Sen. King on the Affordable Care Act & Efforts to Kill It "It's a moral issue" -



At the age of 29, King battled an aggressive form of skin cancer. In his remarks, he credited having health insurance as a young man with saving his life:



"If I hadn't had that insurance, I wouldn't have gone to that checkup, and if I hadn't had the checkup when I did, within months or perhaps a year and a half, I would have been gone."



Here's the transcript of Senator King's remarks last week, as submitted to the Congressional Record:



"I want to begin with a story - a story of two young men, both 29, both married with a couple of kids. Both contracted cancer the same day, malignant melanoma, the kind of cancer that comes from a mole, not uncommon unfortunately in our society. One of these young men had insurance. In fact, he had an insurance policy that provided preventive care, and under that policy they provided a free checkup - and indeed, his insurance covered him, his ability to go and have his checkup in the evening so he didn't even have to take a day off of work.



He went in, had the checkup, the doctor looked, found a mole on his back and said, 'This doesn't look so good, I think we should take it off.' A week later he went back to have the stitches out and the doctor said, 'I think you better sit down. You have a pretty serious form of cancer.'



The young man went to the hospital, had an operation, removed a hunk of his back, stitches under his arm, took out the lymph nodes, found that the cancer had not yet spread - didn't have to have chemotherapy, didn't have to have radiation, he was okay.



The other young man didn't have insurance, so he didn't go to the doctor, he didn't have that checkup, he had the mole on his neck, but he didn't really notice it or pay much attention to it. Six or eight months later, he noticed a lump in his neck. Still didn't pay any attention to it, didn't have insurance, didn't really want to go in and spend the money to go to the emergency room or to go to the doctor, so he didn't really pay much attention and he let it go. Six months later the lump was so large he finally went to the doctor. They biopsied it, found it was the metastasized malignant melanoma. He had chemotherapy, he had radiation, he had surgery, but a year later he died.



That story means a lot to me because I'm the first guy. Forty years ago, when I was a staff member in this institution, I went and had that checkup because I had insurance. They found the mole, they did the surgery, and here I am today. I've often thought about that and wondered, 'Why me?' Just luck - but also because I had insurance. I can tell you to a certainty, if I hadn't had that insurance, I wouldn't have gone to that checkup - and if I hadn't had the checkup when I did, within months or perhaps a year and a half, I would have been gone.



A similar story is the story of a daughter of a friend of mine up in Maine, Dick Gould. Dick had a daughter named Cindy who was born with severe asthma. All her life she battled it. She lived in a very rural part of Maine, not a lot of money, could never afford insurance, but she fought the asthma as best she could, and she did the best but she couldn't afford the expensive treatments. And finally, not long ago at the age of 53, Cindy Gould died, leaving a husband, children and grandchildren, one of whom she hadn't ever met.



Why did she die? Because she didn't have insurance. She couldn't afford to go in and have the care that she needed. Why are we having this discussion here in the United States Senate this week about healthcare? The answer is pretty clear. There are 50 million people in this country who have no health insurance. The estimates are that between 20,000 and 30,000 of those people die each year, like Cindy Gould, because of the lack of health insurance.



Why doesn't that bother us? Why aren't we spending days and nights here talking about how to solve this problem instead of how to dismantle the most significant healthcare program that's come to this country in years? Why? I have a theory about that. It's because those deaths are invisible. They happen one at a time in Greenville, Maine; in Portland, Maine; in San Diego, California; in El Paso, Texas. Nobody knows. It's not listed in the obituary, 'Died because of no health insurance.'



I would submit that if those, say - call the number 25,000, and that's a conservative estimate - if those 25,000 people in this country each all died at the same day in the same place, we'd be turning the world upside-down to solve the problem. Imagine, it's the loss of a small town in your state each year - 25,000 people a year.



On September 11, 2001, we had a tragedy in this country. 3,000 people died. It was a terrible day. And what have we done as a result of that day? We've turned our society upside-down, we protect ourselves at airports. We've spent money for screening and protection. We spend $70 billion a year on intelligence, just intelligence, in order to protect ourselves from another September 11. And yet quietly, insidiously, every year over 20,000 people die because they don't have insurance.



