[Congressional Record Volume 142, Number 114 (Tuesday, July 30, 1996)]
[House]
[Pages H8803-H8809]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               STATUS OF MEDICARE ON ITS 31ST ANNIVERSARY

  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, today is the 31st anniversary of the 
creation of Medicare. On July 30, 1965, President Lyndon Johnson 
traveled to Independence, MO to sign Medicare into law at the home of 
President Harry Truman who had been fighting for Medicare for 20 years.
  The Democrats today had a birthday celebration for Medicare with 
senior citizens and Vice President Gore. Basically, what we are 
celebrating is the 31st anniversary of Medicare because it has been 
such a success in terms of a Government program that may very well be 
the most successful Government program. We want to renew our commitment 
to protecting Medicare from deep cuts and work to continue its solvency 
for many years to come. That is why the families first agenda that the 
Democrats have put forward includes the protection of Medicare as a key 
element of a balanced budget proposal.

                              {time}  1800

  This followed the lead of President Clinton, who proved this winter 
that the budget can be balanced while still extending Medicare solvency 
into the next century.
  Mr. Speaker, I just want to reiterate that the creation of Medicare 
did not happen overnight. On the contrary, it took 13 years to finally 
make Medicare a reality for our Nation's seniors. Against staunch 
Republican opposition, Medicare passed the House and the Senate in 
1965.
  Since the Republicans took over Congress in 1996, 30 years later, and 
for the first time since before the creation of Medicare, one of their 
first acts was to basically make significant changes or suggest 
significant changes in Medicare so that it would not be Medicare as we 
know it. A lot of this was done without hearings, without any real 
input, in my opinion, from the American people, and I think it was the 
wrong way to go.
  Fortunately, Democrats spent most of 1995 and also a good part of 
1996 fighting against these Republican proposals, which would have 
significantly changed Medicare and I think made it into a program that 
we would not have recognized.
  I wanted to stress today, on the 31st anniversary, that prior to 
Medicare less than 50 percent of all seniors had any health insurance 
at all. Today, on the other hand, over 99 percent of America's seniors 
can rely on Medicare's services.
  So the reason Medicare was established was primarily because many 
senior citizens did not have health insurance. It was a need that was 
very much felt back in 1965.
  Prior to Medicare many seniors were faced with the dilemma of 
choosing between food, shelter, or health care. Now America's seniors 
are living longer and can be assured they will have quality health care 
services.
  In 1965 there were Republicans in Congress, including most notably 
then Congressman Bob Dole, who ardently fought the creation of 
Medicare. In 1965, 93 percent of the House Republicans, including Bob 
Dole, voted for a substitute that would have killed Medicare as we know 
it. In 1995, 30 years later, Senator Bob Dole and Speaker Gingrich 
attempted to change Medicare as we know it by cutting $270 billion for 
tax breaks for the wealthy.
  Last October, Senator Dole stated, ``I was there fighting the fight, 
voting against Medicare,'' referring to his opposition to the program 
in 1965. It is no wonder, then, that many Democrats doubt the 
Republican leadership when they say that they care about Medicare or 
they want to fix it. We know that many of them, most of them in fact, 
in 1965 opposed it, including then Representative Dole, who is of 
course now the Republican Presidential candidate.

  We also quote, and I have quoted many times on this floor, Speaker 
Newt Gingrich, who last year stated, ``We don't get rid of it,'' that 
is Medicare, ``in round one because we don't think that's politically 
smart, but we think it's going to wither on the vine.''
  Again I would point out that although Speaker Gingrich has recently 
said that perhaps he did not mean what he said in terms of Medicare 
withering

