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Public Statements

The Progressive Message

Floor Speech

Location: Washington, DC


Ms. HIRONO. Thank you very much. We are going to be focusing on health care tonight for this hour, and I just wanted to share with all of you a little bit of my background because I know what it's like not to have health care.

I came to this country as an immigrant. My mother brought me and my brothers to Hawaii, lucky me, and raised us as a single parent. We didn't have much, and she worked for many years in a job that did not have any benefit, no vacation, no health care, and I remember growing up that my greatest fear was that my mother would get sick, and if she did, she wouldn't be able to go to work, and if she didn't go to work, there literally would not be money for food or rent.

So, today, in our country over 45 million people have no health insurance. I know what that's like. Our current system does not serve these millions of people, nor does our current system serve those who have health insurance because of rising costs which have not kept up with wages.

Our current system also does not serve our businesses well, where employer-based health insurance premiums have nearly doubled since 2000 and continue to rise.

We're spending in this country over $2 trillion annually on health care with no one happy, certainly not 45-plus million people without any insurance, certainly not the business community, certainly not those people who literally, many of them, in fact, many individuals who file for bankruptcy in our country do so because of catastrophic health problems and costs.

And our current system is spending almost 16 percent to 18 percent of the gross domestic product on health insurance, and yet with this kind of expenditure are we getting the kind of results that you would expect for each of us, spending something like $67,000 a year on health care? No.

American children are two times as likely to die by the age of five as children in Portugal, Spain, or Slovenia. Pretty amazing, isn't it?

It is. Did I mention the costs go up and up and up? There's no end in sight, frankly, to rely upon the private health insurance carriers to resolve this problem which has been with us. Remember, when I came here and my mother didn't have health insurance, it was a number of decades ago. I won't tell you how many, but the problems remain.

And this is why the Progressive Caucus is very much focused as we focus on reducing costs and maintaining access and choice for doctors and health care plans and really focusing on affordable quality health care, that we want to have a public option, a public option to give the people of our country a choice as to whether or not, if they have their current private carrier insurance and they're happy with it, they can stay with that. But for those who want to have another option, who want to see competition in the health insurance market through a public option, that's what the Progressive Caucus wants to see.

This is why so many people from all across the country are supporting health care reform. It's not just top down. We have all been having reforms all across the country, in my own State, and I can talk about that a little bit more. I think I have been sort of hogging the time, so why don't I send it over, if you don't mind.


Ms. HIRONO. I also mentioned the fact that so many of our working families who file for bankruptcy do so because of catastrophic medical expenses. And in a country that is spending $2 trillion a year on medical care and 45 million-plus people not insured, it's astounding that we continue this system, which obviously is not working for people who are working, middle class families, for businesses.

We have to do something. And the great thing is that we have an opportunity now, looking at all of this data, to come together to make some changes. For the first time, we have this wonderful opportunity, in over 15 years, to make some changes to the system that is not working for anybody, really.


Ms. HIRONO. It just points out how broken this health care system is when people who are working, when people who are educated and when people who have good jobs cannot afford their health care. So, again, it points out that there are things we need to do.

In fact, I had mentioned earlier in my remarks that many of us have been having health care forums in our communities. I had one in my community last week on the big island of Hawaii, and we had representatives from the hospitals, from the medical profession and from the dean of our medical school. While this whole health care issue is very complicated, certain common themes came out.

First of all, of course, is the recognition that the cost is astronomical and that there is no end in sight. In terms of what we can do, I was really interested to know that there was this focus on prevention, on primary care. These are two areas that our current system does not reward, that it does not pay attention to, so we've got this topsy-turvy kind of a system where we're actually paying a lot of money for quantity, not quality, because if you really cared about saving cost--just focusing on the cost of health care for a moment--we would be spending a lot more on prevention so that people wouldn't have to go for long periods of time until their illnesses would be exacerbated and then they would have to go to the emergency rooms or wherever they would have to go to get much more expensive care. So prevention is really important, but our current system does not really pay attention to prevention.

