Madam President, can I ask the Senator to change the unanimous consent request to add myself after Senator Dorgan. Mr. President, I rise to speak on the SCHIP bill. I have an amendment to the SCHIP bill, but I do not intend to call it up…
Madam President, can I ask the Senator to change the unanimous consent request to add myself after Senator Dorgan.
Mr. President, I rise to speak on the SCHIP bill. I have an amendment to the SCHIP bill, but I do not intend to call it up at this time. I wish to speak on SCHIP, as well as on my amendment.
I also take this opportunity to ask unanimous consent to add Senator Dole as a cosponsor to the amendment.
Mr. President, I think it is safe to say that health care is probably one of the most important things this body can debate. I think you have to look at our overall health care system today to understand why it is so important. It is because we have the best health care delivery system in the world, bar none.
We have seen other countries try to develop a system that fit within a budget framework that, over time, as the dollars got tight, constricted the level of care delivered, creating waiting lines for individuals who had certain health conditions. But the United States has always been considered the innovative health care delivery system of the world. It was accessible for most, regardless of region. I think it is safe to say for a long period of time it was very affordable. But that has all changed.
The U.S. system still provides a level of security if, in fact, you are insured. If you are not insured, I am not sure the sense of security--just knowing there is a hospital or doctors--necessarily provides you with a tremendous amount of security.
With every day that continues on, the level of choice that exists within the United States health care system begins to get less and less. Most of us have been here for the debates of the creation of HMOs and PPOs, and all the products that employers, insurers, and individuals desperately try to create to address this rising cost of health care, while maintaining some degree of benefit for the individual and for their family. But over time, we have continued to see changes to those products, to where there is very little difference between the products now except for what we call them. Clearly, that has eliminated many of the choices.
What has happened to the U.S. system, over a very slow period of time, maybe the last two decades? Over 50 percent of the American people are now on a Government health care plan. It is no longer private-sector driven. We are here with this big question mark about why market conditions do not affect the cost of health care or the cost of premiums or that they do not create choice. In fact, over half of the American people are now in a Government-run system, one that mirrors more what others in the country have tried, only to find out that unless you have an unlimited pool of money, they do not work.
Well, what do Government systems eventually create? They create a system that has less doctors, less nurses, less hospitals, which means less care for those in the country.
I know the ranking member represents a State that is considered to be rural. North Carolina is a State considered to be rural. If you have a contraction of doctors, if you have a contraction of specialists, if you have less nurses in the pool, it means there is not enough to go around all the facilities. There are many regional areas of my State today where we cannot find OB/GYNs to deliver babies.
Now, sure, I can look at a pregnant woman and say: Within a 30 or 45- mile radius, you will be able to get delivery care. But try to explain to a mother, when her water breaks and she goes into labor, that the person who is going to deliver that baby is 45 miles away. In fact, the prenatal care, for that individual who needs it, is now 45 miles away because that is where her OB/GYN is, and we are not going to be able to get the level of prenatal care in rural America that we want.
What has the Government controlling more of health care produced? Less choices, fewer providers, and less services, and especially for those limited amounts of services that are preventive.
Let me state from the beginning of this debate, I am for reauthorizing the SCHIP bill. I will support the substitute that Senator McConnell will offer which provides $38.9 billion over 5 years, which is an increase of $13.9 billion.
I also was in the House, on the Energy and Commerce Committee, in 1997, when we enacted the first SCHIP bill, which was a $40 billion Federal commitment over 10 years to those children at 200 percent of poverty or less. Many States expanded that SCHIP program to cover parents of SCHIP kids and childless adults.
The McConnell reauthorization protects the original SCHIP program by making sure that low-income children are the focus of our effort.
Now, I will say, North Carolina has one of the best SCHIP programs in the United States. I am pleased that Senator McConnell's reauthorization will give North Carolina the additional funds it needs to continue serving low-income children. But I am, sadly, here today to tell you I am not for expanding the rolls of SCHIP. The Finance Committee bill adds more than $30 billion to the current SCHIP base budget--$25 billion--to, roughly, cover 3.3 million additional children.
Now, CBO scored what the State and Federal Government spending will be per child. Let me put that up for everybody: $3,930 per child. Yet, today, the average private health care plan in the private sector is $1,130. My question is, if we are going to spend $3,900 per child in a Government plan, but we can insure them fully in the private sector today for $1,130, where is the choice? As a colleague of ours in the House used to say: Beam me up, Scotty. Something is wrong here. This seems like a no-brainer. This is not an investment that one can make on the part of American taxpayers and feel good about.