Another 700,000 families lose everything because of medical bills. We're the only country in the world where that happens. We're the only country in the industrialized world where people are prone to lose everything because they're swamped with medical bills. That's ridiculous. Would we watch someone die in our front yard? Of course not. We'd call 911. We'd call the doctor. We'd do CPR. We'd do whatever we could to keep them alive - but we're quietly as a society watching over 20,000 people a year die, and we're arguing about the details of how to solve this problem.



To me, it's a moral question. There's a lot of economics involved. There're a lot of questions of cost, and we'll talk about that, but fundamentally it's a moral question. The moral question is: 'Are we going to stand by and watch people suffer and die because of ideology and politics?' No other country in the world has answered yes to that question - and that's the question that's really before us.



So what is this thing called Obamacare? The Affordable Care Act. The first thing to say is what it is not, and what it is not is a tremendous impact on American business. Ninety-six percent of the businesses in America have less than 50 employees. They're not affected by Obamacare at all. In fact, they're probably benefited by it because whether or not they choose to buy health insurance, their employees can get health insurance through the new health exchanges, and that's probably a benefit to those businesses, but 96 percent of the businesses the law doesn't apply to.



Ninety-eight percent of the larger companies - 200 employees and more - already provide health insurance to their employees, so the law really doesn't apply to them. Ninety-four percent of the smaller firms, from 50 to 199 employees, already provide health insurance to their employees - so this idea that somehow Obamacare is taking over the health care industry in this country is just nonsense. Eighty percent of the people are largely unaffected by it. They are either the 50 percent that are covered by the employers now, or the 22 percent or 23 percent that are under Medicare now - seven percent or eight percent under Medicaid - but that leaves 15 percent uncovered, uninsured, unprotected, and that's between 45 and 50 million people.



This is not a government takeover. There is no place in America you can go and sign up for Obamacare. If you go onto an exchange, you get insurance from Anthem or Blue Cross or Health First or Aetna. You don't get Obamacare. You get insurance coverage from private insurance companies, just as we have done in this country for most of the 20th and 21st century.



It is not a government takeover, but here's what it is: it's a mechanism to make it easier and cheaper for those people who are uninsured to find a way to get insurance. To go online to a health exchange- which is nothing but, I suppose, an Amazon or eBay of health insurance - where you can see what your options are and make your choices. You get support if you're within certain income levels from the rest of us, and it makes health insurance affordable.



