Mr. President, let me begin by taking a moment to kind of summarize for the American people where we are in this enormous discussion which is causing a great deal of anxiety all over Vermont and all over America. Several months ago, the…
Mr. President, let me begin by taking a moment to kind of summarize for the American people where we are in this enormous discussion which is causing a great deal of anxiety all over Vermont and all over America.
Several months ago, the Republican-led House passed by, I believe, three votes legislation that would throw 23 million Americans off of the health insurance they currently have--23 million Americans, men, women, and children, people who are struggling with cancer, heart disease, diabetes, and with other life-threatening illnesses. They would simply be thrown off of the health insurance they have.
That legislation also cut Medicaid by $800 billion over a 10-year period. That means children with disabilities in Alaska or Vermont who are now on Medicaid might no longer be able to get the help they need in order to survive or to live a dignified life. At a time when Medicaid provides two-thirds of the funding for nursing homes all over this country, it means that if the Republican legislation were to succeed, we don't know, but thousands and thousands of people all over this country with Alzheimer's, with terrible illnesses, who are now in nursing homes would be thrown out of their nursing homes.
Where would they go? Nobody really knows. When you cut Medicaid by $800 billion and Medicaid funds two-thirds of nursing home care, needless to say, people in nursing homes would be forced to leave, to go--nobody knows where.
Right now in my State of Vermont and across this country, we are dealing with a massive heroin and opioid crisis. Every day, people are dying from heroin, opioid overdoses. It turns out that Medicaid is the major source of funding in terms of treating heroin and opioid addiction.
If you make massive cuts to Medicaid, the impact in States like Vermont, West Virginia, Kentucky--States that are struggling with opioid and heroin addiction--would be horrendous. People would no longer be able to get the treatment they need.
I recall, during the campaign, Donald Trump said that he was a champion of working families; he was going to stand up for workers, take on the establishment. If the Republican House bill were to be passed, older workers--people who are 60, 62 years of age--would see, in many cases, at least a doubling of the premiums they pay. In many cases, they would go from $4,000 a year today to over $8,000 a year. That is not being a champion or a friend of the working class.
My Republican friends, and you hear them even today, talk about freedom, choice. They love choice. They love freedom. People in America should have the right to get healthcare anyplace they want. It should be a right to have any insurance policy they want.
Two and a half million women have made a choice. The choice they have made is they want to get quality healthcare through Planned Parenthood. If the Republican bill in the House were to pass, those 2.5 million women would be denied their choice.
You have a Republican bill in the House that throws 23 million people off of health insurance. How many of those people will die? My Republican friends get very nervous when I raise that issue because they say--and I understand it--nobody here wants to see anyone die unnecessarily. No Republican does, no Democrat, no American does.
According to study after study, including studies done at the Harvard School of Public Health, when you throw 23 million people off of health insurance--people with cancer, people with heart disease, people with diabetes, people with life-threatening illnesses--what do you think will happen? What these studies show is that thousands and thousands of Americans every year will die unnecessarily because they will not have the treatment they need to deal with their life-threatening illnesses. That is the reality. That is not Bernie Sanders talking. That is study after study. PolitiFact backed that up. They looked at all of the studies. They said: Yes, thousands of people will die. That is the result.
In the House bill, after you throw 23 million people off of health insurance, raise deductibles, defund Planned Parenthood, after you make older people pay more for healthcare, $800 billion in cuts to Medicaid, what else is in the bill?
Oh, there are some people who will do well in the bill--not the children, not the elderly, not the sick, not the poor. But there are some people--and we have to acknowledge that--who would do well under the Republican bill; that is, if you are in the top 1 percent. Congratulations. Republican legislation, after throwing disabled children off of healthcare, congratulations--you are going to get a massive tax break.
Who in America believes that it makes sense to throw disabled children off of health insurance and tell people with cancer that they can't continue to get the treatment they need in order to get $300 billion in tax breaks for the top 1 percent and hundreds of billions more in tax breaks for insurance companies and drug companies?