In 1997, we spent $40 billion. It was an honorable goal. Quite frankly, the program has been very popular. The Baucus reauthorization plan, though, would spend $60 billion over the next 5 years.
Now, people will talk about budget gimmicks. I am not here to talk about that. I think they are here. I think it hides millions of dollars that I think are extra spending--and maybe they are going to insure this 3.3 million, and $3,900 per child is incorrect, or maybe there are more people who are going to be covered, and many of them outside of the ranks of low-income children--but there is no question the Baucus- Grassley bill expands SCHIP so much that I feel children who need it the most will get lost in a new, larger Government-run program.
As a matter of fact, if SCHIP works as well as I think it does, why would we change it? I think some would tell us we are not here changing the SCHIP program. But I would only point to section 606 of the Grassley-Baucus bill, where they remove the word ``State'' from the name of SCHIP. See, SCHIP is the State Children's Health Insurance Program. It was always designed as us being an enhanced share for the States, and the States running the program. Now, SCHIP is going to be called the Children's Health Insurance Program. It sounds like a big, one-size-fits-all Government program to me.
The solution to our health care crisis is not to put every child in America in a Government program. Today, one out of every two children in America is in a Government program. They are either enrolled in Medicaid or SCHIP.
The Baucus plan puts more children into Government health care. A recent CBO analysis concluded that for every 1 million additional children covered under SCHIP, an estimated 250,000 to 500,000 will be switched from private insurance to the new public SCHIP coverage.
Now, let me say that again. CBO estimates--this is not me--CBO estimates that for every 1 million new kids we put into SCHIP, somewhere between 250,000 to 500,000 will switch from their parents' insurance to the new Government plan.
Now, that is 3.3 million kids, which means 1.65 million could be switched from private insurance to Government insurance, at 3,900 and some dollars, estimated by CBO. Again, where is the sanity and the obligation and fiduciary responsibility we have to the taxpayers? Why in the world would we create an avenue for people to go off their family's plan and come on a Government plan, where we are committed, as CBO said, to spend $3,900, roughly, per child?
Now, before people think we are all insane--they know I am now--what
should we be discussing? I believe we should be discussing how do we reform the health care system? I do not think I would find much opposition except on how we do that because there are 45 million uninsured Americans today. If they are sitting at home listening to this debate about covering 3 million low-income children, or wherever they are on the income scale, for a person sitting at home, who is an adult today, they are saying: What about me? What about the fact that I do not have insurance?
If they have no job, and they have no income, we know they are on Medicaid. If they have a job, and they do not qualify financially for Medicaid, then where do they go? Well, there are 45 million of them out there somewhere who are in this classification. Some of them are kids and some of them are adults. Every time they access health care, and they cannot pay for it, an incredibly predictable thing happens: The cost that is unrecovered is shifted to everybody else in the system.
In North Carolina, there are 1.3 million who are uninsured. Seventeen percent of the North Carolina population is uninsured, and 16 percent of the American population is uninsured. Yet our debate is limited to 3.3 million children.
It is not about how we insure America. It is not about the rising cost of health care. It is not about the fact that health care premiums have, in fact, doubled in the country since the year 2000. If compared with the growth of inflation since 2000--at 18 percent--and the growth of wages--at 20 percent--health insurance premiums for family coverage have increased 73 percent over the last 5 years. Health care costs are rising three times the rate of inflation, and with no corresponding rise in quality.
Now, there is the red flag. We have seen a 73-percent increase in the premium. If you could turn to something tangible in the system to say that quality has gotten that much better, then one could maybe rationalize this increase. But the fact is, there has been no corresponding rise in quality. As a matter of fact, today there are no health care plans that are focused primarily on wellness and prevention.
I remember when we tried to get mammographies and PSAs covered in Medicare, and we tried to get an array of preventive health care, it was the hardest thing I have ever worked on in health care to try to get added to a system. I guess it is because Medicare beneficiaries are old to start with, and why would we do anything preventive. Yet if we look at the research that goes on every day, and that we pay for, we find the earlier we can detect cancer, the earlier we can detect diabetes, the more we can monitor disease management, the better the outcome is but, more importantly, from a taxpayer's standpoint, the less it costs the system.