Now, it's based upon the free market principle of competition and that group rates are better than individual rates, and that's - the essence of the system - is a marketplace where people can buy private health insurance. It's also insurance reform. It repairs and improves and mandates some improvements in the way health insurance works to avoid some of the real glaring problems that most people have identified with and many people have run up against. One is a limitation that health insurance companies have to spend 80 percent of the money they take in on healthcare. In other words, there is a limit on profit and overhead. I think all of us feel that that's reasonable. And that's already happening, and in fact some people are getting refund checks from their insurance companies because they were spending too much on overhead and profit. U.S. Senator Angus King took the floor of the Senate last week to defend the principles of the Affordable Care Act and its effort to more broadly extend health insurance to thousands of uninsured Americans while several Republicans launched new attempts to defund the law.At the age of 29, King battled an aggressive form of skin cancer. In his remarks, he credited having health insurance as a young man with saving his life:"If I hadn't had that insurance, I wouldn't have gone to that checkup, and if I hadn't had the checkup when I did, within months or perhaps a year and a half, I would have been gone.""I want to begin with a story - a story of two young men, both 29, both married with a couple of kids. Both contracted cancer the same day, malignant melanoma, the kind of cancer that comes from a mole, not uncommon unfortunately in our society. One of these young men had insurance. In fact, he had an insurance policy that provided preventive care, and under that policy they provided a free checkup - and indeed, his insurance covered him, his ability to go and have his checkup in the evening so he didn't even have to take a day off of work.He went in, had the checkup, the doctor looked, found a mole on his back and said, 'This doesn't look so good, I think we should take it off.' A week later he went back to have the stitches out and the doctor said, 'I think you better sit down. You have a pretty serious form of cancer.'The young man went to the hospital, had an operation, removed a hunk of his back, stitches under his arm, took out the lymph nodes, found that the cancer had not yet spread - didn't have to have chemotherapy, didn't have to have radiation, he was okay.The other young man didn't have insurance, so he didn't go to the doctor, he didn't have that checkup, he had the mole on his neck, but he didn't really notice it or pay much attention to it. Six or eight months later, he noticed a lump in his neck. Still didn't pay any attention to it, didn't have insurance, didn't really want to go in and spend the money to go to the emergency room or to go to the doctor, so he didn't really pay much attention and he let it go. Six months later the lump was so large he finally went to the doctor. They biopsied it, found it was the metastasized malignant melanoma. He had chemotherapy, he had radiation, he had surgery, but a year later he died.That story means a lot to me because I'm the first guy. Forty years ago, when I was a staff member in this institution, I went and had that checkup because I had insurance. They found the mole, they did the surgery, and here I am today. I've often thought about that and wondered, 'Why me?' Just luck - but also because I had insurance. I can tell you to a certainty, if I hadn't had that insurance, I wouldn't have gone to that checkup - and if I hadn't had the checkup when I did, within months or perhaps a year and a half, I would have been gone.A similar story is the story of a daughter of a friend of mine up in Maine, Dick Gould. Dick had a daughter named Cindy who was born with severe asthma. All her life she battled it. She lived in a very rural part of Maine, not a lot of money, could never afford insurance, but she fought the asthma as best she could, and she did the best but she couldn't afford the expensive treatments. And finally, not long ago at the age of 53, Cindy Gould died, leaving a husband, children and grandchildren, one of whom she hadn't ever met.Why did she die? Because she didn't have insurance. She couldn't afford to go in and have the care that she needed. Why are we having this discussion here in the United States Senate this week about healthcare? The answer is pretty clear. There are 50 million people in this country who have no health insurance. The estimates are that between 20,000 and 30,000 of those people die each year, like Cindy Gould, because of the lack of health insurance.Why doesn't that bother us? Why aren't we spending days and nights here talking about how to solve this problem instead of how to dismantle the most significant healthcare program that's come to this country in years? Why? I have a theory about that. It's because those deaths are invisible. They happen one at a time in Greenville, Maine; in Portland, Maine; in San Diego, California; in El Paso, Texas. Nobody knows. It's not listed in the obituary, 'Died because of no health insurance.'I would submit that if those, say - call the number 25,000, and that's a conservative estimate - if those 25,000 people in this country each all died at the same day in the same place, we'd be turning the world upside-down to solve the problem. Imagine, it's the loss of a small town in your state each year - 25,000 people a year.On September 11, 2001, we had a tragedy in this country. 