Sheldon Whitehouse

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the Senate proceed to Calendar No. 129, H.R. 1016, the House companion; that all after the enacting clause be stricken and the text of S. 423 be inserted in lieu thereof; the bill, as amended, be read a third time and passed; the motions to reconsider be laid upon the table; that upon passage of H.R. 1016, S. 423 be returned to the calendar, with no intervening action or debate.

Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 101, S. 423.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I rise today to introduce legislation that would help families struggling with medical debts overcome hurdles that under current law make it difficult for them to find relief in the bankruptcy system. With medical costs at an all-time high and the unemployment rate hovering near 10 percent nationwide--and 12.4 percent in my home State of Rhode Island--too many individuals and families struck with injury and illness have no other option but to file for bankruptcy. According to a recent Harvard University study, health care-related costs have been a primary driver of personal bankruptcy filings, contributing to over 62 percent of filings in 2007. The statistics are as shocking as the personal stories are heartbreaking. Countless Rhode Islanders have written to me during my time in office asking for help with crippling medical costs, and I want to share just two of their stories with you today. Adam, a 23-year-old from Bristol, recently underwent surgery for cancer. Adam's treatment plan requires him to undergo a CT scan every 2 months. While his insurance initially paid for his health costs, he received word not long after his surgery that his policy was ``maxed out'' and that he would have to pay $6,700 out of pocket for an upcoming CT scan. As of today, Adam, a young man just starting his adult life, has $20,000 in medical debt and reports that he ``cannot see any light at the end of the tunnel.'' Robert, a veteran and retiree also from Warwick, suffered a major heart attack in November of 2004. Although he had health insurance, Robert was responsible for paying a $2,000 deductible plus 20 percent of the cost of his care. After 40 years of working and saving, these medical costs wiped him out, and he had to sell his home. Adam and Robert have both suffered unexpected medical costs that have turned their lives upside down. These Rhode Islanders, like millions of others nationwide, may be forced to file for bankruptcy to get a clean start--but when they do, they will learn that the bankruptcy process can be time consuming and costly and ultimately may not allow them to stay in their homes. The legislation that I am introducing today, the Medical Bankruptcy Fairness Act of 2009, would help people who because of medical costs have no other choice but to file for bankruptcy. The bill would waive procedural hurdles so that Adam and Robert would have the option of a speedier, less expensive, and more efficient bankruptcy. To begin with, it would waive credit counseling requirements for these debtors. Such requirements have little relevance to people whose debt stems not from poor budgeting but, rather, from uncontrollable medical expenses. The bill would also waive the so-called ``means test,'' making the filing process quicker and less costly and making sure that people have the ability to file to have their debts discharged in chapter 7, as opposed to a chapter 13 plan under which they would have made debt payments for 3 to 5 years. In addition to removing these procedural hurdles, the Medical Bankruptcy Fairness Act would give people with high levels of medical debt the ability to retain at least $250,000 in home value through the bankruptcy process. The ``homestead exemption'' is one of many aspects of bankruptcy law that looks to the laws of the individual States. While filers in some States already have the ability to preserve home equity at this level, a number of States offer homestead exemptions of $5,000 or less. With the average home price nationwide around $200,000, the $250,000 exemption included in this bill will allow the majority of individuals and families crushed by medical debt to keep their homes. Finally, the bill would eliminate an obstacle that prevents many bankruptcy filers from accessing the chapter 7 bankruptcy system, which as I mentioned earlier is the simplest and most efficient form of bankruptcy. Because attorneys' fees are ``discharged'' at the end of a chapter 7 bankruptcy, attorneys generally require the upfront payment of fees in chapter 7 proceedings. Many debtors who would be better off filing for a quicker and less costly bankruptcy in chapter 7 are forced to file in chapter 13 because they don't have enough cash to pay the attorney. The Medical Bankruptcy Fairness Act would make attorneys' fees nondischargeable in chapter 7 bankruptcies, as in chapter 13 bankruptcies, making it easier for debtors to elect the more efficient chapter 7 proceeding. Before I conclude, I want to acknowledge the hard work of my colleague from Massachusetts, Senator Kennedy, on the issue of medical debt. Senator Kennedy offered amendments during the consideration of the 2005 bankruptcy reforms that would have given people struggling with medical debts treatment similar to that which they would get under the Medical Bankruptcy Fairness Act. Unfortunately, those amendments were voted down. I look forward to working with Senator Kennedy to make sure that we don't miss another opportunity to help Americans struggling with medical debt. There are people in every State suffering from medical hardship and related debts who would benefit from this legislation. I urge my colleagues to work with me to pass it to Adam and Robert and the millions like them nationwide a clean start in bankruptcy.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. I rise to speak in support of the Foreign Manufacturers Legal Accountability Act of 2009, which I am introducing today with the ranking member of the Judiciary Committee, Senator Sessions, and Senator Durbin. This bipartisan bill is an important step in protecting American consumers and businesses from injuries caused by defective products manufactured outside the United States. Those products hurt American consumers--they lead to serious injuries, and even death--and they hurt the American businesses that must deal with angry customers, product recalls, and unusable inventory. The list of recent examples of Americans injured by defective foreign products is shocking. Last year, a contaminated blood thinner from a foreign manufacturer caused severe medical reactions and contributed to numerous deaths. In 2006, a foreign-made, lead-tainted charm bracelet claimed the life of a 4-year-old. The autopsy demonstrated that the charm was 99 percent lead, 1,650 times more than the 0.06 percent lead limit specified in enforcement guidelines for children's jewelry. Imported food products from seafood to honey have been contaminated with unthinkable chemicals, including veterinary drugs banned in domestic production, potentially harmful antibiotics, and unapproved food additives. Sixty million packages of pet food contaminated with tainted wheat gluten have been recalled in the last two years. Substandard tires have failed, leading to fatalities. Most recently, defective drywall imported from China has been found to contain excessively high levels of sulfur, causing houses to smell like rotten eggs, corroding copper wiring, and making expensive appliances fail. Thousands of homes may be affected. At a hearing that I chaired in May, the Subcommittee on Administrative Oversight and the Courts explored the legal hurdles facing consumers who are injured by defective foreign products and by businesses that find that their foreign partners refuse to honor their contracts. These hurdles allow foreign manufacturers to continue to injure American businesses and consumers, and also put American manufacturers at a competitive disadvantage since they allow foreign manufacturers to offer cheaper products that do not comply with American safety requirements. Two major hurdles to proper accountability are the inability to serve process on the foreign manufacturer and the ability of that foreign manufacturer, even if served, to evade the jurisdiction of American courts. As the witnesses testified at the hearing, legislation that addresses these issues is necessary and appropriate. The Foreign Manufacturers Legal Accountability Act addresses both concerns. The first problem, the inability to serve process on a manufacturer, essentially means that it is difficult for an American to give a foreign manufacturer the documents necessary to give it the legally required notice that it is the subject of a lawsuit. This sounds like a simple step, and it should be. Unfortunately, however, it is very hard to serve process on foreign companies abroad. As witnesses explained at the hearing in May, service abroad is complicated by the Hague Convention on the Service Abroad of Judicial and Extra Judicial Documents in Civil and Commercial Matters, to which the United States is a signatory. Under that convention, a complaint must be translated into the foreign language, transmitted to the Central Authority in the foreign country, and then delivered according to the rules of service in the home country of the defendant. This can cause months and even years of delay, not to mention great expense for Americans. The Foreign Manufacturers Legal Accountability Act will allow Americans to overcome that procedural hurdle by serving legal papers inside the United States on registered agents of foreign manufacturers. The bill requires the heads