[Congressional Record Volume 141, Number 73 (Thursday, May 4, 1995)]
[Senate]
[Pages S6136-S6138]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE
Mr. WELLSTONE. I thank the Chair.
Mr. President, we are, in a very short period of time, going to have
a historic debate about the budget and about priorities in our Nation,
the United States of America. Part of that debate--and I know my
colleague from California will be speaking to this as well--will focus
on Medicare.
As I have followed over the last couple of days some of the press
conferences and some of the discussions taking place about Medicare, I
think it is really important to come to the floor and speak about
Medicare, not so much in political terms but in substantive terms.
We are faced with a real irony. It may very well be that a good many
of my colleagues will now discover that health care reform--not just a
focus on Medicare or Medicaid but real health care reform--is a
pressing, compelling issue in this country.
First of all, Medicare is a benefit program. It is not just an
actuarial program. It is important for me to make this point, Mr.
President. My mother and father are no longer alive. Both actually had
Parkinson's disease, but I can tell you, for my parents in their older
age, Medicare, imperfections and all, was extremely important and it
continues to be extremely important to senior citizens in this country.
It is not by any means perfect. It does not cover catastrophic
expenses, it does not cover prescription drug costs, and elderly people
over 65 years of age pay four times as much out of pocket as citizens
under 65 years of age. But I think this focus on the budget is going to
get us to the point where all of us understand some realities about
health care and health care policy in the United States.
Eighty-five percent of Medicare expenditures pay for care for seniors
with household incomes of less than $25,000 a year. So let us also
understand that these benefits help hard-pressed people, not people who
have plenty of income on their own.
Second point, Mr. President. I was on the floor the other day in a
debate with one of my colleagues--I think it was the Senator from
Texas, Senator Gramm--and he was talking about his efforts to block
health care reform in the last Congress and he was proud of that. In
another point in time, we will have a debate, and I do not have a
practice of debating colleagues when they are not on the floor, but I
will say, as a matter of fact, one of the reasons that we are now
dealing with the whole question of Medicare and how to finance Medicare
is because we did not pass any comprehensive health care reform last
Congress.
Mr. President, 89 percent of the growth in Medicare spending since
1980 has been due to medical inflation, general inflation, and changes
in enrollment. Let me go over those.
Medicare is a benefit program that, of course, we have to finance. It
is part of what we are about as a country. It is, indeed, a contract
with senior citizens, and as we move into the next century, a larger
percentage of our population are older Americans, and a larger
percentage of those older Americans are older. That means that the cost
of the program goes up.
Then there is the issue of general inflation. There is not much we
can do about the first issue that I mentioned. And there is not that
much we can do about general inflation, but we can look at medical
inflation.
The interesting thing is that the Congressional Budget Office made it
clear last Congress--I did not say Democrat, Republican, but CBO--that
there are two ways you can contain medical costs. One is through global
spending caps, as in the single payer proposal, or, if you do not
prefer that, by placing some limits on insurance premiums. Some limit
on insurance premiums is a very effective way of containing costs.
But, Mr. President, if you just focus on one segment of the
population and you cut $250 to $350 billion
between now and the year 2002, you will have a severe impact on that
population. Let me say to my colleagues, when you were talking about
rationing last Congress when we were talking about comprehensive health
care reform, when you were yelling and screaming about rationing last
Congress, I did not think that you had a case to make. But if you are
just going to target Medicare, if you are going to cut expenditures for
just one segment of the population, then you will ration by age, you
will ration by disability, and if you throw Medicaid into the equation,
you will ration by income. But now I do not hear my colleagues talking
about rationing at all.
Second of all, if you make these cuts in Medicare, you are going to
throw this whole health care system into--and I do not want to
exaggerate--I would say a fair amount of chaos, if not utter chaos.
I ask unanimous consent to have printed in the Record a statement
from the National Leadership Coalition for Health Care Reform, which
includes many businesses in this case.
