John Garamendi

Mr. GARAMENDI

Mr. GARAMENDI. Speak the truth, man. The Republicans did nothing.

Mr. GARAMENDI. Let me introduce to all of us a young woman from California who preceded me by about 9 months in a special election last spring, Congresswoman Judy Chu. Thank you for joining us.

Mr. GARAMENDI. Thank you so very, very much for a very good and thorough description of the problem that women face in this issue and why this reform is so important to them. I see our colleague from Illinois was getting kind of excited and wanted to get into this and add to this, so please do.

Mr. GARAMENDI

Mr. GARAMENDI. I often wonder what part of the world our colleagues are living in on the other side of the aisle. I arrived here on November 5. On November 6 there was an up-or-down vote on a major health reform bill in this House. The Senate did it just before Christmas. I think it was Christmas Eve. There has been an up-or-down vote, and now this week we will have an opportunity to take up this bill, pass it on to the President, get it signed, and simultaneously make corrections in the Senate. It sounds to me like that's an open process, and we've been at this now for more than a year here and this Nation for more than a century, trying to provide health care for all. And let's keep in mind that our economy absolutely demands that we take action now. Seventeen percent of our economy is being used. The more we spend, the more uninsured we have. We solve those problems with this bill. It's time for action. It's time to stop saying ``no'' and get on with solving a major fundamental problem here in America.

Mr. GARAMENDI

Mr. GARAMENDI. Mr. Speaker, a few moments ago, we heard one of the most outrageous charges I've seen in many, many days and heard in many days around here concerning the health care bill. The notion that somehow the health care bill overrides the HIPAA law that's more than a decade over is foolish nonsense. The privacy remains for every individual in America under the HIPAA law, and in no way does the health reform bill invade or change in any way the HIPAA law, which provides privacy on all medical records, whether they are with your local doctor, the clinic, the hospital, the Federal Government. Whether you are on Medicare, Medicaid, or whatever program you are in, your privacy is assured by a decade-old law. And what will be before us in the days ahead is a change not in the HIPAA law, but in other sections of the laws pertaining to health care in America. There is absolutely no truth whatsoever that the privacy of individuals are in any way changed by the bills that we will be taking up in the days ahead.

Mr. GARAMENDI

Mr. GARAMENDI. Thank you. I want to thank the gentlelady from Pennsylvania and the gentleman from New York for the opportunity to discuss this critical issue of small business and jobs. We know the statistics are very bad. But the discussion you two were having a moment ago used the word ``investment.'' And we talked about the American Reinvestment Act. It's now 13 months old. And it's absolutely critical that we always ponder investment because the investments that we can make at the government level will lead to short-term job growth as well as to long-term job growth and stability. Years ago, we looked in California about how do you grow the California economy. I did a report on it. This was more than 25 years ago. And we noted that the history of California's great economic growth was centered on five things. The first and foremost of them was the enormous investment that was made in education, both in K-12 and community colleges and in the research institutions. It was that investment that gave the foundation. And here we are today with enormous disinvestment, backing away from that critical investment in education. Now, the legislation that we talked about, the American Reinvestment Act, moved billions of dollars into the education sector so that we can continue to educate our kids at the universities and K-12 and the community colleges so that people who had lost their jobs could come back and learn the new skills, as you were saying, Mr. Tonko, the new skills in the green technology. Extraordinarily important investment in knowledge, investment in the ability of people to compete internationally. Our friends on the Republican side say, No, we shouldn't have done that. So what are these people to do? They have lost their job. They don't have the opportunity to get new knowledge and new skills. The second thing that we learned that was one that you also just talked about, the two of you a moment ago, about the necessity for research. It is in the research that the new jobs are created. Why? Because those are new products. Those are things that people demand and want and need for the growing economy. And in that is the high profit margin. And, again, for the first time, the Democratic Congress and the President--without the help of the Republicans--passed the greatest increase in research money in the last 20 years, putting money into research that will again lead to jobs sooner and later as the economy grows. There are many other pieces of this. One that's before us is the health care legislation. I know a young couple in their mid-thirties that want to start their own business but they cannot leave the job that they have today because they know that as small business people, they will not be able to get health care insurance. They have two kids. So these are things that we're bringing to the American public--last year, with the American Recovery Act and now this year, as we look at how we're going to deal with health care. These are the critical investments that we need to make. And I thank you so very much for bringing this to our attention, to the attention of the American public.