of federal government agencies such as the Food and Drug Administration to pass regulations requiring that foreign manufacturers of products regulated by their agencies register an agent who will accept service of process. It allows regulators to exclude manufacturers who only import a minimal amount of products into the United States. It imposes a minimal burden on foreign manufacturers, since they would only have to appoint one agent to accept service of process for all state and federal regulatory and civil actions anywhere in the United States. The bill allows the manufacturer to choose any location for that agent with a ``substantial connection to the importation, distribution, or sale of the products of such foreign manufacturer or producer.'' This clear and straightforward system will allow Americans to commence their lawsuits fairly and promptly, and ensure that foreign manufacturers have proper and fair notice of the proceedings brought against them. It will not conflict with American obligations under the Hague convention, since that convention applies to service of process on foreign manufacturers in their home countries, not in the United States. The second hurdle, the inability to establish personal jurisdiction over foreign manufacturers, can end a lawsuit against a foreign manufacturer before it even begins. Think about how unfair this is. A foreign manufacturer sells its defective products in the United States, injures American consumers and businesses, and then argues that it is not subject to the courts in the state where the American was injured-- in legal parlance, that the courts do not have personal jurisdiction over it. As witnesses explained at the hearing, foreign manufacturers raise this technical legal defense to avoid liability even when serious injuries or even death have been caused by their products--their defective tires, fireworks, exercise equipment, bikes, and toys. The Foreign Manufacturers Legal Accountability Act will enable injured Americans to surmount this hurdle. It will make clear to foreign manufacturers that by importing their products into the United States and by registering an agent in the United States, they are consenting to the jurisdiction of the courts in the state where their agent is located. By consenting to jurisdiction, the manufacturers will avert unnecessary and expensive legislation about technical legal issues and allow courts to settle the merits of disputes. This approach is fair to foreign manufacturers since all American manufacturers are subject to the jurisdiction of the courts of at least one state. This bill therefore complies with the trade principle that we should not subject foreign manufacturers to burdens not already imposed on domestic manufacturers. Indeed, the Foreign Manufacturers Legal Accountability Act is ultimately about fairness. We all know American manufacturers comply with regulations that ensure the safety of American consumers and businesses. When they fail to do so, they must answer to regulators and are held accountable through the American tort system. Unfortunately, however, foreign manufacturers are not being held to the same standards--injuring American consumers and businesses, and putting American manufacturers at a competitive disadvantage. We must level the playing field for all manufacturers and provide justice for American consumers and businesses. The Foreign Manufacturers Legal Accountability Act will allow us to make a major step in that direction. It covers major product categories including consumer goods, drugs, cosmetics, and chemicals, and it requires relevant agencies to study workable approaches to ensure that foreign food producers also are brought within the ambit of the American legal system. Protecting Americans and holding foreign manufacturers accountable when their products harm American consumers and businesses is a bipartisan issue. Everyone agrees that we should do what we can to keep Americans safe from defective products. So too, I think, do we all agree that American companies should not be at a competitive disadvantage to their foreign counterparts. The Foreign Manufacturers Legal Accountability Act builds on those fundamental agreements. I am grateful to my colleagues Senator Sessions and Senator Durbin for their hard work on this bill and look forward to working with my colleagues on both sides of the aisle to see it passed into law.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I rise today to introduce legislation that would help families struggling with medical debts overcome hurdles that under current law make it difficult for them to find relief in the bankruptcy system. With medical costs at an all-time high and the unemployment rate hovering near 10 percent nationwide--and 12.4 percent in my home State of Rhode Island--too many individuals and families struck with injury and illness have no other option but to file for bankruptcy. According to a recent Harvard University study, health care-related costs have been a primary driver of personal bankruptcy filings, contributing to over 62 percent of filings in 2007. The statistics are as shocking as the personal stories are heartbreaking. Countless Rhode Islanders have written to me during my time in office asking for help with crippling medical costs, and I want to share just two of their stories with you today. Adam, a 23-year-old from Bristol, recently underwent surgery for cancer. Adam's treatment plan requires him to undergo a CT scan every 2 months. While his insurance initially paid for his health costs, he received word not long after his surgery that his policy was ``maxed out'' and that he would have to pay $6,700 out of pocket for an upcoming CT scan. As of today, Adam, a young man just starting his adult life, has $20,000 in medical debt and reports that he ``cannot see any light at the end of the tunnel.'' Robert, a veteran and retiree also from Warwick, suffered a major heart attack in November of 2004. Although he had health insurance, Robert was responsible for paying a $2,000 deductible plus 20 percent of the cost of his care. After 40 years of working and saving, these medical costs wiped him out, and he had to sell his home. Adam and Robert have both suffered unexpected medical costs that have turned their lives upside down. These Rhode Islanders, like millions of others nationwide, may be forced to file for bankruptcy to get a clean start--but when they do, they will learn that the bankruptcy process can be time consuming and costly and ultimately may not allow them to stay in their homes. The legislation that I am introducing today, the Medical Bankruptcy Fairness Act of 2009, would help people who because of medical costs have no other choice but to file for bankruptcy. The bill would waive procedural hurdles so that Adam and Robert would have the option of a speedier, less expensive, and more efficient bankruptcy. To begin with, it would waive credit counseling requirements for these debtors. Such requirements have little relevance to people whose debt stems not from poor budgeting but, rather, from uncontrollable medical expenses. The bill would also waive the so-called ``means test,'' making the filing process quicker and less costly and making sure that people have the ability to file to have their debts discharged in chapter 7, as opposed to a chapter 13 plan under which they would have made debt payments for 3 to 5 years. In addition to removing these procedural hurdles, the Medical Bankruptcy Fairness Act would give people with high levels of medical debt the ability to retain at least $250,000 in home value through the bankruptcy process. The ``homestead exemption'' is one of many aspects of bankruptcy law that looks to the laws of the individual States. While filers in some States already have the ability to preserve home equity at this level, a number of States offer homestead exemptions of $5,000 or less. With the average home price nationwide around $200,000, the $250,000 exemption included in this bill will allow the majority of individuals and families crushed by medical debt to keep their homes. Finally, the bill would eliminate an obstacle that prevents many bankruptcy filers from accessing the chapter 7 bankruptcy system, which as I mentioned earlier is the simplest and most efficient form of bankruptcy. Because attorneys' fees are ``discharged'' at the end of a chapter 7 bankruptcy, attorneys generally require the upfront payment of fees in chapter 7 proceedings. Many debtors who would be better off filing for a quicker and less costly bankruptcy in chapter 7 are forced to file in chapter 13 because they don't have enough cash to pay the attorney. The Medical Bankruptcy Fairness Act would make attorneys' fees nondischargeable in chapter 7 bankruptcies, as in chapter 13 bankruptcies, making it easier for debtors to elect the more efficient chapter 7 proceeding. Before I conclude, I want to acknowledge the hard work of my colleague from Massachusetts, Senator Kennedy, on the issue of medical debt. Senator Kennedy offered amendments during the consideration of the 2005 bankruptcy reforms that would have given people struggling with medical debts treatment similar to that which they would get under the Medical Bankruptcy Fairness Act. Unfortunately, those amendments were voted down. I look forward to working with Senator Kennedy to make sure that we don't miss another opportunity to help Americans struggling with medical debt. There are people in every State suffering from medical hardship and related debts who would benefit from this legislation. I urge my colleagues to work with me to pass it to Adam and Robert and the millions like them nationwide a clean start in bankruptcy.