There being no objection, the material was ordered to be printed in
the Record, as follows:
The National Leadership
Coalition for Health Care Reform,
Washington, DC, April 3, 1995.
Senator Paul David Wellstone,
Hart Senate Office Building, Washington, DC.
Dear Senator Wellstone: We are writing to express our
serious concerns about the proposed cuts in the Medicare and
Medicaid programs. Our Coalition is the nation's largest
nonpartisan alliance of business, labor, consumers, and
providers dedicated to improving the health care system--in
order to enhance the availability, affordability, and quality
of care. (Our membership list is attached.)
We have long been on record as strong supporters of cost
containment for both public and private payers. Until we
contain costs, our citizens cannot be secure in coverage for
themselves and their families. However, we believe that
further drastic cuts in Medicare and Medicaid, coming on top
of deep cuts legislated in 1993, would pose program
difficulties and force the provider community to increase the
shifting of costs to the private sector. Such cost-shifting
would result in even more limited access, especially for low
and middle-income Americans, and an increase in the number of
uninsured.
We are troubled by approaches that focus primarily on
cutting the price of services. One of our central concerns--
as patients, payers, and providers--is that the quality of
care be enhanced by changes in the health care system. If
draconian cuts are made in prices, quality could further
suffer. We urge a balanced approach, one that would control
total system cost while improving quality, stopping cost-
shifting, and expanding universal coverage.
We believe that if our nation were to concentrate on better
outcomes and quality initiatives in addition to measures
targeted on costs, there would be significant gains both in
the appropriateness and efficiency of services, and in the
reduction of costs. Strong quality assurance mechanisms are
also essential as we shift more to better systems of managed
care.
[[Page S6137]] We urge Congress to take an integrated
approach to addressing our three serious and interrelated
problems of cost, quality and access. We fear a one-
dimensional approach, or one dealing only with federal
programs, will only make matters worse. We stand ready to
work with you on a balanced solution that will create a
better system for all our citizens.
Sincerely,
Paul G. Rogers,
Co-Chair.
Robert D. Ray,
Co-Chair.
____
Members of the National Leadership Coalition for Health Care Reform
Acme Steel Company.
Almalgamated Clothing & Textile Workers Union, AFL-CIO.
American Academy of Family Physicians.
American Academy of Pediatrics.
American Association of Retired Persons.
American Automobile Manufacturers' Association.
American College of Physicians.
American Federation of Teachers, AFL-CIO.
American Iron & Steel Institute.
American Nurses Association, Inc.
American Physical Therapy Association.
American Psychological Association.
American Subacute Care Association.
Association of Academic Health Centers.
Association of Minority Health Professional Schools.
B. C. Enterprises.
Bannon Research.
Bethlehem Steel Corporation.
Blue Cross Blue Shield of Iowa.
Blue Diamond Growers.
Brown & Cole Stores.
Burlington Coat Factory.
Ceridian Corporation.
Christian Children's Fund.
Chrysler Corporation.
Cold Finished Steel Bar Institute.
Communications Workers of America.
CoreStates Financial Corp.
Del Monte Foods.
Designworks Inc.
Drummond Company Inc.
Families USA Foundation.
Filter Materials.
Ford Motor Company.
GEC-Marconi Electronic Systems Corporation.
General Motors Corporation.
Giant Food Inc.
The Great Atlantic & Pacific Tea Company, Inc.
Gross Electric Inc.
The Heights Group.
H. J. Heinz Co.
Inland Steel Company.
INSIGHT Treatment Services.
International Brotherhood of Electrical Workers.
International Multifoods.
Internatinal Union of Bricklayers and Allied Craftsmen.
Johnstown Corporation.
Keller Glass Company.
Lincoln Telephone & Telegraph Co.
LTV Steel Company.
Lukens Inc.
Mankoff, Inc.
Maternity Center Association.
Maytag Corporation.
MEDNET.
National Association of Childbearing Centers.
National Association of State Boards of Education.
National Council of Churches of Christ in the U.S.A.
National Education Association.
Natinal Steel Corporation.
