[Congressional Record Volume 141, Number 148 (Thursday, September 21, 1995)]
[House]
[Pages H9408-H9415]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      THE REPUBLICAN MEDICARE PLAN

  The SPEAKER pro tempore. Under the Speaker's announced policy of May 
12, 1995, the gentleman from Texas [Mr. Doggett] is recognized for 60 
minutes as the designee of the minority leader.
  Mr. DOGGETT. Mr. Speaker, during this next hour I and a number of my 
colleagues are going to be discussing the Republican Medicare plan. It 
is the pay more, get less plan. We have been discussing it this week 
during the special orders because of the fact that there is no real 
opportunity to debate this plan on the floor of the U.S. Congress, 
except during these sessions.
  Indeed, it has been impossible to get even a public hearing so that 
citizens across America could come forward, the experts could come 
forward; and our seniors are among the leading experts on how Medicare 
works. There has been no opportunity for them to come forward for all 
of these many months really and be heard on a specific Medicare plan. 
All they know is 

[[Page H 9409]]
that they will have to pay more and get less.
  Tomorrow we will have the only day that has been allocated to hear 
their concerns. And as I begin this discussion, I think it is 
appropriate, because the gentlewoman from New York [Ms. Slaughter] has 
spoken so eloquently this afternoon on this matter, to hear the 
conclusion of her remarks, because she shares the same concern I do 
that if our seniors are saddled with a pay more, get less plan, this 
Nation will be much the worse off, and I would welcome the observations 
of the gentlewoman.
  Ms. SLAUGHTER. I thank the gentleman for yielding to me, and I will 
be very brief.
  I just want to make the point that the $270 billion cut in Medicare 
is almost equal to the defense budget of the United States. I think we 
pour over this month after month, and committee after committee looks 
into it, and debate often takes days on the floor of the House. To this 
day, a bill that we are supposed to vote on next week has not been 
printed. Nobody has seen a single written word on what the bill that 
the hearing is going to be held on tomorrow will cover, not one thing.
  If you want to put this in some kind of context, imagine, if you 
will, the health care plan that was debated in Congress last year, had 
there been not a word of what was in it, not one sentence of what the 
consequences might be, just simply slash and burn, and that may give 
you some idea of what we are facing here with Medicare.

  Mr. DOGGETT. Would the gentlewoman yield on that point?
  Ms. SLAUGHTER. I would be happy to.
  Mr. DOGGETT. I am a new Member, and so I was not here last year, but 
I read that when that health care plan came up and when the Congress 
moved along near the August recess, it was the Republican members of 
this body who were saying, even though there had been extensive 
hearings in several committees, we need more time, the people need more 
time.
  Ms. SLAUGHTER. Absolutely, we need more.
  Mr. DOGGETT. I know I read in the Dallas Morning News, a well-known 
publication and has been known throughout its history to have been 
known to have at least a slight Republican tinge to it, actually 
referring to the Republicans this year, and it was not my word but 
theirs, the Dallas Morning News word, as being guilty of hypocrisy.
  How is it in 1 year, after having weeks of hearings on a health care 
plan, they could come to this Congress and deny us and the American 
people all but 1 day to focus on this essential problem?
  Ms. SLAUGHTER. I think it is safe to say that nothing on the 
magnitude of this cut has ever gone through the Congress of the United 
States without complete hearings, without participation of the public, 
without an opportunity to go home and say to our constituents, what 
they have ahead of them.
  We do not have anything to take home to show them. We get little 
notices in the press, and then we hear it is going to be $7 a month, 
and then we find out that that is not true. So, so far we are standing 
on sinking sand and shifting sands below us, and we do not know how it 
will affect the elderly of this country or indeed the fate of health 
care.
  Mr. DOGGETT. I thank you for your important observations.
  I see that we have been joined by other colleagues from Texas.
  Again, I congratulate my colleague, the gentleman from Texas, Mr. 
Gene Green, for the work that he has been doing this session and for 
his victory this week on behalf of individuals with disabilities as he 
worked to preserve our State vocational rehabilitation system.
  I know that there are people with disabilities across this country. 
Even though our focus in talking about this Medicare plan has been that 
it means pay more, get less for America's seniors, the same is true for 
many people with disabilities, several million in fact across America 
who are not 65 but because of a disabling condition are reliant or 
dependent upon the Medicare system. Perhaps you are aware of how they 
will be impacted by this vague plan that we have had presented.
  Mr. GENE GREEN of Texas. Well, I thank the gentleman from Texas for 
yielding to me and my colleague from San Antonio. This is not just the 
Texas hour here.
  But it will impact people who are not seniors, not only those who are 
disabled before they are 65 but the seniors' families. We all have 
family members who are over 65 and enjoy Medicare, because I have 
shared with my relatives what we had before 1965 when we had no 
Medicare, and we know the difference between 1964 and 1995 when we had 
no Medicare.
  I rise today objecting to this phantom plan that we have that will be 
released today for two reasons: One, it is a proposed cut; and also 
objecting to the lack of the public hearings on the proposal.
  Now, we have been told that the committees have been hearing Medicare 
proposals and talking about Mediscare tactics on what needs to be done, 
but we have not actually seen the plan, and we have not seen it as of 
today. And what they are going to have a hearing on tomorrow, 1 day of 
hearings is just wrong.
  The propaganda being dumped on American people by the Republican 
Medicare plan that will be released, that it is not a cut and just 
slowing the growth is preposterous. We know that we have to plan, 
whether we are in business or in government, your expected growth in 
your business or in your senior population.
  It is real simple that the population served by Medicare is growing, 
and there are going to be more people who will be 65 next year than 
were 65 last year or the year before. The people, thank goodness for 
our health care successes, are living longer. And yet when they say 
they are only slowing the growth in Medicare, they are actually going 
to end up rationing in the cut and in the growth. You either have to 
push people out of the system or you are going to provide people 
proportionally with less services. When they reduce that growth, they 
are affecting not only those who are currently beneficiaries in 
Medicare but those people who will become 65 next year and the year 
after and, you know, until the year 2002.

