[Congressional Record Volume 142, Number 82 (Thursday, June 6, 1996)]
[House]
[Pages H5984-H5990]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                                MEDICARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of May 
12, 1995, the gentleman from New Jersey [Mr. Pallone] is recognized for 
60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, this afternoon I want to talk again about 
the issue of Medicare and my concern over what the Republican 
leadership is trying to do to the Medicare Program and in the context 
of the budget or the budget resolution which is likely to be voted on 
between the two Houses sometime in the next week or two.
  I wanted to point out again the reason that I feel so strongly about 
Medicare and the changes, the negative changes that I see the 
Republican leadership proposing, is because I believe that Medicare is 
really one of the best programs that we have in the Federal Government. 
When it was established in the early 1960's by then President Johnson 
and the Democratic Congress that was in the majority at the time, it 
was established because of the realization that so many senior citizens 
did not have health insurance and that it was very difficult for them 
to either obtain health insurance, either because they could not afford 
it or because of their condition.
  And now, today, and certainly for the last 30 years, we have had 
Medicare on the books and those who are over 65 or even others in some 
cases are able to know that they will be guaranteed a health insurance, 
that if they go to a hospital or if they go to a doctor, that most of 
the services that they need for health care purposes will be provided 
in a relatively high quality way.
  That is a significant fact and when those on the other side of the 
aisle, when Republican leaders get on the floor and propose changes 
that I consider very radical in the Medicare Program, the reason that I 
and a lot of the other Democrats are opposed to those is because we 
think that Medicare works, and we do not want to see it downgrated to a 
second class program or perhaps not even exist for many senior 
citizens.
  I point that out today by way of introduction, because I think it is 
important to note that many of the Republican leaders have actually 
expressed themselves on the floor of this House or in the Senate or on 
other occasions over the years as actually being opposed to the very 
idea of Medicare.
  One of the things that we often quote is the statement by the 
Republican Presidential candidate on Medicare, which he made in October 
1995. He said, I was there fighting the fight, voting against Medicare, 
1 out of 12, because we knew it would not work in 1965. So he is making 
reference to the time back when he was in this House of 
Representatives, when Medicare first came up and he voted against it. 
Again, a very strong indication of the fact that in this case the 
Republican Presidential candidate and many of the Republican leaders 
are very much opposed to the very idea of Medicare.

  We also had another quote, which we frequently cite, from Speaker 
Newt Gingrich on Medicare. This one is from October 24, 1995, last 
year, where he says, and I quote,

       Now we don't get rid of it in round one because we don't 
     think that that is politically smart and we don't think that 
     is the right way to go through a transition period. But we 
     believe it is going to wither on the vine, because we think 
     people are voluntarily going to leave it.

  Once again, a strong indication, in this case the Speaker of the 
House of Representatives, that Medicare as a program is not something 
that they support. That is why many of us on the Democratic side of the 
aisle feel very strongly that we must continue to speak out on the 
issue of Medicare, because this is a program that has worked, that 
protects America's seniors so that they know that they have

[[Page H5985]]

health care insurance, they have health care coverage. If we let the 
Republican leadership basically do what they will with the Medicare 
Program, we are very concerned, a lot of us, that it may simply wither 
on the vine or not exist for many senior citizens.

                              {time}  1615

  Now, yesterday the Medicare trustees came out with their annual 
report where they talk about the financial state of Medicare, and once 
again the Republican leadership and many Republicans on the floor have 
taken advantage of that report which came out and indicated that 
Medicare would be insolvent by the year 2001.
  Well, I said before that many times when the trustee's reports come 
out, they talk, in the past they have talked, about insolvency for even 
a shorter period than that, in some cases maybe 2 or 3 years.
  So this is not a new phenomena, and Democrats in the Congress have 
traditionally dealt with that by making some changes in the Medicare 
Program so that it remains solvent in future years. And, in fact, we 
have already, both last year as well as this year, voted on Democratic 
proposals, most recently the President's proposed budget, that actually 
would continue the solvency of the Medicare Program well into the next 
decade; I believe at least until 2005.
  So we, as Democrats, know how to deal with the Medicare trust fund; 
we have had to tinker with it in the past. But the Republicans, instead 
of saying, OK, we will support President Clinton's proposals and we 
will make some changes that are necessary in the Medicare Program to 
keep it solvent, instead they have been proposing very radical changes 
in the very substance of the program and also deep cuts, deeper cuts 
than are necessary for Medicare to remain solvent.
  In fact, the level of cuts right now in the Republican proposal are 
$168 billion in cuts in Medicare, whereas President Clinton, talks in 
the proposal, in his budget, about $116 billion. The difference 
basically goes to pay for tax cuts for the wealthy; that is what the 
Republicans have in mind.
  But, in addition to that, they have been talking about major changes 
in the Medicare Program that would push seniors into managed care, that 
would make it so that they cannot choose their own doctor and even, in 
some cases, their own hospital, and also those who refuse to go into 
managed care, those who stay in the traditional fee-for-service 
program, the current Medicare program, would be basically faced with 
tremendous over charges.
  Right now the most that your doctor can charge you beyond the 
Medicare reimbursement rate is 15 percent of the bill. But this under 
the Republican proposal would be unlimited, and basically the doctor 
could charge you essentially whatever he or she wanted beyond what 
Medicare pays. Those types of overcharges would essentially force 
people into HMO's or managed care because they would say, well, how can 
I continue to stay in a traditional program where I can choose my own 
doctor if I face those kinds of unlimited charges?
  Another thing that the Republicans have proposed is to basically 
break down the Medicare Program and the insurance pool, if you will, so 
that the wealthy and the healthier senior citizens could opt for what 
we call medical savings accounts, which basically allows them to take a 
catastrophic health care coverage and then to pay out of pocket, if you 
will, for health care needs that are not of a catastrophic nature. 
Well, the problem with that is that people who do not have a lot of 
money and cannot pay a lot of money out of pocket will not opt for the 
catastrophic health insurance, and as a result the insurance pool which 
depends on the healthier and wealthier people being part of it in order 
to be solvent essentially would be broken up and the people that would 
be left in the pool who did not get the catastrophic coverage would 
tend to be the poorer people and the less healthy people, and the 
result would be that Medicare would end up costing more because the 
insurance pool would have a much poorer and sicker group of people in 
it.