Navistar International Transportation Corporation, Inc.
Norwest Corporation.
Olympia West Plaza, Inc.
PAR Associates.
Pella Corporation.
Preferred Benefits.
R. R. Donnelley & Sons Co.
Ralphs Grocery Company.
Regis Corporation.
Rohm & Haas Company.
Safeway Inc.
Sara Lee Corporation.
Scott Paper Co.
Service Employees International Union, AFL-CIO.
Sokolov Strategic Alliance.
Southern California Edison Company.
Strategic Marketing Information, Inc.
Texas Heart Institute.
Time Warner Inc.
United Air Lines,Inc.
United Food and Commercial Workers International Union,
AFL-CIO.
United Paperworkers International Union, AFL-CIO.
United States Catholic Conference.
United Steelworkers of America, AFL-CIO.
U.S. Bancorp.
The Vons Companies, Inc.
Westinghouse Electric Corporation.
Wheat, First Securities, Inc.
Wheeling-Pittsburgh Steel Corp.
The Whitman Group.
Wisconsin Public Service Corporation.
Xerox Corporation.
Mr. WELLSTONE. That is why the business community is opposed to these
cuts in Medicare, because they know it will be a shell game. Mr.
President, this will result in utterly irrational charge shifting. What
will happen is that the providers already not receiving reimbursement
they need will just shift the cost to the private sector, to those of
us who have private health insurance plans. The business community
knows that.
Some of my friends who were talking about Medicare just as a way of
reducing the deficit, or even when they talk about reforming health
care but just focusing on Medicare, I think really overlooked problems.
Third of all, Mr. President, I could tell you right now, I would
fight this tooth and nail if for no other reason than in rural
Minnesota, greater Minnesota, many hospitals and clinics will go under.
In some cases, 75 percent of their revenues comes from Medicare. If you
are going to take a meat-ax approach, a slash-and-burn approach, if you
are not going to contain costs in the health care field but you are
going to have these cuts in Medicare alone, then I could just tell you
right now, many of our hospitals will go under and clinics will go
under in our rural communities.
Fourth of all, Mr. President, this idea of vouchers--this is
unbelievable. People are going to have to get real with the people that
we represent. To say we will just give you a voucher, that we will set
some kind of limited per capita payment, and then you go out, senior
citizens, and sort of negotiate whatever plan works well for you. Mr.
President, with preexisting condition exclusions, with no risk
adjustment between plans, with no community rating, how do you think
that is going to work? How do you think that is going to work? If you
have a preexisting condition, you may be flat out of luck. If there is
no risk adjustment, under a capitated system there will be a tremendous
incentive for health plans not to accept people who are older and
sicker. You have to make an allowance for that and that involves
serious insurance market reforms.
Mr. President, my colleagues and I were able, a couple weeks ago, to
restore the funding for an insurance counseling and assistance
program--unwanted by Republicans, unfortunately. They wanted to even
eliminate a small program providing counselors for elderly people to
make sure people do not get ripped off by some of these private
Medicare supplementary plans. It is as if they are just going to give
people a voucher and say, good-bye, you are on your own.
Finally, Mr. President, let me make a point that the Medicare payment
system is the way in which we finance some of the most important things
we do in medical education. If we take away that funding, we are going
to lose one of the most important things we do in this country.
Training residents is a public good--the competitive private insurance
market will not pay for it. You would have to ask everyone to pay into
a fund in order to eliminate Medicare funding. But I have not heard
such a proposal this year.
Mr. President, in Minnesota we have efficient markets. We have done
an excellent job of holding down the costs. But there has been very
little equity in terms of the kind of per capita payment. Parts of New
York get $646 per month per enrollee, and Hennepin County in Minnesota,
urban Minneapolis, gets $363 per month per enrollee. This is in terms
of our reimbursement now for Medicare managed care plans. My State does
not have any fat. If you are going to talk about across-the-board cuts,
I will just tell you right now the impact on a State like Minnesota
will be severe. We are in a very precarious position.
