The Progressive Caucus Message Hour

Floor Speech

Mr. WEINER. I thank you very much. I am an honorary member of the Progressive Caucus. I am not a member of the caucus, but I am very interested in the work that you've done on this issue. I just want to pick up on a point that you just made.

Part of the reason doctors understand the need for the public option is that they deal every day with insurance companies. You and I, when we get sick--and God willing, that's not often--and when our constituents get sick, they have to deal with their insurance companies. They deal with them every day. They've got six or seven different in-boxes on their desks. About 20 percent of their overhead is dealing with insurance companies, and I don't mean dealing with them as in, ``Hey, how are you doing? Let's have a doughnut and coffee together.'' I mean sitting on hold, getting approval, trying to find out when they're going to get reimbursed, spending months and months and months waiting for insurance companies to give them money for services they've already provided.

So when doctors look at this debate, they say, You know what? Having some level of competition is helpful to them as well. Just so we understand the context of this, we swing wildly between people who say the public option in this health care debate is going to transform the world and people who say it's not really going to do anything. Somewhere in between is probably right.

When this health care plan goes into effect under the President's proposal we have here in the House, for most Americans, they're not even going to have the ability to go sign up for the public option because they get health insurance at their work. If they decide to leave their employers, they're going to leave whatever the employers are putting into the kitty, so they're probably not going to do that. They effectively are not going to go into the public option. If you're on Medicare, Medicaid, the VA, or the Department of Defense, you're not going to be even eligible to go into the public option.

So the people who are going to benefit are a small group of people, an important group of people who are underinsured, meaning their employers don't provide even the basic health insurance we believe they should, or those who have no coverage at all. They're going to be able to shop. Even for those people, it is going to take a while for this public option to get up and running.

The reason it's so important--and you've made this point continually during the debate--is that we should have at least some experiment with how it might work. We should have some way to look through the lens and say, You know what? Here's a private insurance company that's paying for advertisements and that's paying bonuses. The CEO of the public option will probably make--I don't know--$190,000 a year, whatever it is, versus an institution, a public option, which might say, You know what? Maybe we can do it for less because we don't have to look out for shareholders. That sliver of competition has the insurance companies mortified.

The question is why. Why are they so afraid?

Because, I say to my colleague from Minnesota, at the end of the day, it could just be that these insurance companies say, You know what? If I'm going to compete, maybe I'll have to turn a little bit less over to profits, a little bit less over to advertising and over to bonuses. Now, for them, that might not be so good, but for the rest of us and for the country as a whole, that is actually, probably, a pretty good thing.

Mr. ELLISON. If the gentleman would yield briefly--and I'll hand it right back to the gentleman from New York--I just want to throw this out there:

I propose that the people who support the public option and the people who oppose the public option do so for the same reasons.

One is that the public option will be competitive. Because we don't have to funnel monies into these things that don't really go to care, we will be able to provide cost-competitive products for people to be able to purchase.

Mr. WEINER. Well, let me make one other point. First, that's funny, you made that observation, great minds think alike or average minds think alike.

I had written an op-ed a month ago, made the same exact point that actually the two sides agree on this. But what's interesting about some of my Republicans friends who have fought so vehemently against it is, at the end of the day, we are introducing another market player. That is, you always want more market players because that's where competition comes from.

We are introducing another one. Now we have tied its hands behind its back a bit more than I would have liked, but we are introducing another market player. It's fascinating because the argument seems to be, wait a minute, if you give my constituents choice, they might take it. Now, it's fine that--we apparently believe that our constituents are smart enough to choose us to be their representatives, but, oh, no, we can't trust them to be smart enough to choose the health insurance plan.

By the way, I already see the TV commercials. Don't go with them, you don't want government-funded health care. Yes, the private insurance companies are going to do everything possible to compete in that way. But at the end of the day, we are trying to introduce market forces where they don't exist today.

Let me just make this one final point. We hear all the time from the other side. Let the marketplace work. There is no marketplace for health care as a commodity the way we know it.

If I have an appendix burst right now standing here, I am not going to say, You know what, I am not going to get an appendix, I am going to shop for a liver instead. Or I am not going to say, You know, I am going to wait. I understand appendix goes on sale in December, I am going to wait. Or I don't have the ability to say, I am going to go buy some books and learn how to sew up my own appendix. That doesn't happen.