  Some of these things get a little complicated, and I do not mean to 
complicate things, but the point I am trying to make is the Republican 
proposals not only cut Medicare a lot more than is necessary under the 
President's proposal, but also make major changes in the Medicare 
Program that ultimately are going to cost seniors a lot more money out 
of pocket and are going to make it so they cannot choose their own 
doctor or again, in many cases, their own hospital.
  I would like at this point, if I could, to yield to the gentlewoman 
from Connecticut [Ms. DeLauro] who has been on the floor of the House 
over the last 18 months repeatedly pointing out how the Republicans are 
trying to basically destroy Medicare, and I know that she has been a 
leader on trying to bring this issue to the attention of the American 
people.
  Ms. DeLAURO. I want to thank my colleague from New Jersey for all of 
his efforts on the issue of Medicare-Medicaid and more generally for 
the whole issue of working families in this country and what they are 
going to be faced with if some of the cuts are made; and particularly 
in the Medicare Program you said something at the outset of your 
remarks, I think I just want to expand on it a second.
  Today, 99 percent of seniors have health care, health insurance. That 
was not the case before Medicare. Now what happened before Medicare was 
that families had to take care of their loved ones, as families will 
do, because there was no opportunity to have health care coverage, so 
you went in with your children.
  What is one of the big issues that we are very, very concerned about 
today if we are going to see these incredible cuts in Medicare and in 
Medicaid, which as my colleague knows, that takes care of about two-
thirds of the costs of Medicaid, has to do with seniors who are in 
nursing homes.
  In my State of Connecticut almost 70 percent of the seniors who are 
in nursing homes, getting nursing home care, that care is paid for in 
part or in whole by the Medicaid system. So that if today, if these 
programs are unraveled, if we do not--we need to fix them, but if we 
destroy them the way it is being suggested by our Republican 
colleagues, then this is not only an issue for older Americans, it is 
an issue for their families.
  I have a mother who is 82 years old, and, you know, thank God and 
knock on wood, she is in good health. I am not going to let my mom go 
without health care if somehow Medicare is unraveled and less people 
are being covered or it is more expensive for her to be able to get 
health care coverage. That is going to be my responsibility. I am an 
only child. I am going to make sure my mom has the best health care 
that is possible.
  So this is a system that has not been created for seniors, people who 
are over 65. This is meant to be first-rate health care so in fact 
there can be that dignified, secure and decent retirement for seniors 
without--and that maintenance of their independence--without having to 
have them be dependent on their families. And I think younger people 
are very concerned about what happens here as well.
  Another point that my colleague made that I just want to talk about 
is no one has ever suggested, and the trustee's report did come out, as 
it did last year, and they confirmed what truly has been known for more 
than 6 or 8 months, that the fund will be exhausted by the year 2001. 
The fact of the matter is that no one has ever suggested that we do not 
fix the Medicare Program. We could have a bipartisan commission, the 
same way that we did with Social Security, to allow so that we insure 
the solvency of the Social Security system; we could do the same kind 
of thing today. however, yesterday the gentleman from Texas [Mr. 
Armey], the majority leader of the House of Representatives, on a 
television show said ``no to a bipartisan commission to look at the 
long-term solvency of the Medicare system.''

  It was just last year in February, in 1995, that the ranking member 
of the Committee on Ways and Means introduced the bill that would have 
appropriated $90 billion, which was the amount of money that the 
trustees that our Republican colleagues are holding up their report, 
but it was the trustees last year who said $90 billion could deal with 
the solvency of the Medicare Program.
  Well, there was a bill on this floor. We got a chance to vote. That 
is the

[[Page H5986]]