                              {time}  1430

  If we go back to the days when seniors had to choose between health 
care and food on their tables, are we going to do that, and I think 
that is what will happen by cutting a program with a growing 
population. We will need rationing.
  Last year I was here. My colleague was still on the Supreme Court of 
Texas. I was here and involved in the health care reform, and the fear 
from all of us, and we would have rationing if we had some national 
health care. Well, here we have a plan that will create rationing for 
seniors, and the health care will be rationed to those who can afford 
to pay more out of pocket. They will be asked to pay more and more of 
their fixed incomes, which will lower the standard of living for our 
seniors.
  Now I have heard and read the articles that everyone has read about 
how our seniors are so much better off today than they were 30 and 40 
years ago, and that is true. That is why Medicare was established, 
because you realized in the 1940's, and 1950's, and early 1960's, that 
seniors were being left out of the growth and the benefits of America 
after they spent their life to build this country, and a number of them 
literally put their life on the line to make sure this country can 
still enjoy the freedom, and now we are going to take those people who 
served in World War II and say, ``OK, now you received Medicare, and 
we're going to make you pay more for less.''
  I think your poster is so correct, I say to the gentleman. We need to 
ask ourselves, ``Do you want the force to pay senior citizens to pay 
more for less service and choose between health care and food? Do you 
want our elderly loved ones to have to have surgery in a hospital 
pushed to the brink of bankruptcy due to cuts in Medicare funding?''
  In my district in Houston we have a number of hospitals that their 
patient base is substantially Medicare, and Medicaid, and managed care, 
and managed care is forcing hospitals to transfer those costs to 
Medicare recipients, and there is just no place to go if you 

[[Page H 9410]]
cut the cost of Medicare. You are going to have hospitals close not 
only in rural areas, but in urban areas. Do you want to have to be 
operated on by a physician or surgeon whose training may have been 
reduced by the cuts in Medicare that we do now for medical education?
  We hear a lot these days about avoiding a train wreck. Well, the 
seniors of our country will experience one of the most destructive 
train wrecks in history if this plan is passed.
  If you answered no to any of these questions, then I hope it is not 
only our duties as Members of Congress, but our constituents and people 
all over the country, to oppose this Republican Medicare train wreck 
that will be fostered on us tomorrow.
  My second objection is lack of public hearings that we have had to 
this not-yet-released plan, and here we are Thursday, and you and I 
have not seen it. Of course we do not serve on the Committee on Ways 
and Means, so we might not see it even until tomorrow when it is 
released publicly.
  But I participated in 10 days of hearings on the Waco incident. I saw 
28 days of hearings on Whitewater and 8 days of hearings on Ruby Ridge, 
and I do not object to those hearings.
  Mr. DOGGETT. If the gentleman will yield on that, so that is 10 days 
about the tragedy that happened in Waco, 28 days about what the 
President may or may not have done; was that 12 years ago? Some long 
time ago, back when he was Governor of Arkansas. Twenty-eight days on 
that. And how long on this incident in Idaho?
  Mr. GENE GREEN of Texas. Well, 8 days on the Ruby Ridge incident that 
happened in 1992, long before most of us, least the majority in the 
House, were ever elected. So we had all those days of hearings after 
the fact, and here we are only going to have 1 day of hearings, 1 day 
on a plan that will be released maybe today for hearing tomorrow, and 
that is where our priorities are wrong, and that is why the Republican 
majority is wrong, and they need to look at what the American people 
are saying, that we need to get our priorities straight here in 
Washington. We need to realize that we need to listen to our 
constituents, we need to have more than just 1 day to hear from them, 
and the people are asking us, ``Don't go to Washington and lose 
touch.'' Well, this is a prime example of losing touch, by announcing a 
plan on Thursday, have 1 day of hearings on Friday, and then the whole 
House has to consider it.
  Mr. DOGGETT. Let me ask you about that.
  When you say ``announcing a plan'' it is true that the press release 
this week is thicker than the press release from last week, but you are 
going to be going, I know, in a few minutes back to a hearing on one of 
the other Republican ideas of this session, which is to destroy, or 
abolish, one of the Cabinet offices that has been here for decades in 
the United States. You do not go to that hearing without having a piece 
of legislation to consider. In other words, instead of just going 
there, and scratching your head, and thinking about somebody's good 
idea, or some think tank that has come up with some theoretical 
approach to deal with the security of health care for 37 million 
people, you do not go there without a specific proposal; do you?
  Mr. GENE GREEN of Texas. We have had this proposal abolishing the 
Department of Commerce that I am not in favor of. I agree, in fact, 
that when we were in the Texas Legislature, you were the father of the 
sunset legislation, and you were in the State senate, and I was in the 
House, and I served on the sunset commission. I like the idea of 
looking at agencies and reforming them, but we reform them over a 
period of time. We do not all of a sudden wake up on Thursday and say 
we are going to abolish and we are going to change this agency to 
deliver services and provide assistance to American businesses. We are 
going to have vote on that Friday. You do not do that on those 
agencies, and why should we do it to the most important issue that this 
Congress may consider? It is like you said the health care for 37 
million elderly U.S. citizens.
  Mr. DOGGETT. And you know I am reminded by your comment that another 
of our fellow Texans who does not serve in this body, though I know he 
aspired to come to Washington, Ross Perot, who recently commented on 
this plan, though I have some differences with him about this subject 
among others, but he suggested if we were going to have these big 
changes in the way Medicare works, that just as you pointed out with 
business, you do not just jump what you have got and go to something 
else. You test it before you proceed to apply that to everyone and 
suggested that new ideas should be tested out before you make 37 
million Americans the guinea pigs for this new approach that really 
amounts to little more than pay-more, get-less.
  Mr. GENE GREEN of Texas. Well, we need to ask ourselves then why is 
the Republican majority rushing the Medicare reform bill to the House 
floor for a vote before the American people without time to review 
the consequences. Well, I think the answer is clear. The Republican 
majority does not want the American people to know what is in their 
Medicare reform bill because it is incredibly harmful. Frankly, it is 
no wonder that the plan is shrouded in secrecy. If I had a plan that 
was going to make seniors pay more for less service and force them to 
give up their, possibly their, lifelong doctor, and all to pay for ill-
advised tax cuts, I think I would be scared, too, and I would want to 
rush it through on a short notice.

