(Senate - January 31, 2008)

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[Pages S530-S532]
From the Congressional Record Online through the Government Publishing Office []

                         HEALTH INSURANCE CARDS

  Mr. ENZI. Mr. President, I rise to express some disappointment with 
some items that we were not able to accomplish last year. I hope we 
will quickly turn to these priorities the first thing this year.
  My wife Diana and I travel to different parts of Wyoming most 
weekends. The No. 1 issue on people's minds is health care. Well, maybe 
it is the economy. But when they talk about the economy, they are 
talking about health care. They may be talking about some housing 
crunches. They may be talking about some other things. But I can tell 
you that to a person they think health care is a big part of the 
economy, and health care is someplace that we ought to be doing 
something. They all ask me what I am doing to make sure they have 
health care. I tell them about the things I am doing to increase 
access, to decrease costs, to promote informed choices, and to ensure 
that health care is more affordable, and everyone gets it.
  I also want to say, everyone understands it. Our constituents deserve 
our help. I hope we are able to really do something on health care 
early this year. This doesn't need to be the subject of every debate by 
the Presidential candidates. There is a lot of overlap in what the 
Presidential candidates are saying. The people don't want to wait until 
November in order to be able to wait until the next year in order to 
wait for us to do something. There is plenty of things out there that 
can be done. So I hope we are able to do something about health care, 
and do it now.
  It is time for real action. All eyes are on this Congress to get 
something done. After this last week of having one vote, I think they 
are hoping we can either get FISA done or maybe we can get a stimulus 
package done. Get something done. Maybe it would be easier to be doing 
something in the area of health care. That is a big concern of theirs.
  It is shameful we haven't been able to make sure that all Americans 
have access to affordable health insurance. I am saying: Do something. 
The people of Wyoming are saying to me: Do something. Even if it is 
wrong, it will at least be something. And it might help.
  Now, as the senior Republican on the Committee on Health, Education, 
Labor, and Pensions, I spend a lot of time working on solutions to our 
health care crisis. I have even talked to

[[Page S531]]

