[Congressional Record Volume 141, Number 70 (Monday, May 1, 1995)]
[Senate]
[Pages S5873-S5874]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. WELLSTONE. Mr. President, I know the Senator from Arizona is 
here. He is going to wish to lay down an amendment and speak about it. 
I have an amendment that I laid down on Thursday that I want also to 
speak on. But I thought we might stay in morning business just for a 
few minutes and I might respond to my colleague from New Hampshire and 
then we will go back on the bill. I do not come with any well-rehearsed 
remarks, but as I was listening to the presentation of my friend from 
New Hampshire, I did want to respond in a couple of different ways.
  First of all, I was immersed in the health care debate in the 103d 
Congress. Of course, at the very end, we were deadlocked and there was, 
on the part of a good number of Senators, I think, a very strong 
commitment to blocking any legislation from being passed and therefore 
we were not able to pass any kind of health care reform. I point out to 
my colleague that many of us made the argument that the only way we 
were going to be able to contain costs--and that included looking at 
Medicare and Medicaid, which are two very big Government programs--was 
within the context of overall health care reform.
  I take exception to what I heard my colleague from New Hampshire 
saying in a couple of different areas. First of all, let me just be 
crystal clear. I think the proposition that on the one hand--at least 
some Senators have proposed this, and many in the House of 
Representatives have proposed this--we go forward with broad-based tax 
cuts which amount to about $700 billion over the next 10 years, of 
revenue we would have to make up, and on the other hand go forward with 
cuts--some say just decreasing the rate of increase of Medicare--I 
think that proposition just will not be credible. It will not be 
credible with a lot of senior citizens, but that is not even the point. 
It will not be credible with their children and their grandchildren.
  You cannot, on the one hand, say you are for deficit reduction and 
then move forward on broad-based tax reduction to the point where you 
have to figure out how to offset $700 billion before you even go 
forward with deficit reduction, and at the same time be proposing 
fairly draconian cuts in Medicare.
  I have said all along I actually feel quite credible on this issue 
because from the very beginning of this debate about balancing the 
budget by 2002 I have raised the question, ``Why 2002?'' I have raised 
the question of how you can do it without separating capital and 
operating budgets. I have tried to be intellectually honest about this. 
I have talked about dancing at two weddings at the same time.
  I have said to citizens in Minnesota, beware of any breed of 
politician--Democrat, Republican, Independent--and others who say: On 
the one hand, you are going to have broad-based tax cuts, on the one 
hand you are not going to cut the military budget, on the one hand you 
are going to pay interest on the debt because we have to, on the one 
hand Social Security is going to be put in parenthesis and not touched, 
on the one hand now we are not going to really cut Medicare--but we are 
going to balance the budget, cut $1 trillion, by 2002.
  But students, it is not going to be higher education. Veterans, do 
not worry. And children, it is not true that we are going to cut the 
nutrition programs. The arithmetic of this does not add up. My 
colleagues are discovering that they are in this context--talking about 
balancing the budget--are going to have to propose deep and significant 
cuts in Medicare and Medicaid. Please remember about 75 percent of 
Medicaid payments do not go to AFDC mothers, or what we view as 
welfare, but actually go toward long-term care for the aged. It is not 
just older people we are talking about. We are talking about older 
people; we are talking about their children and grandchildren; we are 
talking about families in this country.
  Now we have a new wrinkle where colleagues come out and say the trust 
fund is in trouble, and they talk about this as an actuarial issue. 
This is a benefits program. You can use all of the insurance language 
you want to about trust funds and talk about actuarial assumptions and 
all the rest. The fact of the matter is that in 1965 we passed the 
Medicare and Medicaid Programs in the U.S. Congress. It was an 
inadequate installment of universal coverage but nevertheless it was 
significant. From my family having had two parents with Parkinson's 
disease, let me just say one more time that Medicare, imperfections and 
all, was probably the difference between disaster and being able to at 
least live the end of your lives with some dignity. Both my mother and 
father have passed away.
