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National Defense Authorization Act For Fiscal Year 2010

Floor Speech

Location: Washington, DC


Ms. STABENOW. Madam President, thank you, very much.

First, I want to congratulate, actually, on the underlying bill, my friend and colleague and the leader of the Armed Services Committee for all of his hard work on the bill that is in front of us. It is so important for the troops. I thank him for his leadership in such a strong way on behalf of the men and women who are serving us every single day and for all the things they need to be able to be supported, along with their families. So this is a very important bill, and I am hopeful we are going to be able to move through this very quickly.


Madam President, I did want to take a moment, though, tonight to talk about health care, about the specifics of the bill we have been working on now for about a year. We have had forums and meetings and drafts and proposals and working sessions for about a year now, I believe. I commend Senator Baucus for the incredible amount of time he has put in, as has his staff, with he and Senator Grassley, working, as they always do, so well together.

There has been a tremendous amount of effort that has gone into this, and we will speak more as the process moves along about the specifics of the health care legislation. But tonight I want to take just a moment to talk about why it is so important to do it.

If the system worked well now for everyone in the country, if everyone could find and afford health insurance, we would not be having this discussion. We would not have had this debate. This would not be something that would be a top priority for the President of the United States.

But the reality is, the current system does not work for everyone. Even if you are part of the majority that has health insurance, you are probably seeing your copays go up, your premiums go up. You may be worried about whether you will lose your insurance if you lose your job or your spouse loses his or her job. You may be in a situation where you cannot find insurance because you have a preexisting condition that the insurance companies will not cover.

There are many reasons why people today, even though they have some kind of insurance, are incredibly worried about the future, about what happens when they get sick or what happens when the kids get sick.

Then, for those who do not have any health insurance, of course, it is an even more challenging story. We know there are millions of Americans--47 million and counting, in my home State of Michigan alone over 1 million people--who have no insurance at all. What happens to them when they get sick or when the kids get sick?

So this is a huge issue, and the time has come to decide that health care is a right, not a privilege, in the greatest country in the world.

We have been working for years. It has been 90 years--ever since President Roosevelt wanted to have a health care system that all Americans would be able to use as part of the Social Security Program--that we have been trying to do this, trying to get it right. At that time, 90 years ago, there were not the votes to do that. Since then, Harry Truman wanted to have health care reform. It did not get done.

President Johnson initially wanted to have a system that every American would be able to benefit from. That did not get done. But I am very proud that a first major step was taken with President Johnson and a Democratic majority and some Republican colleagues joining with them. I hope we are going to see that kind of bipartisan effort now. But we ended up with something called Medicare.

If seniors or people with disabilities could have been able to get health insurance that they could find and afford at the time, Medicare would not have passed in 1965. It passed, along with Medicaid for low-income seniors and families, because people could not find insurance. They could not afford it. That is why it passed.

We are now in the same situation. Since that time in 1965, there have been a number of different efforts. A very important effort, one that there was bipartisan support to do, children's health insurance, was put in place--but still, not a system in America where everyone would be able to afford to buy insurance, to be able to get health care for themselves and their families.

So here we are today. It is time to finish the job that was started years ago, to finally say: OK, we understand that health insurance is not like other kinds of insurance. You can choose not to buy a car if you do not want to, and you do not have to have car insurance. You can choose not to buy a house and not have homeowners insurance. You cannot choose not to be a human being and to get sick. So it is different.

So the question for all of us is not whether people will ever need to use the health care system or whether they ever, in fact, will get health care; it is when and how and how expensive it will be.

One of the major reasons today that the health care system is so expensive--and, in fact, we spend twice as much as any other country on health care. When you think about that, how crazy is that? We spend twice as much as any other country on health care and have over 47 million people with no health insurance. Any economist would kind of look at that and say that is crazy.

But we have a system now where the people who are uninsured or underinsured--or have their premiums and copays going up too much where they cannot afford to use their insurance--go to the emergency room, moms and dads going to the emergency room with their children.

I have had the opportunity to visit emergency rooms, both when I have been in an emergency but also just there with emergency room physicians, with the nurses, to watch what happens. Anytime you have seen that, you
know there are lots of moms and dads who have no other choice for their children than to take them to the emergency room.

We also have more and more people who, because of dental problems--the inability to get basic dental coverage--end up in the emergency room of the hospital. When that happens, people are served. That is the job of the hospitals, and I believe we should be focusing on emergency rooms and emergency room physicians and giving them extra support because of what they do. But the reality is, they are served. Then who pays for it? Well, everybody who has insurance pays for it because the hospital then takes the uncompensated care and rolls it over into the costs of those with insurance. That is the system today. People get care.

They walk in the emergency room sicker than they otherwise would be--maybe waiting until late Friday night to have something happen, hoping they were not going to have to go to the doctor because they could not afford it, and they end up in the emergency room on the weekend.

The reality is, we have now institutionalized the system that is the most expensive way possible to provide health care in this country. So that is a huge issue.