beauty of this place: We vote. And 233 Republicans said thumbs down, 
no, to insuring the solvency of the Medicare system through the year 
2006.
  So, they are a little bit disingenuous when they are holding up the 
report here, because we have known what the issue is going to be.
  Now, if we are going to fix the program, if we are going to fix this 
program, I just submit to my colleague, and you brought up two of the 
quotes that were not made, I mean that are just unbelievable in terms 
of where people want to see the Medicare Program going. But if you want 
to fix the program, and we agree that it needs to get fixed, into whose 
hands do you want to entrust this program to be fixed? Do you want to 
go to Bob Dole, the current Presidential candidate for the Republican 
Party, who is proud of his vote against Medicare? He cheers and lauds 
the fact that he voted against it, it is a program that does not work. 
Now that, I mean it tells you something about into whose hands you want 
to trust it. Into Mr. Gingrich's hands, who says that he wants to see 
it wither on the vine, to go one step further?
  Now we are talking about leadership here; we are not talking about 
any comment made on the floor of the House. These are the people who 
have taken on the leadership of the Republican Party and who want the 
opportunity to lead the country. They do not believe in the Medicare 
program.
  Let me give you one further; again, the gentleman from Texas [Mr. 
Armey]. This was July 11, 1995: ``Medicare is a program I would have no 
part of in a free world.'' Again in July 1995: ``Hundreds of thousands 
of seniors rely on Medicare; I am sorry they do, but they do.''
  Again I mention Mr. Armey, who does not want to see a bipartisan 
commission to do something about the long-term solvency of the system.
  Let me have one more quote from the budget director, the gentleman 
from Ohio [Mr. Kasich], who said again in February 1995 that their 
budget, the Republican budget, quote, ``would require Medicare cuts 
unlike any this town has ever seen before.''
  Now, the numbers are not so much the issue, as my colleague from New 
Jersey pointed out. The issue is Medicare or no Medicare and the 
policies that the Republican proposals, if they were enacted, what they 
do to the Medicare system. They do not control costs. They shift the 
costs to seniors by encouraging doctors, as my colleague pointed out, 
to charge seniors extra billions for the basic Medicare package. They 
herd seniors into managed care plans without adequate consumer 
protections. They destroy the Nation's safety net and academic research 
hospitals. They spend an extra $4.6 billion on the medical savings 
account that my colleague pointed out are for the wealthy healthy, and 
they weaken, something that is not talked about too much, major 
antifraud loss.
  The dollar difference is significant, but more significant is the 
policy difference, and, as you pointed out, the difference in the 
dollars is not to make the Medicare Program solvent, but in fact to 
deal with tax breaks for the wealthiest Americans.
  Let me just make one more point because I think it is important. This 
is something that a number of my colleagues on the other side of the 
aisle talk about all the time. They talk about only in Washington is an 
increase a cut and that there is not a cut in the Medicare Program.

                              {time}  1630

  Mr. Speaker, let me just say this. I want to quote the Speaker of the 
House, again, the gentleman from Georgia [Mr. Gingrich]. This has to do 
with the defense budget. This was in 1987. ``The 4-year budget includes 
a 10-percent real cut in defense spending.'' This is Newt Gingrich 
describing a decline in the rate of growth of the defense budget in 
1987.
  They are going to stand here and tell us that this is slowing the 
rate of growth. It is just a boondoggle. There is no accounting for the 
increased numbers of the people who enter the Medicare system, there is 
no accounting for inflation, and there is no accounting for the 
increased costs in medical care.
  So they tell us that we need $150. We have $100 today, we need $150 
in order to take care of the increase of people, the increase in 
inflation and the increase in technology, but they are going to give us 
$125 and they will tell us that it is not, in fact, when we need $150 
to make it, except they are willing to say that when it comes to the 
defense budget, which they have talked about, the gentleman from 
Georgia [Mr. Gingrich], in 1987.
  The chairman of the defense authorization bill says that ``The bill 
provides $2.4 billion more than the current fiscal year, but when 
adjusted for inflation, it reprsents a real decline of 1.5 percent in 
spending, and not an increase.'' You cannot talk out of both sides of 
your mouth. These are real cuts in Medicare, real pain in the Medicaid 
system. What we cannot allow that to do is to happen. We have to make 
the same kind of fight, the same kind of arguments that we did in the 
last year of this Congress, so that in fact they cannot destroy a 
system which they truly do not believe in. I think my colleague for 
letting me join with him this afternoon in this special order.
  Mr. PALLONE. Absolutely, Mr. Speaker. There is absolutely no question 
that what the gentlewoman is saying is correct. I think the bottom line 
is that the policy changes that the Republican leadership is proposing 
are all money driven in some way.
  When we talk about this whole notion of the Speaker saying that this 
is not really a cut, we are actually increasing the program, but it is 
not a cut. The reason for that, there is this new book out, I do not 
think the gentlemwoman made mention of it. It is called, ``Tell Newt to 
Shut Up,'' a new book by award winning Washington Post Journalist David 
Marins and Michael Westkopf, which says that avoiding the word ``cut'' 
became part of a coordinated Republican strategy after pollster Linda 
Duvall said that the public reacted negatively when told that the 
Republicans would cut Medicare.
  Basically what these two people are saying, that the Republicans 
vowed from then on that they would not allow reductions in the rate of 
growth to be called cuts. But it is nothing but semantics. We all know 
that if you do not allow a certain amount of money to be available, and 
you have to go out and buy the same thing because of inflation or 
because more people are in the program, that not allowing a significant 
level of growth essentially is a cut. That is what the Speaker, what 
the gentleman from Georgia [Mr. Gingrich], actually said in the context 
of the defense budget when he wanted to use it for his own advantage.
  Mr. Speaker, the other thing that I think is really crucial also in 
that respect is where are these costs being shifted to? That is why I 
think the issue of the overcharges is so important, because basically 
last year, when they wanted to shift costs, they essentially raised the 
part B premium. I think we had some figures that last year's Republican 
proposal actually doubled the Medicare part B premium from $46 in 1995 
to about $89 in 2002, so it would have increased the Medicare premium 
by $440 per couple per year.
  That did not work, because seniors became aware of the fact they were 
going to have to pay these incredibly high premiums, so they dropped 
that. Now, this year, they are coming back with the overcharges, and 
they are saying that if you stay with the traditional Medicare system 
and do not move into managed care or HMO's, then the doctors can charge 
you whatever they want.
  Mr. Speaker, we had some statistics from the Physician Payment Review 
Commission, which is a nonpartisan panel of experts that advises 
Congress on Medicare policy, and they said and I quote, that:

       This could lead beneficiaries to be exposed to substantial 
     out-of-pocket liability in the range of 40 percent of the 
     bill.