3,000 people died. It was a terrible day. And what have we done as a result of that day? We've turned our society upside-down, we protect ourselves at airports. We've spent money for screening and protection. We spend $70 billion a year on intelligence, just intelligence, in order to protect ourselves from another September 11. And yet quietly, insidiously, every year over 20,000 people die because they don't have insurance.Another 700,000 families lose everything because of medical bills. We're the only country in the world where that happens. We're the only country in the industrialized world where people are prone to lose everything because they're swamped with medical bills. That's ridiculous. Would we watch someone die in our front yard? Of course not. We'd call 911. We'd call the doctor. We'd do CPR. We'd do whatever we could to keep them alive - but we're quietly as a society watching over 20,000 people a year die, and we're arguing about the details of how to solve this problem.To me, it's a moral question. There's a lot of economics involved. There're a lot of questions of cost, and we'll talk about that, but fundamentally it's a moral question. The moral question is: 'Are we going to stand by and watch people suffer and die because of ideology and politics?' No other country in the world has answered yes to that question - and that's the question that's really before us.So what is this thing called Obamacare? The Affordable Care Act. The first thing to say is what it is not, and what it is not is a tremendous impact on American business. Ninety-six percent of the businesses in America have less than 50 employees. They're not affected by Obamacare at all. In fact, they're probably benefited by it because whether or not they choose to buy health insurance, their employees can get health insurance through the new health exchanges, and that's probably a benefit to those businesses, but 96 percent of the businesses the law doesn't apply to.Ninety-eight percent of the larger companies - 200 employees and more - already provide health insurance to their employees, so the law really doesn't apply to them. Ninety-four percent of the smaller firms, from 50 to 199 employees, already provide health insurance to their employees - so this idea that somehow Obamacare is taking over the health care industry in this country is just nonsense. Eighty percent of the people are largely unaffected by it. They are either the 50 percent that are covered by the employers now, or the 22 percent or 23 percent that are under Medicare now - seven percent or eight percent under Medicaid - but that leaves 15 percent uncovered, uninsured, unprotected, and that's between 45 and 50 million people.This is not a government takeover. There is no place in America you can go and sign up for Obamacare. If you go onto an exchange, you get insurance from Anthem or Blue Cross or Health First or Aetna. You don't get Obamacare. You get insurance coverage from private insurance companies, just as we have done in this country for most of the 20th and 21st century.It is not a government takeover, but here's what it is: it's a mechanism to make it easier and cheaper for those people who are uninsured to find a way to get insurance. To go online to a health exchange- which is nothing but, I suppose, an Amazon or eBay of health insurance - where you can see what your options are and make your choices. You get support if you're within certain income levels from the rest of us, and it makes health insurance affordable.Now, it's based upon the free market principle of competition and that group rates are better than individual rates, and that's - the essence of the system - is a marketplace where people can buy private health insurance. It's also insurance reform. It repairs and improves and mandates some improvements in the way health insurance works to avoid some of the real glaring problems that most people have identified with and many people have run up against. One is a limitation that health insurance companies have to spend 80 percent of the money they take in on healthcare. In other words, there is a limit on profit and overhead. I think all of us feel that that's reasonable. And that's already happening, and in fact some people are getting refund checks from their insurance companies because they were spending too much on overhead and profit. Under the insurance reforms of the bill, women are treated equally for the first time. There's an emphasis on preventative care - and I go back to my own story. The preventative care saved my life, and it was a heck of a lot cheaper than the care that was provided to the fellow that didn't have insurance because he didn't catch it in time. He ended up in the emergency room. He ended up having surgery, chemotherapy and radiation, ultimately futilely, but that treatment cost a lot more than my treatment did because I was insured and had preventative care. It also allows kids to stay on their parents' policies until they're 26. This is a big deal, because it allows kids to take jobs and do things and travel and work, but not have to focus on whether or not they have health care, they can stay on their parents' policies until they are 26. That's happening right now all across America.



