[Congressional Record Volume 141, Number 147 (Wednesday, September 20, 1995)]
[House]
[Pages H9357-H9360]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    THE TRUE SITUATION WITH MEDICARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of May 
12, 1995, the gentlewoman from North Carolina [Mrs. Myrick] is 
recognized for 25 minutes as the designee of the majority leader.
  Mrs. MYRICK. Mr. Speaker, we thought we would like to give an 
explanation of what is really going on in the situation with Medicare. 
We have heard so much discussion over this past couple of weeks, and we 
are going to hear more, especially tomorrow, when the plan is actually 
released.
  I wanted to clarify just a very simple point. That is that it really 
is true that the fund is going bankrupt, and will be bankrupt in 7 
years, and this is not something that is just a figment of someone's 
imagination or politics or political rhetoric, it really is true. This 
is part of the conclusion of the Medicare trustees, as we see on the 
chart before us, that the fund will be exhausted in 2001, and that they 
also made a statement right after that that simply says that the 
present financing schedule for the Medicare program is sufficient to 
ensure the payment of benefits only over the next 7 years.
  This is why the Republicans have taken it very seriously, that we 
must deal with this, we must be up front on this issue, and we must be 
responsible. We must find a solution. That is what we are doing with 
the help of the American people.
  The thing that has been so gratifying to me is that when I have been 
home in my district over the last few weeks, we have spent so much time 
not only talking with seniors but talking with the hospitals and the 
providers, the doctors, and really getting a lot of input. I know all 
my colleagues have been doing the same thing. The encouraging part is 
that the people really do understand that there is a problem, and they 
want to be part of the solution.
  We have been very, very, I think, pleased with the idea that people 
have come forward and said, ``I want to help, and I would like to give 
my suggestions, and will you really take these to heart?'' We want the 
American people to know that yes, we take these suggestions to heart, 
and we really are going to incorporate them to make a better system for 
the American people.
  Mr. HAYWORTH. Mr. Speaker, will the gentlewoman yield?
  Mrs. MYRICK. I am delighted to yield to my colleague, the gentleman 
from Arizona.
  Mr. HAYWORTH. The gentlewoman from North Carolina, Mr. Speaker, makes 
a very valid point. As I look here tonight for this special order, I 
see my colleagues, the gentleman from Arizona, two of my colleagues 
from Oklahoma, and a colleague from Indiana.
  I think nationwide we have been getting outstanding input from 
members of our various districts, citizens and constituents in our 
district. I think the unique aspect of this is something that the 
gentlewoman from North Carolina [Mrs. Myrick] referred to. In stark 
contrast to that very cynical statement that laws are like sausages, no 
one should watch closely while either are being made, we are going in 
totally a different direction with this.
  Indeed, because we are representatives serving here in the Congress, 
we are going home. We are not only talking to seniors in the district, 
but pulling together folks from various walks of life for our task 
force meetings, and the thing that I think is important to stress is 
that this discussion is open to everyone, regardless of their partisan 
affiliation or political dispensation, regardless of their age. Every 
citizen in this country should be involved in this vital debate, for 
while it now affects seniors, and I think particularly of my granddad 
who resides in the State of North Carolina, 91 years of age, and my 
parents who reside in the district represented by the gentleman from 
North Carolina [Mr. Coble] who will soon be aging into that program, I 
think some 3 years away from Medicare, this is a program that vitally 
affects our seniors, but also has great implications for our future as 
a Nation in term of offering choice; indeed, in terms of bringing 
elements of the free market back into medical coverage, and 
transforming and saving and improving Medicare for future generations.
  I think the gentlewoman from North Carolina is to be commended for 
setting aside this time to take a look at what has transpired in the 
past, and again to say to the American people, Mr. Speaker, those 
joining us tonight via television, those who have written us, faxed us, 
phoned us, the debate continues on.
  Mrs. MYRICK. That is very true.
  Mr. HAYWORTH. I know with great clarity my colleague, the gentleman 
from Arizona, put together a town hall that was really quite a sight 
and very gratifying. I know that the input continues.
  Mr. SALMON. Mr. Speaker, will the gentlewoman yield?
  Mrs. MYRICK. I am glad to yield to the gentleman from Arizona.
  Mr. SALMON. Mr. Speaker, this debate is probably the most crucial 
thing we have debated since we began this Congress in January. It is 
important for a lot of reasons. It is important because, as I have done 
my town halls back home and I have talked to the senior citizens in my 
district, they have very, very clearly given me the understanding that 
they want to change Medicare so that it lasts beyond the next 7 years.
  I give the seniors that have come to my town halls, that have called 
my office, that have come in to visit with me personally, a lot of 
credit. They are not individuals who are shortsighted, who are not 
concerned about the future of this program. No. 1, most of them hope to 
live beyond the next 7 years, at least the ones that I have talked to. 
No. 2, they realize that this is an important program that needs to be 
around for their children and their children's children.
  I have sensed a lot of support. In fact, the town hall that the 
gentleman from Arizona [Mr. Hayworth] was referring to, we had about 
700 to 800 people show up. I was so pleased to see the kind of can-do 
attitude that Americans have always had, that we will fix this system, 
that we will preserve and protect the Medicare system, because it is 
too important to politicize.
  As we talked about options, I think very clearly they gave me a 
message. That is, ``When you go back there to fix this problem, make 
sure that you preserve our dignity and that you do not interfere with 
our relationship with our doctor, and that you do not take away our 
choices, but you enhance our choices so we can take the direction for 
our own medical care and take it away from the bureaucrats, 