  So if you essentially go into this for a certain operation or 
procedure, you could end up paying 40 percent right out of your pocket.
  Ms. DeLAURO. Mr. Speaker, if the gentleman will continue to yield, on 
that point what is really important to know, and truly people know, 
today doctors do, doctors and hospitals, there are restrictions on this 
overcharging. what is very central and very simple here is those 
restrictions are eliminated. They are eliminated, so therefore they 
cannot do the overcharging.

  Just a final number which I think is important on this inflation 
issue, when

[[Page H5987]]

they keep talking about how these are not cuts, what they are doing 
with Medicare is they are holding it at about 16 percent below the rate 
of inflation. That represents a real decline. That is no increase. We 
cannot let them get away with talking about these as not being cuts, 
because the numbers are real. I thank the gentleman.
  Mr. PALLONE. Mr. Speaker, I yield to the gentlewoman from Hawaii.
  Mrs. MINK of Hawaii. Mr. Speaker, I thank the gentleman for yielding 
to me.
  Mr. Speaker, I appreciate the contributions that both the gentlewoman 
from Connecticut [Ms. DeLauro] and yourself have made in this constant 
battle to explain what it is that the Republican majority is attempting 
to do, and the obfuscation of the truth that constantly you can read in 
their press conferences and in the statements that they make across the 
aisles. So I appreciate what the gentleman is doing, and I hope that 
the seniors across the country are getting the real message.
  Mr. Speaker, there is absolutely no doubt in my mind that what the 
Republicans are trying to do is to completely dismantle the Medicare 
Program. We deal with this issue in terms of big numbers, like a $290 
billion cut versus a $168 billion cut now. And they have moderated 
their position. But the reality is the issue is not a monetary issue.
  We cannot get into a box of deciding, well, who is cutting less in 
terms of the dollar amount, because what they are rally trying to do, 
in my estimation, is to completely dismantle the Medicare Program as it 
was enacted in 1965. That is the message I think we have to tell the 
seniors: What are they being left with if we restructure Medicare? They 
are going to be shoved into a private insurance kind of program which 
does not have the protections that Medicare now offers.
  One of the things that the gentleman just discussed is about this 
balanced billing. The current law does not allow it, so therefore there 
is this protection for the seniors who are in the program now under 
Medicare, that they will not have to suffer these overcharges. If the 
Republican plan were enacted as it has been proposed, we are going to 
have to see these seniors being billed way beyond what it is that 
Medicare has approved in terms of the costs of these expensive 
surgeries. I think that is what the seniors have to be told.
  The restructuring of it is going to be severely expensive and 
demoralizing. In other words, we are going to go back to the old system 
before 1965, where the children of the families are going to have to 
make these hard decisions as to whether their parents are going to have 
the important, necessary medical attention, surgery, or whatever.
  Mr. Speaker, I had an orthopedic surgeon in my office, that is why I 
could not come to the floor promptly, and they are apparently having a 
conference here in Washington. The first thing he said to me is, ``We 
as physicians are concerned about free access to medical care. We feel 
that the proposals that are now being discussed are going to severely 
damage access, freedom of choice of the seniors as to what kind of 
services, what doctors they can obtain.''
  One of the things that he pointed out to me is that under the HMO and 
these new ideas that are coming across by the Republican majority, 
there might be limitations on the specialty services, for instance, 
that their particular profession of orthopedics could offer. They feel 
that that is extremely dangerous.

  Second, he pointed out that many of the insurance companies and other 
kinds of group practices that they are in are already gagging them and 
saying that they cannot even talk about options, optional kinds of care 
that they might obtain. So these people in the medical profession are 
really concerned about freedom of choice, access to the necessary kinds 
of medical services that are required, and this terrible kind of 
pressure, that when they sign onto these group practices, that they are 
being restricted by the insurance companies that are servicing them 
from even discussing with their patients open and available information 
as to what their choices ought to be in terms of their medical 
services.
  Mr. Speaker, I think all of this suggests that if we go the private 
insurance route, which obviously is part of this dismantling, and force 
everybody into the private market to let the market control or HMO's or 
whatever, that the seniors are going to be very, very severely 
impacted.
  Compounding on that is this medical savings thing, which in my 
estimation favors the wealthy and the healthy, and the people in the 
middle are then going to have to bear the burden and costs of the 
Medicare system. So, Mr. Speaker, I think in going back to my seniors 
in my district, I am going to have to try to move away from this 
discussion of dollars, their focus on this idea whether the program is 
going to become bankrupt, or we are going to have to find the money, 
and they are all money-oriented right now. But I think that the 
Congress is going to have the responsibility to find ways to make sure 
that the system is fiscally sound.
  But in doing so, we must not allow the program itself to be 
restructured and broken and completely torn apart so that the idea of 
universal protection for seniors will be completely disrupted. That is 
what I came to the floor to contribute today, and to hope that that 
point can be explained to the seniors as we debate this issue.
  Mr. PALLONE. Mr. Speaker, I think the gentlewoman makes her point 
very well, particularly with regard to what happens if seniors become 
shifted to managed care HMO's. If I could just make one point, and then 
I will yield further, following up on what the gentlewoman said, a lot 
of times the Members of the other side, the Republican Members, get up 
and say, ``Under our plan, there is still going to be choice. You do 
not have to go to an HMO, you can stay in the traditional system of 
Medicare where you can stay in the traditional system of Medicare where 
you choose your own doctor, choose your own hospital.''
  But the key there are the overcharges, because if you say to someone, 
``You can stay in your traditional Medicare system but now the doctor 
or hospital can charge you whatever they want as a copayment,'' then 
most people cannot afford to do that. Then they are forced essentially 
to move to the managed care, the HMO, whatever the alternative is.
  Then the other thing is that by cutting and constantly reducing the 
reimbursement rate for the HMO or the managed care system, the 
Republicans essentially forced those systems to do the types of things 
that the gentlewoman mentioned; in other words, they do not allow 
people to get specialty doctors or specialty care unless they go 
through some bureaucratic rigamarole because they do not want to pay 
the cost of that specialty care.
  At both ends of the spectrum, essentially, people are being squeezed. 
They either stay in the traditional system and then they have these 
tremendous out-of-pocket expenses, or they go into the managed care HMO 
where the dollars are constantly squeezed, and therefore the level of 
care and the type of care that you can get is more limited.

