50 percent of their personnel are not dedicated to providing health care but are dedicated to fighting with the insurance companies to get paid and to get prior authorization. On top of that, 50 percent of their personnel--they pay almost $300,000 a year to fancy consultants whom they have to hire to fight back against the insurance industry.

So one thing they can stop doing is taking the profits out. Another thing they can do is to wind down all that administrative cost, stop torturing the doctors and hospitals, let them wind down their administrative costs, and bring down the arms race over claims payments and approval we are living with right now. That is something a public option can do in addition to not taking out profits.

The third thing is to reform the health care system. We have all heard the testimony and seen the steps we put into our legislation to improve the quality of health care. When you improve the quality of health care, it saves money. It is interesting the way that works. When you improve the

infection rate in intensive care units, people get out sooner and they don't get those postoperative infections, and it costs about $60,000 for infections, on average. It saves money. Everybody is out sooner and the costs are less. In Michigan, in 15 months, they saved $150 million and 1,500 lives just by cleaning up and preventing infections in hospital intensive care units.

So you can save money and save lives if you are focused on improving quality instead of torturing the doctors and the providers and denying care and trying to throw people out when they get sick. It is a different way of going about the business. But it is something a public option can do.

The same logic applies to the prevention of illness. We don't do anywhere near enough to prevent illness in this country. A public option is willing to invest in prevention. We will invest in health information technology and in promoting better public health records for everybody. We will make sure people understand the value of the treatments they get, how much they cost, and whether they work. People will make better decisions about their care.

Finally, through the public option we will be able to stop paying doctors and hospitals for doing more and more tests and procedures and pay them for results. That will help change the direction of American medicine. That is how you get to the $700 billion a year the President's Council on Economic Advisers said could be saved in our health care system.

People talk about the Lewin Group, which is a knowledgeable group about health insurance and health care costs. Here is what they say:

Current levels of spending could be reduced by limiting excess consumption, managing disease, promoting competition and improving transactions.

Here are the sources of potential excess costs. Right now, they are at $2.4 billion, the total cost. You can save $151 billion in excess costs from incentives to overuse services; $519 billion in excess costs from poor care management and lifestyle factors; $135 billion from excess costs due to competition and regulatory factors; $203 billion from excess costs due to transactional inefficiency. That is a fancy way of talking about administrative warfare between insurers and doctors.

There are big savings to be had out there, and this legislation builds in
those tools--quality, prevention, transparency, information technology, and payment reform. The key to making them all work their best is a public option that will pick them up and do the job for the American people.

The question fundamentally for this legislation is, Do you trust the private insurance industry? Do you trust the people who, if you have a preexisting condition, won't let you in the door or will deny coverage for that? Do you trust the people who, the first time you show up after having been a loyal customer for years, the first thing they do is go back to look at the form to see if you filled it out wrong so they can throw you off because suddenly you became ill and expensive? Do you trust the people who, when you get sick and your doctor recommends treatment, butt in and say: No, no, no, we don't want you to get that treatment; we want something different than what your doctor recommends. They will say it is because of quality, but what you will notice is that every single time the insurance company steps in to prevent your care from coming from your doctor, what they recommend is something that is cheaper for them. They have never once said: Wait a minute, what the doctor recommended is not right, you need a more expensive regime of care because we want to treat you right. No, they say: Sorry, that is too expensive; we are cutting you off. Do you trust that industry to lead America out of this cost problem and into this new future? I don't. That is why we need the public option. And I think there are other reasons.

Mr. DURBIN. Will the Senator yield for a question?

Mr. WHITEHOUSE. Yes, I am happy to.

Mr. DURBIN. One of the aspects of the bill now being considered by the Congressional Budget Office is the opt-out provision. We have heard from the Republican side of the aisle for as long as this debate has gone on about their resistance and opposition to the idea of so-called government-run health care.

I have yet to hear the first Republican Senator come to the floor and suggest we eliminate Medicare, which is a government-run health care program which some 40 million Americans use every day to protect themselves when they need health insurance; nor have they suggested eliminating Medicaid, which involves health insurance for the poorest in America. Some 40 million to 50 million Americans are covered by Medicaid. They have not suggested eliminating veterans health care, another government health care program which helps millions of those who served our country; nor have they suggested eliminating the Children's Health Insurance Program, a creation of the Federal Government, so that literally millions of children across America have this kind of protection and the parents have peace of mind.