Mr. WHITEHOUSE. I rise to speak in support of the Foreign Manufacturers Legal Accountability Act of 2009, which I am introducing today with the ranking member of the Judiciary Committee, Senator Sessions, and Senator Durbin. This bipartisan bill is an important step in protecting American consumers and businesses from injuries caused by defective products manufactured outside the United States. Those products hurt American consumers--they lead to serious injuries, and even death--and they hurt the American businesses that must deal with angry customers, product recalls, and unusable inventory. The list of recent examples of Americans injured by defective foreign products is shocking. Last year, a contaminated blood thinner from a foreign manufacturer caused severe medical reactions and contributed to numerous deaths. In 2006, a foreign-made, lead-tainted charm bracelet claimed the life of a 4-year-old. The autopsy demonstrated that the charm was 99 percent lead, 1,650 times more than the 0.06 percent lead limit specified in enforcement guidelines for children's jewelry. Imported food products from seafood to honey have been contaminated with unthinkable chemicals, including veterinary drugs banned in domestic production, potentially harmful antibiotics, and unapproved food additives. Sixty million packages of pet food contaminated with tainted wheat gluten have been recalled in the last two years. Substandard tires have failed, leading to fatalities. Most recently, defective drywall imported from China has been found to contain excessively high levels of sulfur, causing houses to smell like rotten eggs, corroding copper wiring, and making expensive appliances fail. Thousands of homes may be affected. At a hearing that I chaired in May, the Subcommittee on Administrative Oversight and the Courts explored the legal hurdles facing consumers who are injured by defective foreign products and by businesses that find that their foreign partners refuse to honor their contracts. These hurdles allow foreign manufacturers to continue to injure American businesses and consumers, and also put American manufacturers at a competitive disadvantage since they allow foreign manufacturers to offer cheaper products that do not comply with American safety requirements. Two major hurdles to proper accountability are the inability to serve process on the foreign manufacturer and the ability of that foreign manufacturer, even if served, to evade the jurisdiction of American courts. As the witnesses testified at the hearing, legislation that addresses these issues is necessary and appropriate. The Foreign Manufacturers Legal Accountability Act addresses both concerns. The first problem, the inability to serve process on a manufacturer, essentially means that it is difficult for an American to give a foreign manufacturer the documents necessary to give it the legally required notice that it is the subject of a lawsuit. This sounds like a simple step, and it should be. Unfortunately, however, it is very hard to serve process on foreign companies abroad. As witnesses explained at the hearing in May, service abroad is complicated by the Hague Convention on the Service Abroad of Judicial and Extra Judicial Documents in Civil and Commercial Matters, to which the United States is a signatory. Under that convention, a complaint must be translated into the foreign language, transmitted to the Central Authority in the foreign country, and then delivered according to the rules of service in the home country of the defendant. This can cause months and even years of delay, not to mention great expense for Americans. The Foreign Manufacturers Legal Accountability Act will allow Americans to overcome that procedural hurdle by serving legal papers inside the United States on registered agents of foreign manufacturers. The bill requires the heads of federal government agencies such as the Food and Drug Administration to pass regulations requiring that foreign manufacturers of products regulated by their agencies register an agent who will accept service of process. It allows regulators to exclude manufacturers who only import a minimal amount of products into the United States. It imposes a minimal burden on foreign manufacturers, since they would only have to appoint one agent to accept service of process for all state and federal regulatory and civil actions anywhere in the United States. The bill allows the manufacturer to choose any location for that agent with a ``substantial connection to the importation, distribution, or sale of the products of such foreign manufacturer or producer.'' This clear and straightforward system will allow Americans to commence their lawsuits fairly and promptly, and ensure that foreign manufacturers have proper and fair notice of the proceedings brought against them. It will not conflict with American obligations under the Hague convention, since that convention applies to service of process on foreign manufacturers in their home countries, not in the United States. The second hurdle, the inability to establish personal jurisdiction over foreign manufacturers, can end a lawsuit against a foreign manufacturer before it even begins. Think about how unfair this is. A foreign manufacturer sells its defective products in the United States, injures American consumers and businesses, and then argues that it is not subject to the courts in the state where the American was injured-- in legal parlance, that the courts do not have personal jurisdiction over it. As witnesses explained at the hearing, foreign manufacturers raise this technical legal defense to avoid liability even when serious injuries or even death have been caused by their products--their defective tires, fireworks, exercise equipment, bikes, and toys. The Foreign Manufacturers Legal Accountability Act will enable injured Americans to surmount this hurdle. It will make clear to foreign manufacturers that by importing their products into the United States and by registering an agent in the United States, they are consenting to the jurisdiction of the courts in the state where their agent is located. By consenting to jurisdiction, the manufacturers will avert unnecessary and expensive legislation about technical legal issues and allow courts to settle the merits of disputes. This approach is fair to foreign manufacturers since all American manufacturers are subject to the jurisdiction of the courts of at least one state. This bill therefore complies with the trade principle that we should not subject foreign manufacturers to burdens not already imposed on domestic manufacturers. Indeed, the Foreign Manufacturers Legal Accountability Act is ultimately about fairness. We all know American manufacturers comply with regulations that ensure the safety of American consumers and businesses. When they fail to do so, they must answer to regulators and are held accountable through the American tort system. Unfortunately, however, foreign manufacturers are not being held to the same standards--injuring American consumers and businesses, and putting American manufacturers at a competitive disadvantage. We must level the playing field for all manufacturers and provide justice for American consumers and businesses. The Foreign Manufacturers Legal Accountability Act will allow us to make a major step in that direction. It covers major product categories including consumer goods, drugs, cosmetics, and chemicals, and it requires relevant agencies to study workable approaches to ensure that foreign food producers also are brought within the ambit of the American legal system. Protecting Americans and holding foreign manufacturers accountable when their products harm American consumers and businesses is a bipartisan issue. Everyone agrees that we should do what we can to keep Americans safe from defective products. So too, I think, do we all agree that American companies should not be at a competitive disadvantage to their foreign counterparts. The Foreign Manufacturers Legal Accountability Act builds on those fundamental agreements. I am grateful to my colleagues Senator Sessions and Senator Durbin for their hard work on this bill and look forward to working with my colleagues on both sides of the aisle to see it passed into law.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the Senate proceed to the consideration of S. Res. 249, which was submitted earlier today.

Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, and the motion to reconsider be laid upon the table.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I want to respond to what the Senator was saying, that this trajectory is very likely to continue. Every signal and every prediction is it is going to continue and we will hit that 35 percent, spending a third of our entire economy just on health care, and that really does break our country. It is a terrible indictment of our generation if we allow it to happen. But we also have a great opportunity here, which the chairman has also pointed out. As you know, over and over again, as the distinguished Presiding Officer knows, over and over again, in legislation, we are asked to make hard choices between two things, and if you go one way, you cannot go the other. Economists would call it a zero sum game. You cannot have both. There is no win-win. This is a situation where there is a win-win. As the distinguished chairman pointed out, we are spending 17 percent of our gross domestic product on health care in this country. It is the worst record, the highest expenditure, of any country in the world. Most other developed nations spend 8 or 9 percent. That is the average of the European Union of their gross domestic product on their health care. For that exaggerated expenditure, what do we get? Lousy health outcomes. We are way behind our developed competitor nations in obesity. We have far higher rates of obesity in our country. We are way behind in child mortality. We have far greater rates of child mortality in the United States than there are in our developed nations with which we compete. There is far greater longevity in those countries than ours. Americans do not live as long as people in our competitor nations, the developed ones, and a lot of it has to do with our health care system. So by bending that curve, by investing in prevention, by improving the quality by investing in electronic health records, by eliminating those medical errors, we accomplish two things at once. We improve the health statistics of our Nation, we have people who live long, we have less babies who die in childbirth, we have a thinner and less obese and less ill nation, and we lower the costs, and we do it together. So it should be something we could agree on, on both sides of the aisle, but, unfortunately, these old canards about socialized medicine and how we could not possibly have a public option--except for the fact we already have it in half our States, including our own; but we are not going to talk about that right now, we are just going to say we could never have it--that is the quality of the debate, when we have this huge win-win in front of us. I hope everybody has a chance to sort of think about this over the break when we are gone and that we can come back with a new spirit of bipartisanship to really address this problem, seize that win-win, change the cost curve down, and solve this problem for the American people. I will make one last point. We have misled the public a little bit in our discussion, and we have done so because of the Congressional Budget Office and its professional capabilities. The Congressional Budget Office is very good at predicting what costs are going to be. So everybody has heard that our bill might be $600 billion, that the Finance bill might be $900 billion. They see the costs and they say: Well, how could you possibly be talking about savings when all we hear about are costs? All CBO can say about savings is that--and this is a quote--large reductions in health care costs are possible--large reductions. But they cannot quantify it. They cannot give us a number. And they have told us why they cannot give us that number. They cannot give us that number because we can give the Obama administration, here in Congress, the tools to solve this problem. We already passed the electronic health records legislation. If, God willing, we pass the chairman's legislation from the HELP Committee, they will have the tools to improve the quality and turn the curve. They will have the tools to improve prevention and turn the curve. They will have the tools to reduce the unnecessary, wasteful administrative fighting between doctors and hospitals and insurance companies, that try not to pay them. That whole fight can disappear or at least shrink a lot, and that will help turn the curve. But CBO cannot predict how effectively the Obama administration will do that. Like any CEO, the President of the United States and his staff are going to have to manage this problem, and that is where the savings will come. So people should not be misled that there are not real savings possible. Not only are they possible, they are mandatory. We have to turn this curve, and we have to do it dramatically. We can do it because we could drop our GDP expenditure of this by 50 percent and still have health care as good, if not better, than all of our competitor nations: France, New Zealand, Canada, England, Holland--all these countries--Japan. We can do it. The promise is out there. We should not let the CBO scoring fool the public. That is my last point. Mr. President, I yield the floor, and I will relieve the distinguished Presiding Officer so he can speak as the Senator from Colorado.

Mr. WHITEHOUSE. Mr. President, will the Senator yield for a moment?