  Mrs. MINK of Hawaii. If the gentleman will continue to yield, Mr. 
Speaker, I think the thing on point is what is happening to women who 
deliver their babies in a hospital. They are just being pushed out the 
door within time limits of 24 hours or whatever, so now we have to 
engage in that debate to protect women, to make sure that these kinds 
of harsh procedures to save a few dollars are not going to prejudice 
the health care of these women. It is exactly the same situation with 
respect to our seniors, who are going to have to face those kinds of 
brutal decisions.
  Mr. PALLONE. Mr. Speaker, that is a perfect example.
  Mrs. MINK of Hawaii. I think we have to constantly remind our seniors 
that this is not just a dollar, they should not mount this debate on 
whose money plan sounds better, because it is the policies behind those 
money decisions that are going to end up bringing sorrow to them and 
grief, grief to their children, who are going to have to pay the bills. 
I thank the gentleman.
  Mr. PALLONE. Mr. Speaker, I thank the gentlewoman for joining us. I 
yield to the gentleman from Texas [Mr. Doggett].
  Mr. DOGGETT. Mr. Speaker, I appreciate the observations of our 
colleague,

[[Page H5988]]

the gentlewoman from Hawaii, and the gentleman's response, because I 
think as you described how Medicare would be eventually destroyed, what 
the gentleman is really getting to is, to use the Speaker's own words, 
Speaker Gingrich, saying that he was going to let it wither on the 
vine. That is, I suppose, an indication.
  We have the Republican majority leader quoted down in Houston the 
other day, and my colleague, the gentleman from Texas [Mr. Armey], 
saying that he views Medicare as an imposition on his freedom. But they 
recognize that the Medicare Program, which it is now almost 31 years of 
existence since President Johnson signed it into law, we now have, 
instead of more than half of America's seniors having no health 
insurance, we have 99 percent covered.
  So they realize that they cannot have a direct assault to just 
abolish and vote against the program. That is what they want to do. 
Simply, as the majority leader so candidly admitted, their philosophy 
is ``Medicare is an imposition on our freedom.'' Most Americans, I 
think, believe that Medicare is one of the best things that this 
Congress has ever set up, just like Social Security, which our 
Republican colleagues have also questioned, but in lieu of a direct, 
frontal assault to just abolish Medicare, to do as Bob Dole in fact 
said here just a few months ago, that he was so proud that he was one 
of those who stood and voted against, on the floor of this House before 
he ever got over to the Senate, who voted against creating Medicare in 
the first place, they would let it wither on the vine.

                              {time}  1645

  Mr. Speaker, we got a lot of things down in Texas that are withering 
right now. We have a little bit of a drought down there. But barring 
those unusual circumstances, I think most of the people that I know 
that are commonsense folks around central Texas, if they have something 
that is withering on the vine that they have entrusted to a gardener, 
they know the best thing to do is to get another gardener, and I think 
that is what we are going to have to do here if we do not want Medicare 
to wither on the vine.
  I came across a book this week concerning this so-called Gingrich 
revolution and I wanted to know if my colleague from New Jersey has 
seen the part of this book that is written by two Washington Post 
reporters who have been studying this revolution and apparently getting 
behind the closed doors, which are really the signature of this 
revolution, all the secret meetings that go on, the secret task forces. 
This particular one is on page 72 of this new book, and I just want to 
quote from it.
  It says, at a leadership meeting over dinner in Gingrich's office, 
that is the Speaker of the House, Newt Gingrich, the fellow who wants 
Medicare to wither on the vine, on February the 15, that is February 
15, 1995, Kasich, that is the chairman of the Republican Committee on 
the Budget, John Kasich, our colleague from Columbus, OH, and his aids, 
expressed concern that a 7-year balanced budget would require Medicare 
cuts ``unlike any this town has ever seen before.'' Kasich was hoping 
to have more flexibility. ``Who said we have to do 7 years,'' he asked? 
Gingrich remained adamant.
  That is from this new study about Medicare cuts, the fact that they 
would, in the words of the House Republican Committee on the Budget 
chair, have to be unlike any this town has ever seen before.
  Are you familiar with this new study?
  Mr. PALLONE. Mr. Speaker, I am familiar with it, and I was making 
mention of some other aspects of it before. But I really appreciate the 
gentleman bringing that particular section up, because I think it 
points out one of the things that I and I know you have been saying 
from the beginning, which is this whole idea of dealing with Medicare 
in the context of the budget. That in itself is wrong. In other words, 
if we are going to restructure or make changes in the Medicare Program, 
why is it that we are dealing with it in the context of the budget?
  In my opinion, the reason for that is very simple: Because they want 
to use the cuts in Medicare for tax breaks for wealthy Americans. They 
want to be able to use the money for that to achieve whatever their 
other goals are. It is not because they are trying to save Medicare or 
restructure Medicare in a way that is actually going to help the 
program. They are funneling that money into tax breaks. So every time 
we deal with the budget, we get the Medicare cuts once again.
  Mr. DOGGETT. Instead of a trust fund, a slush fund. Instead of 
furthering and strengthening the trust fund, they would raid that fund 
in order to provide these special tax breaks.
  Mr. Speaker, I know you have focused already on this trustees' 
report, and the key word there is trust. Who do the American people 
trust to ensure the long-term solvency of Medicare so it will be there 
not only when we retire, but when our children and our grandchildren 
retire, so provide them the kind of health care security they need.
  I would just want to add one other thing. I see our colleague and one 
of the few physicians in this body, the gentleman from Washington, Dr. 
McDermott, is here who has worked so hard on this. But I think as we 
consider the millions of people that are going to be adversely affected 
if the Speaker is successful in letting Medicare wither on the vine and 
shrivel up and go away for middle-class Americans, I just wanted to 
bring a picture of a couple of Texans, hard-working Texans that are 
going to be impacted, because I think we have to bring this down to 
human scale.

