[Congressional Record Volume 141, Number 165 (Tuesday, October 24, 1995)]
[Senate]
[Pages S15592-S15594]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         WHOSE SIDE ARE YOU ON?

  Mr. LAUTENBERG. I will try to confine my remarks to 10 minutes, not 
simply to spare the distinguished occupant of the Chair from further 
duty but to try and consolidate the message so that it has meaning and 
is clearly understood.
  Mr. President, I look at what is proposed in terms of this budget 
reconciliation, and I truly believe that the American people are being 
deceived; that there is kind of a sneak attack on senior citizens and 
the impoverished in our society; that they do not yet know what is 
planned for them for their future.
  The question that arises is a very fundamental one, and that is, 
Whose side are you on? Whose side are we on in this body when we pass 
legislation? Are we on the side of the people who have worked hard, who 
try to put away a few bucks, who have tried to protect their security 
in their old age, who worry about what happens to them in their golden 
years?
  Are we on the side of those who are making lots of money, who will 
get a benefit, the benefits of a tax cut that is being proposed as a 
result of the exorbitant request that is being made of the senior 
citizen population of our country or of those who are dependent on 
Medicaid? It is a backdoor attack.
  I do not mean to insult my friends on the other side of the aisle. I 
am describing what I think is their approach to decimate a program that 
has been of value. All one has to do is look at the human dimension as 
we discuss these programs. Forget about the accountant's approach for 
just a moment, forget about the fact that we are strapped, that we have 
to figure out ways out of our dilemma in terms of our budget deficit. 
Just think first about the people who are affected, think of those who 
worked hard, who put away small sums of money by paying their insurance 
premiums over the years, who believe deeply that a Government contract, 
a contract with their Government was something of value that could not 
be diminished.
  We know one thing, Mr. President. That is, that that program, the 
Medicare Program, has worked incredibly well. All you have to do is 
look at the life expectancy in our population today and look at the 
quality of life that people can enjoy even as they age if their health 
is good, if they take care of themselves at the appropriate time, if 
they get the right kind of medication, if they get the right kind of 
physician attention or health care provider attention. The program has 
worked.
  In Russia today, the former Soviet Union, the life expectancy for a 
male on average is 57 years. Fifty-seven years in this country is 
beginning to look like the prime of life. I know guys who are becoming 
fathers for the first time at 57 years of age. It is not something I 
recommend. I have no opinion on it. I am simply stating a fact. Fifty-
seven is young. Age 72, 73 is a time when lots of people can do things 
that they did when they were much younger. I invite people to go skiing 
with me sometime to see. I do not like to tell anybody, but my next 
birthday is going to be my 72d birthday. I served in World War II. I 
worked hard all my life before I came to the Senate and, I think, since 
I have come to the Senate, because I believe so deeply in those things 
that this Government of ours can and should do for its citizens.
  We are looking at a $270 billion cut in Medicare opportunity for our 
senior citizens, a $180 billion cut in Medicaid. Mr. President, those 
who are dependent on Medicaid are either impoverished or disabled. The 
senior citizen who runs out of funds, who needs nursing home care, 
which is becoming an evermore present condition in our society, and who 
has to spend their time in a nursing home depends on Medicaid for care.
  Seventy-one percent of the funds applied for Medicaid are for senior 
citizens and the disabled, 71 percent. For the disabled, Mr. President 
we have seen people who are totally dependent on Medicaid support for 
the sustenance of their lives.
  We had a young man in his 20's appear at the Budget Committee the 
other day breathing from a device on his wheelchair. And as he spoke, 
he was obviously straining for breath, straining for volume in his 
voice. He said, ``If they cut out Medicaid the way they are planning, 
if they reduce it the way they are planning, I will lose my ability to 
continue my life.'' He is a college student. And that is what is going 
to happen. This is just not an accounting exercise.
  Mr. President, I want us to see a balanced budget in our society, in 
our country. Frankly, I am not upset whether it takes 7 years or 10 
years. I think if we get on the right kind of a down slope, we will be 
doing the right thing. We have other ways of getting to a balanced 
budget than slashing programs that the elderly depend on for their 
health and well-being. We do not have to spend as much on defense as we 
are spending. We do not have to spend as much giving away mining claims 
to the folks out West who get benefits from the Federal Government that 
are beyond comprehension for most people. We do not have to continue to 
support wealthy corporate farms or corporate ranches. That is not 
necessary. But we do have to support those people who depend upon us 
for their very existence. And those are the senior citizens and those 
who live as a result of having assistance from Medicaid.
  Mr. President, again, the question is simply put, whose side are you 
on? And when we examine the sum of money, the sums that are being asked 
for reductions in health care programs, $270 billion is in the Medicare 
cut, a $245 billion tax break, much of it for the wealthiest in our 
society.
  The House proposed that if you had an income of $350,000 a year, you 
would get a $20,000 tax break. How does that square? Mr. President, it 
does not square. We do not believe that it is necessary to lop $270 
billion off Medicaid to save the program as the proponents are 
suggesting. This is the case where the medicine is far worse than the 
cure because it could kill you. The medicine can kill you when we start 
worrying elderly people about whether or not they are going to be able 
to continue to have health care, whether or not they are going to have 
to depend on their kids, having the kids worry about whether or not mom 
or pop or grandma or grandpop is going to have to come to them begging 
for them to take over. That is what is going to happen if we go ahead 
with the program as proposed.
  (Mr. ASHCROFT assumed the chair.)
  