Mr. WHITEHOUSE. Let me thank Chairman Dodd for his leadership and for his remarks. He said he would give us a discussion of where we are, and he has done a wonderful job of showing how this bill will improve the lives of regular Americans in a very concrete way, including particularly Americans who have insurance. To supplement his discussion of where we are, I wanted to give a quick discussion of where we have been because the trajectory of where we have been to where we are tells us something about where we are going. And everybody in this country, insured or uninsured, should have some real concern about where we are going in health care in this country if we do not act. The year I was born was 1955, and this was the headline from the New York Times in 1955. It is hard to read the little part here; I will read it to you. It says: The Problem of Cost. Millions of Americans cannot afford to pay the costs of medical care, and they are not protected by adequate health insurance. That was 1955. This section says: In human terms, this meant that the American had to scrap his budget, dig into savings or go into debt, to pay some $7.5 billion for doctors, hospitals, dentists, nurses, and the myriad physical accessories of medical care. That was 1955, when the Nation's medical bill ran over $10 billion. They were horrified to say over $10 billion. It is now over $2.5 trillion. So that is the year I was born. We were already bemoaning the state of America's health care system. This is 1979. I had just gotten out of college. And the HEW Secretary said: Health cost called unjustified. HEW Secretary Patricia Roberts said: The quality of American health care does not justify its price tag of more than $200 billion a year. Still bemoaning the health care problems, still not getting anything done about it. Now, 1988. This was the year my wife became pregnant with our first child. And here it is. Prospects: Soaring health care costs. Joseph Califano said--he was the former Secretary of Health and Welfare--``The average jump in premiums could hit 30 percent in 1989.'' But at the same time, we are getting less for it. Chairman Dodd just talked about a 20-percent jump in his State recently. You think this was happening today? It is from 1988, 20 years ago. The more things change in health care, the more they stay the same. Here is 1992. Health care costs increasing at more than twice the rate of wages have made benefits so expensive it would be surprising if companies were not responding. ``Health care costs dampening hiring.'' And they dampen wages, as we have seen, and increasingly businesses are having to avoid health care because they cannot keep up with that cost. That from 1992. So we took those stories and we put them together on this chart. This shows the increases in America's spending on health care in each of those years, starting back the year I was born, that first story, 1955, then 1979, then 1987, then 1992, then 2009. It increased from $12 billion, which seemed like a big number then, to $200 billion, to over half a trillion dollars, to $850 billion, nearly a trillion, and now $2.5 trillion. Look how much it has bumped from 1992 to 2009. This, my friends and colleagues, is what is called a trajectory. It is going to keep going if we do not do anything about it. The latest estimates for my home State of Rhode Island are that in 2016, which is not too far from now, in 2016, probably about this far up on the graph, $26,000 a year is what a family will have to pay for family coverage--more than $26,000 a year. That means if you are a comfortably earning hard-working individual pulling down a salary of $52,000, half of your income, pretax income, goes out the door for health care before you start anything else. That is not sustainable. That is why we talk about Thelma and Louise instead of Harry and Louise. That is why we need to change the direction of our health care system, not just for the uninsured but for everyone so that all Americans can have a secure health care future. No American will have a secure health care future if this trajectory is allowed to continue. So if you are out there asking, How would a change in the direction of our health care system help me, think of Thelma and Louise headed off the cliff because that is what the American health care system is like right now. The cliff is coming, and we are all in the car together, and together we have to solve this problem. Because we have to solve it together, it is very disappointing that so many of our friends on the other side have refused to participate in this conversation and have reverted to labels and name calling: socialized medicine, government mandates--things that have nothing to do with our legislation but are designed to scare people and to provoke those who have not sat down and read the bill and do not know better. It is unfortunate. What does it measure up against? Let me show you a couple of other things. We have had a lot of talk in recent days about the stimulus plan and how effective that has been--a $787 billion stimulus. There it is, that $0.88 trillion is the stimulus for all of the barking and moaning we have had about how much that cost this country. That is what it is. The $8.9 trillion is what George Bush ran up in debt for this country during his Presidency. Three-quarters of the debt this country bears, George Bush ran up during his Presidency. It was an orgy of fair-weather borrowing. When we didn't need to go into debt to protect our economy, when things were humming along, that is what he did, $9 trillion. Here is our unfunded Medicare liability, $38 trillion. We don't have $38 trillion now. Unless we do something about this cost, we are truly going off the cliff in that car with Thelma and Louise, following that trajectory of cost I showed. It is not all going for health care that makes everybody better. It is going to a lot of other things. Here is one thing it is going to. Insurance industry profits. Have you noticed your wages going up a lot in the last couple years? For a decade, from 1999 to 2009, wage growth has been 29 percent. That is less than 3 percent a year and way less than 3 percent a year compounded. That is what wage growth has been like. If you don't feel like your wages have gone up much in the last decade, you are right. They haven't. For many Americans, wages flat- lined for a decade. How about your insurance premiums? Did they flat- line? No, sir. The insurance premiums went through the roof, increased 120 percent, more than doubled in one decade. That is the steep curve I showed you, 120 percent. How about insurance industry profits? Up 428 percent in the same period that wages were up 29 percent. So there is something we can do something about. On insurance, so many Americans are uninsured, it is worth taking a look at this. We have all used and heard the figure about 46, 47 million Americans who are uninsured. That is the people who are uninsured at any given minute. As I stand here at this desk right now, out there in America there are about 47 million people who are uninsured. But some people gain insurance and some people lose insurance. Over the course of a year, the number of people who lose their insurance, whose families lose their insurance, is nearly 87 million. If you started on the east coast and moved your way west, and when you got to the Mississippi and you started into Minnesota, Iowa, Missouri, Arkansas, and Louisiana and you took the population of every single State west of that all the way to California, the population of all these States is about 87 million, to give you an idea of how many Americans lose their health insurance and have to go without it at a point during the year. Then there are catastrophic levels of waste in our health care system. Our former Treasury Secretary, a Republican, knowledgeable about this, ran the Pittsburgh Regional Health Initiative for years. He said $1 trillion of annual waste is associated with process failures. He has calculated $1 trillion a year of waste in our health care system. The Lewin Group is a group many people talk about here. They are described on the Senate floor as the gold standard in health care information. Sources of potential excess costs: Excess costs from incentives to overuse services, from poor care management and lifestyle factors, excess costs due to competition and regulatory problems, excess costs due to transactional inefficiencies; $151 billion here, $519 billion here, $135 billion here, $203 billion here. As we say in Washington, a billion here and a billion there, and pretty soon it starts to add up. This adds up to over $1 trillion in waste in congruence with what the former Treasury Secretary said. It is not just newspapers that are saying it. It is also President Obama's own Council of Economic Advisers. Their report on July 9 said that: Efficiency improvements in the U.S. health care system potentially could free up resources equal to 5 percent of U.S. GDP which is above $700 billion a year. They also noted: [It] should be possible to cut total health expenditures by about 30 percent without worsening outcomes . . . [which] would again suggest that savings on the order of 5 percent of GDP could be feasible. Again, two calculations coming to the same point, savings of over $700 billion a year. That is one of the things we are trying to do. In addition to family- by-family improvements, small business-by-small business improvements, individual-by-individual improvements that Chairman Dodd has wrought through this bill, we are also trying to turn around a health care system that has been out of control, that has not been reformed for my entire lifetime. So that now is our moment, and it is on a trajectory that will break this country if we don't do something about it. We simply cannot continue a cost curve such as this that is already at $2.5 trillion and is accelerating northward. We can't be competitive with our international competitors in trade if we do this. We can't sustain our families if we do this. We simply cannot keep this government fiscally solvent if we do it. We have to turn the car before it gets to the cliff. If we can't do that, then shame on us. I think we need to be in this together. One of the ways we will do this is through a public plan. A public plan is important because there are a number of ways in which you change those cost curves. You don't have to take services away from people because of all that waste. What you have to do is deal with the waste. You build in electronic health records for every American so the efficiencies that other industries have enjoyed from the computer revolution finally hit health care which, according to the Economist, has the worst information infrastructure of any American industry except mining--the mining industry and then health care. Huge improvements and huge savings from that. Quality improvements can save money. It has been demonstrated over and over again, as in Senator Stabenow and Senator Levin's home State of Michigan. They did quality improvements in intensive care units. In 15 months, they saved $150 million and 1,500 lives, and it wasn't even in all the intensive care units. It was just in one State. It was that one kind of quality improvement program, just in intensive care units. So huge gains to be made from quality improvements. Prevention. Senator Harkin spoke the other day about what can be gained from preventing particularly conditions that arise from diabetes. Enormous savings, if we can focus on all that. Transparency and improved administrative efficiency so doctors and insurers aren't fighting all the time. We can do all those things, but somebody has to lead. The question for us is, can we trust the private insurance companies to lead in all those areas. If you look back, you see they never have. We are way behind where we should be. They are not leading. It will take a competitive public option to pick up those issues and run with them and show what we can do. I will close with this. One of the things we are hearing is you can't possibly have a public option. It is a line in the sand. The very distinguished ranking member of the HELP Committee has said it is intolerable to have a public option. It simply would not work. It can't happen. There are two ways we get health insurance in this country. One is through a private health insurance provider. The other is through workers' compensation, which the business community runs in order to protect itself against the injuries and illnesses and diseases and catastrophic harms that can happen to people at work and that they have to protect themselves against. All across America, there are State funds, public options that deliver health care insurance, State by State, over and over again. So when the ranking member goes home to his State of Wyoming, not only is a public option for delivering health insurance not anathema, it is what he goes home to. He goes home to a single-payer public option for health care, one his business community appears perfectly satisfied with and he appears perfectly satisfied with. Their Presidential candidate, John McCain, goes home to Arizona to a public plan with 56 percent market share. It competes in a lively workers' compensation health insurance market. The distinguished minority leader goes home to Kentucky, and in Kentucky his business community enjoys a public option for workers' compensation health insurance. So we should be able, in the spirit of coming together in the face of this national emergency, to put aside the old notion that a public option simply can't exist, can't happen. It happens in nearly half our States. It is supported by the business communities in those States. It delivers care efficiently, and none of the Republican Senators from those States have, to my knowledge, ever complained about it in that context. I will conclude with that. I think we are at a turning point, and it is important, as we go, that we remember this is a long struggle we have been on. My entire lifetime, since 1955, it has gotten dramatically worse, and the rate at which it has been getting worse is increasing. It is worsening. We have to do something about it now--for everybody in this country, for businesses large and small, and for people and families, insured and uninsured, and we are pledged to do that. I thank the very distinguished chairman and yield the floor.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid upon the table, with no intervening action or debate, and that any statements relating to the resolution be printed in the Record.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the Finance Committee be discharged from further consideration of H.R. 3325 and that the Senate then proceed to its consideration.

Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the bill be read three times, passed, and the motion to reconsider be laid upon the table; further that any statements be printed in the Record.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid upon the table, with no intervening action or debate, and any statements related to the resolution be printed in the Record.

Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the Judiciary Committee be discharged from further consideration of S. Res. 40, and the Senate proceed to its immediate consideration.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I am honored to join my distinguished colleague from New Jersey here today on the Senate floor to speak in support of the confirmation of Judge Sonia Sotomayor as the next Associate Justice of the U.S. Supreme Court. I had the privilege to sit on the Judiciary Committee for her confirmation hearing, and I join all of my committee colleagues on both sides of the aisle who have complimented Chairman Leahy for a very well-run hearing. I was proud to vote for Judge Sotomayor in the Judiciary Committee, and I will be proud to vote for her confirmation here on the Senate floor. Judge Sotomayor's remarkable education and professional qualifications, her commitment to public service, her uncontroversial 17-year record on the Federal bench--longer than any nominee in 100 years--her responsiveness and patient judicial temperament at the hearing, all confirm to me her pledge that she will respect the role of Congress as representatives of the American people; that she will decide cases based on the law and the facts before her; that she will not prejudge any case but listen to every party that comes before her; and that she will respect precedent and limit herself to the issues that the Court must decide; in short, that she will use the broad discretion of a Supreme Court Justice wisely. I applaud those of my colleagues who have acknowledged that Judge Sotomayor falls well within the mainstream of the American legal profession. At the same time, it is disappointing that so few Republican colleagues have been willing to recognize her clear qualifications for our highest Court. The nearly unanimous party-line opposition offered by Republicans in committee and here on the floor raises serious concerns whether some of my colleagues would ever be willing to vote for anyone outside of the Federalist Society. To my Republican colleagues in opposition, I ask: What Democratic nominee would you vote for, if not Judge Sotomayor, with her vast experience, her commitment to the rule of law, proven indisputably over 17 years, her remarkable credentials, and her extraordinary moving American life story? Unfortunately, Judge Sotomayor seems to be walking proof that conservative political orthodoxy is now their confirmation test, masked as concerns about judicial activism. Many of my Republican colleagues unfairly ignore her long record to base criticisms on strained interpretations of a few routine and appropriate circuit court opinions and a few remarks taken out of context. Those criticisms feel, quite frankly, like the criticisms of someone who is determined to find fault with a nominee. Take, for example, the New Haven firefighters case. The per curiam opinion in Ricci was based on controlling second circuit and Supreme Court precedent. The sixth circuit took the same approach in a similar case arising in Memphis. The role of a circuit court is to follow existing precedence of the Supreme Court and the circuit court. That is what the Ricci per curiam did. The Supreme Court may have reversed, but it did so 5 to 4 on the basis of an entirely new test it created. It is absurd to call Judge Sotomayor an activist for following existing precedent. If you want a judicially conservative opinion, the Ricci per curiam is just that. The decision in Maloney was also properly conservative in a judicial sense. It approaches with caution a newly minted and narrowly enacted constitutional right whose extension to the States would upset generations of practice and experience by sovereign States regulating guns within their borders. A seventh circuit panel, with two very prominent conservative judges on it, correctly did exactly the same thing. A ninth circuit panel reached a different conclusion, and then that decision was vacated by the circuit to reconsider that case en banc. Rather than engaging in a serious inquiry of Judge Sotomayor's fitness for the Supreme Court, many of my colleagues have made this nomination into a referendum on whether the newly minted right to bear arms should be incorporated against the States for the first time in our Nation's history. This is doubly unfair. First, Judge Sotomayor could not answer questions at her hearing that would suggest how she would rule in later cases. That is inappropriate. Second, it is inappropriate to try to force on a judge a particular political view as the price of admission to her judicial office. Criticisms of a few stray lines in Judge Sotomayor's various speeches are equally perplexing. Judge Sotomayor's long and noncontroversial 17- year judicial record should allay any concerns about those remarks, but so should the context of those speeches themselves. The ``wise Latina'' comment we have heard so much about came in a speech that argued how important it is for judges to guard against bias and to be aware of their own prejudices. Is it not better and truer to admit that we all have prejudices we must manage than to pretend that White males form some sort of ideal cultural baseline that has no biases? Senator Specter said it well at the committee vote. ``There is nothing wrong with a little ethnic pride and a desire to encourage her law student audience.'' Maybe we should try to put ourselves in their shoes. Perhaps, with a little empathy ourselves, it might be easier to understand how a profession and a judiciary dominated by White males might look to those young law students, and how important a little encouragement to them might be that their experiences might give them something valuable to contribute; that they are not the exception; that they are welcome and fully a part of our society, and that they bring something valuable not only to the profession but, one day, perhaps, even to the judiciary. In sum, my Republican colleagues' criticisms of Judge Sotomayor appear to be grounded in conservative political idealogy rather than legitimate concern that Judge Sotomayor is not fit to serve on the Supreme Court, grounded in a desire for more of the rightwing Justices who in recent years have filled out a conservative wing on the Supreme Court. That wing has marched the Court deliberately to the right in the last few years, completely discrediting the Republican claim that judges are mere ``umpires.'' Jeffrey Toobin is a well-respected legal commentator, particularly focusing on the Supreme Court. He has recently reported: In every major case since he became the Nation's 17th Chief Justice, Roberts has sided with the prosecution over the defendant, the State over the condemned, the executive branch over the legislative, and the corporate defendant over the individual plaintiff. And is it a coincidence that this pattern has served the interests and reflected the values of the contemporary Republican Party? Some coincidence. Some umpire. The phrase ``liberal judicial activism'' is now conservative speak for any outcome the far right dislikes. They did not use it when the conservative block of the Court announced, by the barest of a 5-to-4 margin, an individual right to bear arms that had gone unnoticed by the Supreme Court for the first 220 years of its history. If that is not an activist decision, the term has no meaning. It is just activism that conforms with a deliberate Republican strategy of many years duration to pack onto America's courts proven conservative judges who will deliver the political goods they seek. Setting aside all this politics, we should also never forget, never overlook the historic role that judges play in protecting the less powerful among us. We should always appreciate how a real-world understanding of the real-life impact of judicial decisions is a proper and necessary part of the process of judging. Judge Sotomayor's wide experience, I hope, will bring her a sense of the difficult circumstances faced by the less powerful among us--the woman on the phone, shunted around the bank from voice mail to voice mail for hours as she tries to find someone to help her avoid foreclosure for her home; the family struggling to get by in the neighborhood where the police only come with raid jackets on; the couple up late at night at the kitchen table after the kids are in bed sweating out how to make ends meet that month; or the man who believes a little differently or looks a little different or thinks things should be different. If Justice Sotomayor's wide experience gives her empathy for those people so that she gives them a full and fair hearing and seeks to understand the real-world impact of her decisions on them, she will be doing nothing wrong--nothing wrong by the measure of history, nothing wrong by the measure of justice. Experience, judgment, wise use of discretion, and a willingness to stand against oppression have always been the historic hallmarks of a great judge. As to experience, Justice Oliver Wendell Holmes famously explained: The life of the law has not been logic: it has been experience. The felt necessities of the time the prevalent moral and political theories, intuitions of public policy, avowed or unconscious, even the prejudices which judges share with their fellow-men have had a good deal more to do than the syllogism in determining the rules by which men should be governed. The law embodies the story of a nation's development through many centuries, and it cannot be dealt with as if it contained only the axioms and corollaries of a book of mathematics. As to judgment, Justice John Paul Stevens has observed: [T]he work of federal judges from the days of John Marshall to the present, like the work of the English common-law judges, sometimes requires the exercise of judgment--a faculty that inevitably calls into play notions of justice, fairness, and concern about the future impact of a decision. As to discretion, Justice Benjamin Cardozo wrote: The judge, even when he is free, is still not wholly free. He is not to innovate at pleasure. He is not a knight-errant, roaming at will in pursuit of his own ideal of beauty