By my estimation, more than a third of the people in America have protection from government health insurance. Although our friends on the Republican side are critical of government health insurance, they do not want to eliminate any part of it, but they are arguing that basically Americans do not like it.

The polls say otherwise. When you ask the American people, throughout this debate, they say: We are generally confused, but we do know one thing; that is, if we have a chance to get Medicare for everybody, two out of three would like to see that. That is a government health program that two out of three Americans would like.

Senator HARRY REID, the Democratic majority leader, prepared a bill with a public option with an opt-out provision. I ask the Senator from Rhode Island what the opt-out provision will mean for those political leaders or people or legislatures or Governors in the States who might come to the same conclusion as our Republicans here, that they are opposed to any form of a public option that might involve the government.

Mr. WHITEHOUSE. The opt-out plan, as I understand it, would allow States to decide they don't want a public option in their State, so they don't have to have one. Each of us comes here representing a State. My colleague is the very distinguished majority whip, but he is also the Senator from Illinois. Our distinguished friend, Mr. Udall, is the Senator from New Mexico.

The health care our constituents get is delivered to them almost entirely in our States. So one would think it would be satisfying to the people on the other side who object to a public option that they could go home and they could say: You know what. This public option is a terrible idea. You know what I have done. I have worked out an opt-out and have protected you from it. It is only these crazies in places such as Rhode Island who want to take advantage of the public option. But I have saved you, and it is their funeral.

The way we designed it, as I mentioned earlier, is State to State it has to be solvent. There is no cross-subsidization, that one State has to carry the water for another State. They would not have to pay for Rhode Island's costs if they got out of control, whether they have a public option or they do not. So they are protected.

One would think that would be an adequate argument for them. The fact that it is not an adequate argument suggests to me there is a little bit more at stake; that the real party in interest is not the constituents of their own States, it is the private insurance industry.

Mr. DURBIN. If the Senator will yield, to put clarity and a final point on this, if this is enacted into law and a Governor or some leaders in any given State decide that the public option in their State, giving the people who live in that State an additional choice when it comes to the health insurance they want to buy, if they decide that is too extreme, too socialistic, too French--whatever they happen to decide--they could initiate an effort to eliminate the public option under this law so it would not apply to anyone living in their State. Whether these are the folks inspired by the tea party folks or others, they have their chance. They have the last word as to whether there will be a public option in their State.

Mr. WHITEHOUSE. Absolutely, it is wide open, as the distinguished majority whip has pointed out. The choice would entirely be theirs.

I suspect what we would see is, many people who are railing against the public option right here would find that their States, when they actually had the choice, would take it. Ninety-four percent of U.S. insurance markets are deemed highly concentrated by the U.S. Department of Justice. That is like the alarm going off in those markets, saying that if you find anticompetitive behavior, because that market is highly concentrated, you focus on it. You have to act.

Ninety-four percent of our major urban areas are in that situation. So to add another choice for those consumers I think is something that when practical people look at it in real life and see what its effects will be in real people's homes and in their jobs and in their finances and in their world, it will be a lot harder to keep it going, but it will be their choice.

Mr. DURBIN. If I can make one last point in a question. I know the Senator from Rhode Island is a former prosecutor, as is the Senator from New Mexico. When we come to the competitive nature of insurance companies--I know the Senator from Rhode Island was with me at a hearing recently in the Senate Judiciary Committee on the McCarran-Ferguson law, which in the 1940s exempted insurance companies--in this case, health insurance companies and medical malpractice insurance companies--from antitrust regulations, so that literally the executives of insurance companies--in this case health insurance companies--could all meet in a room and decide what the premiums would be in any given place in America, across the Nation. They could meet together and come to a common agreement as to which States would be dominated by which companies and, as I understand the McCarran-Ferguson law, the Federal Government would have no power to stop them.

We can stop virtually any other group of companies trying to do the same anticompetitive things, but there is no power to stop the health insurance companies because of McCarran-Ferguson under our Federal antitrust laws.

I say to the Senator from Rhode Island, does this not also suggest that when the health insurance companies threaten they are going to raise premiums, we ought to take them seriously? They have the power to do it,
and they certainly have a long, rich history of doing that. So when they say: If you pass health care reform, we are going to raise premiums, count on it; they are going to do it.

If we do not create the competition of a not-for-profit public option health insurance company, they literally will not face competition.