  We hear a lot of times about how Medicare is in trouble and we need 
to reform it. We have reformed it over the last 30 years from the time 
it was passed, but right now we can deal with fraud, abuse, and waste 
in Medicare and do some of those reforms that will save us some money 
and reform Medicare, but not for $270 billion to pay for $245 billion 
in tax cuts.
  Mr. DOGGETT. Let me ask you about that because we do hear examples on 
the press. Seldom do you go out and visit with seniors, as I know you 
do in your district, and I do up in Austin, without hearing about an 
incident where a health care provider perhaps abused the system. That 
is the kind of subject that we ought to have some bipartisanship about. 
I have not seen anyone yet come on the floor and defend fraud, maybe 
someone will, but we ought to be able to come together and work 
together.
  But let me ask you about in that regard in trying to achieve some 
bipartisanship. I am amazed to hear this. Except for the experience we 
have had within the last few weeks here, I understand that the chairman 
of the Committee on Rules, actually the ranking member of the Committee 
on Rules, the gentleman from Massachusetts, Mr. Moakley's office went 
over to the chairman of the Republican Conference's office to ask for 
the 30-page outline that is now available on this plan, that this 
happened as we have been here debating this afternoon, and was told 
that is not available to Democrats.
  Now, I do not know if you have seen other incidences of that kind of 
rude and arrogant behavior here before, but those who come and say you 
need to be more bipartisan, it is a little different to be bipartisan 
with people that would not allow a hearing and would not even give an 
outline of their sorry plan to you.
  Mr. GENE GREEN of Texas. Well, in an outline that is 30 pages long 
can you imagine how big the plan must be for us to be able to analyze 
it before the hearing tomorrow and before the members of the Committee 
on Ways and Means may have to have it? The numbers on the plans are 
that we have heard leaked out just do not seem to add up either. We 
talk about increases in seniors paying their monthly amounts that they 
pay doubling it over the next 7 years, or maybe more. But there is 
still an $80 billion hole that they are looking for.
  The President has come up with, has a Medicare reform plan, and even 
the trustees, who our majority, have talked about that they are running 
around like the world is going to end unless we listen to the trustees' 
report, these very same trustees said we do not need to cut $270 
billion out. We can do $90 billion worth of reform and safeguard 
Medicare.
  Now 10 years from now, 8 years from now, Congress is going to have to 
revisit that issue because again I wish you and I could stand here 
today and solve our problems today, but that does not work. We always 
have to be ready to change in reform whether you are in 

[[Page H 9411]]
government or whether you are in business. There are different ways to 
do things. But we can solve Medicare's problems by without cutting $270 
billion, and again I hope the American people understand we are looking 
at cutting $270 billion at the same time they are granting $245 billion 
in tax cuts, $245 billion. Medicare is paying for those tax cuts, and, 
if they can stand there on the floor and say that, I want to be 
bipartisan?
  Let us solve Medicare's problem, but let us take those $245 billion 
in tax cuts off the table, and then we will talk about solving 
Medicare. Do not use Medicare to pay for tax cuts. We need to balance 
the budget, but we do not need to do it on the backs of Medicare.
  I thank my colleague from Texas for the time, and I look forward to 
continue to being in the trenches.
  Mr. DOGGETT. I know you have to be back for a piece of legislative 
markup, and, as you are departing, I will just continue some 
observations on this, and I think an appropriate observation in 
discussing this matter is to reflect on Congressman Green's remarks 
that many of the people who will be most directly affected by this are 
people who served our country both at home and abroad during World War 
II, and I do not think anyone served our country in a more 
distinguished role than a gentleman who figures prominently in this 
debate and was on national television last night, and that is the 
distinguished gentleman from Florida [Mr. Gibbons], the ranking member 
of the Committee on Ways and Means, who will be considering this 
measure.

  The gentleman from Florida [Mr. Gibbons], for those of you who do not 
have personal familiarity with him, is a true American hero. He was a 
paratrooper on June 6, 1944, D-day, in France. He fought for this 
country. He fought against fascism and against tyranny, and since 
returning is now serving his country in another way in this body. He 
continues to be a true American patriot. It is not unlike the 
experience I just reflected on, about the inability of Democrats to 
even receive a copy of this measure, the incredible experience that he 
had yesterday.
  True, sometimes the news media likes to focus on the fight rather 
than the substance of what produced the fight. But the American people 
and all of our colleagues who were not there should know that the 
reason that the gentleman from Florida [Mr. Gibbons] expressed the 
anger and the dissatisfaction that he did was because of what occurred 
in the Committee on Ways and Means which was supposed to get a full 
outline of this measure yesterday and have a hearing on it as we are 
debating here this afternoon. But instead the committee met and refused 
to even permit the ranking member, a distinguished and senior Member of 
this body who served his country with such valor and distinction, to 
say word one. They would not let him discuss the proposal at all. 
Instead he was cut off without being able to say a word, a vote was 
taken in an autocratic method, and so his remarks were confined to what 
occurred in the hall outside this Chamber.
  Again it is an example of how difficult it is for those of us who 
want to achieve a bipartisan solution not only to the issue of Medicare 
and the security of our Nation's health care, but on a widening range 
of matters in this House that, when you proceed with such arrogance, 
with such high-handedness, with such determination, to do it your way 
or no way, that it is very difficult to have a basis for reason and for 
moderation.
  It is not only the State of Florida, of course, who has contributed 
heroes to this country like the gentleman from Florida [Mr. Gibbons]. 
We have done our share in Texas as well. One of his contemporaries, I 
suppose, and someone who I have admired since earlier days in the 
public school system of Austin where he served as a distinguished 
member of the Texas legislature, is the gentleman from San Antonio, TX 
[Mr. Gonzalez], my colleague who I know has some observations that bear 
on Medicare and a number of other things that are occurring here, and I 
would like at this time to yield for remarks that I know he has.
  The dean of our Texas delegation, the Honorable Henry B. Gonzalez.