or of goodness. He is to draw his inspiration from consecrated principles. He is not to yield to spasmodic sentiment, to vague and unregulated benevolence. He is to exercise a discretion informed by tradition, methodized by analogy, disciplined by system, and subordinated to ``the primordial necessity of order in the social life.'' Wide enough in all conscience is the field of discretion that remains. And, as Alexander Hamilton explained in the Federalist Papers, courts were designed to be our guardians against ``those ill humors, which the arts of designing men, or the influence of particular conjunctures, sometimes disseminate among the people . . . and which . . . have a tendency . . . to occasion . . . serious oppressions of the minor party in the community.'' Those oppressions tend to fall on the poor and voiceless. But as Hamilton noted, ``[c]onsiderate men, of every description ought to prize whatever will tend to beget or fortify that temper in the courts: as no man can be sure that he may not be tomorrow the victim of a spirit of injustice, by which he may be a gainer to- day.'' We should not discard the wisdom of centuries. Experience, judgment, discretion, and protection from oppression--the standard for judges of Hamilton, Holmes, Cardozo, and Stevens. History stands with them. And thoughtful people will note that empathy is a common thread through each of these characteristics. Why might empathy matter? When might it make a difference? Take, for example, the history of the Colfax massacre. Go back to Sunday, April 13, 1873 when a gang of White men murdered more than 60 Black freedmen in Colfax, LA. Some were burned in a courthouse where they had taken refuge; others were shot as they fled the burning courthouse; others were taken prisoner and then executed. U.S. Attorney James Roswell Beckwith determined to prosecute white citizens involved in the Colfax Massacre--not a popular call in those days. The case was tried before a U.S. District Judge William B. Woods, who determined that rule of law should prevail in his district. Predictably, polite White society was outraged. It took notable human empathy in that place and time to see the massacre of the Black freedmen as a crime, and to contemplate trying White men for the murder of Black men. The case was brought as one of the first applications of the Federal Enforcement Act, implementing the Constitution's new 14th amendment, so there was wide room for judicial discretion in that uncharted area of law--no ``balls and strikes'' here. District Judge Woods assured a fair trial, but he also was prepared to honor Congress's desire that outrages upon the Black community should be punished as crime. He had sufficient empathy with the widows and children of the slain freedmen to take seriously their need for vindication, and he had sufficient courage to face the scorn and anger of the White community. Another judge was involved, U.S. Supreme Court Justice Joseph P. Bradley, who under the procedural rules of the time ``rode circuit'' for Louisiana, and could sit in on trials. And sit in he did. He had no sympathy for the former slaves, and little regard for Congress's intent to punish the abuse of freedmen. Disagreeing from the trial court bench with Judge Woods, Justice Bradley found repeated technical faults with the indictments, took a restricted view of the authorities of the 14th amendment, dismissed the charges, and released the defendants to flee, on low bail, pending an appeal. The U.S. Supreme Court upheld its colleague Bradley's opinions, thereby gutting the 14th amendment and the Enforcement Act for a generation, and a wave of murder and violence by Klansmen and White League members, emboldened by de facto immunity from prosecution, swept the South. Reconstruction was vitiated in those weeks. Justice, for the murder of a Black man by a White, departed the South for nearly a century. History and the law ultimately proved district Judge Woods correct, but how much turned on the character of two judges: one who had the empathy to see Black men as victims of crime, and the courage to outrage White opinion by allowing the trial of White community leaders, before a mixed jury no less; the other a judge who valued the status quo, and recoiled from any shock to proper White opinion and authority; indeed, who was the reflection of that proper opinion. That is what we mean by empathy, and while the divisions in our society are less today, there are still people who feel voiceless, whose voices a judge must be attuned to hear; there are still Americans who come to court bearing disadvantages that have nothing to do with the merits of their case. Empathy to look through those disadvantages to see the real merits of the case, even when it is unpopular or offends the power structure is the hallmark of a great judge. The words of Hamilton, Holmes, Stevens, and Cardozo I have quoted display it as history; the contrasting approaches of the two judges after the Colfax massacre display it as justice. My Republican colleagues' misunderstanding of judicial history has led to a missed opportunity for bipartisan support of a highly qualified and moderate judge who falls well within the mainstream of American legal thought. We could be celebrating the first Latina justice of the Supreme Court as a great American achievement. Instead we are having to defend basic principles of American history from assault from the right. I hope that, as the future looks back on this day, it will be the historic nature of this nomination that will be remembered, not the strange and strained efforts to impose right-wing political orthodoxy on the courts that defend our constitutional rights. I look forward to Judge Sotomayor's service as an excellent Supreme Court Justice. I will vote proudly for her confirmation. Mr. President, I ask unanimous consent to have printed in the Record a letter of support of Justice Sotomayor from New York City's mayor, Michael Bloomberg. I also ask to have printed in the Record a letter of support for Judge Sotomayor from former FBI Director Louis Freeh. I yield the floor.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. I would be delighted to talk about that. But the first thing I would like to do is react to a point the distinguished chairman has just made regarding how ironic it is that some of our friends on the other side are so opposed to increasing competition in the insurance industry. One of the things that is particularly ironic is that a great number of our colleagues on the other side go home to their home States to a health insurance system that already is a public option for their business community, their workers' compensation system. The two places you get health care are from the general health insurance marketplace and from the workers' compensation marketplace. You can get workers' compensation coverage, and it will cover small workplace injuries, it will cover catastrophic workplace injuries, it will cover temporary conditions, and it will cover lifetime chronic conditions. It has all of the elements of health insurance coverage and the need for it. Well, when our colleague from Wyoming, the distinguished ranking member of the HELP Committee, goes home to Wyoming, he goes home to a single-payer public option for workers' compensation health insurance. So it can hardly by anathema to have a choice public option. The distinguished gentleman, Senator McCain, who was the Republican candidate for President, goes home to Arizona to a competitive public plan providing workers' compensation health insurance in his home State. The Republican leader himself, Senator McConnell, goes home to Kentucky, to a State where there is a public plan that delivers health insurance, a competitive public plan. And I suspect his employers like it and the people are comfortable with it. Our colleague, Kay Bailey Hutchison, is shortly to go home to Texas to run for Governor. When she does, she will go home to a State that has a competitive public plan that delivers health care through the worker's compensation system. Our distinguished friends in Utah, Senator Bennett and Senator Hatch, who have done so much work on health insurance issues over the years, go home to Utah, where their business community has a competitive public plan for delivering health insurance. So, in addition to the irony of being against competition, their business communities, I believe, are highly favorable to a public plan that competes in the market to deliver health insurance that the business community funds, the workers' compensation health insurance market. So I guess ironies abound here. I would also like to compliment Senator Brown for keeping it real here on the Senate floor and reading those letters and reminding us that when push comes to shove around here, it is not the nametags and the labels that matter, it is not ``socialized medicine,'' it is not ``government takeover,'' it is people who have real problems. I was struck by a letter that was brought to my attention today. I do not know exactly what day it came in, but I saw it today. A working couple with a son, sort of the ideal American family, doing nothing wrong, doing everything right, playing by the rules, working hard. The son becomes grievously ill, has a very grave illness. Over the years, his condition worsens, and ultimately his disease takes his life. They were insured through this whole period, but the insurance was not enough. There were copays, there were limits, there was cost sharing. As a result of all of this, they are deeply in debt. They had to take time off work and spend time caring for him, and so they have had employment issues. Now, this is, again, sort of the ideal American family. They are both working hard. They have a son whom they love. They are doing everything right, and they are playing by the rules. And because he got sick and because our health insurance system is such a nightmare for a family in that situation, they have lost their son, they have lost their savings, and they are about to lose their home. They are about to be put out of the house that has all of the memories of their son. You know, there are people for whom this is very real, and we have to keep our eye on that ball and not on all of the smoke and all of the fear mongering that is happening around here. A lot of that smoke and fear mongering is happening around our public plan. Well, it is not that complicated. It is competitive. It is fair. It has no special subsidies for people who are