Mr. WHITEHOUSE. Yes, exactly correct. Unless they are involved in boycott or coercion, they can fix prices, carve up territories, do innumerable anticompetitive things that any other industry in America would have to answer for in a court of law. They get a pass on it because of the McCarran-Ferguson Act. But it shows, as the Senator from Illinois is pointing out, how vitally important competition is because that public option, I doubt it is going to sit down with private insurance industry and fix prices or carve up territories. It will have a public purpose and a public function, and it will be serving the people rather than the shareholders of the insurance company.

Mr. UDALL of New Mexico. Madam President, I say to Senator Whitehouse, let me join in here with him and Senator Durbin because the thing he pointed out--and that is the crux of this argument, right here on this chart--that when we talk about a public option--and the Senator has hit it over and over again and Senator Durbin mentioned it--it is competitiveness. That is what we want to see, competitiveness. We are not talking about a government takeover. We are not talking about single payer. We are not talking about all these things our friends on the other side of the aisle say about this reform. We are talking about making the system more competitive.

People may not realize that in many of our States, when you talk about insurance company monopolies, there are States where more than 75 percent are covered by just two insurers. So we have the State of Montana with two insurers, more than 75 percent of the market. Look at Minnesota, Iowa, all these darker States, Maine. These States have very little competition going on.

What the Senator talked about is, No. 1, the Federal Government cannot move in. I don't know if Senator Durbin heard this. But at the beginning, there was a big national news article that said the insurance companies are getting ready to raise the rates because they know reform is coming, and there is not a single thing the Federal Government can do about it. We have a great antitrust unit over in the Justice Department, but they cannot do anything about it because we have these laws in place.

This is, once again, what we are going to see. This is the pattern in the past: Skyrocketing insurance premiums, sky-high insurance company profits. In the last 7 years, a 428-percent increase, and all that is going on while these 47 million Americans are without insurance, premiums doubled in 9 years, and these huge CEO salaries.

I think the public option is the key to bringing competitiveness to this market. I am glad the Senator from Rhode Island and the Senator from Illinois are working in committee to see that our antitrust units may be able to get involved in these kinds of situations in the future.

(Mr. BENNET assumed the chair.)

Mr. WHITEHOUSE. If the distinguished Senator will yield, the way this works out in individual people's lives--it is important for us as policymakers to understand what the Senator from New Mexico pointed out; that is, a 428-percent increase in insurance company profits in just 7 years, while they are turning people down and pushing them off coverage, even 47 million Americans uninsured, denying their claims, while the profits are going up like that. That is a very important story.

But then you get down to the actual people who get tangled up in this and what it does to their lives. Nicole from Providence, RI, wrote to me. In 2008, her doctor prescribed a number of tests she needed to take because she was experiencing stomach problems. Similar to many Americans who have gotten into these nightmares, they come in thinking they are all set, they have good health insurance.

Nicole thought she had good health insurance. She never imagined she would have any problem covering her medical costs. But the insurance company, once it started getting the bills, went scurrying around through its files and started to look for a way to get out of having to pay. Sure enough, they decided that her condition was ``preexisting.'' The magic word so they don't have to pay. Sure enough, they denied thousands of dollars of Nicole's claims.

So now there is Nicole. She thought she had insurance. She thought everything was fine. She had this stomach illness. She had to take these tests. She sends in the bills to the insurance company and they say: No, sorry, that is preexisting. So she is scrambling to pay off thousands and thousands in debt. That starts you off into the whole set of other problems, those administrative costs I was talking about. Those administrative costs are spent fighting patients, fighting their clients.

Here is Nicole constantly on the phone trying to get the correct documentation from her doctor to the insurance company, trying to get it to match up, and it never does and the bills keep coming. It is not only that she did not get the health care she needed and the company would not pay for it, it is when she tries to sort it out, she gets into this bureaucratic nightmare with that bureaucracy that grew 109 percent just in this decade arming up to fight people such as Nicole.

Here is what she concluded. This is a regular person from Providence, RI, snarled in the health insurance system. She says:

I have a full-time job with a good salary. I own a home. I have health insurance. I am a middle-class American doing everything I think I should. And yet I am now saddled with thousands of dollars in medical bills that I cannot afford to pay.

The stories go on and on of people in this system. Coreen from Cranston, RI, wrote me. She has health insurance through her employer, but the insurance company jacked up its premiums so high this year that her husband's employer was forced to switch to a high-deductible plan. She has a deductible of $2,000. So now Coreen and her husband take turns who is going to see the doctor, depending on which one of them they think is the most ill. The healthier one doesn't go and lets the one they think is sicker go. Do they know? Of course not, they are not experts, they are not doctors, but they have to make this decision because they have had this limitation put on their policy.