There are no lifetime caps. As I mentioned earlier, we are the only country in the world where people get wiped out by health care costs. Nowhere else is that even remotely an issue the way it is here. And then finally, you can't be denied health insurance because of pre-existing conditions. That's crucial because there are millions of people across this country through no fault of their own, because of the vagaries of health, that have problems they were born with, or that came on in youth, and they can't, under the old rules, get insurance. Now they can't be denied insurance, and that's going to make a lot of difference to people in this country.



Now, because of that, and I watched Senator Cruz last night, and he talked about this. If you're going to require that insurance be issued to people even if they have pre-existing conditions or some kind of illness, then you've also got to mandate that everybody buys it, otherwise nobody would buy it until they were in the ambulance on the way to the hospital. If you didn't have to buy fire insurance before the fire, everybody would buy it when they saw the flames coming up from their house. I think Senator Cruz, the Senator from Texas, used that image last night. To me, that just makes common sense.



It also makes common sense because it's a matter of personal responsibility. I always thought that was a conservative principle. I remember in the '70s and '80s, it was a conservative principle that people should take responsibility for themselves. And right now in our society, if you're sick and if you have no insurance, you're treated. The hospital cannot turn you away - but what that means is that we all pay. That person is in effect a free rider. They've got insurance, it's all the rest of us, and I think it's a basic principle that they should take care of their own responsibility.



People act like this is some kind of radical notion. We've had, and I don't know about your state and other states, but in Maine we've had mandatory automobile insurance for as long as I can remember - and nobody questions it because it's responsibility. You need to be responsible for yourself. As I say, this was always a conservative principle until lately, and all of a sudden it isn't, and it reminds me of the old line of Mort Sahl, the comedian back in the 1950s who said if you maintain a consistent political opinion in this country long enough, you will eventually be tried for treason, and here we are. What was once a conservative principle is now anathema, but I think it's all about personal responsibility and providing for yourself.



I understand and I've seen press releases that there are people going around the country telling young people not to sign up for coverage. I think that's outrageous. It's unbelievable, and they are sentencing some of those people to death, or to severe injury, because they're not going to have health insurance when they're going to need it. All young people are immortal. I was when I went in for that checkup when I was 29 years old. They think they are. But to tell people not to get insurance when it's available, and particularly when it's available at a low cost, I think is something that should weigh on the conscience of whoever is funding and developing that campaign around the country.



Okay, so what is the Affordable Care Act? It's a mechanism to buy insurance. Number two: it's reform to the insurance industry in terms of what the requirements are; and number three: buried in it are pilot programs that may turn out, in my view, to be the most important part of the bill because they encourage changes in the way we deliver health care. And as I'll mention in a minute, the real problem with health care is cost, and these pilot programs that are being used around the country, including in Maine, are already having some spectacular results.



I talked to two people from our two major Maine hospitals this morning. They're seeing a 60 percent reduction in emergency room use and a 70 percent reduction in rehospitalization because of what's called the 'accountable care organization' structure that they put in place for Medicare patients in Maine. They're seeing better care at substantially lower costs, and this is the kind of pilot and innovation program that's also in the Affordable Care Act that nobody ever hears about or talks about, that I think, as I mentioned, may turn out to be the most important part of the law.



That's it: limits on insurance provisions and greater access to insurance. I think we need to calm down around here about what this bill really does. Now, it's not perfect. It's complicated. It does have some implementation issues that I'm worried about. I'm worried about too much regulation. I'm worried that they'll overdo the regulations somewhere in the government as they implement this, and I think that's something we need to pay close attention to. There are problems like the 30 hour work-week versus 40 hours. Those are the kinds of things that I think we need to pay attention to and we need to fix.



There has never been a perfect piece of legislation, perhaps those Ten Commandments on Mount Sinai, but we need to try to fix things and not just say, 'Oh, we're just going to tear the whole thing apart and start over.' I'm a little skeptical on the starting over part because I haven't seen any inclination to do so.



Now, as I mentioned, the larger health care problem is cost. We're now spending 18 percent of our gross domestic product on health care - by far the highest number in the world. Japan is at about 11 percent. Everyone else is at eight percent or nine percent. We are spending twice as much per capita as anyone else in the industrialized world, and our results aren't that good. By all kinds of international standards of infant mortality, longevity, customer satisfaction, we are in the 15th, 17th, 20th, 25th in the world, and we're paying twice as much.



This cost problem is what's killing our budget. All of the debt and deficit problem that we're projecting in the federal budget is based upon healthcare costs - Medicare, Medicaid, and public employees. That's where the deficit is. It's not in the National Parks. It's not in Head Start. It's not even in the Department of Defense. It's healthcare costs - and we need to talk about that and work on it and do something about it, and I think these pilot programs within the Affordable Care Act are showing amazing promise just in the last couple of years that they've been in place.



A note on process and then I'll yield the floor. I have never known of a time when the repeal of a particular piece of legislation has been used - has been held hostage- in order to keep the government running. We've had arguments about budgetary matters at the ends of budget periods, and there was a shutdown in the '90s about spending and budgets, but I've never heard of a time when a group tried to use a bill and say, 'We're going to repeal this bill or we're going to shut down the government.'