We know that happens in the Government system. We don't implement wellness and prevention like we should. If we did, we would require it in Medicaid. But we have an opportunity--as we talk about redesigning the American health care system, we have an opportunity to build wellness and prevention as the main piece of this broken system.
Today we have a system that only triggers when you get sick. It doesn't trigger when you want to stay well. It triggers when you get sick. But if you look at companies that have said: There is no way I will ever be competitive if, in fact, the health care system doesn't change in America--they made a decision that they are going to go outside of the insurance products that are available today, and they are going to do things that are creative out of the box. And they are self-insured and they have gone out and partnered with somebody to administer their plan. What do you find? It is Dell Computers, which now has about 4 years of experience with disease management and how to bring down the overall costs of health care for their employees--not just corporately but for their individual costs to their employees--all the way to Safeway, that has a model that I know every Member on the Hill has probably been briefed on--what Safeway is doing, which is giving people control of their care but, more importantly, stressing to them that prevention and wellness is something for which they will actually receive an incentive.
People without access to employer-sponsored coverage are severely disadvantaged under the current system. I know both of the Senators who are in charge of the tax committee probably would agree that we have inequities. Ninety-one percent of workers in large firms have health insurance. Sixty-six percent of workers in small firms--10 employees or less--have health insurance. Twenty-nine percent of the uninsured work in small business. The percentage of employers offering coverage has dropped 8 percent since the year 2000.
Whoa. Global economy. That is what has happened since 2000. There is a global economy where it doesn't matter where you manufacture. All that matters is where are your customers. Most U.S. businesses have changed from a model that was predominantly for domestic consumption to a model today where 60 or 70 percent of their business is international, and 30 or 40 percent of it is domestic--in the United States. We ought to look at some of the decisions they have made and wonder: why didn't we have this challenge before this point with those employers, looking at their business model and saying: How can I continue to pay a health care cost that rises in double-digit ways each year with inflation and remain competitive with my global competition which doesn't have that cost?
Well, I am going to put the Senate on notice: This is happening at an alarming rate. If U.S. businesses determine that they are not competitive in the marketplace they are selling to, which is global, and health care cost is the No. 1 issue that makes them noncompetitive, in the absence of us reforming the system and creating a way for them to provide health care--not that seeks double-digit inflation every year but begins a downward pressure on the cost of health care--I will assure you they have two choices: they eliminate the benefit or they leave the country, and both of them are devastating to the United States.
If we don't reform health care, what happens? Health care becomes unaffordable for people. U.S. businesses become uncompetitive. Government will have its normal reaction. It will ratchet down the reimbursements that we pay through Medicare and Medicaid and the effect of that is that private insurance sees that as an opportunity to ratchet down the provider reimbursements. Doctors and nurses get paid less. More people go on Government health care. Doctors and nurses will become Government employees. Hospitals will become Government property. Insurance companies will become paper pushers. We must all agree that the outcome has to be better for us.
By the way, taxes will rise too. I am not sure whether it is individual or corporate, but let me assure my colleagues, though some believe that health care is free, somebody pays for it. Look at the systems around the world where the government is in control of their health care, and the beneficiaries may think it is free, but one of the problems--one of the reasons they are ratcheting back the scope of coverage they have is the fact that as the government runs out of money and can't find ways to raise revenues, they have a choice. They can tax individuals, they can tax corporations, or they can reduce benefits. When you look at the prevailing tax rate they have now, you understand why their only choice is to cut benefits. The likelihood is that we will be faced with the same thing as socialized medicine is just around the corner, and I think time is actually running out.
The current tax structure for health care benefits exists for employer-focused plans. Employers get a tax deduction for the amount of the health care benefit provided for their employees, but the deduction unfortunately doesn't exist for individuals who shop in the marketplace. We spend 50 percent more of our GDP--16 percent--on health care than the next three spenders--Germany, Japan, and France--but we aren't any healthier. It is time we begin to focus on how our system becomes more efficient, healthier, and more affordable.
One out of every four dollars in health care spent in this country does nothing to help patients. It is actually wasted on defensive medicine, unnecessary paperwork, and outright fraud. When you put individuals in charge of
their health care--not just constructing it or negotiating it, but responsible for whether the system is efficient and effective--you would be amazed at how you wring out that 25 percent, that one out of four. The source of the problem is runaway health care costs which is caused by a lack of choice and a lack of government control.