She wrote to me:

We have no other option but to be held hostage by our insurer. In our current system, people come second and profits come first.

For all the big picture stuff we are talking about, it is important to remember that all these big pictures come down to homes and families and people and workers all across this country, all of whom find that this health care system is a nightmare for them under the private health insurance regime.

Mr. DURBIN. If the Senator will yield, I would like to note that I received a similar letter from a man in Illinois who had a $5,000 deductible because he had a history of illness. So in order to buy health insurance he could afford, he had to be willing to first put out $5,000 in cash out before they would cover the first dollar. He was told by his doctor, because of an examination, that he would need a colonoscopy, which is rather common and certainly a thoughtful thing to do when there is an indication. But he found it would cost him $3,000 out-of-pocket for a colonoscopy, and he would have to pay that because the insurance plan didn't cover it. He didn't have the $3,000.

Mr. WHITEHOUSE. May I inquire back if the insurance company, to the Senator's knowledge, actually checked to see if by taking the $3,000 colonoscopy they might find out something about his health so that in the long run everybody would save money because they did the test at the right time?

Mr. DURBIN. Well, I don't know the answer to that, but I would suspect that they did not because the concern for that insurance company is the bottom line for that quarter. They are not concerned, as they should be, about the long-term health of this man. If there is an indication that leads to a colonoscopy, it makes common sense that you would do it because things
discovered early can often be treated successfully, and things that you don't treat can turn into very expensive and deadly diseases.

Mr. WHITEHOUSE. The public option, therefore, might be much more adept and likely at making that investment in the constituent's health because it is worth spending $3,000 for a colonoscopy if it will help prevent a catastrophic illness later on.

Mr. DURBIN. That is the key word, ``prevent.'' We have to move toward a new mindset that health insurance companies don't think about--wellness and prevention. If we put a little money into those, we can keep people healthier and keep costs down.

I am sure the Senator from Rhode Island and the Senator from New Mexico will recall the visit we had from the CEO of a major grocery store chain--Safeway/Dominix--and how they decided for their management to try to do preventive care. I recall the CEO telling us that because of preventive care, they have been able to keep their health insurance, which is a self-insured plan, even for 3 straight years without increases.

So prevention and wellness not only keep people healthier but reduce cost. But if you were trying to drive the bottom line and just said no to people who need a colonoscopy or need a mammogram or prostate cancer treatment, diabetes maintenance--if you are saying no to all of those things and those people--the ultimate cost in human life and in dollars goes through the roof.

Mr. UDALL of New Mexico. If the Senator will yield, the Senator from Illinois has hit on an example that comes home to me because I had a gentleman write to me from a small community in New Mexico--Pena Blanca--about his wife. He said his wife had reached the age of 50, and she wanted to do what she could in preventive care, which is what we want to encourage, as the Senator is talking about, to get out in front of illnesses and try to do that preventive care. So she wanted a colonoscopy, and she went to the insurance company that said: Well, it is going to cost you $3,000. They didn't have $3,000, so she had to forgo the colonoscopy. That was when she was 50 years of age.

At 54 years of age, she was diagnosed with colon cancer. So he writes to me saying that his wife is dying and he is in this situation now where he realizes if they had had that kind of preventive care, he would have his wife with him and would have her with him a lot longer.

It demonstrates what the Senator has just said, that if we reorient our health care system to prevention, to wellness, if we use the public option--we use the nonprofit method--we will then be moving in the direction of getting way out in front of these illnesses rather than having tragedies such as this gentleman from the small town of Pena Blanca, NM, describes. It is a crying shame to see that kind of thing happen to a family.

As Senator Whitehouse has said, we talk about all these things--skyrocketing premiums and profits and everything--but it comes down to families and individuals with serious health care problems. In many cases, those problems are not being dealt with in our health care system.

Mr. WHITEHOUSE. The story the Senator just told, reminds me of one. I do regular community dinners around Rhode Island. I go to a community, and we put out nothing fancy--pasta and meatballs, a salad and punch, and we invite people to come in and just have a general discussion about the issues that concern them.

At one of my recent community dinners, a lady spoke about some difficult run-ins with the health care system. The worst part of it was about her sister, who had the same situation as the Senator's constituent. She did not have health coverage and she missed an appointment with the doctor. She didn't want to put out the money, so she went without. By the time she actually did go to the doctor, the condition had worsened.