Also, if we had more emphasis and support for primary care providers, it would be the same thing. We would probably save billions and billions of dollars every year by enabling people to see their primary care providers. Of course, we know that we don't have as many primary care physicians and nurse practitioners and others as we need; but if we spent more time on the primary care side, then we would avoid some of these really expensive kinds of treatments later on. So this system is very topsy-turvy.

I yield back.


Ms. HIRONO. Small businesses. You have them all coming in, saying: Let's really fix this. Let's identify the problem and let's fix it.

In our country, we like competition, but I don't think anybody could really say that there is competition going on among the private health insurance carriers. It's all very complicated. JAN talked about how, if you don't read the fine print, you don't even know if you're not covered for something that you think you're covered for. So it's all very nontransparent.

That's why the Progressive Caucus is supporting a public insurance option that is accountable and that is transparent. Believe me, those two adjectives do not apply to the private insurance carriers, because insurance is traditionally regulated, or in a manner of speaking, very little regulation actually occurs at the State level. I'll use Hawaii as an example.

The State of Hawaii regulates the rates for automobile insurance because Hawaii is a ``no fault'' State. The State regulates the rates for workers' compensation. I would say most States regulate workers' compensation insurance rates, but there is no rate regulation, and there is no review of the rates that private insurance health care carriers charge. In fact, most States, I would venture to say, don't even require any kind of information from their private insurance carriers. That is why there is no competition.

As Americans, we like competition. We want to see competition between a transparent, accountable public insurance option and a private option. Believe me, if people like their private options, or their private carriers, then that's what it is. It's a choice, and they can keep it. If they are satisfied, they ought to be able to keep it.


Ms. HIRONO. I think that when the American public finds out what we're talking about with a public option that they will support it because it's choice. Nobody is forcing anything down anyone's throat. So when the American public receives accurate information, as opposed to being scared to death, I think they know what the appropriate answers are. That's part of what we need to do here. That's what we're doing tonight, to talk about these options that we have to talk about, what kind of focus we should have in terms of how we're going to use our health care dollars: Are we going to use it for prevention? Are we going to use it for primary care? Are we going to make those kinds of decisions with regard to how we spend $2 trillion every year? We hope we can reduce that. But with accurate information, I think the American public is perfectly able to make the correct decisions or appropriate decisions.


When you talk about the people who are already being covered by Medicare or are about to get there, the fact of the matter is that our country is a rapidly aging country; and, in fact, Hawaii has one of the fastest aging populations in the entire country. So the issue of health care coverage and how we're going to do it is very much on people's minds. When you talk about, how are people supposed to take care of their long-term care needs, that is a huge, huge concern in our country.

So what we should be also talking about is, how are we going to help our elders age in place as opposed to having to be institutionalized where the costs are so much greater? There are just so many choices that we can be making that truly enables the people of our country to sleep soundly at night, knowing their needs are being met.


Ms. HIRONO. I don't think there is anything wrong with the single-payer. But as you say, we are dealing with a lot of interests and ideas, and as President Obama said, this is a time when all of the perspectives ought to be given consideration and due respect. And I think that moving this discussion to a consideration of a public insurance option is a pretty large step, in my view. And if you add that in addition to the promoting of the use of information technology for medical records, and there are a number of other things we can do to move the ball so that we can get quality medical care for more people and have it affordable, I think that what we are talking about right now with the public option moves that ball in that direction.


s I had mentioned earlier, it is generally the States regulate, so-called regulate, insurance companies. So most States do not have the kind of resources or even the laws that allow them to look at what the health care insurance companies are doing, how they are basing their cost increases or their premium increases. So there really is a lack of transparency and accountability. And when you don't have the ability to look at the relationship between the rates they are charging and what the claims are, how can you even begin to say that people's needs are actually being met or that cost containment is actually occurring? You can't.


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