[[Page H 9358]]
give us more decisions. If the problem is waste and fraud, involve us 
in the solutions. Let us shop around so we can get the best deal.''
  That is why I am so thrilled with the prospect of the medical savings 
accounts, which puts the power back in the hands of the individual, not 
bureaucrats who do not have a vested interest in the outcome of
 this individual's health care, but it gives seniors the ability to 
barter, to choose the doctor of their choice, to stop the mumbo-jumbo 
that is created here in Washington, and to take control of their own 
lives. I am just really pleased that we have come up with a plan that 
incorporates so many choices, and will help seniors again to take 
control of their own destiny.

  Mr. McINTOSH. Mr. Speaker, will the gentlewoman yield?
  Mrs. MYRICK. I yield to the gentleman from Indiana.
  MR. McINTOSH. Mr. Speaker, I want to say I appreciate my colleague's 
putting together the opportunity tonight to share with the American 
citizens what we are hearing about Medicare. I wanted to share a report 
from Indiana about what citizens in my district have been saying. I 
held 12 town meetings in August, and four more meetings just last 
weekend with a special Medicare advisory task force dedicated to 
developing ideas to preserve and protect and improve Medicare.
  I wanted to let people know, probably the greatest worry that 
constituents in my district have was preserving Medicare. They are 
worried that if we do not act soon, it will not be available for 33 
million Americans, and it will go bankrupt within the next 7 years.
  I wanted to get their ideas on how we could fix that very serious 
problem. I told my constituents I would forward these ideas to my 
colleagues here in the House of Representatives, and to the Speaker, 
the gentleman from Georgia [Mr. Gingrich], as we considered legislation 
in Congress to preserve, protect, and improve Medicare.