[[Page S 15593]]

  Mr. LAUTENBERG. Mr. President, I ask unanimous consent that a letter 
I have be printed in the Record. It comes from the chief actuary for 
the Health Care Financing Administration. It says that we need $89 
billion to continue Medicare and its viability until the year 2006. The 
cut proposed by the Republican majority is to take care of things until 
2002. They say it needs $270 billion. Let me correct the record, Mr. 
President, because I think there is an arithmetic error here. For $89 
billion we can take care of the program until the year 2002, $89 
billion versus $270 billion.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                             Health Care Financing Administration,


                                            The Administrator,

                                   Washington, DC, August 3, 1995.
     Hon. Thomas Daschle, U.S. Senate, Washington, DC.
       Dear Senator Daschle: This is in response to your request 
     for information about the effect of the Medicare savings in 
     the President's balanced budget initiative on the exhaustion 
     date of the Hospital Insurance (HI) Trust Fund.
       Attached is a memorandum that I have received from the 
     Chief Actuary of the Health Care Financing Administration 
     (HCFA). The memo indicates that the year-by-year savings in 
     the President's plan, which would total $89 billion in Part A 
     over the period 1996-2002, would extend the life of the HI 
     Trust Fund from 2002 to the fourth quarter of calendar year 
     2006 (the first quarter of fiscal year 2007). This estimate 
     is based on the 1995 Annual Report of the Board of Trustees 
     of the Federal Hospital Insurance Fund intermediate 
     assumption baseline.
       Please let me know if I can provide any further 
     information.
           Sincerely,
                                                 Bruce C. Vladeck.

  Mr. LAUTENBERG. I thank the Chair.
  Mr. President, I also want to include in the Record an article that 
appeared in the New York Times a couple weeks ago. It talks about the 
arrangement made between the House Republican leadership and the AMA 
and about how, by reducing the reductions that the doctors and the 
health providers may have to take, that, in fact, they were able to get 
the doctors, the AMA, aboard for their health plan.
  Mr. President, while they were doing that for the doctors, they were 
not talking to the seniors who are alarmed by the prospects that their 
health care options are going to be substantially reduced. And I ask 
unanimous consent that this article from the New York Times be printed 
in the Record as well.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

          Doctors' Group Backs Plan of Republicans on Medicare

                            (By Robert Pear)