                              {time}  1445

  Mr. GONZALEZ. Madam Speaker, I, in turn, want to thank my colleague 
from Texas, a young gentleman I have admired from the beginning and 
have watched his political trajectory as he rose in Texas and am so 
proud of him. I want to thank him for his kind remarks.
  Congress is getting ready to pass something called the Budget 
Reconciliation Act, which is a bill that's required to bring Government 
spending into line with the budget resolution passed earlier this year. 
Usually, budget reconciliation is pretty straightforward, but this year 
the new Republican majority in the House is putting together a bill 
that does far more than line up spending with the desired targets. This 
year, the reconciliation bill is being used for all kinds of radical 
projects that the Republicans hope to force through, without letting 
anybody have a fair hearing, let alone a fair shake.
  The biggest piece of this stealth legislation involves changes the 
Republicans want to make in Medicare. So far, we've seen only the 
barest outlines of their proposal, but what we've seen makes clear that 
senior citizens are about to get less medical care and pay more for it.
  But the reconciliation bill is also going to be loaded down with 
other ideas, like legislation to eliminate all federally required 
highway speed limits and just about all safety requirements for mid-
sized trucks. Legislation that says that mid-sized trucks don't need 
safety equipment is a crazed notion at best, and has nothing to do with 
balancing the Government's books.
  In my own Banking Committee, the Republicans are using the 
reconciliation bill to wipe out what's left of the savings and loan 
industry. They're moving fast and ignoring lessons of the past that 
time after time have proven you have to be very careful when you change 
banking laws in such basic ways.
  Another project of dubious merit is the Republican plan to gut 
something called the earned income tax credit, which is a tax benefit 
that goes to poor, low-wage workers. The tax benefit doesn't go to 
anybody that earns more than $11,000 a year, but it has the effect of 
putting $25 billion a year of money where it does the most good--right 
in the hands of underpaid and hard-working Americans who want to have 
the pride and dignity of work even at low wages. But the Republicans 
want to cut this benefit, by perhaps a third.
  If we want people to work instead of drawing welfare benefits, we 
should adopt policies that make it possible to earn a living wage. One 
way to do that is to adjust the minimum wage upward, which hasn't 
happened in many years. And another way to help people get off welfare 
and into work is to be certain that they get child care and medical 
care. But guess what? The Republicans don't want to do any of those 
things. It looks as if they're simply aiming to make the poor a whole 
lot more miserable.
  The greatest asset any country has is its own people. Laws that help 
people get an education; laws that help people to get a decent, 
affordable house; laws that help people earn a living wage; laws that 
enable people to get adequate medical care at a reasonable cost--those 
are the kinds of laws that make this or any other country a better 
place. Sadly, every one of the laws that are intended to make this a 
cleaner, better, safer, and more decent country are under attack in 
Congress. There are some who think that it doesn't matter, but the 
truth is in the end, all of us will suffer together if poverty grows, 
if schools aren't improved, if the air we breathe and the water we 
drink are degraded, and if more and more of us find it impossible to 
get and keep a decent job or to afford decent housing and medical care.
  Many of the actions that are about to unfold in the so-called budget 
reconciliation bill are downright silly or verge on the irrational--but 
others are mean spirited and can only result in a country that offers 
less hope to those who are struggling to rise above poverty and 
personal tragedy.
  I feel certain the President will veto the reconciliation bill, and 
will also veto many of the worst bills that are working through 
Congress these days. But no doubt about it, the next couple 