Do you know what? My Republican colleagues may think that is a good idea. That is not what the American people believe. The latest poll that I saw, the USA Today poll, had 12 percent of the American people thinking that was a good idea. I can only believe those 12 percent had not really looked at this issue. There is massive opposition from Republicans, Democrats, and Independents to this absurd Republican proposal.
It is not just the American people who think that it is absurd to give tax breaks to the rich and throw 23 million Americans off their health insurance. It is not just the American people. It is
those people who are most engaged in healthcare in America--the people who know the most.
It is important to understand that throughout this process, whether in the House or in the Senate, virtually every major healthcare organization in America--the people who treat us every single day are opposed to this Republican legislation.
One might think that maybe my Republican colleagues would say: Well, wait a second. What is going on when those in the American Medical Association--our doctors, the people who treat us--think this legislation is a mistake? Doctors say no. The American Hospital Association says no because they understand that when you make massive cuts to Medicaid, rural hospitals in Vermont and all over this country may go under. Then what happens to a rural community that no longer has its hospital?
The American Hospital Association is opposed to this legislation. The American Cancer Society is opposed to this legislation. They know what its impact will be for folks who are struggling with cancer. The American Heart Association, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Psychiatric Association, the Federation of American Hospitals, the Catholic Health Association, the American Lung Association, the Cystic Fibrosis Foundation, the March of Dimes, the National MS Society, and the American Nurses Association--one might think, when virtually every major national healthcare organization in this country is opposed to legislation, that maybe, just maybe, my Republican colleagues might think twice about going forward.
In this process, they have not had the opportunity, amazingly enough, to hear from doctors, to hear from hospital administrations, to hear from patient advocates. As you well know, despite the fact that we are dealing with an issue that impacts every single American--which is what healthcare does--an issue that impacts one-sixth of the American economy, over $3 trillion a year, there has not been one hearing, one public hearing on this bill. This bill has been written behind closed doors. Senator McCain the other day made that point.
How do you deal with one-sixth of the economy and their desire to transform the American healthcare system without listening to one doctor, without listening to one hospital administration, writing a bill with a few Republican Senators behind closed doors?
This is an unprecedented and disastrous process for healthcare. On those grounds alone, what every Member of this Senate should agree to-- and Senator McCain made this point; this process has been awful. Kill it now. Go back to what is called regular process, regular order. Go back to the committee and start this discussion. Please do not throw 22, 23 million people off of health insurance without hearing from doctors, patient advocates, hospital administrators.
No, that is not where the Republicans are today. They want to rush this through behind closed doors and get a quick vote on it.
Interestingly enough, as I understand it, Senator Daines of Montana today is going to introduce legislation for a Medicare-for-all healthcare system. That is very interesting. I hope this is really a breakthrough on the part of my Republican colleagues. I very much hope they finally recognize that maybe the United States of America should join every other major country on Earth in guaranteeing healthcare to all people as a right and not a privilege.
I hope that when Senator Daines comes down here, he will say: No, it does not make sense to throw 23 million more people off of healthcare, but, in fact, we have to move forward, do what Canada does, what Germany does, what the UK does, what France does, what every major country on Earth does, and guarantee healthcare to all people as a right. I hope very much that is what Senator Daines will be saying.
Do you know what? I kind of think that is not what he will be saying. I kind of think that in the midst of this discussion in which millions of Americans are wondering whether they are going to continue to have healthcare, what is going to happen to their kids, what is going to happen to their parents, I suspect what Senator Daines is doing is nothing more than an old political trick: trying to embarrass Democrats. Will they support the Medicare-for-all bill introduced by Congressman John Conyers?
At a time when we are engaged in a very serious debate about the future of healthcare, I think this is not a time for political games. If Senator Daines is serious about a Medicare-for-all proposal, let's work together, but now is not the time for political games.
Senator Daines, as I understand it, is going to offer an amendment, but we don't know what he is amending because we don't even know what is in the legislation the Republicans will bring forward.