We know if everybody is in it, if everybody is part of the system, and we spread all the different ages and health conditions and geographic disparities and all of the different pieces and variables in the system, and we have everybody in some way covered--everybody in--costs actually go down, which is also different than other kinds of goods and services. So health care is, in fact, different.

But we now have a system where we are paying for this and providing for this in the most expensive way possible. So there are many reasons--many reasons--why we need to have a sense of urgency about health care and what we are doing here. We need to remind ourselves daily that this does not go away just because we are not paying attention. When we are not paying attention, the prices go up. When we are not paying attention, people get sick. When we are not paying attention, businesses continue either not to be able to cover their employees or drop coverage because of what is happening on the costs.

The only question we have is, when are we going to act? That is the only question for us--not whether we are going to pay for it but it is how we are going to pay for it. Are we going to create a system that over time actually lowers costs by doing the right thing and having a system that incentivizes the right things or are we going to continue to do what we do now: costs going up, exploding, and the availability of care going down?

That is the system now.

As we discuss all of these issues, it is very complicated. All of us involved in this wish it were not. This is an incredibly complicated issue. As we have been working our way through this very hard, we have heard from lots of people in this discussion, those who operate as a business, who make a profit off this current health care system, those who are involved in it in various capacities. But I don't think we hear enough from those who are affected, from people in Michigan, people in North Carolina, people around the country who are trying to take care of their families, trying to be healthy, trying to get the care they need when they are sick, operating under this system.

Because of that, I set up on my Web site something I am calling my Health Care People's Lobby. We have lots of lobbyists here. I have invited people from Michigan to be a part of my Health Care People's Lobby and share their stories about what is happening for them. I wish to share a few of those comments with my colleagues this evening, from thousands of people who are now a part of my Health Care People's Lobby.

Tricia Kersten from Bloomfield Hills, MI, says she doesn't understand why some Senators don't seem to understand the ``unbelievable, daunting, and debilitating effect the cost of health care causes their voters.''

She is right. We all need to be paying attention to that. The cost of health care today, as I mentioned, is crushing our families and businesses, large and small, and that has to be part of--and it is, it is--part of the goal. In fact, it is at the top of the list in terms of our goals--lowering the cost.

Janet Rodriguez, St. Joseph, MI, wrote that her health care premiums for her family of three are over $700 a month. Because her employer pays a portion of her premium, and because those premiums are going up and up every year, she hasn't gotten a raise in 3 years.

This is a very common situation for workers who get their insurance through their employer. More and more people are having to trade off getting a wage increase that would help pay the mortgage and food and clothes and send the kids to college for a health care cost increase that is occurring, and their employers having to pay more of that or their having to pay more of that.

Cheryl Crandall of Pontiac, MI, is about to lose her COBRA benefits next month and has been shopping for personal insurance. Within 2 weeks, the price had already jumped from $22 a month to $667 a month. So it was $22, and it jumped to $667 a month. That is $150 more than her house payment. She says: ``We are very, very frugal people. No big vacations, no expensive toys, and we are not impoverished yet. But premiums like this for mediocre coverage, large deductibles, large copays, can break even the most stable family.''

We know that is what is happening. Her story is shared by thousands and thousands of people I know across Michigan.

Our current health care system is bankrupting too many families. We know that over 60 percent of bankruptcies are linked to medical expenses. Seventy-five percent of families who file for bankruptcy actually have health insurance, and those who have insurance on average have medical expenses of over $18,000 when they file, even though they have a health insurance policy. It is even worse for those without insurance.

Sandra Marczewski from Waterford, MI, wrote to me that she and her husband have been without insurance for 7 months. She writes: ``You have no idea the fear I walk around with every day.''

This is a fear faced by millions of Americans, tens of millions of Americans, hard-working Americans, people who have done the right thing their whole life and now find themselves struggling in this economy and facing that fear. After they put the kids to bed at night they say a little prayer: Please don't let the kids get sick. They stay up worrying about what is going to happen if they do get sick; avoiding that cancer screening because they don't want to hear it if it comes back positive, because they don't think they can do anything about it. It is a fear that grips the heart of too many Americans, and it is so critical that we move forward in a way that will allow us to address what is happening with American families.

Lee Harshbarger of Ypsilanti lived with that fear. He had no health insurance for 9 years. Thankfully, his wife's job now covers him, but they worry every day: What will happen if she loses her job or if her employer has to cut back on insurance or drop insurance? What will happen then?

It is not just families who are hurting either. We know it is our businesses, large and small. I have had so many small business people come up to me and say: You have to do something. I want to cover my 10 employees, my 5 employees. I can't even find insurance for myself at a reasonable rate, let alone the small group of people who work for me.

A.J. Deeds from Ann Arbor, MI, used to operate a small business in Birmingham. They had 12 employees and they offered them health insurance, but they soon found their competitors didn't offer these benefits and they were left behind competitively, so they faced what many businesses and families face, which is a race to the bottom. You can't compete if you offer health insurance or a good wage, so you drop the health insurance and you push down the wage.

By 1997, he wrote, they had to stop providing health insurance because they couldn't afford it anymore and be competitive with the other companies that didn't offer insurance. That same year, A.J.'s first child was born and his monthly insurance premium shot up to over $800 a month for three people.