Now, let me assure you that in Sweden today, heart patients wait 25 weeks to be seen. In England today, Heritage said cancer patients sometimes wait a year between their diagnosis and their chemotherapy treatment. Canada's Supreme Court Justice, Beverly McLachlin, said it best in a 2005 ruling:
Access to a waiting list is not access to health care.
We have a roadmap as to where we are going, and we have an opportunity to change that today.
What happens if the Senate, if the Congress of the United States, becomes the visionary body that it needs to be and the reform body that it has to be if, in fact, you want to protect the delivery system in this country? Americans have to have three things: They have to have choice, they have to have ownership, and they have to have control. They have to have the ability to construct their insurance policies to meet their age, their income, and their health condition. Health care needs to be portable, just like a 401(k).
When you give an individual ownership of a 401(k), they are no longer strapped to an employer about their pension or retirement; they have the ability to take that money with them to the next job. Well, we have reached the point now that health care should be the same thing. It should be ownership, and we should have the ability to take that health care from employer to employer where we are not locked in, and for the first time Americans would have the freedom to make decisions about their future and about the future of their families.
Innovation works. We all know it. A year ago, a 46-inch plasma TV cost as much as $11,000, but today you can buy the same TV for $2,839. In 1908, Henry Ford made a car for $850. Eight years later, Henry Ford produced the same car for $360.
Innovation also works in health care--don't fool yourself. Between 1999 and 2004, the cost of LASIK surgery, which is set by the market forces and outside the current system, went down 20 percent while health care expenditures per person increased by more than 44 percent. LASIK surgery is this new surgery that individuals have on their eyes. If they have a certain condition, they can have LASIK and throw their glasses away. A controversial thing, and innovation brought it. It went through and FDA approved it. The cost was very high to begin with, and as more people have sought LASIK surgery, the price has come down and down and down and down and down. I am sure Dr. Coburn will talk more about it as we go through this debate.
Duke University set up a program to manage congestive heart failure. Half of all of the congestive heart failure patients typically have a 5-year life expectancy, and costs are a total of $22.5 billion for congestive heart failure annually in the United States. Duke developed a program that integrated the care to develop best practice models for congestive heart failure patients. The approach resulted in better patient outcomes, increased patient compliance with their doctor's recommendations and, most importantly, a 32-percent drop in the cost per patient of treating congestive heart failure. Innovation allows incredible things to happen but only when we have a marketplace that rewards innovation.
I said when I stood up I had an amendment that I didn't intend to call up, and I am not going to call it up. That amendment is the Every American Insured Health Act. I want to just briefly talk about it.
Hopefully, this accomplishes everything I have spent the last 20 minutes talking about. It provides the resources for every American not on a government plan to access the coverage they need. Let me say that again. It provides the resources for all the uninsured in America to negotiate the coverage they need in the private marketplace.
No. 2, it eliminates cost shifting. It eliminates that bill we get through our premium costs or through the cost of a service delivered that we can't figure out who used it, but somebody didn't pay because they weren't insured and it got shifted to everybody else. We eliminate that by providing the resources for every American to negotiate coverage. We estimate that it may be $200 billion a year that we eliminate in cost shifting.
Now, how do we accomplish it? Because one might say: I know how expensive SCHIP expansion for 3.3 million children is going to be. Can we afford what it is going to cost us to insure everybody who is uninsured in America? Well, here is what we do. We address the tax inequity. Through that we treat those who get insurance provided by an employer the same way we do individuals. Then we turn around to every American who is not on a government plan and we do this: We give them a refundable, advanced, flat tax credit. For an individual, it is $2,160 a year. If it is a family, it is $5,400 a year.
Now, if, in fact, you had tax consequences from this new equality in treating individuals and employer plans the same, the likelihood is that if your health benefit from your employer doesn't exceed $15,000 from the employer on a family plan, then $5,400 is more than enough to cover the tax consequences.
If, in fact, you are an individual who is uninsured and you get a refundable tax credit on an annual basis of $2,160, then you can go out and negotiate in the private sector for health care coverage that on average today is between $1,500 and $1,700 nationally for an individual plan and about $4,500 to $4,600 for a family plan. You could insure yourself as an individual or as a family, and you could do that all within the confines of the refundable tax credit we have allowed.