How do you amend something when we don't even have a base bill to amend? This is, I suspect--I hope I am wrong. I hope Senator Daines has seen the light, but I suspect not, and I suspect it is just a political game. I do hope, by the way, at some point within this debate, if we can--if not, certainly in the near future--to, in fact, be introducing a Medicare-for-all single-payer program. It will be somewhat different than my friend John Conyers' bill in the House, but what it will do is say that in America, if you are rich or if you are poor, if you are a man, woman, and child, yes, you are entitled to healthcare as a human right and not a privilege.
As you may or may not know, our current healthcare system is the most expensive, bureaucratic, and wasteful system in the entire world. While the healthcare industry makes hundreds of billions of dollars a year in profits--and in many ways what our healthcare system is about is not providing quality care to all of us but seeing how the insurance companies and the drug companies can rip us off. The truth is, even today, we have some 28 million people who have no health insurance so our goal should be to say to those 28 million: We are going to provide health insurance to you, to all Americans, and not throw 22, 23 million more people off of health insurance.
All of us recognize that the Affordable Care Act is far from perfect. What the American people want us to do--and poll after poll suggests this--is they want us to improve the Affordable Care Act, not destroy it. The American people are paying deductibles that in many instances are far too high, keeping people from going to the doctor when they need to. Today, copayments are much too high; premiums, much too high. I do find it interesting that when Donald Trump campaigned for President, he talked about the high cost of prescription drugs. He is right. In this country--and I am going to get into that in a moment--we pay, by far, the highest prices in the world for prescription drugs. That is what the American people want us to deal with in healthcare legislation, not throw 22 million people off of healthcare. They want us to lower the cost of prescription drugs. I have not heard one word from the Republicans about the need to lower the cost of prescription drugs.
The United States spends far more per capita on healthcare than any major country on Earth. We often have worse outcomes. If we go back to regular order, if we go back to committee process--which is what we should do--the very first question a Member of the Senate should ask is, How does it happen that here in America we spend far more per capita on healthcare than do the people of any other country? Here is the chart. The United States is spending $9,990 per person on healthcare, almost $10,000 per person on healthcare. What do they spend in Germany? Well, they spend $5,300, almost half of what we spend. What about Canada? I live 50 miles away from the Canadian border. It is a really nice country. They spend $4,533. How does it happen that we are spending more than double per person compared to the Canadians and almost double what the Germans do? The French spend less than half of what we do. Australians spend less than half of what we do. The Japanese spend less than half. The UK spends about 40 percent less.
Don't you think the very first question a Member of the Senate might ask is, Why do we spend so much compared to other countries? By the way, all of these other countries guarantee healthcare to all of their people. In many instances, the outcomes, the
health outcomes in those countries, are better than our country. They live longer. The life expectancy is longer. Their infant mortality rate is lower. In some particular diseases, they do better in treating their people. Here is a simple truth. The truth is, if we took a hard look at countries around the world--all of which have one form or another of national healthcare programs, all of which said healthcare is a right, whether you are rich or you are poor--maybe we might want to learn something, but, no, we have not had one hearing in order to discuss why we spend twice as much per capita on healthcare and why we pay the highest prices in the world for prescription drugs.
You know why we haven't had any hearings on that, fellow Americans? Because it might get the insurance companies a little bit nervous. Insurance companies pour hundreds of millions of dollars in campaign contributions into the political process. The pharmaceutical industry spends a huge amount of money on campaign contributions and lobbying efforts.
I say to my colleagues in the Senate, maybe, just maybe, we might want to stand up for working people and the middle class rather than for the owners of the insurance companies and the pharmaceutical industry.
It is interesting. One never knows what to expect from the President. Every given day there is another adventure out there, but a couple of months ago, the President met with, I believe, the Australian Prime Minister. That was in May. President Trump said during that meeting: Australia has a ``better healthcare'' system than the United States. That is what Donald Trump said. To my Republican friends here who support President Trump, listen to what he said. On this one instance-- he is not right very often--but I will confess on this issue, he is right. In Australia, everyone is guaranteed healthcare as a right. Australia has a universal healthcare program called, ironically, Medicare, that provides all Australians with affordable, accessible, and high-quality healthcare. While the United States has the most expensive, bureaucratic, wasteful, and ineffective healthcare system in the world, Australia, it turns out, has one of the most efficient.