[[Page H 9412]]
of months are going to be as mean as they ever get.
  I thank my colleague.
  Mr. DOGGETT. Madam Speaker, I thank the gentleman so much for his 
observations. I think actually, in referring to my colleague, Mr. 
Gibbons, and some of his contemporaries, I may have referred to World 
War I. There actually may be some World War I folks that will benefit 
or be adversely affected by what we do on Medicare, but the gentlemen 
from Florida [Mr. Gibbons] is not quite that senior and served during 
World War II. I think it is particularly that World War II generation 
that will be most troubled and has most reason to be concerned about 
what is happening here on Medicare.
  Madam Speaker, I see that my colleague from New York, who has spoken 
so many times about the importance of not taking the care out of 
Medicare has arrived, and I would yield to him for such observations as 
he might have about the troubling developments of the day where the 
Republicans issue a bigger press release but do not give as much in the 
way of a detailed plan.
  Mr. ENGEL. Madam Speaker, I thank my friend from Texas, who has 
certainly been one of the shining lights of the new freshman class of 
this Congress, who has spoken so eloquently on the floor not only today 
but many, many days, and the gentleman is quite right, the Republicans 
simply want to take the care out of Medicare.
  Madam Speaker, Medicare actually was a program that was put into 
effect in the 1960's. It is a plan that many Republicans want to kill. 
And, in fact, that has been the modus operandi, the way the Republicans 
have operated, during this whole Congress. They take plans, they take 
bills, they take laws that they have wanted to kill for many, many 
years and say this law needs fixing. So instead of just fixing it, what 
do they do? They kill it or gut it.
  We have seen it time and time again, not only with Medicare and 
Medicaid, but we have seen it in assaults against working people in 
this country. We have OSHA, which protects people; occupational safety 
and hazard laws, which protect the safety of American workers. Do they 
want to fix it? No, they want to kill it. They want to gut it. The 
National Labor Relations Board, which monitors unfair labor practices. 
They are trying to cut it, cut the funding and kill it. Davis-Bacon, 
which guarantees construction workers prevailing wage, a decent salary. 
They want to get rid of that, too.
  As my colleague from Texas just mentioned, all the good environmental 
laws that bipartisan Congresses have put into effect for so many years, 
what are they trying to do? Not fix those laws, but kill it and gut it. 
Student loans. The same thing. Kill it and gut it.
  The Republicans have been using the fact that they believe certain 
bills, certain laws like Medicare need fixing. They do not fix it, they 
kill it. So, Mr. Speaker, this is just the first assault on Medicare as 
we know it.
  If we cut $270 billion from the program, we are, in essence, killing 
the program. It just starts that way and it goes on and on. One thing 
really ought to be made very, very clear. Medicare is a program that 
serves middle-class America. This is not some boondoggle or some 
program that is being doled out to people who have not worked in their 
lives, or people who have not made sacrifices in their lives; to people 
who have not done what they should do. Medicare benefits middle-class 
America, senior citizens who have worked hard and struggled all their 
lives, put a few dollars together only to see it dissipate in their 
later years. They are as scared as can be.
  Madam Speaker, I take the case of my mother, who lives in Florida, 
and all her friends. They do not have money for prescription drugs 
right now. Many have to choose between eating well and buying 
medicines. Can any of us imagine what it will mean when $270 billion is 
cut out of Medicare? To my Republican friends who say, well, it is not 
a cut, we are actually increasing the funding; and, how could it be a 
cut if we are increasing the funding? Everybody knows if we do not 
increase the funding, with the rate of inflation, it is a cut. 
Everybody knows if we manipulate part A and B, it is a cut.
  The bottom line is this, Madam Speaker, what kind of care do seniors 
get now under Medicare, and what kind of care will they be getting in 
the year 2002 after there is $270-billion worth of Republican cuts? The 
answer is very easy. Senior citizens, as my colleague from Texas says, 
the GOP Medicare plan means seniors will pay more for their health care 
and get less. That is the bottom line. Pay more in premiums, get less 
health care, get less choice, be forced into HMO's, be forced to accept 
strange doctors, because they sure will not be able to choose their 
doctors.

  As we are talking right now, I will bet that senior citizens will 
suffer from a lack of choosing of their own doctors. It is not right, 
Madam Speaker. All we are saying on the Democratic side of the aisle is 
we want to have open hearings on this. The Republicans in this Chamber 
have the votes. They can outvote us every time. What is so terrible to 
let the light shine in so that the American people can understand what 
this means?
  In the last Congress President Clinton proposed a health care plan. 
At the very, very beginning everyone seemed to be in favor of it, but 
as more and more people found out about it, for whatever reason, they 
decided they would not support it. And the Republicans, quite frankly, 
are afraid that if we let the light of day shine on their Medicare 
sham, or their Medicare proposal, that the American public will say, 
wait a minute, guys, this is not what we want. Medicare is a sacred 
covenant with the American people and we do not want to gut it. We do 
not want to hurt senior citizens.
  They are afraid when their plan is exposed that seniors will 
understand that it hurts them; that it will be terrible for the senior 
citizens in this country. So how do they get around it? Let us only 
hold one hearing on this particular bill.
  Now, the hearing is tomorrow. I do not know what is in their plan. I 
have not seen their bill. How can anyone have an intelligent hearing 
when we do not know what is in the bill? They would like to just 
blindfold us, gag us, not allow us to ask questions, and not allow us 
to hold hearings. What is so terrible with an open procedure?
  Madam Speaker, the Republicans ranted and raved on the other side of 
the aisle in previous Congresses about muffling the minority. We are 
not talking about the minority or the majority. We are talking about 
the American people. They have the right to understand what this 
Congress is about to do. The only way we can do that is by holding 
hearings.
  The hearings we are going to hold tomorrow are going to be on the 
lawn of the Capitol. That is because we could not get a decent hearing 
room in the Capitol to hold these hearings. What a disgrace. It is 
absolutely a gag rule. It is being perpetrated not on the Democrats in 
Congress but on the American people.
  So the bottom line here, for me, is what is the quality of health 
care that senior citizens get under Medicare now, in 1955, and what 
will be the quality of care that they will get under the Republican 
plan in 2002? When we couple the 270 billion dollars' worth of cuts in 
Medicare and, at the same time, give $245-billion worth of tax breaks 
to the rich, that only adds insult to injury. To my friends on the 
other side of the aisle who say one has nothing to do with the other, 
well, $245 billion and $270 billion sounds pretty equal to me. If we 
eliminated the tax breaks for the rich, and even if we had to cut the 
Medicare Program, 270 minus 245 is only $25 billion. So we would have 
to cut it a lot less if we gave up on the tax breaks for the rich than 
we would under the Republican plan.
  Mr. DOGGETT. Let me ask the gentleman one question about these 
hearings. Beginning about 9:30 or so eastern time tomorrow morning the 
gentleman has referenced hearings that will occur just outside the 
House Chambers here on the Capitol Grounds. Do I understand those 
hearings will continue into next week?
  Mr. ENGEL. Yes, those hearings are planned to continue into next 
week, because if we cannot get 4 weeks of hearings, as we requested, we 
feel that we could at least have 4 days of hearings where senior 
citizens and representatives of senior citizen groups and people 
involved with Medicare can come and testify and tell us their opinions 
and tell us what Medicare means to 

[[Page H 9413]]
them and tell us what the GOP Medicare plan will be.
  Those are the only open hearings, unfortunately, that are going to be 
held on Capitol Hill.