                              {time}  2320

  The following is what some of the Hoosiers in my district told me we 
should consider as we look for ways to improve the current Medicare 
system and ensure that we keep our compact with senior citizens to be 
able to provide them the quality health care in the world.
  First, do not play politics. They do not want us to play around with 
this legislation. They do not like the fact that the President and 
members of the minority party are willing to do nothing in order to 
score political points, and they commend our effort to step up to the 
plate and address this very serious problem.
  Second, they want us to tell the truth. A lot of them were very 
nervous about cuts in Medicare, and they were seeing on the nightly 
news that we are cutting Medicare. They asked me, ``What are you going 
to do about this?'' I showed them a chart similar to the one that we 
have here tonight and pointed out to them that the truth is Medicare is 
actually going to be increasing under our plan. It is going up from 
$4,800 per beneficiary this year to over $6,700 per beneficiary in the 
year 2002.
  People were pleased that we were being honest about this. We pointed 
up, that is not as fast as some people want it to grow in Washington 
and they are calling it a cut because we did not increase it as fast as 
they wanted to, but they were relieved to see that Republicans were 
committed to increasing spending in Medicare so that we can provide 
good quality health care.
  And then the No. 1 issue that senior citizens asked us to address was 
to reform the system so that they could eliminate the fraud and abuse 
that is driving up the cost, and the No. 2 issue was to provide them 
more choices, so that they could take advantage of a lot of the new 
benefits in the health care system and be able to choose for themselves 
what type of health care they wanted, what type of coverage they wanted 
to get, and how they wanted to have their relationship with their 
doctors structured.
  I want to close my report from Indiana by saying that I was very 
pleased with the input I got from citizens all over the district and 
pleased that they were willing to spend the time to help us craft 
legislation that will allow us to increase spending on Medicare, 
preserve and protect the system for senior citizens in the future, and 
I think they will be thankful that this Congress did not play politics 
with a very serious issue and stepped up to the plate to do what is 
right for all Americans.
  Every senior had a personal example of fraud in his Medicare billing, 
including one in Milroy who was billed $5 for one aspirin, or another 
in Columbus who would take a taxi to the hospital instead of a bus 
because Medicare would not reimburse travel for the less expensive bus.
  Constituents in Pendleton said they were told by hospital officials 
not to worry about what was on their bills.
  ``Don't worry,'' one hospital official said. ``You're not paying for 
this--Medicare is.''
  Excessive paperwork required by Medicare also was mentioned at every 
Town Meeting.
  One constituent from Alexandria suggested paperwork could be reduced 
by introducing competition.
  She suggested private-sector firms could be used to process claims, 
with those that process claims the fastest receiving a bonus.
  A man in Pendleton suggested a flat tax-like form to reduce Medicare 
paperwork.
  Seniors told me they should be allowed to purchase their own 
insurance, and that competition would reduce fraud and overall costs.
  One woman in Cambridge City said her daughter's HMO provided greater 
coverage, such as for eyeglasses and dental services, than Medicare 
does.
  ``Competition is good,'' she said.
  ``Let me decide the kind of insurance that's best for me.''
  A woman in Elwood said people should be held responsible for their 
own bad health habits.
  For example, she said, smokers should pay more for Medicare than 
nonsmokers, giving Americans an incentive to live healthy and reduce 
overall health costs.
  One witness, in Muncie said that he welcomed choices but wanted to 
make sure we had ``Truth in Health Care,'' each choice lays out cost 
and coverage.
  Finally, Mr. Speaker, a man in Union City said seniors who work full-
time past the age of 65 should have the option of remaining on their 
private insurance plans.
  Mr. Speaker, I was heartened to learn that Hoosiers recognize the 
need for immediate action to save Medicare.
  But more than that, they want to ensure that we learn from the 
problems in the current system as we work to preserve, protect and 
strengthen Medicare while also offering seniors more health care 
choices.
  Mr. Speaker, Indiana seniors are paying attention to this issue.
  They understand that something must be done. They expect us to act. 
They know we are listening, and I insist that we act boldly, 
responsibly, and without delay.
  I see my colleague from Oklahoma has risen. Would you like to join us 
in reporting on what you are hearing from your part of the country?
  Mr. WATTS of Oklahoma. If the gentleman will yield, I would like to 
do that.
  Mr. McINTOSH. With pleasure.
  Mr. WATTS of Oklahoma. It is interesting, my colleague from Indiana 
put up the chart there that says that Medicare spending will go from 
$4,800 per beneficiary this year to over $6,700 per beneficiary in the 
year 2002. Somehow or another over the last 4 or 5 months, some have 
been able to get a cut out of that. I know that my math is not what my 
other colleague's from Oklahoma is, but I just cannot figure that out, 
how that is a cut. That is almost like my son coming to me and let us 
say I am giving him a $10 allowance and he comes to me and he says, 
``Daddy, I want my allowance raised to 20 bucks.''
  I say, ``Well, I'll give you 15,'' and he goes to his friend and 
says, ``My dad cut my allowance.'' How he can get a cut out of that, I 
do not know.
  In the town meetings that I did, and I did about 18 different forums, 
town meetings, over the August break, and what I found, it was 
interesting that last March I started doing some focus groups and 
visited with some folks, about 60 senior citizens in a local church, 
and we had dinner together. After dinner, we talked about Medicare. It 
was amazing what they were saying then, and I think because they use 
the system, they are out there in the trenches on a daily basis trying 
to make this system work, they saw many of the flaws that are in the 
system.
  The number one complaint all over the district they have been talking 
about is the fraud and the abuse of the system and how that hurts those 
people that really do it the right way and 