       Washington, Oct. 10.--After receiving assurances that 
     Medicare payments to doctors would be cut less than 
     originally planned, the American Medical Association tonight 
     expressed support for a House Republican plan to redesign the 
     medical plan for the elderly.
       Leaders of the association issued a statement after meeting 
     with House Speaker Newt Gingrich saying, ``A.M.A. endorses 
     House G.O.P. plan to transform Medicare.''
       Republicans in the House and Senate alike want to cut 
     projected spending on Medicare by $270 billion, or 14 
     percent, in the next seven years. Of that amount, $26.4 
     billion would have come from strict new limits on Medicare 
     payments for doctors' services.
       Kirk B. Johnson, senior vice president of the association, 
     said tonight that the doctors would receive billions of 
     dollars more than the Republicans had planned. But he and Mr. 
     Gingrich refused to give details, nor would they specify 
     which other groups might receive less money to make up the 
     difference.
       Mr. Gingrich had been wooing the doctors all summer in the 
     hope of winning their endorsement for the Republicans' 
     Medicare plan. But just last week--a few days after details 
     of the Republican plan were disclosed--spokesmen for the 
     American Medical Association complained that the Republican 
     plan would not only slow the growth of Medicare payments to 
     doctors, but actually reduce payments for many services.
       In response to such complaints, House Republicans made 
     unspecified financial concessions to the doctors, and their 
     support tonight was apparently one result. Mr Gingrich, 
     thrilled with the endorsement, said it showed that the 
     Republicans were willing to listen to suggestions from 
     various interest groups.
       The president of the association, Dr. Lonnie R. Bristow, 
     said, ``This legislation will expand choices for Medicare 
     beneficiaries, allowing them to open medical savings accounts 
     in conjunction with high-deductible insurance policies, 
     enroll in private sector coverage plans or remain in the 
     traditional Medicare program.''
       For the association, he said, the Republican plan 
     ``represents the end of a decade-long quest to put Medicare 
     on a fiscally sound basis, as well as the beginning of a new 
     journey toward delivery of appropriate quality care in a more 
     fiscally prudent environment.''
       Dr. Bristow praised elements of the Republican plan that 
     would exempt doctors from antitrust laws in certain 
     situations and limit payment of damages to some victims of 
     medical malpractice.
       In the debate over President Clinton's health plan last 
     year, the association endorsed the goal of universal health 
     insurance coverage, but criticized many details of the 
     Clinton plan.
       The medical association sways votes on Capitol Hill. It has 
     shrewd lobbyists and a political action committee that 
     donates tens of thousands of dollars to congressional 
     candidates. In the battle over President Clinton's health 
     plan, the association endorsed the goal of health insurance 
     coverage for all Americans, but criticized many details of 
     his plan and wavered in its support for his proposal that all 
     employers be required to buy health insurance for their 
     employees. The association's failure to endorse Mr. Clinton's 
     plan was politically damaging to the White House.
       Elsewhere on Capitol Hill, Republican efforts to revamp 
     Medicare gained momentum today as House Republicans voted 
     down a series of Democratic proposals that would have 
     established consumer protections for Medicare beneficiaries 
     who join private health plans.
       Democrats repeatedly failed in their efforts to set 
     detailed Federal standards for such private health plans, 
     which would serve millions of elderly people under the 
     Republican plan. Democrats said the standards were needed to 
     protect those who enrolled in the plans. Republicans said 
     they would stifle growth of the health care market.
       The House Ways and Means Committee appeared today to be 
     moving on schedule toward approving the Republicans' plan to 
     cut projected spending on Medicare by $270 billion, or 14 
     percent, in the next seven years. The committee is expected 
     to approve the legislation on Wednesday, with the full House 
     likely to vote on a Medicare bill next week. The Senate 
     Finance Committee has approved similar legislation.
       Democrats noted that the Ways and Means Committee worked on 
     the legislation for 14 hours on Monday, and they complained 
     that the panel was moving too fast. ``What is the hurry?'' 
     Representative Sam M. Gibbons, Democrat of Florida, asked 
     today. Republicans said they were moving quickly to save 
     Medicare from bankruptcy.
       The heart of the Republican measure is a proposal to open 
     Medicare to hundreds of private health plans, so elderly 
     people would have a much wider range of health insurance 
     options. Democrats today offered numerous amendments to 
     remedy what they see as severe weaknesses in the Republicans 
     plan, but the proposals were rejected, generally on party-
     line votes.
       By a vote of 22 to 13, the Ways and Means Committee 
     defeated a proposal by Representative Pete Stark, Democrat of 
     California, to set detailed Federal standards for private 
     health plans enrolling Medicare beneficiaries. He would, for 
     example, have required such plans to serve all parts of a 
     metropolitan area, not just the affluent neighborhoods. Bruce 
     C. Vladeck, who supervises Medicare as administrator of the 
     Federal Health Care Financing Administration, said that under 
     the Republican bill ``health plans could gerrymander their 
     service areas so that minorities and low-income people will 
     not be offered the same choices as everyone else.''
       Consumers Union and the American Association of Retired 
     Persons supported Mr. Stark's proposal, but Republicans 
     rejected it, saying such Federal regulation would frustrate 
     the development of a private health insurance market for the 
     elderly. Representative Bill Thomas, Republican of 
     California, said the Democrats would establish ``an 
     entangling bureaucratic structure.''
       Today's debate was bitterly partisan and acrimonious, full 
     of snide remarks. Lucia DiVenere, a lobbyist with the 
     National Association for Home Care, said: ``What you see 
     here, in microcosm, are two totally different approaches to 
     Government, two philosophies completely at odds with each 
     other. It's all black or white. There is no gray area.''
       Mr. Stark said the elderly needed the Government to protect 
     them because the Republicans were ``forcing Medicare 
     beneficiaries into the arms of private for-profit insurance 
     companies.'' Republicans replied that the Democrats' 
     proposals for more Federal regulation would perpetuate the 
     heavy hand of Government. Representative Nancy L. Johnson, 
     Republican of Connecticut, said the Democrats' proposals were 
     evidence of ``old thinking, the view that Government can 
     serve seniors better than the private sector'' can.
       To help control Medicare costs, the Republicans would limit 
     the growth of Federal payments to health maintenance 
     organizations and other private health plans. Democrats today 
     proposed to eliminate these limits, saying they would force 
     H.M.O.'s to cut services or increase premiums. ``Let's not 
     tie Medicare payment levels to arbitrary budget caps,'' said 
     Representative Sander M. Levin, Democrat of Michigan.
       The Democrats' basic theme is that some of the Republicans 
     policy proposals would 