many of the people in this body who have an idea on health care. I have 
been collecting those ideas. I took those ideas, and I put them in a 
package--a package of steps that could achieve what I am talking about, 
which is access to affordable health insurance for every American. Any 
one of those steps would improve the situation.
  Why did I put it in steps? Well, I have noticed when we are trying to 
do something comprehensive around here that one piece of the package 
will have 5 people who are opposed, another piece of the package will 
have 8 people who are opposed, another one will have 11 people who are 
opposed, and another one 7. Pretty quickly you are at 51. You cannot 
pass something unless you have 51 who are for it.
  So if we do the steps a step at a time--granted, it is not as grand 
and as promising for publicity, but if we do them a step at a time, if 
there are 5 people who do not like it, it is 95 to 5. That is pretty 
passable around here, and it makes progress. And chances are pretty 
good those people will express what their concerns are, and it might be 
possible to work out some of those.
  You would be surprised how many times on this Committee on Health, 
Education, Labor, and Pensions we are able to go with a third way and 
figure out something that solves a problem for somebody without 
upsetting everybody else. I would be willing to bet over the last 3 
years we have had more pieces of legislation passed from that committee 
unanimously than any other committee, and it has always been one of the 
most contentious committees in the Senate. But it is also a committee 
where people work together to come up with solutions. That is why I 
collected these ideas from people.
  We have had a number of hearings over the last 3 years that dealt 
with this issue. There are solutions that are available. So if you look 
at my Web site, you will find ``Ten Steps to Transform Health Care in 
America,'' which would fix many of the common complaints I hear from my 
constituents. Now, I am not going to go into all the details of that 
bill today. But I would encourage everyone to look at my Web site, 
which is, to learn more about the bill. This is a 
  Now, there are a lot of transformations that can be done on it, but 
this has 10 possibilities for ways we can improve health care in 
America. I have to say, there are ideas from both sides of the aisle. I 
try not to get into a polarized situation where we are saying this is 
the Republican way, and then have somebody else say this is the 
Democrat way, and the two never meet. We have to meet. We have to solve 
the problems. So take a look at that Web site and 
send your letters and comments and talk to me personally, those of you 
in the Senate.
  If this bill were to become law, the end result would be an insurance 
card for everyone. Now, lots of people have insurance cards. Members of 
Congress have them. People who work in big companies have them. The 
kids in Wyoming who participate in the State Children's Health 
Insurance Program, SCHIP, have them. Lots of people have them. Most of 
those people who have insurance cards are pretty happy with the care 
they are getting.
  This part of the bill would not change that. If you have an insurance 
card now, you can keep that card, and you can keep getting the exact 
same care you are getting now. The problem is, 47 million or so 
Americans do not have an insurance card. This bill gives all of those 
people insurance cards. If they cannot afford the cards because they 
are low income, one step helps them out by giving them the money they 
need to purchase the insurance card. The bottom line is, everyone has a 
card and everyone will be able to get the care they need.
  Now, some of my colleagues on the other side of the aisle have said 
the only way to give everyone an insurance card is to give all 
Americans a Medicare card. I have to disagree with that. The Federal 
Government should be the payer of last resort, not the primary 
  When my wife and I are traveling in my home State of Wyoming, we 
visit a lot of senior centers. During these visits, I always hear about 
problems with Medicare. Some seniors get upset that the cost keeps 
going up. Some seniors tell me they cannot find a doctor who takes 
Medicare anymore. Some seniors tell me the way the Government runs the 
program is confusing. Some seniors tell me it takes them months to hear 
back from Medicare when they have problems.
  Now, I also have a lot of doctors and pharmacists--not nearly as many 
as we would like to have. We have a huge health care provider shortage 
in Wyoming, including veterinarians. I mention that a lot. We keep 
trying to encourage them to come, and we are having some success at it, 
but we have a huge problem. I tour the hospitals, the hospice 
organizations, the nursing facilities, and the rehabilitation centers.
  The one consistent message all these folks relay to me is that 
Medicare does not pay them enough. Sometimes I even hear stories about 
how they do not get paid enough to cover their own costs. You cannot 
stay in business on volume if you cannot cover your costs. And this is 
not a volume business. This is one where it is one person at a time. 
Some folks are even closing their doors and going out of business 
because they cannot afford to keep their doors open under Medicare.
  They do not like the Government telling them what they can and cannot 
do. They do not like the Government prescribing how they practice 
medicine. With all the problems in this program, why would Congress 
multiply the problems giving every American a Medicare card?
  I have to tell you about a guy who lives just outside of Pinedale, 
WY--Big Piney, WY. All these big cities kind of get me confused. But 
his name is Dr. Close. He is actually well known internationally 
because he spent most of his life in Africa studying Ebola. And he is 
also known because he has a daughter named Glenn Close whom people may 
have seen in a movie or two. But he now lives by Big Piney, WY--a 
little bit out of town--and he is now an old-fashioned country doctor. 
He makes house calls. He even does hospice work. If somebody is dying, 
he will stay with them during those difficult times--hours and days on 
  When I visited him last time, he showed me some documents that he 
gives to people who are going to be his patients. It says: I am not 
going to do Medicare. He will not take Medicare. He says it takes too 
much time. It costs too much money. So he does not volunteer if 
they cannot afford to pay, but he has a pretty good thing of people 
donating--some of them who have been helped before, some who have money 
who have kind of donated to a foundation for him. He adds some money 
that is in a foundation. So he is able to get by that way. But he is a 
great source on some of the problems with Medicare and why we are 
having less providers who are willing to provide to anybody who needs 
Medicare. We have a lot of people out there who need help, and they 
have Medicare. So, Medicare, as it stands right now, is not the best 
answer for people.

  So there is a much better way to get everyone an insurance card that 
does not take us down the path of Government-run health care. I want to 
repeat that and make sure folks at home know what I mean when I say 
``Government-run health care.''
  Government-run health care means that a committee in Washington is 
deciding the care you are going to get. A committee is deciding what is 
best for you. The decisions would no longer be made by you and your 
doctor. Oh, yes, within limits they would be but not really. A 
committee in Washington is deciding what doctors you can go to and 
deciding how much the doctor gets paid.
  A committee in Washington is deciding which prescription drugs are 
the most effective for you. It would not matter that you know your 
body, that your doctor knows your body. You do know how your body 
works, and you will have worked closely with your doctor to know what 
drugs you should be taking. If that committee in Washington decides you 
should not have the drugs you have taken your whole life, and instead 
decides you should take another similar drug, then you have to take 
another similar drug.
  I went around Wyoming talking about Medicare Part D, and helping 
people to know, if they needed to make a choice, how to make a choice. 
I got the volunteer people working all over the State. We had a 
tremendous signup

