Sen. Maria Cantwell (D-WA) addressed her fellow Finance Committee members today as markup began on the health care reform bill.
(We've detailed her amendments to the Finance Committee bill here, here, and here.)
It was a long speech, but here's the graf you're looking for:
“And so Mr. Chairman, as we look at solutions in this bill I am going to be very concerned about instead of providing true competition in the form of a public option to these insurance plans, instead we are providing consumers with a subsidy to buy the expensive insurance.
“Why would we do that, when it’s more cost-efficient to drive down the cost through other measures? Through actually giving them a plan that’s cost-effective."
(I've linked her entire statement below the fold.)
Despite complaints from the left earlier this summer that Sen. Cantwell wasn't advocating strongly enough for the public option, my sense had always been that Cantwell was simply holding her cards close to her vest (her office hinted to PubliCola at the time that Cantwell was working on keeping the public option in the mix.)
I believed her because Sen. Cantwell has a strong record of populist stances on consumer issues.
The public option that Sen. Cantwell has signed on to—the one that's included in the Senate's Health, Education, Pensions, and Labor Committee—has been called anemic by some liberal groups. Others, though—like SEIU president Andy Stern—like it.
“Thank you Mr. Chairman.
“Now Mr. Chairman, I want to say that you have proved that you are truly a distance runner. This process has been like a marathon and you have kept on pace. I guess my only request is that the committee process will give the due kick to the system that we need to have at the end of this. Because I do think that we do need to make some changes and I appreciate your willingness to make those changes.
“I’m not a member of the gang of six. But I am a member of the gang of six million Washingtonians and the way that they look at this bill may be a little bit differently than they look at the discussion we’re having today.
“And that is, my constituents, the 90 percent of people that have coverage, want to know what we’re going to do to drive down the cost of their current insurance.
“Now, the discussion that we’re having about how we’re going to cover the uninsured is an interesting question. I personally don’t think it’s a very hard question. It’s probably along philosophical lines or cost-effective lines, but the really hard question here is, what policies are we going to adopt that change the course curve that we are on.
“We know that inflation is about two to three percent a year, but we know that health care costs are rising eight percent a year. So the question is what policies are we going to put in this legislation that are truly going to drive down costs for Americans who already have insurance? It’s just unfair for Americans to have to pay a doubling of their insurance rate over the last 10 years and be faced with the same consequences staring them in the face. That’s why doing nothing is not an option. And we have to look at what policies we are going to have that are really will effect that doubling of insurance rates.
“And when I look at it, I see Medicare spending going to double in the next 10 years if we do nothing and I see the individual premiums, if we don’t provide enough competition, doubling in the next 10 years. So my constituents want to know what we’re going to do to drive down costs.
“And that’s why one of the things that’s most important to me is the reform of the current fee-for-service system. Right now, our medical system is rewarding an almost relentless utilization.
“If this was a restaurant, your waiter would be bringing everything to your table, whether you ordered it or not or whether you could consume it or not. If this were the legislative process, we’d be getting paid for how many bills we passed, instead of whether they were really necessary or needed.
“The fact is that we waste about 700 billion dollars a year, 30 percent of our health care, on a system that is really not doing the service to our constituents. Our constituents want to know that when they go to see a physician, that they have their full attention and note many practicing physicians do the best they can under a system that rewards them for how many patients they see and how many procedures they order.
“But the biggest thing we can do in this bill to change the cost curve of people who already have insurance is to reform Medicare fee for service and instead institute an efficient plan that rewards physicians not on volume, but on the value that they deliver to their constituents.
“And I can tell you that everyone knows what its like to go to a doctor’s office and have the physician be in a hurry. Everybody knows that there are three or four questions that they didn’t get to ask or the physician didn’t have time. It’s not to say that the physicians don’t care or aren’t working hard or aren’t caring, talented individuals. The system right now is a disincentive for us to have efficient health care.
“So if we don’t change this fee-for-service system, everything is going to be more expensive. Not just the cost to the government, but the cost of insurance is going to be more expensive. Right now, Medicare is one in five health care dollars and its going to make even insurance even more expensive.
“There is a great deal of concern across America when you can have the same insurance benefits, the same benefits to individuals cost 300 percent difference across the country. That is, you can have an individual in Kentucky have the same exact benefits as someone in Massachusetts, but pay drastically different amounts, almost $200 a month different. The same individual, same age, same basic demographics, and yet they’re paying almost $2400 more a year.
“And is there any rhyme or reason to this? No. The issue has to do with the way we do the reimbursement system.
“But there is a second issue, Mr. Chairman. And that is the lack of competition. And while we are looking at this bill and say how we are going to institute competition, our solution right now as it relates to the uninsured seems to be saying let’s subsidize the insurance companies that already at high concentrations of the insurance market. That is to say, that two companies in 94 percent of the markets, two companies have the majority of control. And so that is the other reason, the lack of competition, why prices are going up.
“And so Mr. Chairman, as we look at solutions in this bill I am going to be very concerned about instead of providing true competition in the form of a public option to these insurance plans, instead we are providing consumers with a subsidy ato buy the expensive insurance.
“Why would we do that, when it’s more cost-efficient to drive down the cost through other measures? Through actually giving them a plan that’s cost effective.
“So there are going to be many areas of this legislation where I’m going to be fighting for more cost control measures. I am going to be fighting to change the way we fund long-term care. It’s ridiculous that we continue to focus on putting people in nursing homes, instead of community-based care, when its 70 percent cheaper. We ought to give the senior citizens of America the chance to stay in their home as long as possible. And to give them a place to get the health care they deserve. And we have to take on the PBM market, the prescription benefit market, of drug companies that are negotiating discounts from the federal government and then pocketing those discounts themselves. We are never going to drive down the price of drugs, unless we have transparency in our drug markets.
“So Mr. Chairman, I applaud the efforts of this committee and the staff and my staff for the many hours that people have put into this legislation. But we have much more work to do, if we are going to make this a cost-effective plan for Americans and give them true choice and true competition that is going to drive down cost of health care.
“I thank the Chairman.”