Now, people have questioned whether there is a little bit of a shift in wealth. Yes, there is. We are taking people who have rich health care plans, more health care than they need, plans that are priced because there are no out-of-pocket costs--there are a lot of things that we know we need to do from the standpoint of making sure Americans know they have skin in the game every time they go to the doctor's office for the facts of utilization--and we are shifting it down to where we give people refundable tax credits that are barely over the Medicaid qualifications, and we are going to give them a soup-to-nuts plan--$2,160 for an individual or $5,400 for a family annually, a refundable tax credit that is only good for health care.
When they sign up with an insurer, the money will go directly from the U.S. Government to the insurer. If money is left over, it would automatically transfer over into a health savings account for that individual to use for other health care benefits, whether it be for copayments, deductibles, whatever the structure of the plan is, and they are allowed to design a plan that meets their age, their income, and their health conditions.
We give States incentives to make sure that in every marketplace there is an affordable plan. It is absolutely crucial that you begin to have insurance reform at the same time you are creating a marketplace that is driven by individuals.
Our goals are to give Americans the resources and the right to purchase health care in the private marketplace, to end the tax discrimination, to encourage individuals to take control, to eliminate the current cost shift, so that every American's health care begins to come down because of this new benefit, and to ensure the accessibility and affordability of high-quality health care.
By the way, this plan I have just described that did this for the first time--insured everybody who is uninsured, provided annually a $2,160 refundable tax credit for individuals and $5,400 for a family--I still didn't tell you how much it costs. I am like the guy on the infomercials who waits until the end to spring on you how great of a bargain it is.
Well, this is budget neutral. It doesn't cost the American taxpayer one new dollar. That doesn't take into account that there may be $200 billion worth of cost-shifting going on in the system. We get no scoring for the fact that we could potentially drive $200 billion of costs out of the health care for everyone else in the system by making sure everybody is insured. We get absolutely no credit for being able to put
together plans that promote prevention and wellness, that begin to drive down utilization and make Americans healthier, that begin to create data for us so we know exactly what the right reimbursements are for doctors, nurses, hospitals, and community health centers. We pull that out of the sky today, and they complain. And they should because there is no relation to that in reality.
This, by creating a real marketplace, real competition from the insurer all the way through to the service delivered will begin to build the database of information we need to know what reimbursements the marketplace says are fair to the people who provide it. Then they can make a decision. I believe we will find that every doctor, nurse, hospital, and community health center will receive this in a warm way because now they believe that this is a system which will evaluate what they deliver and what cost they are reimbursed for.
Mr. President, I am sure the chairman of the committee and the ranking member would have preferred to have this solely focused on SCHIP tonight. I know that. I think it is also rational to understand that when you are talking about expanding the rolls of Government insurance coverage to 3.3 million kids, somebody ought to stand up and ask: What about the other 45 million Americans? If, in fact, Members find there is value to the reform for the entire system, then why would we put the 3.3 million kids in a program that CBO already told us would cost $3,930 per child, which we can buy in the private marketplace for $1,130 worth of coverage today? Why don't we integrate them into the last system, which is reform our health care system.
Let's bring equity to the tax side and provide every American who is uninsured with the resources they need to go out and negotiate their coverage, whether they are individuals or families. Let's give the health care delivery system the confidence of knowing we are willing to create a market. This is not an unusual thing for us. We did it with Part D Medicare. The chairman of the committee was very instrumental in its passage. Today, 1 year after enactment of Part D Medicare, we created transparency and competition on what was one of the most price- sensitive areas: prescription drugs. What has the net result been? Premiums reduced 28 percent the first year, and drugs were reduced 33 percent. It was because we created competition and transparency. We made people show their prices and made sure there were multiple plans that people could choose from. The net result of that is exactly what we are trying to mirror here, but do it in a way that treats health care in its entirety. You cannot do that without prevention and wellness being the main pieces of it.
I thank the chairman for the fact that he listened. I appreciate that. I plan to be on the floor probably several times this week. I will try to do it when it doesn't interrupt the SCHIP debate. I think it is an important time to begin to educate our Members, to begin to educate America about the need for health care reform and how health care reform can actually enhance the future of the very special delivery system we have in this country.
I yield the floor.