The doctor told the woman at my dinner: Your sister's condition, if she had come in earlier, we could have cured her. But as advanced as it is now, I don't think there is much we can do about it. They tried what they could, and it was very expensive, obviously, but ultimately they could not save her.

So when we don't get this right, and when people forgo health care because they can't afford it, and because our system is set up to not pay for things that are essential preventive care, people lose their lives. It is a matter of statistics and it is a matter of cost and it is a matter of tragedy, but ultimately it is also a matter, for many people, of life and death.

Mr. DURBIN. If the Senator would yield once again, I would like to make note for the record that we are on the Senate floor this evening, and we have time to speak on this important issue because the Republicans are blocking our efforts to pass a bill that sends unemployment compensation to literally hundreds of thousands of Americans who have been out of work for a long time and need these checks to keep their families together. They have now resisted us for 21 days to extend unemployment benefits to these people across America. I am sure in each of our States, as I found in Illinois, many of these unemployed people have also lost their health insurance as a result of losing their jobs.

I would like to ask either or both of the Senators to comment on what this health care reform proposal that we are talking about would do for a person who has either lost a job or is in a low-income category; someone who is scraping by with a low-wage job, hoping for something better, or maybe that is the best they can come up with.

Would either of the Senators like to respond as to what this legislation, our health care reform bill, is proposing?

Mr. UDALL of New Mexico. Well, Mr. President, to talk a little about that situation, I think it is important to understand, first of all, that we have so many people out there who are uninsured--absolutely uninsured. As Senator Durbin has described, many times they lose their job and they lose their insurance, and that is what this reform is all about. We are not going to have that connection any longer. We are going to say to Americans: You are going to have your health care coverage, and if you go from job to job, you are going to be able to continue your health care coverage. If you are unemployed, you are going to be able to continue your health care coverage.

That is a big new step for us, to take people who didn't have insurance, who were subject to the vagaries of existence out there, and point the way to where they are going to get insurance. They are going to get help for their families, and I would just say that we are at the right place at the right time. Things have aligned.

We have President Obama, we have a Democratic Senate, we have a Democratic House, and we need to get this done in this time period. We know we are going to be opposed. Our friends on the other side are going to do the same thing the Senator mentioned on unemployment benefits. They are going to stand up and use every trick in the book. They are going to use all these filibuster rules, and they are going to make us file everything. But we will stay here long nights, we will stay through to the end so that we can help the individuals like those we have been talking about to get insurance regardless of what their personal circumstances are, regardless of things such as preexisting conditions and serious illnesses and getting dropped by insurance companies.

Senator Whitehouse.

Mr. WHITEHOUSE. I would add another element in responding to Senator Durbin's question. They may very well be eligible for Medicaid or Medicare, in which case they would go on to those programs. But, if not, they would very likely be eligible under this health care reform for a significant subsidy to help them pay for health insurance.

What is interesting about the way that works is that they do not have to go into a government program to get the subsidy. We are trying to make health insurance more available to more middle-class families. So what they do is go to the health insurance exchange, which is like a market for health insurance or, if they work for a big company or the State or county or Federal Government, there is a period where they go and sign up for the health insurance they want.

Your H.R. person says: OK, now is the time to choose your policy for the coming year. They give you your choices and you select from your choices. You have a labor agreement or a contract agreement or a statutory provision that lets you know how much your employer is going to contribute, but you get to choose, just like the Federal Employees Health Benefits Plan we are in--that all Federal employees are in.

That is the model, so that somebody who can't afford the insurance they want will get their stipend from the government and then they will go to the exchange and be able to choose. That is why it is called the public option. If there is a public option in that State, they will be able to choose the public option. If they do not like the public option, they can choose Aetna or Blue Cross or Wellpoint or Cigna or whoever is doing business in that State and buy through the exchange.

So for people in the circumstance the Senator talks about, who are in economic straits, this will be an easier way to buy health insurance. It will be a way they can afford health insurance, and it is a way that leaves the choice up to them. That is where the public option comes in because when they have that choice, I think for a lot of Americans looking at the way costs are going and looking at the way they get treated by the health insurance companies, they are going to say: The choice between all those for-profit health insurers, that is no choice at all. That is, which enemy do you have to sign up for? I use the word ``enemy'' because I have had people tell me the terrible thing about getting ill in this country is that they have to, on the one hand, fight the disease and, on the other hand, fight the insurance company. And they do see them, when they get involved in that, as the enemy.

When they have a choice between a whole bunch of insurance companies and they all share the purpose of trying to throw them off coverage if they are sick, trying to deny them coverage when they get sick, trying to deny the claims their doctor puts in, trying to interfere with what their doctor wants them to do to get better, if those are all their choices, that is not much of a choice.