If I am like 80 percent of all people that get their insurance from an employer, I have one option. My employer walks in and says, Congratulations, everyone here at the supermarket. We have Blue Cross or we have Oxford, and here is the coverage.

I don't get to say, Hey, boss, uh-uh, give me my money, I am going to go shop around a little bit more. That doesn't happen.

So the idea that we have some kind of a free market guaranteed choice doesn't exist. Now we are introducing a little bit here, but at the end of the day, this is not a commodity, like a suit of clothes that you can say I am going to buy or I am going to not. It's also true when people say, Why should I have to get insurance, I am not sick.

Well, you might not be sick today, but if, God forbid, you get hit by a car and you have $170,000 worth of insurance, of health care costs, and $100 in your pocket, you know who is paying? You and I are.

But what happened to the idea of letting us all make free choices? The right of your choice stops where it starts impacting me. As my father would frequently say to me when he was explaining to me the law, the right of my fist stops at your nose. You can't have this kind of conversation that--but if you really believe in the marketplace, introduce more players.

That's what Mr. Ellison has talked about, and that's what the Progressive Caucus talked about. That's what, frankly, overwhelming numbers of Americans and overwhelming numbers of doctors are talking about.

If you are interested in making sure that we have a marketplace that is not just dominated by the idea if you can afford to pay, you do, and let me make this final--I know I keep saying final point. There is one other thing. You know, I have made the point that insurance companies for health care at the end of the day are not like insurance companies in any other walk of life.

Your car insurance company, since we all have automobile insurance coverage, they are apportioning risk. They are trying to figure out how you spread risk around. Health insurance companies don't do that. They are not covering anyone over 65. They are not covering anyone that has a preexisting condition. People like my father who tried to get health insurance before he was 65 were charged so much he effectively couldn't get it. So they are not doing that either.

So the question becomes what are the insurance companies doing? They are taking our money and giving it to doctors, giving it to hospitals, giving it to clinics. But they are putting 20 percent in their pocket.

So why don't we, if we are trying to figure out savings, not that I have anything--I mean insurance companies aren't venal people; they are doing what we frankly have allowed them to do and they have risen up for natural reasons. Let's start with that 20 percent. Let's start with that 350 or so billion dollars out of a $2.5 trillion pot. You know what, let's put that back into health care, let's put that back into tax cuts. Let's put that back into other service.

Frankly, that's the argument behind the public option, and it's 4 percent overhead, compared to the health insurance plan that I have, which has about a 25 percent overhead.

Mr. ELLISON. If the gentleman would just hang with me for a minute--well, tonight, we are short here tonight, we are going to be handing it over in a little while.

But I just want to explore this issue of competition with the gentleman from New York one more time. Now you pointed out how we have real problems with competition. We have real issues with flexibility within the market because, when you need the operation, you need it. There is not much opportunity for shopping around.

But what about the number of health care insurance companies that are in markets as they exist today? As you look around the cities of our country, are we seeing health insurance companies proliferating throughout these cities where you have multiple companies to choose from or are you looking at large markets being dominated by one to five actors?

I believe 75 percent of all the major markets are dominated by no more than five actors. Even if you could go shop around for that policy, do you have a lot to choose from?

Mr. WEINER. It's an interesting point. One of the most common things we hear from people who oppose this comprehensive health plan is they pick a reed of information and say, Why don't we do this? Why don't we let all insurance companies around the country compete in every market?

Well, I am open to the idea, but I have got to tell you they don't seem to want to. We have 50 States that have 50 State insurance commissions, and you can knock on the door of any one of them and say, I am an insurance company, I want to apply to provide insurance here in Minnesota or New York.

Now you know we have a grand total of zero applications from insurance companies in New York who want to operate in Maine. I tell you why, for an obvious reason. If you are a health insurance company in New York, you don't know any of the doctors in Maine. What

your patients and your customers are going to want is my doctor in your network.

So they have to go organize all these doctors, create a whole new network. It's hard to do. I honor health insurance companies for trying to do it. They make a lot of money. Maybe it's because they were able to do that. But you want to know, there is one insurance entity that has been able to do it for the entire country. It's called Medicare. Not only have they have been able to do it, but they have been able to do it at 3.5 percent overhead compared to a 30 percent overhead.

