Statement: Floor Remarks of U.S. Senator Ron Wyden
on Health Care
January 4, 2005
Mr. WYDEN. Mr. President, before he leaves the Chamber, I commend
the majority leader for his interest in health care, in particular.
I have always thought it is far away the most important issue at
home. I have come to the Senate to talk about some of the opportunities
in this session to work in a bipartisan way on these critical issues.
In fact, I was going to mention that the Senator and I have pursued
legislation to tackle the problem of child obesity. I appreciate
the majority leader=s interest in health care and look forward to
working with him in this session.
Mr. President, colleagues, I have believed health care is the most
important issue at home since my days as director of the Oregon
Gray Panthers. I have thought health care was the most important
issue because, in a sense, if our folks do not have their health,
it is not possible to work, to learn, to raise children, or do much
of anything the American people value.
For me, this is the big priority at home. When we look at what
is happening today with medical costs gobbling up everything in
sight, the demographic revolution with so many more older people,
the tremendous lifesaving technologies we have today which, of course,
carry a big price tag, all of these forces come together to present
an issue that just cannot be ducked any longer. To put it in perspective,
David Walker, the Comptroller General of the Government Accountability
Office, put it pretty well, saying that the Medicare problem is
about seven times greater than the Social Security problem and it
has gotten much worse. It is much bigger. It is more immediate.
It is going to be much more difficult to effectively address.
That is the view of the Comptroller General. He is talking about
Medicare. But in my view, the concerns that David Walker talks about
with respect to Medicare extend to the health care system as a whole.
This afternoon for a few minutes I will chart a course as it relates
to health care: first, a number of steps that could be taken right
now that would significantly help the American people as we deal
with this health care challenge.
Then I will discuss, for the longer term, another bipartisan effort
I have had a chance to team up with Senator Hatch on that will be
implemented over the next few weeks.
But if I might, I would like to start with Medicare. I think Senator
Frist is right; these Medicare costs are soaring. For the prescription
drug legislation alone, it is clear now the price tag will be in
the vicinity of $100 billion more than Congress originally calculated.
That is the current estimate. Many have said it will be much greater.
I think it is critically important that steps be taken to contain
costs, particularly as relates to this fast-growing area that we
will be faced with, that is prescription drugs.
We all hear about it from our constituents. Every time we are home,
folks tell us about how skyrocketing prescription drug costs are
such a hardship on them. They want to know what Congress is going
to do to respond to it.
One of the things I think has been so exacerbating about this
issue of cost containment as it relates to prescription drugs is
that the Medicare program is not even employing the kind of cost
containment tools you see in the private sector. If you are talking,
for example, about a big timber company, the Presiding Officer (the
Senator from Idaho) and I know big timber firms and other natural
resources firms use their bargaining power in order to try to hold
down the cost of medicine and other essentials. The Medicare program
is not doing that. The Medicare program is not using the kind of
bargaining power that exists in the private sector today.
In fact, if you are an older person, and you go off and purchase
your medicine, either now or even in the future, under many of the
plans that will be offered under the new program, you have no bargaining
power, and in effect you are subsidizing those big private-sector
buyers, whether they are steel firms, timber firms, auto companies,
or various other kinds of concerns. I do not think that is right.
(Mr. TALENT assumed the chair.)
Mr. WYDEN. I am very pleased I have had a chance over the last
few years to team up with Senator Snowe of Maine on a bipartisan
effort to contain those prescription drug costs, using essentially
the model of more bargaining power the way private sector firms
have.
Part of the Medicare prescription drug bill that I think is very
unfortunate is a statutory ban on Medicare using its bargaining
power to hold down the cost of medicine the way big private-sector
buyers would use their bargaining power. So Senator Snowe and I
would like to change that. We would like to lift that bargaining
power restriction so Medicare would be in a position to use marketplace
forces to hold down the cost of prescription drugs.
A few weeks ago, we got a big boost for our bipartisan legislation
when the outgoing Secretary of Health and Human Services, Secretary
Tommy Thompson, said he wished he had had the power the bipartisan
Snowe-Wyden legislation would provide. Secretary Thompson gave a
press conference, I believe on the day he announced his resignation,
and specifically said he wished he had had the tools that the bipartisan
legislation the Senator from Maine and I have authored would provide
at the time of his service because he could have made those scarce
Medicare dollars stretch further.
So I think Secretary Thompson gave a pretty ringing bipartisan
endorsement for the legislation Senator Snowe and I will be reintroducing
very shortly. It seems to me to make sure that seniors get the best
value in the marketplace, that taxpayers get their money's worth
under the Medicare program, a program that is, of course, soaring
in costs, we ought to make sure we use the kinds of tools the private
sector uses.