Some have argued that a public health insurance plan would put bureaucrats between you and your doctor. How many times have we heard that? But right now, we have a bureaucrat between you and your doctor, and it is an insurance company bureaucrat. This notion that the doctor can offer whatever tests or procedure he or she feels they should for you is just that; it is not in the real world. It is not real that an individual who has insurance can go out and see a doctor or see any doctor they want, get any procedure, any treatment they want. They first have to look through mounds of paperwork in the insurance policy to see if it is covered, and then the first call the doctor makes is to the insurance company to determine whether they will pay for it.

I believe it is incredibly important that we create a system--this is what we are working to do--that is much more about doctors and patients, much more about that. A critical part of this--and I appreciate that the industry is supportive of this--is changing the system so that someone can get insurance if they have a preexisting condition, that we change the rating bands to make it more affordable and do a number of other insurance regulation reforms. This is incredibly important. But it is also true that right now, your decisions about health care depend upon, A, whether you have health insurance; and B, what it will cover, what the copays are, what the premiums are. You are in a box that is dependent on whatever that insurance policy is and what it will cover. The worst thing is when someone pays in for years and believes something is covered, and it should be covered, and finds out it is not or finds out they are ill and are then dropped. So there are a number of changes that need to take place there as well.

I have to put a plug in because in Michigan we have, by State statute, established BlueCross BlueShield as a nonprofit to insure everyone in the State, the insurer of last resort, and that has worked very well for us, and I am very appreciative of the great work they do. That is not true everywhere. I think we have some serious issues around the for-profit insurance companies that we need to take a look at as relates to the costs that people are paying.

Robert Balmes from Negaunee, MI, up in the Upper Peninsula, had to jump through hoops with his insurance company to get a medical device he needed. He was forced to deal with the company's in-network sellers, even though he could have gotten the same device much cheaper from a different supplier. His 20 percent copay would have been much lower if he could have gotten the device from the seller of his choice. If he could have gone where he wanted to go, it would have been cheaper, but he wasn't given the choice by the insurance company. He had to pay what the insurance company said or pay the whole thing on his own.

Bea Stachiw from Rochester Hills is also fed up with her insurance company. She has an individual policy, which is one of the most expensive ways you can get insurance, that costs her $400 a month as an individual, which she describes as ``sketchy, at the least, where I have to pay $2,500 up front as a deductible.'' She is limited to two doctors' visits a year. So two doctors' visits. Talk about coming between you and your doctor--two doctors' visits a year, and she has a copay. She needed a routine medical procedure and had to pay over $700 out of her pocket. For people struggling to make ends meet, those kinds of costs are not acceptable. People can't afford this.

Again, this whole process of health insurance reform is about supporting doctors and nurses to be able to do what they were trained and want to do, and to be able to make health care available to Americans, young and old, with families, without, small businesses and large. That is what this is all about.

I am very pleased we are working on an approach that would give people choice, that would allow people to keep their insurance if they wish to, and I think that many people--again, my own family would say, we want to keep ours. Well, we are not in the Federal system, so we know that many people would say they are satisfied, that they like what they have. I say, great, to that. We want to make sure, No. 1, that people can keep what they have, but if the system is broken for you, we want to fix it. That is what health reform is about. Keep what you have if you like it. Let us fix what is broken so everyone has the opportunity to have the health care they need.

There are a number of ways in which we are working to do that. I mentioned earlier making sure that everyone is covered, a part of lowering the costs so we don't have too many people using the emergency rooms inappropriately. We know that payments to providers drive the system, and the proposal we are all working on would focus on quality, not quantity, of tests; would focus on health and wellness, not sickness, so we are incentivizing those things that allow people to be healthy, that encourage and support primary care doctors as the first line of defense, and nurses as a first line of defense so that people being able to get the care and the funding they need, the screenings, the prevention they need, that is all part of this very important change.

The long-term savings in the system come from changing the system to health care rather than sick care and quality rather than quantity. We also know that, as I said before, insurance reform is an incredibly important part of it, so everyone can get the insurance they need, that it is affordable, and that they know they won't be dropped if they get sick.

Finally, it is very important that we have the right mix of choices, that we have private sector options but that there also be a public health care option that is consumer driven, that is a benchmark on the true cost of providing health care, so there can be competition. It needs to be level and fair competition. I believe we need that competition.

Madam President, we have a lot of work to do in the coming weeks. It is very important work. The American people have waited long enough for us to get this done. We know it is complicated. People of good will are working to come together on an approach, but we need to get it done because people in each of our States--my great State of Michigan and across the country--are counting on us because the system doesn't work now for too many people. It is not acceptable. Getting sick is not a choice. Worrying about your children, your family, your moms and dads, your friends and neighbors, and what will happen to them when they do get sick is a fear or a worry we need to be able to address. We need to take that worry off of the American people and say that we get it.

Health care should be a right, not a privilege, in the greatest country in the world. That is what this work we are doing is all about. I very much hope we are going to have a product that will be widely supported and that we can move it on to the President as soon as possible.

I suggest the absence of a quorum.


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