  Lewis Kerclusky is a fellow I met at a senior activity center in 
Austin. He is 94 years old, and he told me that he was there because he 
worked with old people. I was mighty impressed with the tact that he is 
still involved in working with old people in trying to help them get 
services and have the benefit of his assistance. Unfortunately, since 
all he has to rely on is his Social Security check and his 
prescriptions total almost $200 a month, he had to move in with his 
son, Ed. Ed is still working, but he is only about 3 years away from 
having to rely on Medicare himself.
  These are the kind of hard-working people that built this into the 
greatest Nation in the world. And if he let Medicare and Social 
Security simply wither on the vine, if he says, as you were just 
discussing with our colleague from Hawaii, that they are suddenly now 
going to have to pay all that a health care provider would want to 
charge them above the Medicare payment, if we continue a system where 
he cannot even get coverage for his prescriptions, there is no 
protection under existing Medicare for those, and instead of 
strengthening Medicare and fulfilling our trust to America's seniors, 
we are going to weaken that system and let it be used as a slush fund, 
then people like Lewis and Ed are going to still be impacted in a very, 
very significant way.
  I think it is important, even for people that are not as old as Ed or 
Lewis, or as old as you or I, or even the young man from Washington 
State who is joining us here, young people that are out there trying to 
start a family, trying to get kids through the public school, who is it 
that a senior who cannot make it, who cannot even pay his prescription, 
is going to turn to if they have a medical emergency and Medicare is 
not there to stand by them?
  It is going to be those middle-class families that are having a hard 
enough time just making ends meet for themselves and their kids. They 
are going to be called on, instead of providing a college education, to 
take care of an unexpected surgery, instead of being able to do things 
for their family and get ahead and provide their kids the same future 
that they want for themselves, they are going to be called on to 
provide for long-term health care.
  I appreciate your focusing attention on what is really happening 
here, this trust issue, the trust of America's seniors and those who 
will be seniors in our Medicare system and our responsibility to stand 
there and see that that system does not wither on the vine, as much as 
Speaker Gingrich might be determined to let it wither.
  Mr. PALLONE. I appreciate the gentleman's comments. Mr. Speaker, 
before we move to the gentleman from Washington, I just wanted to say 
it is particularly important, and I thought that you mentioned, I guess 
it was Ed, one of your constituents who you said had a very large 
prescription drug bill.

[[Page H5989]]

  Mr. Speaker, I naively thought when we started to deal with Medicare 
in this Congress and the possibilities for some changes that we would 
actually look towards positive changes such as preventive measures, 
like covering prescription drugs, because I have always felt that if we 
add certain services to Medicare, like prescription drugs, like home 
health care, that we actually would save money in the long run, because 
they are preventive measures that prevent people from having to go to a 
hospital or be otherwise institutionalized.