In the bipartisan legislation I have written with Senator Snowe
-- it is called the MEND bill, the Medicare Enhancement for Needed
Drugs legislation -- we would have a chance, in my view, to significantly
rein in these costs using the power of the marketplace. But I bring
this up first by way of saying this is just the beginning of what
I think we could do in this session of Congress.
I want to move now to the issue of catastrophic illness. The Senator
from Missouri and I represent a lot of small businesses. We enjoyed
our service on the Small Business Committee when we were in the
House. I think we and our colleagues all understand if you have
a small business, say a hardware store with six people, and one
or two of them get particularly sick, that essentially blows the
whole health care system for that small hardware store or furniture
shop or what have you. In effect, if one or two of the people get
sick at the small business, the premiums go through the roof for
everybody, and they essentially can go so high that it is not possible
for the firm to offer coverage at all.
I was struck in the campaign by Senator Kerry's proposal because
I thought it was a very innovative way to help those small businesses
rein in their costs. In effect, he was going to use the concept
of reinsurance for very large bills that would be faced by a small
business. If you have the Government picking up the very large bills
for the one or two people at the hardware store in Missouri who
have these illnesses, that can stabilize the rate system for everybody.
I thought the Kerry proposal was a good idea. I come to the floor
to bring it up because I think if you compare the Kerry proposal
to some of the ideas offered by the distinguished majority leader,
Senator Frist, who was just on the floor, in his Healthy Mae proposal,
while different than the Kerry proposal, certainly in a number of
respects both of them are looking at the same core concept, which
is to use this idea of reinsurance to pick up the very large bills
that would be faced by some of our small businesses.
I think when you look at the Kerry proposal, when you look at the
Frist proposal, there is a lot of common ground there to tackle
a health care issue of enormous concern to millions of families.
All across this country we have citizens who face the prospect of
going to bed at night knowing that if the medical bills soar through
the roof, they could lose everything. They could lose their home,
the capacity to educate their kids. They could lose virtually everything.
So I think it is important we enact a catastrophic illness program.
This idea, by the way, has percolated around for decades. Democratic
Presidents have talked about it. Republican Presidents have talked
about it. Senator Kerry has authored an innovative proposal. Senator
Frist has come up with ideas that I happen to think are attractive.
What we ought to be doing as a body is looking for common ground
and the opportunity to work together. As Senator Snowe and I have
done with prescription drug cost containment, I would hope the Senate
could come together for a bipartisan catastrophic illness proposal
that I think would make a very meaningful dent in these huge expenses
we so often face for catastrophic illness.
There are other areas that lend themselves to immediate action
as well. In this regard, I particularly commend the distinguished
senior Senator from New Mexico, Mr. Domenici, and the senior Senator
from Massachusetts, Mr. Kennedy, for their outstanding work on mental
health. We have been working for some time to try to ensure that
there would be mental health parity. Having had my late brother,
Jeff, suffer from schizophrenia, I have watched these families jostled
around in the health care system for years. I know colleagues of
both political parties have as well. There is no reason why we cannot
get a bipartisan mental health parity effort, a Domenici-Kennedy
bill, working with the other body, get that enacted into law, and
get it sent to the President -- again, a chance for immediate action.
Finally, I mentioned briefly the issue of childhood obesity. It
is obvious that we now have literally an epidemic of childhood obesity
problems occurring early on in life that produce other deadly and
costly illnesses such as diabetes and heart disease. Senator Frist
and I, working with a group of health advocates for children and
independent scientists, have put together a bipartisan bill. I hope
we can use that legislation as an opportunity for the Senate to
come together.
Our proposal essentially involves a modest Government role, particularly
at the outset of the program. Then we use a foundation approach
to generate additional funds in the private sector. But at the end
of the day, under that legislation, we would have a grassroots juggernaut
all across the country focused on our schools, on our families,
tackling this issue of childhood obesity. Again, there is no reason
why we could not act immediately.
On these kinds of issues -- and I have outlined four of them now
-- I believe Congress is on the cusp of success. Bipartisan efforts
are underway. Certainly they need some tweaking and some changes,
going through the committee process and the negotiations that are
essential to pass legislation, but for all practical purposes, in
each of these areas -- prescription drug cost containment, a program
to deal with catastrophic illness, mental health parity, and fighting
childhood obesity -- we have legislation that is camera-ready to
tackle these very serious health care concerns. We ought to have
it.