Mr. GARAMENDI. Mr. Tonko, thank you so very much for weaving together all the pieces of the puzzle that the Democratic Party and this Congress are putting together. It is the education piece, the health care piece, and also there is another piece, and I'm going to use an example here of what is taking place in one of the counties I represent. It's Contra Costa County and the Contra Costa Council, which is made up of businesspeople who have said, let's use the purchasing power of government to incentivize and to help the small businesses. Now, it happens that in this particular area, there are major research institutions. The University of California, the Lawrence Berkeley Lab, Lawrence Livermore Lab and the Sandia Lab are all in the area. And out of that comes enormous numbers of new ideas. But those ideas are often left without a real market because they are new and they haven't been able to grow and to develop their market. So the local government said, why don't we get together and become the purchaser and jump-start, use the purchasing power of government, particularly in the area of energy conservation. For example, street lights, there is a new company that is in the LED lighting system, and it's possible for that company, in their own neighborhood, to create a huge market, replacing the existing street lights. They use an enormous amount of energy with the new LED lights. But one example, in order to do that, that is the wise use of government. At the Federal level, billions upon billions of dollars are spent every year, often going to the large companies to what are known as the ``Beltway Bandits,'' the companies that hover around Washington. We in the Democratic Party are doing this today, the Democratic Congress is pushing the President, pushing the administration to push those jobs back to the local community by contracting with small businesses. The small business community needs access to the Federal contracts just as they would like to have access to the local government. That has been the policy of the Democratic Congress and is the policy of the Democratic President to make sure that small businesses have access to the Federal contracts. It doesn't come easy. I was the Deputy Secretary of the Department of the Interior in the 1990s, and we had to literally force the bureaucracies to contract with small business. It is like putting in reporting requirements. We are continuing that today. So once again, there is a web of opportunities, education, health care, the tax laws, all of these things, including contracting and access to the Federal and local government purchasing power that creates opportunities for small businesses. That is our agenda, and it's a good agenda for America. It's a good agenda for business.

Mr. GARAMENDI. Let me give you a very brief example of that connection. The community colleges across this Nation are one of the very best places for people to get specific job training. When the community college is connected to the business communities, the business community can directly affect the educational program that that community college is providing, making the education pertinent to the employer so that when that employee finishes or when that worker finishes the community college program, they are specifically ready. I was listening this last weekend when I was back in California to a local radio station talking about the way in which the community college and the employers are working together to educate unemployed construction workers, preparing them for the solar industry so that they knew how to install solar photovoltaic, so that they could be the salespersons, so that they can do the audits that are necessary, and those people would be immediately prepared. Now, the problem is the community colleges across this Nation are running out of money. Now, Mr. Miller, the chairman of the Education and Labor Committee, has proposed a new piece of legislation called the Local Government Jobs Act, and it has $23 billion to directly go to the educational system so that they can hire the teachers, so that they can do the training in the community colleges to prepare workers for the new economy that is coming our direction. This is the kind of really important and useful legislation that is needed. Some 250,000 teachers would continue to be employed. And I was noticing in the Washington Post today, the headlines, the right-hand column, ``Thousands face furloughs; schools may lose millions.'' That is repeated. That same headline was found in the Sacramento Bee and the Los Angeles Times in the last week. So we need to support the educational system so that unemployed workers have the opportunity to become better prepared to take the jobs that will be there as these tax incentives, the new economy kicks in, as we move to the green technologies and the green energy systems. There is a totality here. There is a holistic approach. That is what the Democratic agenda provides: tax incentives, health care, education, purchasing power of the government made available to small businesses, bringing the new businesses on line. All of these things create a totality that will restart our economy and keep us moving and take these workers that are now tax-takers on unemployment insurance, some on welfare, using the COBRA money that we provided through the American Recovery Act, and let them become taxpayers, building our economy once again. That is our agenda. Thank you so very, very much for bringing this small business agenda to the American public so that they understand that this party, the Democratic Party, is the party that is concerned and is willing to use the power of government to restart our economy and to give small businesses an opportunity to prosper and grow.