In the '50s and '60s the Southerners were dead against civil rights legislation. They filibustered. They tried to stop it, but ultimately it was passed in the early 1960s in a proud moment for this body and this institution.



They never said, 'But we're going to shut down the government if you fund it or enforce it.' They had too much respect for the importance of the continuity of government, over and above any issue, no matter how passionately they felt about it. I hope that this weekend we can let go of this idea that a minority of the government can hold it hostage because of one particular piece of legislation that they don't like.



. . . . this is an economic issue, but it's also a moral issue. It's about trying to help people deal with the shadow, with the shadow of healthcare hanging over them. It's not perfect, but it corrects some of the most glaring defects in the private insurance system, and it provides an opportunity to millions of Americans to escape the day-to-day shadow of a healthcare catastrophe. To those who want to fix it, I stand ready to help. To those who have ideas and suggestions, I stand ready to listen. To those who want to destroy it, however, I stand in your way - and to those for whom the shadow has finally been lifted, I stand at your side." Under the insurance reforms of the bill, women are treated equally for the first time. There's an emphasis on preventative care - and I go back to my own story. The preventative care saved my life, and it was a heck of a lot cheaper than the care that was provided to the fellow that didn't have insurance because he didn't catch it in time. He ended up in the emergency room. He ended up having surgery, chemotherapy and radiation, ultimately futilely, but that treatment cost a lot more than my treatment did because I was insured and had preventative care. It also allows kids to stay on their parents' policies until they're 26. This is a big deal, because it allows kids to take jobs and do things and travel and work, but not have to focus on whether or not they have health care, they can stay on their parents' policies until they are 26. That's happening right now all across America.There are no lifetime caps. As I mentioned earlier, we are the only country in the world where people get wiped out by health care costs. Nowhere else is that even remotely an issue the way it is here. And then finally, you can't be denied health insurance because of pre-existing conditions. That's crucial because there are millions of people across this country through no fault of their own, because of the vagaries of health, that have problems they were born with, or that came on in youth, and they can't, under the old rules, get insurance. Now they can't be denied insurance, and that's going to make a lot of difference to people in this country.Now, because of that, and I watched Senator Cruz last night, and he talked about this. If you're going to require that insurance be issued to people even if they have pre-existing conditions or some kind of illness, then you've also got to mandate that everybody buys it, otherwise nobody would buy it until they were in the ambulance on the way to the hospital. If you didn't have to buy fire insurance before the fire, everybody would buy it when they saw the flames coming up from their house. I think Senator Cruz, the Senator from Texas, used that image last night. To me, that just makes common sense.It also makes common sense because it's a matter of personal responsibility. I always thought that was a conservative principle. I remember in the '70s and '80s, it was a conservative principle that people should take responsibility for themselves. And right now in our society, if you're sick and if you have no insurance, you're treated. The hospital cannot turn you away - but what that means is that we all pay. That person is in effect a free rider. They've got insurance, it's all the rest of us, and I think it's a basic principle that they should take care of their own responsibility.People act like this is some kind of radical notion. We've had, and I don't know about your state and other states, but in Maine we've had mandatory automobile insurance for as long as I can remember - and nobody questions it because it's responsibility. You need to be responsible for yourself. As I say, this was always a conservative principle until lately, and all of a sudden it isn't, and it reminds me of the old line of Mort Sahl, the comedian back in the 1950s who said if you maintain a consistent political opinion in this country long enough, you will eventually be tried for treason, and here we are. What was once a conservative principle is now anathema, but I think it's all about personal responsibility and providing for yourself.I understand and I've seen press releases that there are people going around the country telling young people not to sign up for coverage. I think that's outrageous. It's unbelievable, and they are sentencing some of those people to death, or to severe injury, because they're not going to have health insurance when they're going to need it. All young people are immortal. I was when I went in for that checkup when I was 29 years old. They think they