[[Page H 9359]]
really want to see the system work. But it was interesting the attitude 
shift from back in March when we first started doing the town meetings 
and the focus groups and the different forums to where it was in 
August, when we were doing the town meetings and focus groups.
  Back in March there was a little apprehension and people were saying, 
``Well, yeah, we don't know what's going on with this Medicare thing, 
but we're willing to wait and see because we know there's some fraud, 
we know there's abuse, we know the system's a little out of kilter but 
we're wanting to see what you guys are going to propose.'' That was 
what was being said in
 March. In August they were saying, ``Fix Medicare. Take care of the 
problems. Get rid of the fraud and the abuse, and cure all the problems 
with Medicare.''

  I think it is important to note, as it has been noted here with my 3 
previous colleagues, is that the Medicare Board of Trustees in the last 
2 annual reports, in 1994 and again in 1995, said that it is going 
bankrupt. It will be broke in 1996, it will be bankrupt by the year 
2002. I think it is very irresponsible for any Congressperson that has 
a vote in the 104th Congress to say that we should not do what we must 
do to fix and save and protect and strengthen the Medicare system, as 
my colleague from Arizona said, not just for today's seniors but for 
future seniors that depend and that will be depending on this program.
  I see my other distinguished colleague from the State of Oklahoma 
that represents my home district, by the way, he has risen, and I will 
yield to him.
  Mr. COBURN. I appreciate that very much.
  Mr. Speaker, I bring a somewhat different perspective to this debate. 
Many of the people in my district know that I am a practicing family 
practice physician. I get a unique perspective because not only have I 
been a provider in the Medicare system and I have hundreds and hundreds 
and near thousands of patients who are on Medicare, I get to see what 
they say and what they like about Medicare, and the security they have 
in knowing that their health care is going to be there, and at the same 
time the obligation of being a physician is to offer yourself to solve 
the problem.
  It just strikes me that of the group of people that are talking here 
tonight, what the election in 1994 was all about. There is not a career 
politician among any of the group that has stood up here tonight to 
talk. Many of us have already signed commitments that we do not want to 
be here. I have no plans to be here 6 years from now.
  Therefore, what is our goal? Is our goal self-aggrandizement? Is our 
goal to elevate ourselves? Or is our goal, do we really come here with 
the best interests of everybody in our district, the best interests of 
the senior citizens in this country, to solve the problem?
  I want people to know that there is no patent on caring. I would not 
have left a medical practice, other people would not have left other 
great careers
 to come and do what we are doing if in fact we did not want to solve 
the problems.

  We have lots of input on how to solve this. The one thing that we 
should all ask is are we getting value for what we are paying for? 
Therein lies the problem with Medicare.
  And the seniors know the answers. The seniors know where the problems 
are, whether it is fraud, whether it is waste, whether it is a lack of 
comprehension of how the system works and how we have excluded seniors 
from the payment of bills so they will not know what they cost and how 
we have allowed a system to be overused and abused. It just strikes me 
that the way we solve this problem is that we are honest. We are going 
to make some mistakes. We are not going to have a perfect solution for 
Medicare. But what we are going to do is work hard, listen and try to 
do the right thing.
  You cannot take that away from me. I can sleep every night knowing 
that my interest is best in watching for my district and the seniors, 
and also the taxpayers in our district. We can solve Medicare. We are 
going to solve Medicare. We are going to make a viable, optionable, 
quality-oriented health care system that every senior in this country 
can depend on and can count on and they are not going to have to go to 
bed at night worrying about whether or not it is going to be there in 
the future.
                              {time}  2330