                              {time}  1500

  Mr. DOGGETT. They are open hearings. That is, any American citizen 
who would want to come forward and present their testimony, if we are 
not able to hear from all of them orally, can file their written 
testimony with us and get that to the attention of people, at least 
within the Democratic Caucus, the 200-plus Members here who would want 
to hear their observations.
  Mr. ENGEL. The gentleman is absolutely right. We welcome testimony, 
written testimony and people testifying, from seniors in all walks of 
life, because we think it is very, very important to hear all points of 
view. Again, if the Republicans absolutely insist on ramming whatever 
they want to ram through, they have the votes in this Congress, but it 
ought not to be done under the secrecy of darkness. It ought to be done 
after we have an open and full hearing and the American people 
understand what is about to happen to them in Medicare.
  Mr. DOGGETT. Indeed, given the ramifications of this particular plan, 
it might be well advised to have these hearings at a variety of 
different locations, since the Republicans are not doing that and we 
are forced to have ours outside the Capitol, for those citizens around 
the country who will not be able to come personally, perhaps someone 
who is confined to home and unable to leave and be here. Would there 
not be a mechanism where they could forward their comments here to the 
Capitol and advise people of their concerns about this plan or their 
suggestions improvements in Medicare to strengthen it?
  Mr. ENGEL. Constituents can absolutely write to their Member of 
Congress, be it Democratic or Republican, and let us know what you 
feel, let us know what you think is happening to Medicare. I would hope 
that some of our colleagues would, and I know I plan to do it in my 
district in the Bronx, NY, and Westchester, NY, to have hearings in my 
district, have open forums in my district, so I can hear from the rank 
and file, from my constituents, who will be most affected by whatever 
Congress does on Medicare. I want to hear from them, what Medicare 
means to them, how important it is, not only not to cut Medicare, but 
to expand services. I want to see prescription drugs, for instance, 
expanded. I want seniors to be able to get prescription drugs.
  There was one very interesting point. The Republicans have said that 
they want to balance the budget and they do not intend to touch Social 
Security. Well, for my senior citizens, if you do not touch Social 
Security, but you touch Medicare, it is the same darn thing, because 
senior citizens rely on Medicare as much as they rely on Social 
Security. So it is an absolute fraud to say we are not going to touch 
Social Security, when at the same time you are devastating Medicare.
  Mr. DOGGETT. I thank you very much for your observations. I see 
another colleague of ours, Mr. Bentsen, from Houston, TX has joined us, 
and may have an observation in response to your comments.
  Mr. ENGEL. We have all these good Texans here. It is nice to join 
with them. We can bring New York and Texas a little closer together.
  Mr. DOGGETT. Certainly when the issue is health care security and 
misrepresentation that is being made to our seniors about their health 
future, we all need to come together. I wish we could get more of our 
Republican colleagues coming together. There is nothing in the rules of 
the House that prevents them from coming to the floor this afternoon 
and utilizing their hour of time to outline in detail their plan, but 
apparently they have chosen not to do that.

  Mr. ENGEL. It really is unfortunate, because I think the bottom line 
is, the only way we are really going to get a plan that helps our 
senior citizens is by doing it in a bipartisan fashion; not in this 
way, ramming it down everyone's throat without any kind of open 
hearings. I thank the gentleman.
  Mr. BENTSEN. I thank my colleague from Texas for yielding. I thank 
him for taking the time today to speak about the issue of Medicare.
  Let me just start out briefly by talking a little bit about 
procedure. I am glad to see that the dean of the Texas delegation, Mr. 
Gonzalez, is on the floor, because I was with him the other day in the 
Committee on Banking and Financial Services where we were going through 
a similar process on legislation affecting the financial laws of this 
Nation. That appears to be similar to what is going on with Medicare.
  We are now engaged in policy by the numbers, as opposed to policy for 
good government sake. I do not think there is any Member of the House 
who does not believe that our duty here is to have an efficient 
Government that works for all the people, but what appears to have 
happened is we are now driven purely by trying to achieve numbers in a 
budget and to form and fit the policy into that type of budget. That is 
what has brought us to his situation of having to cut $270 billion from 
Medicare and $180 billion from Medicaid.
  I would start out by saying simply there is just no good way to cut 
$270 billion from the Medicare Program, and that is why we continue to 
hear little about what this Medicare plan will be. Unfortunately, we 
will have very little to say about it before it is put before the 
Committee on Ways and Means and put before the Congress.
  Mr. DOGGETT. In other words, when our Republican colleagues coming up 
here, instead of giving us the details of their plan, they turn and 
say, ``Why do not you Democrats come up with a plan to cut $270 billion 
out of Medicare,'' they are going to have to cut an awfully long time, 
because we do not believe $270 billion ought to be cut out of Medicare.
  Mr. BENTSEN. I think the gentleman is correct. He will recall that 
earlier this year many of colleagues from the other side of the aisle 
would come down and hold up a pamphlet from the trustees of the 
Medicare system saying ``Medicare is going broke and we need to do 
something to save it.'' But the facts are, if you read the report, not 
just the pamphlet, but if you read the report and talk to the trustees 
and hear what they have to say, No. 1, Medicare has always been 
projected, part A of Medicare, the hospital insurance program has 
always been projected to have shortfalls in the out-years, and it has 
been the Congress, and I would have to say the Democratic Congress, 
which has always stepped in to ensure that Medicare is a solvent 
program that runs forward. In fact, that is how the program was 
originally designed.
  It is interesting to note that in the previous years, when both the 
gentleman from Texas and myself were not Members of this body but 
innocent bystanders, I guess, back in Texas, watching what was going 
on, that our Republican colleagues did not see any problem with the 
Medicare situation or the part A hospital insurance situation.
  But, lo and behold, a year later, they are out crying wolf and saying 
we have this major probable out there.
  Mr. DOGGETT. In fact, is it not true that last year, the trustee used 
the very words, save one or two, that they used this year, to express 
concern about the future of the trust fund.