Mr. GARAMENDI

Mr. GARAMENDI. That is yet again an example of what is seen every day in every community in this Nation. There is a denial of coverage by the insurance companies. And for those who have no insurance, they face a situation of death, bankruptcy, and the loss of their jobs. It is not necessary. Now, we have talked about the cost in the system, and perhaps this is where we will let this discussion end today. This Nation is spending 17.5 percent of its total wealth on health care. Our competitors around the world, not including China, which is completely different, but the other industrialized nations of the world, Japan, Korea, the European countries, spend 10 percent or less of their wealth on health care. In all of those countries, they have universally available health care, different kinds of systems, but it is universally available. We are pending 17.5. They are spending 10. You would think with that additional expenditure we would be healthier. Unfortunately, we are not. We don't live as long. Our children die earlier. Our women die in childbirth more often. Our health care statistics rank us in the range of the nation of Colombia. This is a tragedy for America, and it is a blot on our reputation in America. The legislation before us will begin to address that by providing better health care services, as we have discussed with the clinics and other reforms that are taking place; access to health care, because of the expansion of insurance to some 30 million Americans that don't presently have it; and control of the insurance companies. So no more preexisting conditions, no more game playing and discrimination and post-event underwriting, which is you get sick and suddenly your insurance is cancelled. Those things are gone. We are also, in this legislation, controlling the cost of health care in America so that our Nation can once again revive its competitiveness, so we spend our money on education and manufacturing and the things that create a strong economy and a strong society with health care. That is our goal. And the great opportunity that you and I have, and all 432 Members of this House and the 100 Members of the Senate and the President have, is to finally close the gap--finally, after a century of effort--to provide a system that covers Americans with a health insurance program that has the quality and the benefits that they need. I know you have been there. You have been there since I first met you in 1976 in California and the years you have been here. So, Congresswoman Watson, it is a great privilege to engage in this dialogue with you.

Mr. GARAMENDI. Yes, additional cost.

Mr. GARAMENDI. I think that is $1,800 a month.

Mr. GARAMENDI. That is the way it should be, but the way it often is, it is the insurance company that makes the decision. I cannot begin to count the number of times when I was insurance commissioner that complaints would be brought to me that the insurance company decided that this young girl was going to die because she was not going to get treatment for her leukemia. This is not unusual. In California last year, the statistics collected by the Department of Managed Health Care showed that the five largest insurance companies that cover most everybody in California, the denial of claims and the denial of services ranged from 25 to 40 percent. So it is the insurance company, not the doctor or the patient, that is making the decision. It is the insurance company. Now, on the other side of it, in Medicare and in Medi-Cal, you don't see those kinds of denials. There are denials for things that are inappropriate. So we know in the reforms that are coming before us, we open the door for the patient and the medical practitioner, the doctor, the nurse, to have that relationship to make the decision on what is the appropriate care. That is not the case today. It is the insurance company, all too often, that is making the judgment on whether a treatment will be available.

Mr. GARAMENDI. How to deal with what will inevitably be the final days for all of us. We would want that to be in the interest of the individual and the individual's family. Right now, many doctors cannot do that.

Mr. GARAMENDI. The figures I was giving you are based on the Senate bill. Now, the additional changes that are going to be made, corrections to the Senate bill, will provide, we are quite confident, additional reductions in the cost of the total bill and reductions in the national deficit in the years ahead. The other thing that needs to be understood is that these cost reductions will be real, and many will be available in the near term, others as we learn how to implement the medical technology so that we have records that are readily available. So we will be able to see significant reductions in cost, as we have already discussed. One of the things that will also be available as a result of this legislation is the availability of medical providers. You touched on this and hit it hard, and we need to emphasize it once again. There is a lot of discussion like the bill has too many pages, some say. Well, many of those pages specifically deal with making sure that the medical providers are there, extending the availability of loans and programs for primary care doctors, for nurses, for nurse practitioners. And I recall, years ago you carried the nurse practitioner legislation in California.