[[Page S 15594]]
     make sense if the Republicans were not simultaneously squeezing $270 
     billion out of Medicare.
       The Republicans describe the various private health 
     insurance options as ``Medicare Plus.'' But Mr. Gibbons told 
     them: ``You ought to call it Medicare Minus. What you're 
     doing is herding all the seniors together and forcing them to 
     accept managed care.''

  Mr. LAUTENBERG. I thank the Chair.
  I would just like to read from the article for a couple seconds.

       After receiving assurances that Medicare payments to 
     doctors would be cut less than originally planned, the 
     American Medical Association tonight expressed support for a 
     House Republican plan to redesign the medical plan for the 
     elderly. * * *
  Republicans in the House and Senate alike want to cut projected 
spending on Medicare by $270 billion . . . in the next seven years. Of 
that amount, $26.4 billion would have come from strict new limits on 
Medicare payments for doctors' services.

  Obviously, that was obviated or the AMA in this case would not have 
come along.
  Mr. President, what this budget does is painful. It doubles the 
premiums for part B from $46 a month to $93 a month. It doubles part B 
deductibles from $100 to $210. It hurts seniors who want to stay in fee 
for service. It will mean a cut of $6 billion in the State of New 
Jersey that would cause us to lose the services of 40 out of 110 
hospitals in our State, when combined with the Medicaid cuts.
  In short, this proposal, as it is outlined, would result in disaster 
for our senior citizen population.
  The arithmetic is very simply displayed on this chart. ``The GOP's 
New Medicare Plan: The Untold,'' I call it the sneak attack, ``The 
Untold Story.'' Mr. President, $270 billion worth of proposed cuts, $89 
billion is needed for the trust fund. It leaves $181 billion, and where 
is it going? It is going for tax breaks for the well-off.
  And so, when we finally vote on this reconciliation bill, one I voted 
against in committee--I am on the Budget Committee--and one that I 
continue to view as harmful to the very structure of our society, 
breaking promises with people to whom we have had arrangements, I know 
one thing: That I am going to be on the side of the senior citizen. I 
am going to be on the side of the students in this country who are 
depending on our Government for help in getting their education. I am 
going to be on the side of those who need Medicaid for their support, 
and I am going to vote ``no'' on this budget reconciliation bill.
  The one thing I hope will come out in the debate these next couple of 
days is that the American people will fully realize what it is that is 
being proposed; that the notion that these cuts have to be made to save 
the program are patently false, they are untrue and that what we have 
to do is put our thinking caps together, sit down and take the time 
necessary to redesign a program that will fit the bill, that will not 
continue to exacerbate the budget deficit situation.
  So, Mr. President, as we close the debate this evening, I hope that 
our colleagues in the Senate will continue to examine this proposal 
that is in front of us and reject it when the time comes and to think 
about the folks back home and those who are depending on it.
  With that, I yield the floor.

                          ____________________