Mr. ELLISON. Wait a minute, isn't this a government-administered program?

Mr. WEINER. Well, not long ago on this floor, my colleagues on the Republican side of the aisle, who thump their chest and beat the rostrum about being against government-funded single payer health care plans, all voted for it. I mean, maybe not all of them; most of them voted for it.

They are the defenders of Medicare? Well, that's a single-payer, government-funded, government-controlled health care. Now it is not one thing, though--that really needs to be clarified. It's not socialism, and I will tell you why. Socialism means that government controls the means of production.

Government doesn't run the doctors or the hospitals any more than Oxford, Blue Cross or Aetna does. Now it's a common thing to say--and never or hardly ever do my colleagues on the other side of the aisle actually try to figure out the literal sense of what they are saying. It's not that.

It is, in a way, trying to figure out a way that we as a society figure out how to deal with the society problem, but the problem that we have here is the private insurance companies pick and choose markets the same way they pick and choose customers. I have got to tell you something. We can pass a law tomorrow saying that everyone can compete, all over the 50 States. You won't have people applying to go into Idaho and set up a--or probably going into Minnesota.

We have in New York a pretty rich--because we have a lot of customers, a lot of senior citizens. But we also have some of the toughest regulatory regimes because of many of the abuses that we have seen.

Look, I want to tell you something. It is my view we should have something like Medicare for all Americans. We should treat health care like we treat the fire department. Hopefully we don't need it very often. We all pay taxes so that when there is a fire they will come and put out the fire. It's good for our economy that our neighborhood shoe store should worry about selling shoes, not health care.

Under a vote that I am going to be offering, and I think it will have your support----

Mr. ELLISON. Absolutely.

Mr. WEINER. We are going to take the shoe store guy and say, You focus on that. We, the government, have an infrastructure that we know that works for health care. It has a financing problem like all health care does. Actually the curve for health care is not as severe as it is for private insurance. That's the way we should do it.

We should make it less expensive, not more expensive for citizens, because we shouldn't say, Your State taxes are going to go up, your local taxes are going to go up, your hospitals are going to close. We are going to run it the way we run Medicare, which is efficiently, and we will provide it as a service.

But putting that aside for a moment, at the very least, if we're going to have insurance companies be the primary place we get it, how about a tiny reed, a tiny sliver of competition. If you don't do it because you think you should have choice, do it because you think we should save money.

The Congressional Budget Office says that if we take a public option and we link it to Medicare plus 5 percent, we will save another $100 billion. If you are a fiscal hawk, you want the public option. If you want choice, you want the public option.

If you are a doctor, you want a public option. If you are uninsured, you want a public option. If you have insurance, you may not know it, but you want a public option too.

I thank the gentleman for just about every day talking about these important issues.

Mr. ELLISON. I want to thank the gentleman for being as eloquent as he has been. We turn on the TV screen and the gentleman has been on national news talking about these critical issues from the standpoint of the numbers, the logic, but also from the standpoint of the person who really, really needs the change.

Congressman, you have done a great service. I have told you on the floor one-on-one how proud I am of the work that you have done. I think that you are going to keep doing it. You can count on me to support the Weiner amendment, which is a single-payer payment.

Mr. WEINER. Let me say very briefly what the single payer--consider it Medicare fraud. Ask your neighbor, if you are not old enough to have Medicare, ask them how their service is.

Every year they do a survey of all Medicare beneficiaries; 96 percent say they are satisfied with it, which any program or any business would be glad to have that. They also ask the providers, the hospitals, the doctors: Rate it on a score of 1 to 6. Last year the average score was 4.5. That is pretty good. That is essentially an A minus.

What it does is say, Look, we are not going have high overhead. We will not pay you the bust-out top of the market. For every single person you are going to get prompt payment. Everyone is going to be covered. You are going to have customers all around the neighborhood, and we will try to do some smart things to contain cost.

Now make no mistake about it. The canard that's raised--wait a minute. Medicare is a successful program. We don't like it, but there are costs to it. It's true. We have more older people. To some degree Medicare's success is why it's having trouble financially.

We are living 10 years longer today than we were when Medicare was passed. By the way, it's not 10 years in our teenage years, we get 10 years at the end of life when we have more health care costs.