in that plan versus in competing private plans. It has no special advantage. And it honors President Obama's programs and the promise of all of the Presidential candidates that if you like the plan you have, you get to keep it. You are not forced out of anything. So if it has no special advantages, if it has no special subsidies, why do we support a public option? Why is it better? Well, I would say that there are three reasons we can have some confidence that a public option will make a difference for the kind of people Senator Brown was talking about, the family I was talking about, people who suffer through our existing health care system. The first is, a public plan does not need to take profit out of the system. In 2007, in Rhode Island, one of our insurers, United Health Care, asked permission to remove $37 million as its profit in that year from Rhode Island back to its home headquarters. My State isn't as big as Ohio. It is not as big as Iowa or Connecticut. It is a small State. It has a million people. In one year to take $37 million out of that State, when they only had a 16-percent market share, think of that. A 16-percent market share in a State of a million people is about 160,000 folks they cover, assuming that everybody had coverage; $37 million out of those 160,000 people in 1 year gone for profits. Stop doing that. Stop paying exorbitant salaries such as United Health Care's chief executive who got $124 million in salary. That is a lot of money that could go back into other things in health care. That could help families either get better coverage or pay lower premiums. So there is one thing--no profit, no excess cost. The second is, you could have better dealings between insurers and providers and hospitals than we have right now. Fifteen percent of our health care costs from the insurance side goes to overhead and administration. Most of that goes to denying claims and making life difficult for providers, doctors, and hospitals, when they submit their bills. There is a war, a claims war going on right now between the insurance industry and doctors and hospitals. And 15 percent of what we pay for health care gets burned up on the insurance company side of that war. The insurance companies are bigger and smarter, and they set the rules. So you can bet that the doctors' side of responding to that costs more than 15 percent. In fact, the Lewin Group has estimated that 36 percent of a provider's overhead cost goes to fighting with the insurance industry. Everybody in this place has had the experience or somebody they know or love has had the experience of trying to get a claim paid, having it be denied, submitting a bill, having it be denied, having to wait for treatment that you need while your doctor tries to get prior authorization from the insurance company that says: No, we need more papers. All of that is expensive. None of it provides any health care value, zero. It is all administrative overhead and nonsense. In some cases it is big. I was at the Cranston, RI community health center. It is not a big organization. Rhode Island is not a big State. Cranston is not our capital city, not our biggest town. Its community health center does not have an enormous budget. They spend $300,000 every year on the consultants who help them try to negotiate this payment claims war they are stuck in--$300,000 a year. On top of that, 50 percent of their personnel time, half of their personnel time, goes to fighting with insurance companies. So you take a little place such as the Cranston community health center and you can tell them: Half of your personnel costs can go away or can be devoted to prevention, as the Senator from Iowa has suggested, instead of fighting with the insurance industry. That is an improved model. That is something the public option can pursue. You don't have to fight the providers that way, and the amount of waste that is burned up on all of that warfare for no health care value whatsoever is an opportunity for this public option to achieve. The third area is to more broadly change the busines model. There is a failed private insurance business model right now. It is pretty simple to summarize. No. 1, if they think you are going to get sick, they deny you insurance. You don't even get in the door. No. 2, if they make a terrible mistake and let you in the door and then you have the temerity to get sick, they look for a way to deny coverage. They go through the form and look for a mistake you might have made so they can throw it out. They find something that might have been a preexisting condition. They look for a loophole. If they are stuck, if they can't find a loophole, then they deny payment. They tell you that the coverage you need isn't what you need or they refuse to honor the doctor's bill when it comes through the door. But a business model for an entire industry of denying insurance to the people who they think will get sick and then denying coverage to the people who actually do get sick and, when they can't dodge their coverage responsibilities, denying payment to doctors or hospitals or trying to have some person who is not even a doctor second-guess the coverage that your doctor tells you you need, that is a terrible business model. It has caused immense pain across the country, and it has been a disaster. There is a better business model. A public option can pursue it.

Mr. WHITEHOUSE. I wanted to follow up on Senator Merkley's discussion of the different ways in which somebody who is watching this, and who is insured, can look forward to some benefit from all of this. A simple one would be to think, in your own experience, how often you have gone into your doctor's office and maybe been referred to a specialist or you brought a family member in and you had to take a clipboard and fill out on paper for the umpteenth time your personal health insurance, your billing information, your Social Security information, and whatever it is they want. You have to fill it out over and over again. That is the experience many people have with our health care system. Compare that to going online at--pick one--say, Amazon. You log into Amazon and they say: Welcome, Sheldon Whitehouse. Good to have you back. Here are all the books you bought in the last year or so. Based on that, we think here are more books you might like. Choose something you would like, and your billing information is here. Put those experiences side by side and show where our bill can take the American health care consumer, and what that means for quality of care, and not just for the convenience of not filling out the form, but when you are a pharmacy, it is connected to your laboratory, it is connected to your doctor, it is connected to the hospital, and you are the center of it, and all of it is private and secure. That is a new and better world for everybody, including those who have insurance. Who has not had somebody they know go into a hospital and come out with a hospital-acquired infection? It has happened over and over. I have had a friend who went in for a simple knee surgery, arthroscopic surgery. He was a big athlete in college, and he needed a simple surgery on his knee. He got a hospital-acquired infection--a strong, big guy--and it nearly killed him. It took him out of work for weeks. Mercifully, he recovered and everything is fine. It was touch and go for a while, and the cost of all of that was tremendous from that hospital-acquired infection. He required weeks of medical care. Everybody has had that experience. About 100,000 people every year-- Americans we represent--die every year because of hospital-acquired infections. Senator Harkin tells me that it is the fourth leading cause of death--hospital-acquired infections. They don't care if you are insured when it comes to hospital-acquired infections. The insured will get one just as quickly as the uninsured. The quality provisions of this bill will prevent that and diminish that. That number should be under 5,000. It should be a rarity. Instead, it is a commonality. The system has to change for that to happen. If you have an illness, try to find a prevention program. Ask anybody you know where they can go to find somebody who will support them in getting an appropriate, sensible, supported prevention program for themselves. It is rare to find. It is almost impossible. As I said earlier, when I was talking about the person who had a leg removed for $30,000 because there was nobody there to prevent them from letting that disease get to that stage, there are big savings there. It is a human consequence. You can have all the insurance in the world, but if it doesn't have a prevention option, you are not helped. The last thing I will say is that so many of us who feel comfortable right now with our insurance only feel that way because we have had the good luck not to have the experience of having some loved one or ourselves get very sick. People's viewpoints change when they have had that experience. They find the limits of their policy. They see how fast the copays add up. They see the fine print in what they thought was a great policy when times were good and they were healthy, with just a little injury here and there, and everything was taken care of fine; but when they got really sick they found that policy they thought they could count on wasn't there for them. Now the leading cause of families going into bankruptcy and losing everything in this country is somebody in the family having a health care disaster that wiped them out. That should not be. It happens over and over and over. It happens to the insured. That is not the uninsured. If you are uninsured and you have medical bills, you know you will have problems, but it is the insured who are caught by surprise. They have their homes, their stock portfolios, perhaps, on the side; they have a nest egg, and maybe they help support their children a little bit. And, boom, comes the illness and suddenly they have all these costs and these bills and it is piling up and they cannot keep up and they start to get behind. Before you know it, they have lost it all, and they are in bankruptcy. Americans have that experience every day and every one of us have heard from somebody in our State who is right there. So I think the point the chairman has been making, and Senator Merkley made, about how important it is for people who have insurance, in terms of improving their lives, their quality, and their care and prospects is very poor. I applaud the Senator for having made that point.