  But we do not get any of this from the Republican proposals. 
Everything that they propose basically would cut the program, reduce 
services, force seniors to pay more out of pocket.
  So when I hear statements from them about how they want to save 
Medicare or change Medicare, it is never in a positive way; it is 
always in a way that is actually going to make it more difficult, in my 
opinion, to get health care and to get quality health care.
  I appreciate the gentleman's comments.
  Mr. DOGGETT. Actually, it is Lewis, who has almost $200 a month in 
prescriptions not covered now. And I know the gentleman and Dr. 
McDermott will remember that when Republicans put out their big 
strategy, their PR plan on Medicare. They told their own Members, do 
not use the word ``improve,'' because that is going to raise 
expectations that we might really do something to help seniors. They 
were supposed to use other words to create the impression that there 
was some immediate crisis, which there is not, that there was some 
immediate danger of bankruptcy, which there is not.
  There is the need for long-term, bipartisan planning. But the only 
bankruptcy we face today is the kind of political bankruptcy they have 
when they insist on letting Medicare wither on the vine. I thank the 
gentleman.
  Mr. PALLONE. I thank the gentleman and I would now yield to the 
gentleman from Washington, Dr. McDermott.
  Mr. McDERMOTT. Mr. Speaker, I want to thank the gentleman from New 
Jersey for coming out here day after day and bringing this issue to the 
attention of the American people, because I think there is lots of 
confusion. I was just sitting in the Committee on Ways and Means today, 
and we had before us the Secretary of the Treasury, Mr. Rubin, and the 
Secretary of Health and Human Services, Dr. Shalala, to talk about the 
trustees' report. And everybody is waving the trustees' report around 
now and talking about that this is the end of health care for senior 
citizens and everybody should be worried.
  A little history needs to be brought out, people need to understand. 
Since the program was started in 1965, there have been 27 trustees' 
reports. Every year, a trustees' report, that is the job of a trustee, 
is to say how much money do we have and how long will it last? So each 
year, they look at the money, they look at what they are spending, and 
say this is how long it is going to last. At one point we had only 2 
years to go, and it would be all gone. At another time, it was 17 
years. So there have been all kinds of reports. They never were a 
crisis until last year when the Republicans took over the House of 
Representatives and said, we need some money for a tax break. So they 
grabbed this trustees' report and instead of doing what we had done 
since 1965, which was to say there is a problem, we are going to have 
to make some adjustments. And we made them. Every year, no fanfare, 
nobody ever heard about the trustees' report, nobody ever heard that 
the sky was falling. On a bipartisan basis, we made changes in the 
Medicare structure that would have carried it on as we intended to do.
  In fact, the Democratic members of the Committee on Ways and Means 
came up with a proposal last year that for $90 billion in adjustments 
in a variety of different places, without hurting the basic program, we 
could protect Medicare until the 2005, for 10 years out into the 
future.

  Now, the Republicans insisted that it be only their way of adjusting 
the program or there is going to be nothing. It is sort of their way or 
the highway. And in insisting on that, we have not done anything. So 
now we come to the trustees' report that was released yesterday, 
discussed in the Committee on Ways and Means today; everybody is going 
around acting as though the Earth is ending, because it is now 1 year 
less. Instead of 7 years last year, we only have 6 years worth of money 
in the pot to pay bills to 2001.
  Now, if they have made the changes last year that we recommended for 
$90 billion, we could have been out to 2010. But their delay has 
actually made it worse. It is sort of like if you have a problem in 
your car, you hear a clanking noise and say, well, it is still running, 
I am not going to bother checking the oil and you just keep going until 
finally the motor freezes up, and then you say, oh, my goodness, if we 
had put the oil in last year, we would have prevented that. They have 
not done the preventive things that last year they could have done for 
$90 billion.
  Now, to make this problem worse, or to make it even more laughable in 
some ways, last year they wanted $270 billion out of Medicare so that 
they could have a $245 billion tax break. They needed the money. Some 
of it was for Medicare, but most of it was to be spent on a big tax 
break. This year they say, you should be grateful. We are only going to 
take $176 billion out of Medicare. It is obviously way more than is 
necessary to do the job. The President has made a proposal of $124 
billion in changes. So if you want to talk money, they are still asking 
for money that they are going to use in the tax break.
  But the really insidious thing is the kind of changes that you have 
been talking about in the Medicare Program. If you take a senior 
citizen, the average senior citizen on Medicare is living on $11,000 a 
year. Now, there is not a whole lot of slush in $11,000 a year in this 
society. There are 11 million widows living on less than $8,000 a year. 
Their husbands have died, they are living on a Social Security check. 
The minimum is about $8,000.

                              {time}  1700

  What the Republicans are saying is we are going to give you $4,800 
this year to go out and buy a health program. That is about what it 
costs. This year they could buy exactly what they have had.
  Next year the inflation by the insurance industry, they expect it to 
go up by 7 percent. But the Republican proposal says, ``We're only 
going to give you a 3-percent increase.'' That 4 percent that they do 
not give them has to come from somewhere. It either has to come out of 
that widow's $8,000, or she has to turn to her children and say, ``I 
can't afford to buy the same health care package.''
  This argument about whether it is an increase or a cut, yes: they are 
increasing it 3 percent. But they are not giving you enough to buy it. 
It would be as though I said to you, ``A quart of milk is 99 cents, 
here is 99 cents, go buy a quart of milk.'' Next year a quart of milk 
is $1.10. I say, ``Well, Frank, I'm going to give you $1.05. Go buy a 
quart of milk.'' You obviously cannot buy a quart of milk if you do not 
have the amount of money that is necessary to pay for it.
  The cut is that they are not giving them enough to keep up with 
inflation. By the end of 5 years, it is going to cost $1,000 more out 
of pocket. That means grandma has to open her purse and find another 
$1,000 to put with her Medicare money to buy the same program.
  That is by the insurance companies' estimates. That is not some wild 
group out there that is trying to prove the Republicans are wrong. The 
insurance companies are very tightfisted actuaries who look at that and 
they say that is what it is, and they are not providing enough money to 
buy the same package.
  So now that you have that picture in mind, the Republicans offer them 
an alternative. They say, ``Why don't you go into an HMO. An HMO will 
take whatever we give you and then you won't have to pay any more money 
out of your pocket.''
  So they have financially jerked those people around. They have either 
got to take $1,000 out of their pocket or join an HMO or get it from 
their kids. Those are their three choices. If you go into an HMO, I do 
not think everybody has agreed that you are going to be able to choose 
your own doctor. There is every indication in HMO's that if your doctor 
is not on the list, you are going to have to quit seeing that doctor.

