Whitehouse Speaks in Favor of Making Affordable Health Care a Reality for All Americans
November 21, 2009
Madam President, I had the occasion to listen to some of the remarks of our colleagues on the other side of the aisle. It forces the conclusion that the irony department of the Republican Party is working overtime these days.
The criticisms of this bill are over deficit and cost. We are hearing these criticisms about deficit from the party that, when it had control in the Bush years, ran up over $8 trillion in our national debt--$8 trillion, the biggest spendthrifts in history, an orgy of fair-weather debt. They didn't have any hesitation about deficits then. On the wars in Iraq and Afghanistan, we have never heard any interest in having those paid for on a current basis. Borrowing for wars is completely satisfactory to them, it appears. When they had the chance to amend Medicare, they added Part D, and they ran up the cost immensely by providing a special protection for the pharmaceutical industry so that it can dictate prices to the Federal Government. The Federal Government can't negotiate with the pharmaceutical industry for Part D pharmaceuticals. That costs the Federal Government a fortune. Do they mind? No. They spend on deficits over and over. Now, when at last we take on the insurance industry, suddenly they discover a concern about deficits. Well, I would urge that based on that trajectory, these remarks have a lot less to do with the deficit than they do with protecting the insurance industry.
There is another clue of this as well, and that is the concern about cost. We all, indeed, are concerned about cost. But I think the best thing we could do about cost in health care is to pass a public option. Why do I say that? I say that because the Director of the Congressional Budget Office has said that changes in government policy which we adhere to in this bill have the potential to yield large reductions in both national health expenditures and Federal health care spending without harming health. It is not just a possibility. He goes on to say: Many experts agree on the general direction in which the government must go to get those cost savings. But they conclude they can't put a specific score on them yet for the following reason: The specific changes that might ultimately prove most important cannot be foreseen today and could be developed only over time through experimentation and learning.
Now, who is going to develop those changes that will save costs while improving the quality of our health care system over time through experimentation and learning? The public options. There will be public options, if the original health plan is followed, in all 50 States. Each would have to stay within its State on balance, solvent, could not go to the Federal Treasury to make up losses. So they have to look for reform in order to continue to succeed. They would be 50 engines of reform, of experimentation, and of learning.
Who is against the public options? The insurance industry, because they don't want the competition. They love an environment in which they are immune from the antitrust laws--almost uniquely in American business--and in which they have incredible market share. In many cases, there are only two dominant insurers in the entire market around this country. So they love having these huge market shares to be able to dictate price, to be immune from the antitrust laws, and they don't want the competition.
Guess who else is against the public options. Our Republican friends. It is very hard to find any daylight between the position of the insurance industry and the position of our Republican friends.
The problem with this is that it is not just about numbers and it is not just about statistics; it is about people. It is about people by the hundreds of thousands, but it makes their stories better when you actually come down to cases. So let me mention a few cases.
I talked a few weeks ago about one of my very dearest family members who fell victim to the system when his insurance company tried to deny him the indicated treatment prescribed by a world-class physician from the National Institutes of Health on the grounds that it was so-called ``not the indicated treatment.'' This was an individual who had received a devastating diagnosis. He had gone to the top expert for that diagnosis in the country at the National Institutes of Health. He had been told what he should do. He had been told, indeed, that was very standard. This was not anything exotic; this was essentially the automatic way you should treat a particular condition. When he filed it with his insurance company, some faceless bureaucrat said: No; we know better than the top expert at the National Institutes of Health. That is not the indicated treatment.
From that, and from thousands and thousands of Americans who have had their claims denied and have had insurers try to intrude between them and their doctor and interfere with the care their doctor thinks they need, we can tell one thing: the insurance companies do this for a bad motivation, which is to save costs. Of all of the stories I have heard, of all of the stories our colleagues have related here on the Senate floor, never once has there been a story of an insurance company that stepped in and said: Oh, wait a minute, that is not the indicated treatment; the indicated treatment is actually more expensive than what your doctor has indicated. Always, it is less expensive. Go figure.
I wish to share another story today about a person who is close to me, a member of my staff. His name is Richard Pezzillo, and he has hemophilia. He has gotten the treatment he has needed so far, but he has been lucky, and it illustrates how luck now enters into our equation in health care.