are. But to tell people not to get insurance when it's available, and particularly when it's available at a low cost, I think is something that should weigh on the conscience of whoever is funding and developing that campaign around the country.Okay, so what is the Affordable Care Act? It's a mechanism to buy insurance. Number two: it's reform to the insurance industry in terms of what the requirements are; and number three: buried in it are pilot programs that may turn out, in my view, to be the most important part of the bill because they encourage changes in the way we deliver health care. And as I'll mention in a minute, the real problem with health care is cost, and these pilot programs that are being used around the country, including in Maine, are already having some spectacular results.I talked to two people from our two major Maine hospitals this morning. They're seeing a 60 percent reduction in emergency room use and a 70 percent reduction in rehospitalization because of what's called the 'accountable care organization' structure that they put in place for Medicare patients in Maine. They're seeing better care at substantially lower costs, and this is the kind of pilot and innovation program that's also in the Affordable Care Act that nobody ever hears about or talks about, that I think, as I mentioned, may turn out to be the most important part of the law.That's it: limits on insurance provisions and greater access to insurance. I think we need to calm down around here about what this bill really does. Now, it's not perfect. It's complicated. It does have some implementation issues that I'm worried about. I'm worried about too much regulation. I'm worried that they'll overdo the regulations somewhere in the government as they implement this, and I think that's something we need to pay close attention to. There are problems like the 30 hour work-week versus 40 hours. Those are the kinds of things that I think we need to pay attention to and we need to fix.There has never been a perfect piece of legislation, perhaps those Ten Commandments on Mount Sinai, but we need to try to fix things and not just say, 'Oh, we're just going to tear the whole thing apart and start over.' I'm a little skeptical on the starting over part because I haven't seen any inclination to do so.Now, as I mentioned, the larger health care problem is cost. We're now spending 18 percent of our gross domestic product on health care - by far the highest number in the world. Japan is at about 11 percent. Everyone else is at eight percent or nine percent. We are spending twice as much per capita as anyone else in the industrialized world, and our results aren't that good. By all kinds of international standards of infant mortality, longevity, customer satisfaction, we are in the 15th, 17th, 20th, 25th in the world, and we're paying twice as much.This cost problem is what's killing our budget. All of the debt and deficit problem that we're projecting in the federal budget is based upon healthcare costs - Medicare, Medicaid, and public employees. That's where the deficit is. It's not in the National Parks. It's not in Head Start. It's not even in the Department of Defense. It's healthcare costs - and we need to talk about that and work on it and do something about it, and I think these pilot programs within the Affordable Care Act are showing amazing promise just in the last couple of years that they've been in place.A note on process and then I'll yield the floor. I have never known of a time when the repeal of a particular piece of legislation has been used - has been held hostage- in order to keep the government running. We've had arguments about budgetary matters at the ends of budget periods, and there was a shutdown in the '90s about spending and budgets, but I've never heard of a time when a group tried to use a bill and say, 'We're going to repeal this bill or we're going to shut down the government.'In the '50s and '60s the Southerners were dead against civil rights legislation. They filibustered. They tried to stop it, but ultimately it was passed in the early 1960s in a proud moment for this body and this institution.They never said, 'But we're going to shut down the government if you fund it or enforce it.' They had too much respect for the importance of the continuity of government, over and above any issue, no matter how passionately they felt about it. I hope that this weekend we can let go of this idea that a minority of the government can hold it hostage because of one particular piece of legislation that they don't like.. . . . this is an economic issue, but it's also a moral issue. It's about trying to help people deal with the shadow, with the shadow of healthcare hanging over them. It's not perfect, but it corrects some of the most glaring defects in the private insurance system, and it provides an opportunity to millions of Americans to escape the day-to-day shadow of a healthcare catastrophe. To those who want to fix it, I stand ready to help. To those who have ideas and suggestions, I stand ready to listen. To those who want to destroy it, however, I stand in your way - and to those for whom the shadow has finally been lifted, I stand at your side." X