That is where the public option can provide a real choice to people when they come in. They will have the dignity of being able to make that choice for themselves and their family through this program in our reform.

I see we are joined by the distinguished Senator from Colorado, Mr. Bennet.

(Mr. UDALL of New Mexico assumed the chair.)

Mr. BENNET. I have been listening to the debate, and I wanted to join in and respond to Senator Durbin's question about people leaving their insurance carrier and going on Medicare and Medicaid today, if they are eligible; and if they are not eligible, they are just out of luck. I think it is important, as we think about what this reform will bring, to remind people about what is happening with the status quo as it exists right now.

We are having all this debate about whether a public option is a good idea, whether the other insurance reforms are a good idea, accusations that this is just a government takeover of health care. What people are ignoring is what is happening right before our eyes.

In my State, median family income has actually declined by over $800 over the last 10 years. That is before this recession we are in right now. In the country it has gone down $300. In my State, the cost of health premiums over that same period of time went up 97 percent--it doubled. We are saying to working families, you are going to earn less but the cost of health insurance is going to go up by twice. Not only that, but the cost of higher education is going to go up 50 percent. Working families are getting squeezed.

What is happening is--because they are having double-digit cost increases every year, because small businesses are spending 18 percent more than large businesses to cover their employees--we are seeing already fewer and fewer people getting insurance from their employer. The number of people who are insured by employers in my State is dropping like a stone. The number of small businesses that are able to offer insurance anymore to their employees is dropping like a stone, which is heartbreaking to a lot of people because a lot of these businesses are family businesses where they pride themselves on having offered insurance for many years.

Where do these people end up in this debate we are having right now about a public option versus not? If they are poor enough, they end up on Medicaid, a government program. If they are not, they end up going to the emergency room where they get uncompensated care that we all pay for as taxpayers.

In the case of my city, in Denver, we have an excellent public hospital. They did a study 3 years ago that showed that in 1 year they spent $180 million treating people who were uncompensated, who were employed by small businesses. These are people working for a living every day but who do not have insurance. Who pays that bill? We, the taxpayers.

What I would say to people on the other side, or even on our side who are saying this is a bad idea, to give people more choice, more option, is that the system we have right now is landing people in public government options or landing them in the emergency room where the taxpayers are having to cover them with uncompensated care. We are just doing it in the least intentional way possible. We are doing it in the least thoughtful way possible and in many respects doing it in the most expensive way possible. People are not getting the kind of preventive care they ought to be getting, the screenings they ought to be getting on the front end so they don't show up in the hospital emergency room when they are dreadfully sick.

When I hear the objections to this and I realize how painful the status quo is right now for working families and small businesses--in the State of Colorado, but I also know in other States as well--I wonder sometimes what people are fighting against. What we are fighting for is a much more intentional approach to coverage, a much more intentional approach to quality, a much more intentional and rational approach to how we finance all of this.

It has been a pleasure to hear you tonight. I wanted to come and be part of the discussion.

Mr. WHITEHOUSE. Of course, anybody in the situation Senator Bennet described, if they don't like the idea of a public option under this legislation they are completely free to not sign up for it. Nobody in America will be forced into the public option. We don't even connect the subsidy, the stipend that makes health care affordable for American families, to the public option. We give it at the exchange in this legislation.

If you want to spend your government stipend to help make health care more affordable on Blue Cross, on Aetna, on Cigna, on whoever does business in your home State, you are welcome to do that. The public option is an absolute free choice. There is not a single person in this room, not a single person in the United States who, if the public option passes and they choose not to participate, has any adverse consequence at all.

The one thing they may have happen to them if the public option is successful is--if it is not sucking profits out of the system, if it is not building that huge administrative superstructure to fight with the doctors and hospitals so that they have to build a matching one to fight back from, if they are actually investing in, as you say, prevention and quality improvement and electronic health records and paying doctors in a sensible way so they don't have to run up procedures to get paid--if they do all that successfully, they will drive down the cost. Because it is competitive, those private insurance companies will have to follow. What you may get if you do not like the public option is you will get your stipend just like anybody else, if you are in the right income category. You will say I don't like the public option. I have no business with anything to do with the government health care, I don't want any part of it, I am going to the private sector--and you can buy that. You may in that circumstance actually see your private sector insurance rates come down because of nothing you did but because of the public option being out there and being competitive.