President Trump was right. In 2014, Australia's healthcare system ranked sixth out of 55 countries in efficiency. The United States ranked 44. Not only does Australia guarantee universal healthcare coverage, it spends less than half what we spend on healthcare per capita. In 2015, they spent $4,500 while we spent almost $10,000. While the Australian Government spent 9 percent of its GDP on healthcare, the United States spent nearly double that, 17 percent. Further, many healthcare services are far cheaper in Australia. An MRI costs about $350 in Australia versus $1,100 in the United States. One day in a hospital costs about $1,300 in Australia versus $4,300 in the United States. An appendectomy costs about $5,200 in Australia versus roughly $14,000 in the United States, et cetera.
Not only does Australia guarantee universal healthcare, spend less on healthcare per capita, and pay less than we do for many health services, they have better health outcomes. In 2014, the average life expectancy in Australia was 82.4 years compared to 78.8 years in the United States. They live longer in Australia. For context, according to a 2014 report from the World Health Organization, Australian men have the third longest life expectancy and Australian women have the seventh longest life expectancy in the world. The United States doesn't even crack the top 10 for life expectancy, despite spending so much more than any other country on healthcare.
What all of this comes down to is the fact that America is the wealthiest country in the history of the world. The question we have to ask ourselves--and I hope Senator Daines will address that question as he introduces his Medicare-for-all bill--is how does it happen that in Canada, every man, woman, and child is guaranteed healthcare? The same is true in the UK, in Germany, France, Australia, Japan, and every other major country on Earth. How does it happen that every industrialized country understands that healthcare is a right of all people, because all of us get sick? All of us have accidents, not just the rich. How does every major country on Earth say healthcare is a right except the United States? How is it today we have 28 million without any health insurance--more who have high deductibles and high copayments, who are underinsured--and the response of our Republican friends is to say: Twenty-eight million uninsured? That is not enough. Let's throw another 22 million people off of health insurance.
Our response should be to move forward and guarantee healthcare to all people, not throw another 22 million people off of health insurance. I don't have the time to go into great detail as to why our wasteful and bureaucratic healthcare system ends up spending almost twice as much per capita as systems around the world. That is a subject for a lot of discussion, and I intend to play an active role in that discussion, but let me just give you some examples: because we have such a bureaucratic and complicated system; because hospitals in America have to deal with this person who has a $5,000 deductible, that person who has an $8,000 deductible; this person who has this, that person has that--they have to deal with dozens and dozens of different configurations for insurance. It requires an enormous amount of time, energy, and manpower to deal with those myriad of insurance companies. The result of that is, the United States spends far more on hospital administrative costs than most other countries. These costs accounted for one-quarter of total U.S. hospital spending from 2010 to 2011, more than $200 billion--over twice what was spent in Canada and in Scotland.
What I would hope--if we don't sit around just worrying about the profits of the insurance companies--what I would hope is, all of us would agree that when we spend a dollar on healthcare, we want that dollar to go to doctors, to nurses, to medicine. We want that dollar to go to the provision of healthcare, not to advertising, not to profiteering, not to dividends, not to outlandish CEO insurance company salaries but to the actual provision of healthcare which keeps us well. Yet we do that worse than any other major country on Earth.
The large health insurance and drug companies are making hundreds of billions of dollars in profits every single year, and they are rewarding their executives with outrageous compensation packages. Once again, the function of healthcare, in my mind, is to provide quality care to all in a cost-effective way, not to make CEOs of insurance companies and drug companies even richer than they are today.
In 2015, the top 58 health insurance companies made $24 billion in profits. Should the function of healthcare in America be to allow insurance companies to make huge profits or should we make sure all of our people get quality healthcare? Not only do the insurance companies make huge profits, but their CEOs make outlandish salaries, while 28 million Americans have no health insurance at all, and others have very high deductibles. In 2015, Aetna's CEO made $17.2 million in compensation. Now, Aetna, like every other insurance company, spends half their life trying to tell people they are not covered for what they thought they were covered, but they do manage to find $17 million in salary compensation for their CEO. CIGNA's CEO made $17.3 million in compensation. UnitedHealth Group's CEO made $14.5 million in compensation. Anthem/Wellpoint's CEO made $13.6 million. Humana's CEO made $10.3 million. Is the function of healthcare in America to make CEOs of insurance companies outlandishly wealthy, or is it to provide healthcare to all people?