As the Congress moves on these initiatives, we have to also move
to address the health care system of tomorrow. In this regard, Senator
Hatch and I have worked for several years on the Health Care That
Works for All Americans Act. We got it funded finally last year
as part of the appropriations legislation. Now the Government Accountability
Office is moving to set in place the first stage of the legislation,
which would involve naming the 14 individuals who would be part
of the Citizens= Health Care Working Group.
The bipartisan effort Senator Hatch and I have pursued for several
years is built on the proposition that it is time for the country
and the Congress to try something different and to look at this
in a dramatically altered way. This may be of some interest to the
Presiding Officer because essentially Harry Truman, in the 81st
Congress in 1945, tried on the health care issue what Bill Clinton
tried back in 1993 and 1994, and essentially all Presidents have
tried in between the 1940s and the 1990s.
That was to write legislation in Washington, DC. The American people
would find these big Federal health reform bills incomprehensible.
The various powerful interest groups would attack each other. And
essentially nothing would happen. It was essentially driven in the
confines of the beltway in Washington. Literally for more than five
decades in the debate about creating a health care system that works
for everybody, we would essentially have paralysis.
What Senator Hatch and I have sought to do is to try something
different; that is, to essentially start this debate outside the
beltway, to try to involve the American people in the most important
questions, not the various arcane issues about what every single
payroll tax level ought to be, but the big kinds of questions --
I will outline a couple of those in a moment -- and then use that
kind of effort, where citizens could be involved in community meetings,
citizens could weigh in online, citizens could participate in a
variety of ways, to try to build a consensus for the kinds of reforms
that would be needed to create a health care system that works for
everyone.
Under our legislation, after the Citizens= Working Group is named
by Mr. Walker, the head of the Government Accountability Office,
what happens next is the working group essentially would put out
for the American people, in simple, straightforward English, information
-- it could be available online, in booklets, senior centers, other
places where folks gather -- about where the health care dollar
goes today. This year we are going to spend in the vicinity of about
$1.8 trillion on health care. That is what we are spending on health
care, yet it is clear that as far as the country is concerned, there
really is no sense where that $1.8 trillion goes now and what the
alternatives are for perhaps spending it in a different fashion.
That would be the first task of the Citizens= Working Group, to
put out online, in booklets available throughout our communities,
information about where the health care dollar goes today and what
the various options are for where it might be targeted as an alternative
so Americans would have a chance to say: Look, what I am interested
in is this kind of approach. Let's say a health savings account
or the Associated Health Plan concept, the health plan concept the
Senator from Missouri has advocated.
Other citizens might say: I am interested in a single payer kind
of system, perhaps in a small community. They think that is the
approach that makes sense for them. The point is, until you tell
the American people where the health care dollar is going now, it
is hard to have a debate with respect to changes that might be necessary
so the Congress, on a bipartisan basis, could in effect move forward
with legislation that would create a system that works for everybody.
When Senator Hatch and I began this effort, we made a systematic
effort to make it as inclusive as we possibly could. The legislation
early on won the support of the Chamber of Commerce, the AFL-CIO,
and the American Association of Retired Persons -- certainly a coalition
that doesn't agree all the time on health care or other kinds of
issues. We have had many groups endorse the effort since. The reason
they have is they believe it is critical that something new be tried.
What happens under our legislation, after the Citizens= Working
Group has made it possible for folks to see where the $1.8 trillion
we are spending on health care goes now, is that our citizens will
have a chance to participate in open community meetings, online,
and other kinds of sessions so that they would have a chance to
be heard on the second stage of this very different approach with
respect to health care reform.
After our citizens have had a chance to be heard, then the Citizens'
Working Group in effect takes that kind of sentiment they have heard
from all corners of the Nation and tries to synthesize it into a
set of recommendations to the Congress. And under our legislation,
within 60 days after the Citizens' Working Group has provided the
recommendations to the Congress with respect to what the American
people have said, each committee of jurisdiction has to begin hearings
on what has come from the Citizens' Working Group in terms of the
recommendations of the American people.
I want to close by giving a few examples of the kind of areas where
I think we have to have the input of the American people where they
have never been asked. For example, the issue of end-of-life care
is absolutely essential in terms of a new focus for health care
reform. We know that many of our health care dollars are spent in
the last few months of an individual's life. We are told by many
medical experts -- doctors, hospitals, and others -- that in many
of those instances there is nothing they can do that is medically
effective, and there is nothing they can do to enhance the quality
of life for the individual. So the question for the country and
for courageous political leadership is: What should we do with respect
to end-of-life care?