  Mr. BENTSEN. That is absolutely correct. In fact, if you go back and 
read the study, as I have done, the actuarial tables, you can see the 
points in time where the trustees in the past have said that Medicare 
would have an even shorter life than is projected today. You can also 
see the points in time where the Democratic Congress came in and made 
the necessary adjustments to make the cash flows work.
  So I do not think that there is much basis of fact to that argument. 
Furthermore, we have heard from the trustees of the Medicare system 
that in fact you do not need $270 billion to save the program, and what 
little we do know of the plan that will be released tomorrow, I guess, 
the Republican plan on cutting $270 billion from Medicare, is that 
there is no evidence whatsoever that any of that money is actually 
going back into part A of Medicare.
  The fact you are raising premiums on elderly citizens, something 
along the lines of $60 or $80 billion, if you look to see where the 
money goes, as they used to say in the Nixon times, you cannot find it 
going back into part A, which would lead me to believe that if in fact 
there is a problem in the fact we are 

[[Page H 9414]]
taking money out of the system and not putting it back in the system, 
we are only going to exacerbate the situation that exists, and it does 
appear we are shifting money out of the Medicare system by raising 
premiums on the elderly into other parts of the budget, presumably a 
tax cut. That really makes no sense whatsoever.
  Mr. DOGGETT. That strikes me as such a critical point. As you say, 
during the Nixon years they said follow the money. It was a good trail, 
to follow the money back there during the Watergate era. It still is 
with this Republican Medicare plan, because the first plank of the 
Republican Medicare plan is pay more. But from looking at the press 
release that came out today, the pay more part is over in the part B 
premiums.
  As you were pointing out, I believe I have this correct, they will 
increase the part B premiums that every senior has to pay, but not one 
penny of those increased premiums will go into this Medicare trust fund 
that they said they were so concerned about after they read the 
trustees report saying the same thing the trustees had been saying for 
years when they did not care a flip about it.
  Mr. BENTSEN. The gentleman is absolutely correct, that in fact money 
from part B is going elsewhere in the budget, and if there is a problem 
in part A, it continues to exist. So I think that that is a major flaw 
in the proposed Medicare plan from the GOP, and it is something that 
the American people need to know about.
  I think that, furthermore, when we look at what has been released so 
far, we find a gaping hole of something along the lines of $80 billion 
that is going to be made up in something that is called the look-back. 
That is sort of a ``trust us'' type approach to governing, that we 
think we can get there, and if we do not get there in a couple of 
years, we will just tell the Secretary of Health and Human Services to 
come up with $80 billion.
  Well, where is that $80 billion going to come from? Is it going to 
come out of somebody's pocket? Higher deductibles, higher premiums, 
higher copayments? We do not know. But that is a major problem.
  When you add to that the global price control which will be set on 
services provided by hospitals and doctors as a result of this, you in 
effect will push the price for fee for service, choice of doctor health 
care, down to a level where I think you will see physicians who will 
get out of the business because they just cannot lose money and do the 
business. You will see hospitals who will say that we have no choice 
but to go into a captive program with a health maintenance 
organization, and seniors will no longer have the choice as current law 
provides; they will no longer have the choice to choose between a 
health maintenance plan like an HMO or a fee for service like they have 
had. They will be left with only what the market will be able to give 
them because of the price controls set by the plan.

  Mr. DOGGETT. I would like to talk about each of those. You have 
extensive experience in business and investment banking, are familiar 
with principles of financial planning, and you referred to this look-
back provision. As I understand it, and I do not believe, though there 
are many pages in this new press release, that there has been any 
explanation of how it is of this $270 billion, how they are going to 
cover their $80 billion or so gap. Just from the standpoint of good, 
sound business, financial planning, what kind of plan is it that says 
we will cut $270 billion, except we do not really know how we are going 
to get $80 billion of that $270 billion? We have just kind of guessed 
if everything we are thinking about but have not put in a bill anywhere 
happens to come out, maybe like we hope some day under the best of all 
circumstances it will, we still got another $80 billion out there 
hanging and we do not know where we are going to get that.
  Mr. BENTSEN. The gentleman is correct. I guess you would say it is 
less than creditworthy in trying to put together a plan. What it will 
result in, I think, is that at some point they will come back and say 
well, gee, we are $80 billion short and have to make it up, so we are 
just going to cut you across the board. Sorry, Medicare recipients, we 
did not think we were going to hit you as hard as we did, but we came 
up short and are going to have to take more money out of your pocket.
  Mr. DOGGETT. If I understand it, then someone in the bureaucracy here 
in Washington, acting under the authority of the Secretary of Health 
and Human Services or the Health Care Financing Agency, when the year 
is gone by and there is this big old gap there of billions of dollars, 
will go back and say well, the gap is there, next year we are just 
going to have to cut how much we pay these health care providers by 50 
percent, 30 percent, or 25 percent, or however much it is. Is that the 
way this so-called look-back provision works?
  Mr. BENTSEN. I think in terms of trying to set a budget, that is what 
you would have to do. It would be equivalent to sequestration, which 
was provided under the Gramm-Rudman Budget Act.
  Mr. DOGGETT. That was a real winner.
  Mr. BENTSEN. The problem that exists with that is it does not allow 
for any strategic planning on the part of health care institutions, 
hospitals, providers of health care services. So if you are going out 
several years and you are trying to set your budget based upon prices 
that you think you were going to receive reimbursement from Medicare, 
but you know out there, there is a $80 billion footnote that can come 
into play some time, it is going to be very hard for you to set your 
plan.
  Mr. DOGGETT. Congressman, representing the city of Houston, I think 
you represented one of the world's finest health care systems, research 
hospitals, teaching hospitals, hospitals that provide services all 
around the world, but particularly provide a wide range of services to 
people who are seniors and who are people without substantial means to 
pay for them.
  What kind of impact could a look-back provision like this, 
continually cutting payments, have on a world class hospital system of 
the type that you have there in Houston?