It is not just the insurance companies. If you ask people in my State of Vermont what their major concern is--and I think they would say the same in Iowa and probably any State in America--they would say: I am sick and tired of being ripped off by the drug companies. I go into my pharmacy, have a medicine I have been using for 10 years, and suddenly the price has doubled, tripled, for no particular reason other than the pharmaceutical industry could get away with it.
We are the only major country on Earth not to control the prices of the pharmaceutical industry. The result is--and this is an outrage, and it speaks to everything that should be discussed but which is not being discussed in the Republican bill--is that
today, one out of five patients under the age of 65 who gets a prescription from their doctor is unable to afford that prescription. How crazy is that? What kind of dysfunctional healthcare system allows somebody to go to a doctor because they are sick, the doctor writes a prescription, and one out of five Americans can't even afford to fill that prescription. What happens to that person? Well, the likelihood is they get even sicker, and then they end up in the emergency room at outrageous costs or, maybe even worse, they end up in the hospital. How crazy is that?
I have not heard one word--not one word--from our Republicans about addressing the absurdity of Americans paying by far the highest prices in the world for prescription drugs. I have a chart over here that just deals with half a dozen drugs, but we can list many, many more.
Lantus, a diabetes drug, costs $186 in the United States. Diabetes is a very serious problem. Lantus costs $186 in the United States and $47 in France. It is the same drug.
This is a healthcare reform debate. I have yet to hear one Republican raise that issue, but I think the people in Iowa and the people in Vermont want us to raise that issue.
Crestor, a popular drug for high cholesterol, costs $86 in the United States and $29 in Japan.
Advair, which is used to treat asthma--another very serious problem-- costs $155 in our country and $38 in Germany.
The list goes on and on and on. That is why millions of people, by the way, are now buying their medicine in Canada and other countries, because they are sick and tired of being ripped off by the pharmaceutical industry--an industry that spends billions of dollars over a period of time on lobbyists here and campaign contributions.
You might think--just might--that when we deal with healthcare reform, one Republican--just one--might stand up and say: Well, you know, maybe we might want to stand with the elderly and the sick in this country and not just with the pharmaceutical industry. I have not heard one Republican in this debate talk about that issue.
To give an example of the greed of the pharmaceutical industry--and I can go on and on. They are the greediest, maybe with the exception of Wall Street. It is hard to determine which one of these institutions is more greedy, but the pharmaceutical industry certainly can make a claim for being the greediest industry in this country. Out in California a few months ago, there was an effort to lower the cost of prescription drugs in their State. It is called proposition 61. The big drug companies spent $131 million to defeat that ballot initiative--$131 million to defeat a ballot initiative in California that would have lowered the cost of prescription drugs. And all over this country, the American people cannot afford the medicine they need, but the drug companies had $131 million to spend just on one initiative.
Meanwhile, while the American people are getting sicker and sicker and sometimes dying because they cannot afford the medications they need, I have received--and I think every Member of the Senate has received--communications from oncologists, people who are dealing with patients who have cancer, who are saying: My patients cannot afford the high cost of cancer medicine. And it is not just cancer, of course.
While the American people are getting ripped off by the drug companies, in 2015 the five largest drug companies in America made over $50 billion in profits--five companies, $50 billion in profits. Yet one-fifth of the American people cannot afford to buy the prescriptions they need. How outrageous is that? And my Republican colleagues are telling us they are dealing with healthcare reform without mentioning one word about the high cost of prescription drugs. Give me a break. You are dealing with many things, but you are not dealing with healthcare reform.
Again, it is not just the pharmaceutical companies that are making huge profits; we are seeing executives from these large drug companies making outrageous compensation. In fact, in 2015, the top 10 pharmaceutical industry CEOs made $327 million in total compensation. Elderly people walking to the drugstore can't afford the prescription drugs they need, and yet CEOs of major drug companies are making $327 million in total compensation.