If the public option is uncompetitive and its rates go up, that is not going to hurt you. You are still in that private insurance company anyway. It is a ``heads I win, tails you lose'' situation for you; you are the winner on both sides.

Mr. BENNET. If the Senator will yield, there is one other important component to this that people in my State have been talking to me about a
lot over the last 6 weeks or so. It has become clear that as part of this reform, because this is the way insurance needs to work if you are going to cover everything, as part of this reform there is a requirement that everybody have insurance.

People are saying to me: MICHAEL, I want you to make sure you give me as many options as possible. If you are going to make a requirement as part of this, I want to maximize my choice. I want to be able to look at everything, whatever you call it--whether it is private insurance or public option, nonprofit plans--I want to be able, they say, to make the best decision that is in the interest of my family or make the best decisions in the interests of my business.

I don't know why we would want to say on the one hand we are going to require you to have insurance and on the other hand say we are going to constrain the range of choices that you can make on behalf of your family. We should not be making those choices here in Washington. Those are choices our families should be making for themselves.

Mr. DURBIN. If the Senator from Rhode Island will yield, on his chart on national health expenditures, I have heard my colleagues on the other side of the aisle, the Republican side, come to the floor many times and decry this whole effort because it was going to cost $1 trillion. We are not sure if that will be the exact number, but take it as an example. We are talking about $1 trillion over the next 10 years. If you accumulate the cost of health care in America over the next 10 years, starting this year at $2.5 trillion, and assuming it goes up to at least $3 trillion, maybe $3.5 trillion, it seems to me we are dealing, over that period of time, with an accumulated cost of health care in America over 10 years of $30 to $35 trillion, I think, is probably a fair estimate.

Mr. WHITEHOUSE. I agree.

Mr. DURBIN. One trillion dollars as a percent of that comes out to less than 3 percent of the overall cost of the system and the savings we are trying to build into this approach, by trying to find ways to reduce costs, to reduce the fraud and waste that is part of health care today, to give people options so that they have more competition, bringing down the cost of premiums--I would say to my friends on the other side of the aisle arguing that $1 trillion is a huge sum, certainly when you deal with $1 trillion it is, but in comparison to the overall cost of health care over the next 10 years it is less than 3 percent of what we anticipate. And it is largely made up of savings within the current system. I think that is the point they miss when they use that figure on the floor so frequently.

Mr. WHITEHOUSE. I think the Senator has made a very good point. I add to it by going back to the figures from the President's Council of Economic Advisers that suggest we could save $700 billion every year out of this health care system if we could wring the excess costs out of it--the unnecessary MRIs because you don't have an electronic health record and you have to go out and replicate it because you don't have the file with you; the totally unnecessary staff fighting with each other over who should get paid and who should not get paid; the $60,000 it requires, on average, when you get a hospital-acquired infection in the intensive care unit. If you could prevent it, you save. Those are the kinds of numbers that add up to these numbers. If you could save $700 billion a year--I am not saying you could do it, but it is a big target out there--investing $1 trillion over 10 years to get a piece of that back only makes sense. It is plain business sense.

If you were in the manufacturing sector and if you had an assembly line and that assembly line was creating costs like this, so the price of your product had to go up and up and you were having all those casualties, people were getting their hands caught in the machine and mangled and it was lighting up on fire because it was running out of oil, and you were having all these problems with the system, somebody would come in and say: You know what, you ought to spend a little money upfront to get a good system put in to fix up your assembly line because you will save costs in the long run. That is all we are expecting to do right now, is get those. There are so many disasters in the health care system right now, and to get that cleaned up and put a little money down for that, that is only good common business sense, particularly when there is a big target such as that $700 billion a year savings and, as you said, the cost of the next 10 years will be well north of $30 trillion if we do not do anything about this.

(Mr. BENNET assumed the Chair.)

Mr. UDALL of New Mexico. Mr. President, the example on the savings is right there, in the examples before us. We just talked about Medicaid. Medicaid has a 3-percent administrative cost. We are talking about a program, when I go into my townhall meetings and visit with people, people say they like Medicaid, they like what they have. Here is a program that is running with 3 percent administrative costs.

When we talk about the insurance companies, because of what the Senator mentioned, how they fight the claims and you have to get all these people in the doctor's office trying to prove claims, and then back and forth--doctor's offices many times told me 50 percent of the people in the office are there doing this administrative work because of what the insurance companies have created.