If we are being told by our best doctors and hospitals that they
cannot do anything that is medically effective, cannot do anything
to promote a better quality of life for individuals, do we want
to refocus the health care dollars to make sure, for example, that
there are better hospice programs and better end-of-life care programs
for individuals facing those kinds of health challenges? I personally
think that is where the American people are going to end up. Let's
ask them, for the first time, how they want to deal with these very
difficult social and ethical issues with respect to American health
care. I submit that financial issues with respect to health care
are very difficult, no question about that. I think the social and
ethical issues, with respect to end-of-life care, where much of
the health care dollar gets spent today, are even more challenging,
but we have to act. That is the kind of question that would be posed
by the Citizens' Working Group.
I think other issues are important.
I am particularly interested in the issue of personal responsibility.
I think that has been part of what has been driving the debate with
respect to health savings accounts and other such approaches. I
have been discussing with my constituents in town hall meetings
the idea that if we are to have a system that works for everybody
in terms of affordable quality health care, I am prepared to say
that an individual should, every time they use a medical service,
if they are not destitute, have to make a payment on the spot so
as to ensure that there is a clear requirement of personal responsibility.
Certainly, that will be controversial, but that is the kind of issue
that has to be discussed with respect to health reform.
Finally, I think the question of addressing health care -- and
particularly Senator Hatch and I have tried to do it in a bipartisan
way -- means you have to get beyond the blame game. Sometimes when
you have a discussion about health care, the topic comes up that
Republicans say it is the trial lawyers' fault; nail the trial lawyers
and everything is going to be fine. Then you go meet with Democrats
and Democrats say, yes, we have to have health reform. Go nail the
insurance companies; do that and everything will be fine. I think
-- and Senator Hatch and I have talked about this -- if we are going
to have a health care program that works for all Americans, we are
going to have to get beyond the blame game. You bet changes need
to be made in the insurance sector, because they do skim the cream
and take the healthy people, and they do send sick people to Government
programs that are sicker than they are. There do need to be changes
in those insurance practices. I think we also understand that there
are frivolous cases and abuses in the legal sector, and changes
would be necessary there if we are to have meaningful reform and
a health care program that works for all Americans.
It seems to me this is an issue that we cannot duck because come
2010, 2011, 2012, medical costs will clearly consume just about
everything in sight. I submit that the problems we are seeing today
in terms of small business premium hikes, folks falling between
the cracks -- they are not old enough for Medicare or not poor enough
for Medicaid; our Medicare providers are understandably frustrated
by the reimbursement system B if we keep nibbling at the Medicare
health care system, the problems we are seeing today are going to
seem like small potatoes compared to what happens in 2010, 2011,
and 2012. On New Year=s Day in 2008, this demographic influx, in
effect, of 7 million-plus retirees we will see over the next few
years is going to start to retire. That happens New Year's Day 2008.
So the reason I have come to the floor this afternoon is I wanted
to outline a number of steps -- four, specifically -- that I thought
Congress could tackle in a bipartisan way that would make a meaningful
difference right now: the legislation Senator Snowe and I have authored
in terms of prescription drug cost containment, using marketplace
forces to hold down prescription drug costs; catastrophic illness,
and looking particularly at ideas that Senators Kerry and Frist
have talked about; the question of mental health parity; childhood
obesity. Again, we can build where there is a bipartisan foundation
for congressional action. These are steps we ought to take now.
Then we ought to use the next couple of years -- as Senator Hatch
and I have tried to do in a bipartisan kind of way -- to build a
health care system that works for all Americans. Our legislation
is moving ahead.
The Government Accountability Office is appointing the Citizens'
Health Care Working Group right now. The $3 million appropriated
for the legislation -- and I am grateful to Senators Specter and
Harkin for that particular work -- is going to allow us, in our
Health Care That Works For All Americans Act, to take a very different
approach to break this spiral which dates back to 1945, tried by
Harry Truman in the 81st Congress, and continued literally up through
the time of President Clinton. Making sure the public has the facts
is the first task of the Citizens' Health Care Working Group established
in the legislation I have authored with Senator Hatch. Second is
to make sure the public gets a chance to weigh in. Finally, to ensure
public accountability, the Congress is under a requirement to move
forward with hearings after the Citizens' Working Group has reported.
So I think it is appropriate on this first day of the new session
to zero in on the health care issue. I have been very closely following
the discussions colleagues on both sides of the aisle have made
with respect to the tragedy that has taken place overseas. I am
very pleased to hear that Majority Leader Frist is leading a trip
to the area and will come back with ideas for bipartisan action
on that terrible tragedy. I wanted to talk about what I think is
the most pressing issue at home, the health care challenge, and
particularly to outline bipartisan steps that could be taken now.
I also look forward to working with my colleagues as the legislation
I have authored with Senator Hatch is implemented in the weeks ahead.
I yield the floor.
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