Former CEO of Gilead, John Martin, became a billionaire because his drug company charged $1,000 a pill for Sovaldi, a hepatitis C drug that costs $1 to manufacture and can be bought in India today for just $4. In this country, it sold for $1,000 a pill, and he became a billionaire as a result of it. That is a healthcare system out of control.
I know it is a radical idea here in the Senate, but maybe--just maybe--we might want to represent the American people and not the CEOs of the drug companies and the insurance companies.
Some of my Republican colleagues have been spending the last few days using words like ``freedom,'' ``choice,'' and ``opportunity'' to try to convince the American people about their abysmal healthcare legislation. This is the same language that rightwing ideologues, like the billionaire Koch brothers, use when they try to discredit government programs and move to privatize them. What the Koch brothers mean by ``freedom'' is their own freedom. And by the way, they are the second wealthiest family in America, worth some $80 billion. What they mean by ``freedom'' is their own freedom to profit off the misery of ordinary Americans who rely on a wide variety of government programs that make life bearable and, in some cases, even possible.
I want to say a word about freedom. This is a 203-foot yacht. This is a yacht owned by a billionaire that costs about $90 million to purchase. Like everybody else, I think, in this Chamber, I think the American people--every American should have the freedom to purchase this $90 million yacht, and I would urge all Americans to go on the internet, find out where the yacht stores are--wherever they sell yachts--and go out there and say: Hey, I got the freedom to buy this $90 million yacht. We all believe in that. You got the money; you buy it.
Here is a picture of a home, and this home is worth tens and tens of millions of dollars. It looks to me like it has 30 or 40 or 50 rooms, probably 5, 10 bathrooms. It is a very nice house, and it is owned by a billionaire.
You know, I think every American who wants to own a home worth tens and tens of millions of dollars, go to your local Realtor. You go out and you buy that home.
What we are talking about today in terms of freedom is not freedom to buy a yacht or freedom to buy a mansion; we are talking about the freedom to stay alive, the freedom to be able to go to the doctor when you are sick, the freedom not to go bankrupt if you end up in the hospital with a serious disease.
So when my Republican friends talk about freedom of choice, fine, we all agree: You got the money, you go out and buy any big house you want or buy any big yacht you want. But where there is a serious disagreement is, we say that the children of this country who have serious illnesses have the freedom to stay alive even if their parents do not have a lot of money; that older people who are now in nursing homes should have the freedom to get dignified care in a nursing home even if they have Alzheimer's and even if they don't have a lot of money. Healthcare is not another commodity. Healthcare is not a mansion. Healthcare is not a yacht. Healthcare is whether we stay alive or whether we don't, whether we ease our suffering or whether we don't. And I believe--unlike, unfortunately, many of my Republicans--that right to get healthcare when you need it is something every American should be able to get.
Here in the Senate, we have good health insurance. Over the last 10 years, a number of Senators have had serious illnesses, and they have gotten some of the best care in the world. If it is good for the Senate, it is good for every American. Healthcare must be a right of all people, not a privilege. Quality care must be available to all, not just the wealthy.
Senator Daines is going to come down here in a while to offer a Medicare-for-all proposal. Again, I hope this is a breakthrough. I hope our Republican colleagues understand that we have to join the rest of the industrialized world. And if Senator Daines comes down here and is prepared to
vote for that legislation, prepared to get his other Republican Senators prepared to vote for that legislation, my God, we can win this vote overwhelmingly and move this country in a very different direction.
But I have a feeling that is not what Senator Daines has in mind. I think this is another joke, another game, another sham as part of a horrendous overall process. So I will not be supporting that amendment, unless Senator Daines and Republicans vote for it as well. But this I will do: Whether in this debate--and I hope I have the opportunity--or in the very near future, I will offer a Medicare-for-all, single-payer program which finally has the United States doing what every other major country on Earth does--guarantee healthcare to every man, woman, and child in a cost-effective way. And when we do that and when we eliminate the need for families to spend $15 or $20,000 a year for health insurance, we will save the average middle-class family substantial sums of money.
I yield the floor.