[[Page H5990]]

  For somebody who is 25 years old, that does not seem like a big deal, 
because when you were 25, who had a doctor? I did not have one when I 
was 25. At 45, maybe you see a doctor once in a while. At 55, you see 
him a little more often. I see him a little more often. When you are 80 
or 90 like my father, and he has had a doctor following his heart 
medication for 20 years, to suddenly say to him, ``Well, Mr. McDermott, 
you cannot have your doctor, you're in this HMO and your doctor isn't a 
participating doctor, so choose a new doctor.''
  If you are 90 years old, that means you have got to sit down with 
somebody and tell your whole history and explain it, and what 
medications have you been on and how did it affect you. All of your 
past in a doctor's head is lost. That is why being able to choose your 
own doctor is important. What you want is somebody who knows your 
history. You do not want to go to somebody who never saw you before 
when you are 90 years old and have to explain your whole history and 
what has happened to you.
  So that financial incentive that says, ``You can stay in the regular 
Medicare Program, it's going to cost you $1,000 out of your pocket, or 
go to this HMO and you might not get your own doctor,'' those are the 
choices that the Republicans are offering senior citizens.

  My view is that is not necessary. I looked very carefully at the 
Medicare Program when I put a bill in cutting $90 billion. I am a 
physician. I would not put together a program that I thought would hurt 
the quality of health care that people get. But you do not need more 
than $90 billion in cuts. All the rest of that money is being cut so 
that they can use it to give away in a tax break.
  The issue that you were talking about as I came in here is one that I 
think is even more difficult to understand, and that is this whole 
question of pharmaceuticals. When you get to be old, you go to old 
people's houses, you will find on the dining room table a plastic box 
that has a bunch of little boxes in it. One is for in the morning, one 
is at lunchtime, one is in the evening and one is at bedtime, and they 
have their pills in them.
  If they are like my father and mother, they spend $220 each month at 
the pharmacy. They have no way except to pay that out of their pocket. 
They are already paying enormous amounts out of their pocket. That is 
why this $1,000 coming in out of their pocket to get this same benefit 
package to pay the doctor, to pay the hospital, to pay the x ray, to 
pay the blood work in the laboratory and so forth is such an impact. It 
is not as though they are not paying something now.
  If your father is paying $200 a month for pharmaceuticals, and then 
to pay $1,000 more a year, now $1,000 a year, divide that by 12, that 
is like $80 a month more that they have to reach in their pocket. What 
does $80 mean? Well, if you make $100,000, $80 is not all that much. 
You could probably absorb $80. But if you are living on $8,000 a year, 
like 11,000 widows are in this country, $80 is about 3 bags of 
groceries. It is a question. Do you want to go to the grocery store and 
get nutritious food, or are you going to have to send it off to buy 
your health care plan?
  Those are the kinds of choices. And the baby boomers in this society, 
the people in the generation under me, I am 59. So, if you are about 55 
or so, below, you are going to have your mother coming to you asking, 
or maybe not telling you and then you will find it out some other way 
that she is not going to the doctor, not buying the medication, or she 
will ask you and you are going to be between the vise of helping your 
mother and helping your own kid in the community college.

  I mean, people in their forties, their thirties, forties, fifties are 
caught between their parents and their children. You care about them 
both. Which one are you going to help if you can only help one? ``Well, 
mother, I'm sorry, you're old, you will have to deal with it yourself 
because I have got to help my kid.'' No; you cannot say that. Then you 
say to your kid, ``I can't help you through college, you're going to 
have to make it on your own, good luck, because I have to help my 
mother.''
  That is the vise that this proposal puts middle-class, middle-aged, 
people in. People in my generation have never spent a dime, I have 
never had to give my parents one single dime for their health care. 
Medicare for 30 years has taken that issue right off the table. Along 
comes this proposal and says we are going to put it back on the table 
and each family can find it themselves.
  Now some can find it. My mother and father have four kids, all of 
whom went to college, all of whom have good jobs. We can find a little 
extra to help our mother, but what about people that do not have that? 
Think about that. Think about the guy who is just laid off at 50 and 
his mother is 80. He cannot help her.
  So it is this kind of thing, and I think that you are doing a real 
public service by coming out here and raising these issues, because the 
trustees' report is simply an annual report and we are going to correct 
it. We are not going to walk away from this. The Republicans would not 
dare walk away from this without fixing this program. They have no 
chance with the American public if they do not step up and fix it. They 
ought to drop the whole business of cutting taxes and deal with 
Medicare.
  Mr. PALLONE. I appreciate the gentleman's comments because you really 
managed to put a lot of this in common sense terms and explain it for 
the average person, which is what we really need to do. I thank the 
gentleman for joining us tonight.
  Again, as I said in the beginning, the reason why we are here is 
because we do believe that the Medicare Program is so important and we 
believe that the promise of Medicare, which is to provide quality 
health care coverage for senior citizens, the promise that a Democratic 
Congress and President Johnson made over 30 years ago must be 
continued, and that it really is not fair for today's seniors or future 
seniors to suggest to them that they cannot have the same kind of 
quality health care that we have now for senior citizens.
  That is what we are afraid as Democrats will happen with this 
Republican leadership plan to change Medicare, that it will be so 
drastically changed that eventually it will simply disappear as a 
valuable program to provide health care coverage for all of America's 
seniors.

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