Mr. WHITEHOUSE. Yes, it would. And it is an important piece of this legislation that has received far too little attention so far in the debate. It has caused an immense amount of personal pain, human anguish, and suffering that our health care system causes. The distinguished Senator from Ohio, Senator Brown, and I wrote an article about this. We wrote: Your health insurer should be your advocate, not your adversary. The community health insurance option will invest in prevention so that when you are healthy, you stay that way. It will invest in care management coordination, if you have a chronic condition, and it will fight for you, not with you, to get you the best possible care with the least possible hassle. That is what this is all about. The new business model can look in these areas: Quality improvement. We know that improvement in the quality of care in this country can save dollars. But as we were saying earlier in our colloquy, it doesn't save money for the person investing in the quality. It saves it for the system. A public option will have the public purpose necessary to pursue those quality improvements that will drive down cost. Health information infrastructure. We have the worst health information infrastructure in this country of any industry. The only industry that has worse information infrastructure is the mining industry. It is pathetic. But the same principle applies. The doctor investing in that equipment on their desk puts out all the money, takes all the risk, absorbs all the hassle, and the savings go to the insurance companies. So we are underinvested. A public option can make those investments in our electronic health record infrastructure. Prevention strategies. I won't dwell on that because the Senator from Iowa has done such a good job already. Same principle: A public option can pursue the public purpose of protecting public health through prevention in a way that insurers never will because they don't have the financial interest at stake. Finally, you can develop new models of payment to make all those happen, because the way we pay for it now is piecework. Procedure by procedure, the more you do, the more you get paid. Not the healthier your patients are, the more you get paid; the more you do, the more you get paid. There is enormous hope for the whole system. In fact, it may be the only hope for our whole system is to change that business model to a model that works on quality improvement, prevention, investment, payment reform, and electronic health record infrastructure for everybody. A public option will lead us in that way. Perhaps you can trust the private insurance industry to do this, although they never have so far. But perhaps now suddenly something will change and you can trust them to start doing this for the first time, when they never did before. But I don't think it is a wise bet to put all of our eggs in that one basket. Give us a public option and let them compete. I think they can help transform this world. The last thing I will say it is cost control. We have heard a lot about cost control on this subject. There is no better way to have cost control than to get a public option out there doing all these things-- stripping the excess profit out of the system, lowering the administrative costs, ending the warfare with providers that provides no value, and working to a business model founded on quality, prevention, electronic infrastructure, and clearer payment signals. That is where we need to go. The public option takes us there. Nobody cares more about this than the distinguished chairman and particularly the people he has heard from in Connecticut. I would revert back to the chairman to discuss the personal aspects of this on the part of the people he serves.

Mr. WHITEHOUSE. I ask my distinguished colleague from Iowa a question about prevention because it strikes me, if you are a community health center and you want to invest in a health prevention strategy that will help the community you serve have healthier lives and therefore lower the costs to the system for everyone--you put out the money for that program if you are the community health center, you have to staff it, you take all the risks, you do all the work, and yet the benefit of what you have done doesn't come back to you. It goes to private insurers, it goes to the Federal Government, it goes to patients and better health. But it makes it a very unfortunate business proposition for anybody who is doing this on their own, which suggests this is an important place for the Federal Government to invest because the market, by itself, will not take care of this because you invest and you don't get it back. You invest and it goes to the insurance company. You invest and it goes to Medicare. I know Senator Brown wishes to make some statement. I wish to make that point because Senator Harkin's work has been so important on this, and I think that is an important thread.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Mr. President, I met in my office today with Donna, a Rhode Islander who suffers from vascular disease. Donna's condition forced her to give up her job, and therefore her insurance. She cannot afford to buy it on her own, since it would cost her $650 a month-- money she does not have. So she pays for her medications out of pocket. They should be $2,000 per month, but her doctor got them down to $450. But even this is no walk in the park. Donna read me a laundry list of procedures and services she needs but cannot afford, so like so many Americans, she sits waiting, struggling, hoping she does not get worse. I want to tell my colleagues what I told Donna today: the Affordable Health Choices Act, the bill that the HELP Committee passed out last Wednesday, would mean hope and change and help for Donna. It would mean that insurance companies could not deny her a policy because of her vascular disease, as they can, and do, right now. It would mean that insurance companies could not charge her sky-high rates because of her vascular disease, as they can, and do, right now. It would mean that if Donna needed financial help to purchase a health insurance plan, she would get it. No preexisting condition exclusions, affordable premium rates, and subsidies for those who need help purchasing a plan. That is what the HELP Committee's plan offers every American in this country. I also have heard from Madeleine, a Pawtucket resident who cannot afford health coverage despite working two jobs. Her family has a history of colorectal cancer; both her sister and mother lost their fight to this disease. Tragically, Madeleine cannot afford to get a colonoscopy. Without insurance, Madeleine waits and hopes that she doesn't get sick, because that is the only option she has. Under the Affordable Health Choices Act, Madeleine would have the financial help she needs to buy a comprehensive, affordable plan. But even before she did that, even before everything is in place for Madeline to go to a gateway and buy a plan, she could sign up for the Right Choices program. Under Right Choices, even without insurance, Madeline would have access to all basic preventive services. She would get a chronic disease health risk assessment, a care plan, and referrals to community-based resources. Most importantly, she would get the colonoscopy she needs, so that she is not another victim of the terrible disease that took her mother and her sister. It goes without saying that preventing this disease and treating it early would, in the long run, save money for the healthcare system as well as preserve Madeleine's health. I recently had coffee with Shirley, a Middletown resident who described her relief at turning 65. For the past 20 years, she and her husband did not have insurance. As self-employed business owners in their fifties, finding affordable insurance options was impossible, so they went without. They took their chances. Now 65 and eligible for Medicare, they finally have peace of mind. Shirley admits she and her husband were lucky to make it through those 20 years without serious health problems. During our meeting, she urged us to pass health care reform for the millions of hard-working Americans--hard-working, middle-class Americans--who are not as fortunate as she and her husband. Under the bill passed by the HELP Committee, Shirley would not have endured 20 years of fear and uncertainty without health insurance. As a self-employed, small business owner, Shirley would be eligible for tax credits to either continue to offer health insurance to her employees, or to offer it for the first time. Shirley could also take all of her employees to the health insurance gateway, which will give small firms a choice of multiple insurance plans at a lower cost and of a higher quality than what currently exist in the small group market. If you are a small business owner, this bill is for you. Judith from Warwick, has shared with me a story about her brother-in- law, whose lungs collapsed during an outpatient procedure. After staying in the intensive care unit for 28 days, he contracted a hospital infection and was rehospitalized four times. Thankfully, a year later, he is symptom free. However, the costs stemming from the treatment totaled over $500,000. Like her brother-in-law, Judith and her husband are retired and live off of their monthly Social Security check. She reflects that on such a limited income, if she or her husband faced a catastrophic health issue like her brother-in-law, they would be in ``dire straits.'' The HELP Committee bill creates a Patient Safety Research Center at AHRQ, which will support research, technical assistance, and process implementation grants to local providers to teach and implement best practices. No one should go through what Judith's brother-in-law did. No one should contract a hospital infection that leads to not one, not two, not three, but four rehospitalizations. We know how to prevent hospital-acquired infections; we have seen tremendous results in places like Michigan and Rhode Island for years. The HELP Committee bill finally creates a national infrastructure to support the dissemination of these proven techniques so that we can drastically improve the quality of care in our system, and in doing so, drastically lower the cost. Finally, I recently met David, a self-employed resident from Central Falls, who described the astronomical rise in the cost of health insurance for him and his waif. Years ago, he paid $85 per month for their plan; today, he pays approximately $19,000 a year for their health insurance. Despite the dramatic jump in price, their health insurance plan does not cover as much as it used to. To keep their premiums and overall health costs down, David has been forced to drop dental coverage and increase the out-of-pocket expenses he and his wife pay on their plan. He noted, ``I'm almost afraid to get sick, because today's health plans have so many holes in them, they can nickel and dime you to death.'' The Affordable Health Choices Act would do two important things to help David. One, it would require that plans sold in the gateway offer a truly comprehensive set of benefits so that ``affordable'' does not mean ``skimpy.'' Affordable will mean inclusive, available, and accessible. Two, the bill would not allow insurance companies to ``nickel and dime you to death'' as David fears now. Insurance companies would be prohibited from imposing lifetime or annual limits on the dollar value of benefits for any enrollee. So David will not be forced to pay out-of-pocket once he exceeds certain levels of benefits, as he does now. There is some uncertainty both in this building and around this country right now about the future of health reform. I want to remind everyone--my colleagues on both sides of the aisle, my colleagues in the House, Rhode Islanders back home, and Americans across the country, the Senate has already put forth a health reform plan that will work for you. It will work for sill-mil businesses. It will work for Americans with pre-existing conditions. It will work for Americans struggling to pay health care premiums. It will work for Americans who are in small businesses. It will work for Americans who are one illness away from their family going into bankruptcy. It will work for Americans who are uninsured. It will work for Americans who have been victims of hospital errors. It will work for Americans who need preventive services they cannot afford. Most importantly, it will work for Donna, for Madeline, for Shirley, for Judith, and for David, and it will work for their fellow Americans all over this country whose stories are all too similar. Heartache, frustration, exhaustion, and disgust with a health care system that has, at best, disappointed them, and at worst, turned its back on them. The Affordable Health Choices Act offers these Americans a hand up when they need it most, and I am proud to support it. Before I yield the floor, I want to take one moment to thank the distinguished senior Senator from Iowa for his courtesy in allowing me to proceed. I know he has substantial remarks he wishes to deliver. I hope it was not too much of an inconvenience. I yield the floor.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. I ask unanimous consent to speak in morning business for 12 minutes.

Mr. WHITEHOUSE. Mr. President, I ask unanimous consent the order for the quorum call be rescinded.

Mr. WHITEHOUSE

Mr. WHITEHOUSE. Absolutely.