[[Page S532]]

in Wyoming. At every one of the hearings I did, I had somebody come and 
say: I cannot get the drugs I need.
  I would say: You are a veteran, aren't you?
  They would say: Yes. How did you know?
  Well, I knew because the Medicare Part D part was not in operation 
yet, and the Government was negotiating prices on veterans health. The 
only way you can do that is to say what ones are going to be acceptable 
or get the similar ones to bid against each other, which means some of 
them are not going to be available. That is exactly what happened. So 
sometimes when the Government gets involved, they limit what you can 
do. That is the problem with Government-run health care.
  I promise to work hard to make sure everyone is not forced into a 
Government plan. My plan gives every American the choice to pick the 
insurance card they want. Now, there are some things we have to do with 
insurance companies, too. But that plan that they pick can be the one 
that best fits their needs. Every American will have the choice to 
discuss their care with their doctor and decide which plan is best for 
them. This plan puts the patient first. This plan gives patients 
control over their own health care.
  Another important part, this plan is affordable. It is not free. It 
is not free--people do not appreciate things that are free--but it is 
affordable. It needs to be affordable, and it is affordable. Sometimes 
if things are free, people do not think it does anything. Now, there 
are a lot of details on my Web site about how this plan redistributes 
the tax breaks that are currently only going to the people whose 
employers are giving them health insurance cards. And it makes sure all 
Americans get the tax breaks.
  This plan also reduces the cost of health care. Right now, a lot of 
rules are in place that prohibit groups of businesses from getting 
together and pooling their purchasing power so they can negotiate 
better deals on insurance cards. They can get a bigger pool by going 
across State lines, and you have to have a bigger one if you are going 
to negotiate with the insurance companies. Where they have been able to 
do it in high-population States, within their State, it has worked. 
Those same groups have said: Let's expand out a little further.
  First of all, we get a whole lot more people covered, and we will get 
lower rates. So it does not make sense if they cannot go across State 
lines and get these bigger groups--meaning if a group of shoe store 
owners in Wyoming want to get together with shoe store owners in 
Montana and Colorado and band together so they can negotiate greater 
discounts on health insurance, we ought to allow them to do so. That is 
what one of the steps does.
  Now, the plan also recognizes our changing workforce. It provides 
real options for people to take their insurance card with them when 
they change jobs. No one would be trapped in a job just because their 
loved one or they need particular health insurance. Right now, under 
the system, if they move to another business, they are probably going 
to have a preexisting condition that will not be covered. It definitely 
will not be covered for a period of time, but it may not be covered at 
all. If you want to provide real choices, then you should also have the 
choice to keep the coverage you have, even if you do not keep your 
current job.
  Now, to reiterate, this plan gives every American a health insurance 
card. This plan puts patients first. This plan puts the people in 
control of their own health care. This plan lets doctors and patients 
make decisions about what care they need and receive. And this plan 
lets you choose the health care you need.
  It is in steps, and it is evolutionary, not revolutionary. There are 
some ideas around here that are not included in the 10 steps that are 
great ideas. They are just such a quantum leap that they take people 
out of insurance who currently have insurance who like the insurance 
they have. Those people are going to be very skeptical about having us 
change to such a revolutionary system that they lose what they have 
now. So we have to do it in steps. We can get to where every plan 
here--I am talking about those as the 11th and 12th steps--can work 
  So I am encouraging everybody to take a look at them. They are 
sensible proposals we could have enacted long ago, and I am 
disappointed this body has not made progress on any of these issues to 
impact every American. I hope we turn to these issues the first thing 
this year and enact real reform.
  The Americans deserve more than politics. They deserve results. I 
think a surprising thing, sometimes when you look at the debate that we 
do not finish up around here, they even expect results. We need to meet 
those expectations.
  Before I leave the floor, I would also like to address another aspect 
of health care. It is one that often does not get enough attention; 
that is, mental health.
  I am concerned we were unable to move forward on the bipartisan 
legislation to revamp the Substance Abuse and Mental Health Services, 
or SAMHSA. While I am hopeful we can complete our work on this key 
legislation early this year, it is unfortunate we were unable to 
address it last year.
  As part of that debate, I hope we will leave the discussion on 
charitable choice for the Senate floor--as we have done in the past--so 
all Members can engage, if they want to, and so we can get it out of 
committee. I know Senators have strong opinions about this provision, 
and I do believe that the best debate on it will be on the Senate 
floor. It is critical that Congress turn immediately to these issues. 
They will help every American have a healthier and happier new year, 
not only this year, but for many years to come.

  Our work is cut out for us. We can do it. We can do it in a way that 
people will appreciate. We can do it in a way where there is common 
ground across the aisle. I am committed to work on that. I hope others 
will join me on it and help us do something. As my constituent said, do 
something, even if it is wrong.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington is recognized.