  Even so, with Medicare, Mr. President, elderly people pay four times 
as much out of pocket as people who are not elderly. Please remember 
one more time, since we have this stereotype of older Americans being 
rich and not having to really worry about any economic squeeze, that 
the median income for men 65 years of age and older is $15,000; for 
women it is about $8,000. This is no small issue.
  Mr. President, last Congress we talked about how we could move 
forward on long-term care in such a way that we could have more home-
based care. We, I think, reached some consensus, except, when we got to 
the point where we will have to dig into our pockets and figure out how 
to fund it, that elderly people and people with disabilities ought to 
be able to live as 
[[Page S5874]] near in normal circumstances as possible with dignity. 
They ought not to have to go to institutions when they could live at 
home. We put real emphasis on home-based care with a wonderful program 
in Minnesota, a block grant program not adequately funded. But we are 
funding it. It is wonderful. It makes all of the difference in the 
world, and it enables someone who is elderly to live at home. But we 
did not take any action on that.
  We were also talking about some legislation. I introduced the single 
payer bill covering the catastrophic expenses. Medicare does not cover 
the catastrophic expenses of what happens to you when you are in a 
nursing home. Nor does it cover prescription drugs.
  My colleagues are not in any of these proposals talking about any of 
that. They are talking about cutting Medicare. And they want to make 
the argument it is not really a cut, that it is just a lessening of the 
rate of increase. Well, why is it such a big surprise to my colleagues 
that a larger and larger percentage of our population are 65 years of 
age and over, and a larger and larger percentage of that population 
tends to be in their eighties? Of course, it costs money. That is what 
Medicare is about; the commitment to elderly citizens, and that we will 
fund a decent level of health care for elderly people in our country. 
This should not come as any shock. And it is a benefits program. It is 
a contract. It is a commitment we made.
  Mr. President, there are, I think, steps that we can take. In some 
cities and some States you find that the cost of providing coverage is 
much greater than, for example, what it is in Minnesota. I am sure 
there are ways that we can move toward more efficiency.
  But, Mr. President, I must say that all of a sudden this discussion 
about now what we are going to do is talk about the trust fund, we are 
not going to really say this is part of deficit reduction although it 
was always proposed before as part of deficit reduction. And in 
addition, we are going to give people all of these kinds of options. So 
they are really not options because managed care is the place in which 
you can have the savings but in many parts of the country, especially 
outside your metro areas, it is not a real option. And in addition, we 
say, if there are any savings by enabling people to develop to purchase 
vouchers or all the rest, then in fact we will be OK. But, if they are 
not, then we are going to have to make the deep cuts. There are not 
going to be any because, if there are savings, by definition they go to 
those individuals. They do not go to the Government. We are talking 
about public expenditures here and how to cut down on the public 
expenditures.
  So I think that some of my colleagues are trying to dance at two 
weddings at the same time. There was all this bold rhetoric about how 
we were going to balance the budget by 2002, no question about it. I 
saw projections of quotes from colleagues that we were going to be 
cutting Medicare by $400 billion between now and the year 2002. That 
figure has gone down. But make no bones about it. That is what is being 
proposed.
  Mr. President, I think what we ought to do is move forward on good 
health care reform, and there are three critical ingredients to that. 
First, universal coverage; and I promise my colleague from Arizona that 
I will be finished within 2 minutes. Second, cost containment--and, by 
the way, the Congressional Budget Office said really the way you can 
contain costs is you put some sort of limit on what insurance companies 
can charge. Third, we need to deliver care in some of our underserved 
communities like, for example, rural areas where we have to put much 
more emphasis on primary care, on family doctors, on advanced nurse 
practitioners, on nurses, getting health care out of the communities 
backed up by specialization.
  It is in that context that we contain Medicare costs. But, if we just 
target Medicare, you are going to have the same irrational charge 
shifting. You are going to have true rationing by age, income, and 
disability. You are going to be hurting a lot of citizens in this 
country. And, we are going to be moving away from a basic commitment 
that we made in 1965.
  So, I look forward to what I think is going to be an extremely 
important debate but I did want to respond to my colleague from New 
Hampshire. I am sorry he had to leave.

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