In 2003, after a very turbulent airplane flight, Rich unfastened his seatbelt from the airplane, collected his things, and suddenly realized things were going badly wrong. He started to feel tremendous pain. He started vomiting blood. Simply wearing his seatbelt in that turbulent aircraft had caused Rich to begin to bleed internally, inside of his stomach, eventually requiring that his gallbladder be removed.
Rich is a kind and thoughtful young man from North Providence, RI. He was hospitalized in very serious condition. He spent nearly 3 weeks in the hospital. Thankfully, he received excellent treatment, and today he works here in my Washington office. The doctors, the nurses, and the hospital staff in Rhode Island gave Rich the best treatment. He now leads an energetic, vigorous life and does well at a challenging job.
But the stunning part about Rich's story is his treatment and his treatment cost--$1.5 million. At least that is what they said. If you look at a copy of the billing sheet, you will see that the insurance company said that his billing, here, for instance, was $366,240.
The insurance company allowed only $106,000. That is what was actually paid, which gives you a sense of how much funny business is going on in the private health insurance industry and in the health care sector, when an insurance company can get away with paying about one-third of the bill's cost.
We have heard a lot of talk about how burdensome it is for Members of Congress to make it through a 2,000-page long health care bill. If you actually reduce its size to the substantive language--and I am elaborating on what the House bill would do, which is about the same as ours--the substantive language is less than a Harry Potter novel. My daughter could read Harry Potter novels when she was 13. I don't think it is asking too much of our colleagues to plow through a bill that represents one-sixth of our economy--when it is the size of a Harry Potter novel. It would be a good idea.
Rather than fighting about the 2,000-page bill, how about Rich's $1.5 million health care bill? The hard truth is, Rich was able to get lifesaving treatment because he was lucky, since he hadn't graduated from college yet and was still covered by his parents' insurance policy. Because he was covered, the hospital only charged his insurer less than half of that--$106,000. What if things had been different? What if he needed treatment a couple of years later when he wasn't on his parents' policy and couldn't afford his own? What if he had applied for his own coverage but was denied by an insurance company because his illness was deemed a preexisting condition? What if Rich's father lost his job and his health insurance along with it or what if Rich's parents' policy had a limit on benefits, and they had to pay the rest of the $1.5 million out of pocket?
Rich would have been a victim not just of his illness but of the health care status quo. If he or his family had been uninsured, they almost certainly would not have been able to afford the full care Rich needed. Their financial future would have been irrevocably altered--probably ruined.
Luck is no way to run a health care system. Unfortunately, Americans need all the luck they can get when dealing with health insurance companies that use every bit of their bureaucratic guile and financial might to delay and deny health insurance benefits they are obligated to provide.
For example, in March 2006, the Arizona Department of Insurance ordered health insurance giant United Healthcare to pay fines of more than $364,000--the largest in the department's history. Regulators found that the company illegally denied more than 63,000 claims by doctors without examining all of the information needed to accept or deny a claim. It looks as if they were just on automatic pilot to deny them.
In January 2008, California insurance regulators found that a subsidiary of United Healthcare had committed more than 130,000 violations of law in handling claims. For example, the company inappropriately denied more than $750,000 in claims on the grounds that insureds had a preexisting condition. The regulators found that the companies ``made large-scale and willful decisions to use broken systems to process claims and respond to providers, while continually and effectively collecting premiums.'' The total potential liability of the company for all violations is $1.3 billion.
Last year, United Healthcare's CEO, Stephen Helmsley, made $3.2 million and holds almost $120 million in stock options.
The health care reform bill we are talking about today would right this massive power imbalance between the health insurance industry and ordinary Americans who are getting rolled over by it. It would empower average Americans to take control of their health and financial future. Rather than taking their health insurance premium dollars to the health insurance ``casino,'' they could take them to the bank.
Unfortunately, many on the other side of the aisle wildly misrepresent both the status quo and how reform would empower consumers. The opponents of reform depict our bill as an Orwellian takeover of the system.
Madam President, let me close with a story that illustrates how ironic and completely wrong these cries of ``death panels'' or ``government interference'' really are.
In 2000, Christiane Hymel--insured by a subsidiary of Blue Cross Blue Shield of Louisiana--scheduled an appointment for a routine physical. During the examination, she reported to her doctor her history of back pain and weakness in her legs over the past year and a half. Her doctor ordered x rays of her spine and referred her to a neurologist.