But if we want to solve a problem in Medicare, you call your Congressman. You get on the phone. The taxpayers employ those people. If you want to fix your private insurance, if they shut you down, they kick you out, you get on an 800 number or you buy shares in their company. Those are the two ways you influence it.

What we are saying is, let's have a more efficient model, let's have a model that's lower cost, let's have a model that you know works. If you don't think it works, ask our Republican friends how come they keep voting for it over and over and over.

I offered an amendment in the Energy and Commerce Committee. I see my colleague from the Judiciary Committee, but the Energy and Commerce Committee--I said, You don't like single-payer health plan, put your money where your mouth is. I offered an amendment on the day of the 44th anniversary of Medicare to eliminate the program. They say they don't like government-run health care. Eliminate the program.

Not a single one of those people--and I am prohibited on the floor from calling them phonies--not a single one of those people voted ``no''--or voted ``yes'' to eliminate Medicare. Oh, no, no, no, we love Medicare. You like Medicare if you are 65 but not if you are 64?

Not if you're 60, not if you're 45. Why? What's the intellectually honest explanation of that? If you believe the program that you're going to fight and defend--you should have it when you're 65--what's magical about that?

When my dad retired at 60, he wasn't eligible to get Medicare, and he went to the private insurance market. They said, Fine. For $15,000 a year, a retired guy, why not give that guy Medicare? And then maybe in a couple of years we give younger guys Medicare. And we get down to the twenties, where you are, we give you Medicare.

The point is, we know what works. You want simple? We got simple. Medicare for all Americans. You want inexpensive, you want low overhead? We got that. Medicare for all Americans. You want something that every doctor accepts? Medicare for all Americans. You want complete, 100 percent choice of what doctor you go to? Medicare for all Americans.

Now, one thing it doesn't do. It doesn't skim off 20 percent for profits. You won't see TV commercials with people sitting in rocking chairs saying, Boy, I'm glad I got Medicare. No, they're going to put that money into health care.

Does it need some fixing? Yeah. We do some dumb things. We'll put $900 for someone to be in a hospital bed. We won't pay $50 to put up a handrail when one-third of all seniors get into a hospital emergency room because of slips and falls. We do some dumb things, and we need to fix it.

But I've got to tell you something. As a Member of Congress representing 650,00, 660,000 people in Brooklyn and Queens in New York City, in God's country, I would much rather fight with CMS, fight with the Federal bureaucracy which, by the way, I get far fewer complaints about them than I do about private insurance companies, than having to hope that I get a good response from my insurance company.

So that's basically the philosophy behind the single-payer thing. I have to take exception to one thing the President said in his speech. He said, Some people in this Chamber want a single-payer system like they have in Canada. No. I want a single-payer system like we have in the United States of America. I want a single-payer plan that my father has. I want a single-payer plan that my mother has.

I want a single-payer plan that took my grandparents, whose generation had a 30 percent poverty rate before Medicare, and is now at 8 percent. That's the American single-payer.

So don't let people distract you by, Oh, it's Europe; it's socialism; it's Canada. It's the United States of America. We know how to do health care in the United States, and it's called Medicare. The Democrats created it. The Republicans now embrace it. It's got bipartisan support. Let's expand it.

I appreciate it. Let me just yield on this point. First of all, I appreciate it. I'm not a member of the Progressive Caucus. The final stage of the application, as you know, is the talent competition, and I was never able to make it through that last threshold.

But the fact that you, in hour-long blocks, have real thoughtful conversation--this present company excluded--but real thoughtful conversations about this issue that explore the actual facts and the underpinning is exactly why this has been, I believe, a proud moment in our American civic life.

You put aside the people yelling, call people names, put that aside for a moment. This is something all Americans see through the lens of their own experience. They feel very compassionate about it.

So I ask all of the people watching today and all of the people here observing this debate, ask someone about their experience with Medicare and you'll see it's a pretty good ambassador for a government program that works pretty well that we should try to expand to more Americans.

I thank you for your kindness.

Mr. ELLISON. I do thank the gentleman. This will be the conclusion of our Progressive message tonight. The Progressive Caucus, appearing with ANTHONY WEINER, who did such a fine job, we will be back next week, everybody.

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