So, Mr. President, let me conclude this way. No. 1, the idea of
cutting $300, $350, $250 or $400 billion in Medicare, so that we can
have across-the-board tax cuts flowing to the wealthiest segment of the
population, is simply outrageous. It is simply outrageous.
A family making under $30,000 would be getting, roughly speaking,
$100; and families with incomes of over $200,000 would be getting,
roughly speaking, $11,000. And for that, we are going to have these
kinds of draconian cuts in Medicare? It is outrageous.
No. 2, if we do not have that tradeoff--and I think some of our more
responsible colleagues understand we cannot do that--I say to my
colleagues that you cannot move forward with cuts in Medicare unless
you do overall health care reform, and you cannot do it unless you
contain overall costs.
[[Page S6138]] I say to the Senators on both sides of the aisle,
welcome to health care reform. Welcome to the health care issue. It is
back. How ironic it is that when historians write about the 104th
Congress, they are going to say that the 104th Congress had to address
health care reform, how to finance it, how to deliver health care to
people out in the communities in an affordable, dignified way. The
reason the 104th Congress finally moved on this question is that some
Senators realized, finally, that the only way we are really going to
have deficit reduction based on a standard of fairness and the only way
we are going to make sure we are able to provide decent health care
coverage for all of our citizens, regardless of age or where they live
or income, is with significant, meaningful health care reform.
I am ready to work with colleagues on both sides of the aisle,
because I think that will now have to be one of our major priorities.
I yield the floor.
Mrs. BOXER addressed the Chair.
The PRESIDING OFFICER. The Senator from California is recognized.
Mrs. BOXER. Mr. President, I want to thank my colleague for really
putting out in very clear and simple terms the kind of crisis that we
knew about. Indeed, President Clinton was so clear in his very first
and second State of the Union Address when he said, ``If we want to
have meaningful deficit reduction, we better address the issue of
health care reform.''
Here we have a situation--and I serve on the Budget Committee. I am
waiting for the Republican budget, by the way. It is way late. Since I
came here, I have been on the Budget Committee, and the Budget
Committee has been on time. Not this year. Do you know why? Because the
Republicans have promised certain things they just cannot keep: huge
deficit reduction, increases in the military, big tax breaks for some
of the wealthiest again. Guess what? They said they would not touch
Social Security. Thank goodness. Frankly, I think a lot of my
colleagues made that point clear in the balanced budget debate. So the
only cash cow they can look at is Medicare. And at this point, they
want to cut hundreds of billions of dollars out of Medicare, and they
realize, how can we sell that to the seniors? So they are creating this
big crisis.
We talked about the need for health care reform. My friend, Senator
Wellstone, was one of the leaders in this fight. So I say to my friend,
thank you for your remarks this morning. It is almost poignant that we
are at this point. Does he not agree?
Mr. WELLSTONE. Mr. President, I thank my colleague from California
for her gracious remarks. It is ironic that indeed we have now come
full circle back to the last Congress.
The very people who were so proud of having blocked health care
reform are now talking about a crisis in Medicare, talking about how we
will finance it, and are now making a proposal, I say to my colleague,
for rather draconian cuts in Medicare. But they do not want to talk
about rationing. Now they really are making proposals that will ration.
I think there are certain realities now that we all hope we will face
up to and move forward on health care reform. It is the only way to do
it. Otherwise, it will be disastrous.
The kind of proposals I hear people making now to cut Medicare will
not only hurt senior citizens, but as I said, will create absolute
utter chaos in this health care system. They do not deal with
preexisting conditions, they do not deal with any of the bias of not
having community rating, they do not deal with how to make it
affordable. If anything, it will just have a severe impact.
Mrs. BOXER. I just want to thank my friend again. He is, of course,
correct. The kinds of cuts that my colleagues on the Republican side
are talking about out of Medicare simply will ruin Medicare. We cannot
possibly, in the name of deficit reduction, destroy the Medicare system
or the Medicaid system, for that matter.
____________________