Mr. GARAMENDI. Congresswoman Watson, you are very, very aware of all of these, having served those many years in the California legislature, here, and also as an ambassador. And you understand what apparently our colleagues on the other side tend to miss, and that is that the cost is in the system. And because there are so many uninsured who do wind up in the emergency room, the cost actually goes up. Now, for a variety of reasons I was at an emergency room in Sacramento over the weekend, and it was plain to see that there were a variety of people there. Most of them did not have a true emergency from perhaps an auto accident. They were there with a cold, with the flu; and they were waiting. Now, America has been waiting. And they are in a waiting room that is extraordinarily expensive, as you said. The bills, the Senate bill as well as the House bill, address this in two ways. First of all, they provide the health insurance so that a person can go to the doctor before they become seriously ill and go to the clinic, go to the doctor's office rather than to the expensive emergency room. That is one way they save money. The second way is there are a variety of elements in the Senate bill as well as the House bill specifically designed to reduce the cost in the system. You mentioned one: stay healthy. Smoking: we know that if we can keep people healthy we reduce the overall costs. There are provisions in the bill to advance wellness. Great. There are also provisions in the bill to deal with the extraordinary administrative costs in the system. One of them, which I heard our colleagues on the other side of the aisle demean, is a national benefit package, a uniform benefit package across the Nation. Now, I know from my experience as insurance commissioner doctors, insurance companies are faced with hundreds of different kinds of policies, different deductibles, different copays. The result of that is extraordinary administrative cost. One way of dealing with it is to have a national benefit available through what are called exchanges, which are pools which insurance companies can get involved in, creating a large actuarial, a large group so the actuarial cost, the actual cost is reduced per person. And also allowing competition to exist, which is the other third way. There will be competition within the pools. So you have got a uniform benefit, you have competition, you have a national nonprofit company operating within those exchanges. So that would provide additional competition. So you have got competition keeping prices down. And on this floor 2 weeks ago we passed a major change in the antitrust laws applying the antitrust laws to the health insurance. So within this area of legislation that will be voted on next week are major efforts to reduce the costs. And I have only begun. I have gone through three of what I think are half a dozen different ways to reduce the costs in the system. So much so that the Congressional Budget Office estimates that the reforms that will be before us will actually reduce the national deficit in the decade ahead and in the out-years, more than a trillion-dollar reduction in the national deficit as a result of these reforms.

Mr. GARAMENDI. I don't believe it.

Mr. GARAMENDI. Unless you happen to live until you are 65. When you are 65, you will automatically be eligible for a single-payer universal health care program called Medicare. People want to live long enough to get into that system. And at that White House meeting most of the graybeards there were 65, and they belonged to that system.

Mr. GARAMENDI. I am sorry, Congresswoman, but you are uninsurable. You cannot get a health care policy.

Mr. GARAMENDI. Let's talk about that. I was the insurance commissioner in California 1991 to 1995, 4 years, and then again in 2003 to 2008. And in that 8-year period I saw horrible things being done by the health insurance industry in the way in which they discriminated. There are many lessons I learned, but one of the principal ones is for the private health insurance companies it is profit before people; do whatever you need to do to enhance your profits. And you just mentioned one of the ways, which is various mechanisms to discriminate, preexisting conditions. Let me give you an example. I know of a young woman that had been on her family's health insurance program for 23 years. She turned 23, and under the current law a 23-year-old can no longer be on their parents' care. Under the bills that will be before us for final review hopefully next week is a proposal to extend that to 26 years. But for her that wasn't yet law, so she went out searching for insurance. It turns out she went back to the company that had insured her for 23 years. And the company said, oh, we can't insure you. She asked why. You have a preexisting condition. It turns out the condition was acne. The list of conditions that would exclude you from coverage called preexisting conditions is about three pages long for most insurance companies, which basically say if you are a woman in the child-bearing age group you are not going to get coverage. Why? Because you might actually have a child. My goodness, that is expensive. We are not talking about family friendly policies here, are we? But that is reality. For this young woman she was excluded on the excuse of a preexisting condition. Now, I happen to have been familiar with this woman and I said let me see, let me get on the computer and see what this is all about. So I entered her name, came out she was excluded. I went back and entered her name as a male, and she got coverage. Something seriously wrong. And the bills before us next week will eliminate that kind of discrimination, preexisting conditions, as well as discrimination because you happen to be a woman. Those days will be over.

