[Congressional Record Volume 141, Number 78 (Thursday, May 11, 1995)]
[Senate]
[Page S6473]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


  [[Page S6473]] Mr. WELLSTONE. I thank the Chair.


                        THE BUDGET AND MEDICARE

  Mr. WELLSTONE. Mr. President, first of all, I thought I might just 
respond very briefly to my colleagues about the budget and specifically 
about Medicare.
  Mr. President, let me just simply say that the most fundamental 
problem about the proposed cuts in Medicare and Medicaid, up to about 
$400 billion between now and 2002, is that these cuts reflect, I fear, 
a real lack of knowledge about health care policy. That is what bothers 
me more than anything else, Mr. President.
  Mr. President, no one should be surprised about the increase in the 
cost of Medicare, which, by the way, is a benefits program. It is not 
an actuarial program. It is a commitment we made in 1965; by no means 
perfect. Catastrophic expenses are not covered, prescription drug costs 
are not covered. There are many gaps.
  But, Mr. President, the reason that this is an expensive program and 
the reason the expense increases is because more and more of our 
population are aging and more and more of the aged population are now 
in their eighties.
  Obviously, we are not going to be able to do anything about that, and 
I do not think we want to do anything about that.
  The second reason is general inflation.
  The third is medical inflation.
  Mr. President, the problem with this proposal is you cannot single 
out one part of the health care costs, one segment of the population 
and cut there without very serious consequences.
  Let me spell out a couple. First of all, you do ration. This time we 
really do ration. Last year, last Congress, there was a hue and cry 
about rationing when we wanted to have universal coverage. You are 
going to ration by age, you are going to ration by income, and you are 
going to ration by disability.
  Mr. President, that is what happens when you just pick out one part 
of the health care costs and you target the elderly and you target low 
income, and I want to talk about Medicaid as well.
  Second of all, the reason the business community, the larger 
businesses--and I think they are going to get joined by other 
businesses as well--are going to be uniformly opposed to this--and we 
are already hearing from the business community--is because it is just 
going to get shifted to them. This is the problem of charge shifting, I 
say to my colleague, of cost shifting. This is the shell game to this 
whole proposition.
  When you pay less than what the providers need, when you do not have 
adequate reimbursement, which is already too low in rural America, 
those providers have no other choice but to shift it to those who can 
pay. That is private health insurance. Then businesses are hurt more. 
Then employees are hurt more. That is what is going to happen. And more 
people get dropped. You are going to have a huge amount of cost 
shifting. You cannot single out one segment of the population. You 
cannot do it. Welcome to health care reform. That is what we have to 
get back to.
  Mr. President, third of all, in rural America, in rural Minnesota, 
many of our hospitals and clinics have 75 percent of their patient mix 
financed by Medicare payments. These hospitals are already having a 
difficult time. They are going to go under. It is not crying wolf; that 
is what is going to happen. That is exactly what is going to happen, 
Mr. President.
  Fourth of all, and there are a lot of ``alls,'' but there is another 
issue I want to talk about as well. But fourth of all, I smile when I 
hear some of my colleagues make these proposals about vouchers; people 
can go out and purchase their own health insurance and people have the 
freedom to do so. Has anybody ever heard of preexisting condition? Do 
you think that these health insurance companies are going to grant 
coverage to people who are old and sick? They do not do that. It is 
called preexisting condition.
  By the way, managed care plans, by and large, have been most 
interested in people that are healthier. I am telling you right now, 
these cuts--they say they are not cuts--are in relation to an ever-
growing percentage of the population who are aged, many who require 
ever more by way of medical care. I will tell you what, if it is my 
father and mother--both of them had Parkinson's disease--you better 
believe I want to make sure they get the best care. So do not tell me 
you are not going to seriously cut into the quality of care for older 
Americans. You certainly are.
  In addition, you are going to cause a lot of havoc in this whole 
health care system. Just ask doctors, hospitals, clinics, all sorts of 
consumer organizations, all sorts of other people whether or not that 
will not be the case.
  So, Mr. President, the irony is we get back to health care reform. 
There were some very interesting proposals about how to contain costs 
which we have to do if we are willing to have the courage to go 
forward. But this just picks out one segment of the population, and, in 
that sense, it is not intended but I think it will be very cruel in its 
effect. I do not think it is an intended effect. And it will create 
widespread havoc in the health care field. No question about it. From 
where do you think the teaching hospitals are going to get their 
funding?

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