                              {time}  1515

  Mr. BENTSEN. I am afraid that if we continue along this process, that 
it will start to cut into research. I think that as a result of a lot 
of work that has been done to try to explain to the Republican majority 
the impact on medical education, we are starting to hear that, yes, we 
do understand the importance of medical education, and we are going to 
start to provide for that. That is good.
  However, we still do not know all the details. We still have clinical 
research which is carried out in these academic hospitals through the 
Medicare system. As you clamp down on the payments to the hospitals, at 
the same time that you have health maintenance organizations which are 
trying to pay as little as they can, because they are in the business 
of doing that, and that is the way the system works and that is fine, 
the problem is going to become that you are going to lose the necessary 
clinical research dollars that better the health care system, make it 
more cost-effective, and make it more efficient for seniors and for 
everyone else. You also are going to end up with not only cutting back 
on that research, but you are going to end up with jobs being lost in 
large medical centers.
  Mr. DOGGETT. Madam Speaker, the gentleman you mentioned another 
effect of continuing to cut down to too low a level the payments made 
to health care providers. I just happened to come across a report here 
on the impact in central Texas of problems we already have with 
Medicare, the kind of thing that I know you and I want to do to improve 
Medicare to deal with these problems.
  There is the story of Richard Bergin, who is 74 years old, has lived 
in Austin for 40 years, served as a naval officer, as a professor at 
the University of Texas at Austin, and he was doing fine and had a 
relationship of his own with his primary care doctor. However, when his 
83-year-old brother moved into town from out of town to live with him, 
they could not find any doctor there that would take Medicare in all of 
their initial searching. The American Association of Retired Persons 
reports that about 80 percent of the doctors in most Texas towns today 
will not accept new Medicare patients.
  If they have this look-back provision and they keep chopping back the 


[[Page H 9415]]
amount that health care providers are getting, will it not make it even 
more difficult for people like Professor Bergin and the others across 
Texas, whether it is in Houston, LaGrange, or Lubbock, or anyplace else 
in this country for that matter, will it not make it more difficult for 
them to find a physician that will take care of their needs?
  Mr. BENTSEN. I think you are absolutely right. I think the fewer 
doctors who participate in the system, the harder it will be, 
particularly on rural communities and smaller urban communities, where 
there will be even fewer doctors who are willing to participate in the 
system.
  I think there is another problem that comes into play here. By moving 
more people into health maintenance organizations, which again let me 
say, Medicare Select under current law already provides that choice, 
but what happens when you move more and more people into that system, 
basic macroeconomics will tell us that you will start to lose the 
efficiencies, and you will start to lose the ability to save costs or 
save money under that system. Therefore, I think that the projected 
cost savings from moving to an HMO system, where seniors do not have a 
choice of their doctors, are probably not correct. They are probably 
inflated. It is very hard to make those projections in the first place.
  I think if you move from having 7 percent of the elderly population 
which are currently in managed care plans going to 90 percent, as is 
the desire of this legislation, that the cost savings that thus have 
been achieved will not carry forward at that time.
  Mr. DOGGETT. I thank you very much for your observations and very 
helpful comments and, of course, your service here on behalf of all of 
the people of the Houston area and of our whole State.
  My comments, of course, this afternoon and those of my colleagues 
have focused on the Republican pay-more-get-less Medicare plan. But I 
want to take just a moment here in concluding to tell people who are 
out there, who are thinking ``Well, they really cannot do that. They 
really cannot intend to make the kind of cuts that they are making to 
the American people,'' that they have not heard it all yet. Yesterday, 
about the same time that the great American hero, the gentleman from 
Florida, Sam Gibbons, was being denied across the hall even a chance to 
mutter a few words in defense of Medicare and to raise questions about 
why these hearings were not occurring, another of our committees here 
in the House was considering a plan concerning Medicaid.

  Most people think of Medicaid as being a program that provides 
assistance to the poorest of Americans, and it is true that it does; 
but it also, because of some need for improvement in the Medicare 
system, is about the only way that seniors and people with disabilities 
can get nursing home coverage. Most of the people that are in nursing 
homes today, who do not have substantial means, are there with support 
from Medicaid.
  There is another thing that comes out of that system Of Medicaid. 
That is that the Federal Government establishes some patient abuse 
standards, some safety standards in our nursing homes that they have to 
meet in order to receive Medicaid funds.
  Yesterday, at the same time that a slash effort was going on with 
reference to Medicare, another committee was slashing in Medicaid. Now, 
if that committee's handiwork becomes law, there will not be one 
Federal regulation on the books to assure the quality of patient care 
at nursing homes in this country. I think that by itself is an outrage, 
that there are people who have become so committed to a rigid 
ideological agenda that they have forgotten their good sense, they have 
forgotten our responsibility to protect vulnerable seniors. It seems 
that the only time people get interested in some nursing homes is when 
someone is found with abuse, with a death occurring. That is not the 
way it ought to be.
  There are many fine nursing homes out there doing their best to 
provide quality care, but there are always some that try to skim, and 
it is only with the support of these Federal safety standards, and some 
inspections, that we have been able to address some of the worst of 
these abuses, and now that will be totally eliminated.
  As if that were not enough, the same Committee on Ways and Means that 
did not want to hear about Medicare yesterday has, within the last 
several days, approved a proposal that will encourage corporations to 
withdraw as much as $40 billion from their pension plans, $40 billion 
from their pension plans, something that people who are not only 
retired now but may hope, like many of us, to retire some day in the 
future, should be amply concerned about. There are a number of 
troubling developments that only by Americans speaking out and making 
their concerns known are we going to be able to change.
  As for the Republican pay-more-get-less Medicare plan, lest anyone 
think that I have a partisan attitude on that plan, let me end by 
quoting a Republican who was on the radio this week, September 19, 
Kevin Phillips. He said of his fellow Republicans' Medicare plan: 
``Today's Republicans see Federal Medicare outlays to old people as a 
treasure chest of gold for partial redirection in their favorite 
directions: toward tax cuts for deserving corporations and individuals. 
The revolutionary ideology driving the new Republican Medicare proposal 
is simple: Cut the middle class and give back the money to the high-
income taxpayers.'' That is the problem we face, but Americans can turn 
it around.

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