The neurologist, after detecting troubling symptoms, ordered an MRI. In accordance with her insurance policy, the doctor sent Blue Cross a request to preauthorize the MRI. The day before the MRI was scheduled, Blue Cross denied that request on the basis that the service was for a preexisting condition--Mrs. Hymel's back pain.
Mrs. Hymel appealed the insurance company's decision in accordance with the terms of her policy, but Blue Cross never processed the appeal.
After Blue Cross denied coverage for the MRI, Mr. and Mrs. Hymel were told that the MRI would cost about $4,000. They started saving up for it. It took 3 months to save up the money necessary to pay cash for the procedure, but they eventually did. The MRI showed that Mrs. Hymel had massive tumors involving ``nearly the entire cervical and thoracic [spinal] cord.'' She was immediately scheduled for surgery. Helpfully, Blue Cross stepped in to deny coverage for that as well, stating it was for a preexisting condition.
Mrs. Hymel's neurosurgeon later testified at trial:
Tumors inside the spinal cord are growing tumors, as they grow, they cause damage to vital structures in the spinal cord, which are important to walking, sensation, and breathing.
The longer the wait in removing a tumor, the more damage the tumor will cause to the spinal cord. The doctor testified:
Two-thirds of Mrs. Hymel's current condition and disabilities were the direct result of the growth of the tumor during the 3 to 4-month delay between the time Blue Cross denied the MRI until the time Mrs. Hymel was able to pay for it by herself. Additionally ..... this delay also caused the tumor's quick recurrence, necessitating the second surgery.
In ruling for Mrs. Hymel in her lawsuit against Blue Cross, the court described the consequences for Mrs. Hymel of this 3-month delay the insurance company caused by denying her MRI:
Mrs. Hymel testified that when she first woke up from surgery, she could not move her arms or head and she thought she was paralyzed. She felt painful burning sensations in her body. ..... While she was in the surgical ward, she contemplated committing suicide. During her hospital stay, she suffered from bowel obstruction, fecal impaction, and had to wear diapers. Mrs. Hymel didn't see her children in the hospital until two weeks after the surgery, and when her children finally saw her, they were scared of her and would not touch her. Mrs. Hymel spent approximately eight months in a wheelchair after her surgery.
Mrs. Hymel is house-bound, she cannot take a shower, work in her garden, ride a bike, swim, or drive, as she had frequently enjoyed prior to the surgery. ..... Mrs. Hymel must also take large doses of medication to relieve the burning and shocking sensations from which she suffers. She cannot be touched on her back or leg, because the second something touches her lower back, it's like fireworks that go off.
Every day that insurance companies delay or deny payment is another day they earn interest on your premiums, adding to their profits and adding to the funds that support their massive executive pay packages. When Blue Cross of Louisiana failed to pay for Mrs. Hymel's MRI, it wasn't just making a mistake, it was making a calculated decision--a heartless, profit-maximizing decision. Christiane Hymel's story isn't just a sad tale, it is a symptom of a disease that is spreading through the private health insurance system.
For many Americans like Christiane and Rich, our health care system is a casino, where a roll of the dice or spin of the roulette wheel determines one's fate. Such an irrational and random system doesn't comport with the society that Franklin Roosevelt described in his 1944 State of the Union:
We have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence. Necessitous men are not free men.
These days I think it would be more proper to say necessitous men and women are not free men and women.
By passing health care reform, we will take health insurance off the casino floor for the average American family and make it a reliable part of every family's economic foundation. No longer will happenstance or chance determine whether treatment will be paid for. No longer will the casino wheel determine whether Rich Pezillo gets his treatment or that Christiane Hymel does not. Parents of kids like Rich Pezillo would not worry whether their son's illness could lead him to be turned down for that preexisting condition or whether a layoff or lack of insurance could deny their son the treatment he needs.
Necessitous men and women are not free men and women. Let's redeem FDR's promise by passing health care reform. Let's bear in mind, as we go forward, the nature of the arguments that are made against health care reform and the astonishing coincidence between the arguments made between health care reform by our Republican colleagues and by the barons of the health insurance industry. There seems to be literally no daylight between those arguments.
If we are going to turn around the extraordinary spiraling costs of health care, we are going to have to do it by reforming the delivery system. The best way to do that is the public option. Yet they oppose it.
Madam President, I yield the floor and suggest the absence of a quorum.