Mr. Chairman, I want to thank you for beginning what I hope will be a continuing investigation into the enormous cost borne by our entire nation because of our failure to provide health care insurance to all of our citizens. This Committee has a long history of investigating health care and insurance costs. In the 102nd and 103rd Congress, we held a series of hearings on hospital and health insurance industry financial practices and their impact on access to health care and health care costs. One of the issues we looked at is very much in the news again today: the question of whether tax-exempt hospitals were actually providing the charity care that was the basis for their tax exemption. I am pleased to see that Congress is once again asking critical questions of the health care industry and look forward to additional hearings by this Subcommittee.

Today's hearing focuses on the narrow issue of the economic burden that hospital bills place on the uninsured by charging them fees that are double those paid by the insured. But, as we will hear from our witnesses today, often even a discounted bill is too expensive for the uninsured. Discounted hospital bills are no substitute for comprehensive, quality health insurance. This is the real issue this country needs to address. In 2003, almost 44 million Americans lacked health insurance for the entire year, a number that has grown by 2.7 million alone since President Bush took office. In addition, another 80-plus million had gaps in health insurance coverage in the last two years. This situation is untenable, and shameful.

Clearly, there are health consequences to being uninsured - but there are economic consequences as well. This country already spends more money per capita on health care than any other developed country in the world. Yet, our nation's system of dealing with the uninsured is costing us more than if we did the right thing and provided these millions of families with coverage. All of us bear the additional cost of this lack of universal health care. After a two-year study on "Uninsurance in America," the Institute of Medicine concluded that this nation's health care system with so many lacking or having gaps in health insurance costs society twice as much as it would cost to provide health insurance for everyone. Those measurable economic costs - which have enormous public and private implications - include:

It is true that our nation spends billions of additional dollars to provide health care for the uninsured through subsidies to hospitals, community health centers, and other providers and programs. But, as the Institute of Medicine found, "[d]espite this public spending on health services for the uninsured, those who lack coverage have worse health outcomes than do similar individuals with insurance, because dollars alone do not confer the health benefits that continuous coverage does." In other words, insurance matters.

This lack of universal coverage mocks our stated commitment to equal consideration and equal opportunity for all of our citizens. Americans without health insurance have shorter lives and greater declines in health status than those with continuous coverage. They often cannot contribute to society in the same way in which the healthy and cared-for do.

Unfortunately, as we will hear today, the number of uninsured and under-insured is getting larger, not smaller. Fewer and fewer employers are offering coverage, and many of those who still do are paring back on comprehensive coverage. Health savings accounts - a favorite of this Administration - may sound good with a slick name like "Consumer Directed Care" but will not solve the problems of the uninsured. The poor and the sick do not have the money to set up the accounts or to buy the "catastrophic" insurance that is supposed to cover the really big hospital bills. Even if they had the money, they would almost surely be turned down because of pre-existing conditions.

The focus of this particular hearing - reducing the amount of money that the uninsured pay the hospitals - although a laudable goal - will not solve this problem either. If I could not pay $50,000 for my surgery for my car accident, can I pay $25,000? Can I pay $25,000 in the one-year time frame that the hospitals demand? Of course not. As I said earlier, discounted hospital bills are no substitute for insurance. Americans need primary care and preventive care to keep them well, and access to specialists, hospitals, and other facilities when they are sick - in other words, a comprehensive package of health insurance.

Mr. Chairman, this nation must establish a health care system that gives every man, woman, and child the health care that he or she needs so that they can reach their potential. We must do it for them; we must do it for all of us.