  Mr. McINTOSH. Will the gentleman yield for a question?
  Mr. COBURN. I yield to the gentleman from Indiana.
  Mr. McINTOSH. As a doctor, were you hearing from citizens in your 
district that they welcomed the chance to have a choice about health 
care plans; that they would be able to maybe be able to get benefits to 
cover their medications, which they cannot right now under Medicare, 
and some of the other options that the current system, because it is so 
heavily regulated out of Washington, does not provide for senior 
citizens?
  Mr. COBURN. I think that is very true. I think with a problem comes 
opportunity. And we have a problem. The trust fund is going broke, but 
the opportunity that we have is to not only preserve what we have, but 
to strengthen it and improve it.
  I have seniors in my district that choose between eating supper and 
taking a pill. And to have them have an option that would take away 
that burden, where they will not have to make a choice between a 
medicine and supper, is something that many of them would welcome.
  I talked to a lady today on the phone and she said, ``I do not think 
that is possible. I think that is a scam.'' But the fact is, there are 
going to be options out these where seniors can choose to go into a 
program that will offer them their medications.
  Mr. McINTOSH. Would that not be a blessing?
  Mr. COBURN. It would be a blessing for hundreds and hundreds of 
people in my district to have that option. It is not available to them 
now.
  We need to listen to the seniors of this country. They have a lot of 
experience to share with us.
  Mrs. MYRICK. If the gentleman would yield for just a moment, I wanted 
to make a point too. There is another option we really have not 
discussed tonight and that is something that was asked of me a lot in 
my district when people would come up and say, ``What is going to 
happen?'' And we would tell about the choices and they would say, ``Why 
can I just not stay in the plan that my employer had for me? It was a 
good plan and I liked it a lot better.'' That is going to be another 
option that we hadn't talked about; the option that they can stay as 
they are if they want to.
  Mr. McINTOSH. So you are saying, under our reform, if somebody wanted 
to stay in Medicare under
 the program they know right now, they could do that?

  Mrs. MYRICK. That is exactly right.
  Mr. SALMON. Would the gentleman from Indiana yield? That is the 
beauty, and as I have talked to the seniors in my district, in fact, my 
father, before I came back to Washington this last week, he said, 
``Son, you better make sure when you get back there that you guys 
preserve those options that you have talked so much about, because I am 
looking forward to this. Right now, the current Medicare system just is 
not giving me these kinds of options, and I like the medical savings 
account option, personally, because it will incentive me to control my 
own costs. I think I can do a better job of controlling my costs than a 
nameless, faceless bureaucrat in Washington can do.''
  Let us talk about the options. Number 1, I think it has been 
mentioned that they can stay on the current fee-for-services type 
program. They can move to an HMO or PPO type program. They can go to a 
medical savings account.
  Mr. COBURN. They can go to a provider-based network to do that. So 
the options that are, in fact, not available now, are going to be 
available that they have not had before. They not only will have choice 
of options, but choice of doctors.
  Mr. SALMON. And the difference between who decides what those options 
will be is that it will not be dictated by some bureaucrat. The choice 
is up to the individual.
  Mr. McINTOSH. If the gentleman would yield, the minority leader is on 
television a lot telling seniors they are going to have to spend 
another $2,000 under this plan, but is it not the truth 

[[Page H 9360]]
that, in fact, some of these options will mean it will not cost them as 
much as it does right now? That they will actually save money because 
of our plan?
  Mr. SALMON. I believe so. In fact, most people out there will 
actually do better under this plan.
  Mr. McINTOSH. Why do seniors not know that?
  Mr. SALMON. I would say this to the American public. If you think 
that Washington has managed your dollars well in the past, then we have 
every reason to believe that the bureaucrat-laden system that we have 
got is the best thing. But if we believe that the American people out 
there can take control of these costs, and that they can look out for 
their needs better than a bureaucrat can, then this option is the best 
way to go.
  Mr. McINTOSH. So it really is just not true that they are going to 
have to pay thousands of dollars more, and, in fact, sometimes people 
will save money under our plan?
  Mr. SALMON. In fact, I think in most circumstances the individuals 
will save money and will do better under our plan, because there are 
more options and there is less interference between their relationship 
with their doctor.
  Mr. COBURN. I would like to interject one thing. It is not moral to 
take away somebody's comfort about their security. And there is no 
intention anywhere in any of the plans to do anything other than to 
make sure every senior citizen in this country has quality affordable 
health care.
  Mr. WATTS of Oklahoma. If the gentleman would yield for 1 second, as 
we close, I want to clearly define why we are offering options and 
choices. That creates competition with doctors, hospitals, insurers. 
They compete. And when you make the marketplace compete for market 
share, that gives value, that brings about efficiency.
  Just one simple illustration, if I see this ink pen, if I am the only 
one settling it I can sell it for what I want to sell it for. If my 
other colleagues come along and set up shop and say we are going to 
sell ink pens, I have to be more conscious about how much I am selling 
it for. That is why we are giving options for efficiency.

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