When you ask the big question to insurance companies, how much is your administrative cost on the health insurance industry--30 percent. I think there is enormous room for improvement when we are talking about the hundreds of billions of dollars that are out there, from 3 percent in Medicare to 30 percent or more in the health insurance industry.

There is no doubt that the savings can be squeezed out of this system. That is what the public option does. That is what we have been tonight talking about, night after night. I am so thankful that Senator Whitehouse, in the HELP Committee, his service in the HELP Committee, volunteered to write the public option for that health bill. That contributed so much to this debate. It gave us the outside parameters for what we are debating right now, and our leader, Senator Reid, has now stepped forward and said he wants a public option with this opt-out provision.

Mr. WHITEHOUSE. If I may step in----

Mr. UDALL of New Mexico. Please.

Mr. WHITEHOUSE. It was a team effort. I want to make sure that Senator Brown of Ohio, our friend SHERROD BROWN gets recognized. He had a very important role in it. As the Senator knows, he is very committed on this issue and fights very hard to protect the interests of consumers. Senator KAY HAGAN, our friend from North Carolina, also was extremely helpful. Because she has a more conservative perspective than we do, there was a wide range of views that were brought together. I think that is reflected in the fact that when the so-called Blue Dogs, the conservative Democrats over in the House, wanted to work out a public option, the public option they signed off on was the Senate HELP public option.

I think it has good appeal for conservative Democrats as well as progressive Democrats, that it reaches across the whole aisle. I hope by the time the dust settles, reasonable Senators of the other party will also join us in this because it only makes sense. If, as the President's Council of Economic Advisers says, it is ``possible to cut total health expenditures by about 30 percent without worsening outcomes,'' if there is 30 percent of waste and fighting you are talking about, and it adds up to $700 billion as the President's Council of Economic Advisers said, and if you add up the numbers from the Lewin Group, this here--they actually anticipate bigger savings, they anticipate $1 trillion a year in potential savings if--you could get all the excess costs out--it is $1 trillion a year--it is a phenomenal target to shoot for.

That is why making the public option competitive is such a good idea.

With this cost we cannot keep doing the same old thing and subsidizing. We have to change the direction of the health care system and the public option will do that.

Mr. UDALL of New Mexico. We are near the end of our hour right here. I wish to read one more letter and then Senator WHITEHOUSE may have some concluding remarks. But I think this letter drives home what we have been talking about all night. I received a letter from a man in Carlsbad, NM. This man's wife was denied insurance benefits after she fell at the school where she is a teacher. And here is what he said:

Her orthopedic surgeon told us that her fall aggravated her degenerative condition in her knees and spine. He felt he could no longer treat her without surgery and recommended that she have both knees replaced. She had one knee replaced ..... , but before she could have the other knee replaced or her back treated, she was summoned to Albuquerque where she had to appear before a panel of three doctors.

The lead doctor on this panel rules that she needed no further treatment of any kind. One of the doctors wrote a dissenting opinion, but her coverage was cut off. The dissenting doctor later apologized to my wife, stating that he hated serving on those panels because the lead doctor always ruled in favor of the insurance company and against the patient.

The health insurance industry cannot be trusted. Without the public option the American people will not have the choice they deserve. The public option would bring needed competition to the industry. I strongly urge you to support the public option.

That is my constituent writing me. He has really hit it on the head. I think the gentleman from Carlsbad said it best when he said: The public option would bring needed competition to the industry.

You saw this chart earlier here about the lack of competition and how we have these insurance companies with a monopoly. Right now health insurance companies are basically monopolies or duopolies, at best. In New Mexico, we have two companies that hold 65 percent of the market. This kind of control means there is no incentive for competition. There is no incentive to drive down those costs. A public option would insert that competition back into the market and it would keep those insurance companies honest.

I thank Senator Whitehouse, Senator Durbin, Senator Bennet from Colorado, for being down here. We have been doing this for weeks now and we are going to continue this. I do not know if you have any concluding remarks. But I think this has been a very productive session. I hope we will continue until we get health care reform done and with a public option as part of it.

Mr. WHITEHOUSE. Only to thank the Senator for organizing this time so we could engage in this colloquy on a matter that is so important to Americans on a matter where so much of what has been said has been so misleading and unhelpful.

The chance we have to talk about the actual public option as it is in real life, not some overheated imaginary public option that has been cooked up by the other side for the purpose of knocking it down, I think is very helpful to help the American people understand the direction we are trying to go. The Senator's role in getting this done is very much appreciated.

Mr. UDALL of New Mexico. Mr. President, I suggest the absence of a quorum.

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