Mr. GARAMENDI. One of the things that was in both the Senate bill and the House bill was an effort to expand access to care, not just with an insurance policy, but also with facilities. There were major improvements and significant sums of money available to expand community clinics, where most poor people, where many young children and people that are moving from one town to another are able to get their care. That is an enormous expansion of services. So what is wrong with providing a facility, community care? It happens to be good care, and it happens to be very well priced.

Mr. GARAMENDI. If I might for a moment, Congresswoman Watson-- absolutely. It would seem to be the fundamental compassion of a human being to make sure that their children and the community's children, indeed our Nation's children, have health care. And we should extend that well beyond to all of us. It is not in our interest as human beings who presumably have compassion to leave people without health care. We are not rushing to judgment here. We have been at this in America for more than a century. And this House has been at it for a year, heavily debated. I was just elected to Congress back in November, came here 3 days later, and voted on a bill that you and others had worked on for the previous 10 months. So here we are with the House having passed its bill, the Senate having passed a bill back Christmas Eve, I think 72 days ago. That bill has been available. It is my understanding that next week we may have an opportunity to vote on the Senate bill and send that to the President and then follow up with corrections to the Senate bill that are desired by both Houses, such things as eliminating that little advantage that was given to Nebraska and other corrections to the bill. So this is not something that is being rushed to judgment. In fact, it has been debated for a century. It has been debated in this House. Back in the Clinton period, there was a major debate going on during that period of time.

Mr. GARAMENDI. Thank you very much, Congresswoman. As you recall, you and I have had a long, long history of dealing with health care issues. In the late 1970s, I was chairman of the California State senate health committee, and when I left that post, you took it over. And over those many, many years that you and I worked on health care, we are now approaching the final moment in which this Nation will take up an extraordinarily important task, and that is moving towards providing health insurance and health care for all of the citizens in this country. It's going to be a very, very busy week next week. Over the last hour or so, I've heard from our esteemed colleagues on the Republican side talk about a rush to judgment. It was not a rush to judgment if you consider the 30 years that you and I have been spending, trying to provide health care services for all the people in California, and now we have this opportunity to deal with this issue here for the entire Nation. It certainly wasn't a work to rush to judgment in the early part of the 20th century when, in California and across the Nation, men and women were being injured on the job, and to deal with that, the Workers' Compensation programs were created. Even Teddy Roosevelt back in those periods said that we needed to have a health care system for all. It didn't happen then. During the World War II period and before it, the Blue Cross-Blue Shield programs were developed by the medical community to provide services. But again, it wasn't universal, and it wasn't available to all. Later during World War II, I remember in California and on the west coast, Kaiser Industries found that their workers were getting sick. Actually, it was during the Depression when they were building the dam on the Colorado River. And so they started what has become known as Kaiser Permanente to provide health care to their workers beyond just the Workers' Compensation program. In the 1960s, we made a major step forward here in America with Medicare and then following it with Medicaid. An enormous debate erupted, but progress was made, and a universal program was made available to every person--every legal citizen, legal person in this Nation who attained the age of 65. And I noted with some humor that at the President's summit, just I think about 10 days ago, men and women were sitting around the table, nearly all of whom--excluding the President and I think just two others--actually belong to a single-payer universal health care program called Medicare. Yet many of those people said they wouldn't want anything to do with a single-payer universal health care system, but yet they were participating in such a system. So we have been at this a long, long time, and in this House, the debate on how to finish the process began 1 year ago. So there's no rush to judgment here, nor is there a rush to judgment. I yield to the gentlewoman.

Mr. GARAMENDI

Mr. GARAMENDI. Madam Speaker, if I might, we heard just a moment ago from one of our esteemed colleagues from the Republican side that there were no savings in the health care bill. In fact, there are substantial savings, at least according to the Congressional Budget Office, and over time, the American deficit would be substantially reduced. Let me just tell you some of the reasons why. First of all, by extending coverage to most all Americans, you eliminate one of the most pernicious and most difficult cost increases in the system, and that is that the uninsured wind up in the emergency room, usually very, very sick, and that gets to be a very, very expensive matter. That cost is in the system and is passed on to both the Federal Government as well as to those people that are buying private insurance. Also there is a major effort in the legislation to extend the medical technology information systems. We know that that will reduce errors and omissions, and create not only better care but reduced cost. We know that the system will also have a Medicare panel look at ways of reducing the costs in the Medicare system. Finally, there are programs in the system and in the legislation to promote wellness. Healthy people are not expensive. If you are well, you are not going to be increasing the cost of the systems. There are many, many parts of this bill that will significantly reduce the cost, and therefore, this is a good piece of legislation. Finally, I want to speak to one of the issues that our Republican colleagues constantly put before us as a way of reducing costs, and this is the ability of the insurance companies to sell products across State lines. Now, I was the insurance commissioner in California for 8 years, 1991 to 1995 and again from 2003 to 2007. During that period of time, we had insurance companies that were not licensed for business in California, selling products illegally in the State of California. There was a reason why we had a procedure to make sure that insurance companies that were selling health insurance in California were licensed. We wanted to know that they were legitimate companies, that they actually would have the financial strength to pay claims, that their policy actually provided benefits, and that they were able to carry out the contract that they had made with people. All too often, we found that companies that were selling policies illegally in California without the proper license were selling junk to the public. I remember a case in San Diego, a woman who was working, a lawyer, had lost her employment with a law firm. She went out and purchased an individual policy. It was cheap. It was actually too good to believe. She got sick, and she wound up with an enormous expenditure, and she had to actually file bankruptcy in order to cover that cost. So we know that if companies are simply selling across State lines without the proper underlying strength and without the proper regulation, it will not solve the problem. In fact, it will create a whole set of other problems. That is not the solution. What we need is a national program and, in fact, we have such a program in the proposal that will hopefully be before us next week. That proposal establishes a national benefit program. It establishes a mechanism for the pooling of risk and pooling of companies in what are called exchanges, either State, regional exchanges, or a national exchange. That is a procedure that is in the bill and does provide the kind of protections that every consumer needs and also provides some competition. Because one of those companies that will be operating in the exchange--at least the national exchange--will be a nonprofit company that will have a national reach and be able to have the actuarial strength of being able to spread the risk across the entire Nation and all parts of it. So I'm looking forward to next week. It's going to be a terrific week. We will finally deal with something that the Nation has wrestled with for a century, and that is how to expand health insurance to the entire population. We're well on the road.

Mr. GARAMENDI

Mr. GARAMENDI. Mr. Speaker and Members, I want to bring to your attention an extraordinary unit in our military in the Air Force located at Travis Air Force base in Fairfield, California. The 60th Air Mobility Wing does an extraordinary job providing services to the military as well as humanitarian efforts. When the earthquake in Haiti occurred, it was that Wing that brought immediate assistance, using rapid deployment. They also have hospital services available that are immediately deployed. And when it comes time to open a new military base or a new field anywhere in the world, it's the 60th Air Mobility Wing located at Travis Air Force Base, Fairfield that provides those immediate services. So I ask all the Members to recognize the good service, the good work this unit does, the extraordinary service provided by the men and women of the 60th Air Mobility Wing located at Travis Air Force Base, Fairfield, California.

Mr. GARAMENDI

Mr. GARAMENDI. Mr. Speaker, I demand a recorded vote.