[[Page H8804]]

on the vine, if we look at the Republican proposals that have been put 
forward in this Congress, in effect what they do is they make Medicare 
wither on the vine because they provide a situation where there is so 
much money taken out of the program, again primarily to finance tax 
breaks for wealthy individuals, and they make so many changes in the 
Medicare program that essentially force seniors to choose managed care 
where they do not have their choice of doctors or sometimes even their 
choice of hospitals, so that the changes in the programs and the cuts 
in the program ultimately will make Medicare as we know it wither on 
the vine.
  Just to reiterate some of the things that would come about under the 
initial Republican plans, again the changes have been vast. When this 
Congress started out in January of 1995, there were some drastic 
changes in Medicare that were proposed then and we have seen the 
Republican position change a little almost on a monthly basis ever 
since then. But if we go back to the initial Republican plans, those 
that were put forward in January of 1995 when this Congress began, when 
the Republican leadership was in the majority for the first time in 40 
years, under that initial Republican plan, seniors would have been 
faced with additional copayments, increased premiums, increased 
deductibles, rationed care and a limited choice of doctors. Medicare 
eligibility would have gone from 65 years of age to 67 years of age, 
and Medicare availability ultimately would have only been available to 
the neediest of seniors.
  As Democrats began to speak out against these proposals, beginning in 
the early part of last year, many of these proposals were dropped. But 
the Gingrich-Dole Medicare plan of 1995 was still a plan to end 
Medicare as we know it. It did call for a substantial increase in costs 
to seniors while, at the same time, providing less in terms of quality 
of service. It called for cuts of $270 billion. Seniors would have to 
pay more and get less. They would have been forced into managed care 
with no choice of doctors.
  Last year I was here on the House floor on the 30th anniversary of 
Medicare and Democrats stood with seniors to protect Medicare from 
Republican raids. One year later we can say that we defeated Republican 
efforts to enact the Gingrich-Dole Medicare plan, but I need to stress 
that this war is not over. Although Medicare, because of Democratic 
opposition, because of President Clinton's opposition, basically these 
Republican proposals that change it have essentially been dropped and 
are really not talked about any more, but I have to stress that the war 
is not over.
  The Republican leadership has a new budget blueprint they unveiled in 
1996, earlier this year, that calls for $168 billion in cuts for a tax 
break slush fund. Seniors, again, would be forced to pay more and get 
less. In addition, this new plan will allow doctors to overcharge 
seniors for providing health care services. And current law of course 
protects seniors from these excessive charges.
  All I can say is that Republicans are at it again. I think it is very 
important, Mr. Speaker, on Medicare's 31st anniversary today to affirm 
that Democrats remain committed to improving Medicare in a common sense 
fashion. Unlike our Republican counterparts, we are not sorry that 
hundreds of thousands of seniors rely on Medicare. We think it is a 
good program. We are pleased that it has doubled the number of seniors 
who now receive health care and we think it is a proven success story, 
certainly worth protecting.
  Now, Mr. Speaker, I just wanted to make a comparison, if I could, 
between the Republican proposal on Medicare in 1995 and the one that we 
have this year, which again we have not been hearing much about 
anymore, but I think it is worth mentioning because it certainly is 
going to be an issue for many months and many years to come. I just 
want to go through, if I could, in a little detail, the effect of some 
of these proposals.
  Again, I am going back to 1995, the last year when, as I said, some 
of the more radical Republican leadership proposals to change Medicare 
were brought to the floor of this House. And let me just talk about a 
few of them.
  First of all, there was the proposal to double Medicare part B 
premiums. Many people know that Medicare has part A and part B. Part B 
covers the doctors' bills, essentially. The Republican proposal 
basically increased the amount that seniors would have to pay out-of-
pocket every month to get their Medicare part B coverage. Again, the 
Democrats opposed that. And as a consequence, the actual monthly part B 
premium actually decreased at the end of the year instead of actually 
doubling as was proposed by the Republican leadership.
  The last year's proposal also attempted to eliminate doctor's choice. 
Some of my colleagues on the other side of the aisle said, ``We want to 
give you more choices because we want to give you the choice of managed 
care.'' But as many seniors know, and most people know, managed care 
often does not allow you to have the doctor you are used to having.
  Senior citizens tell me in my district over and over again that the 
biggest concern they have about Medicare is they want to be able to 
choose their own doctor. And how did the Republican proposal move 
people into managed care? It did not say you had to go into managed 
care, but what it said was you had to provide a higher reimbursement 
rate for physicians who were in managed care than for those who were 
not. So there were financial incentives to make doctors as well as 
senior citizens effectively be forced into managed care.
  Another thing that was done that I think was really terrible was the 
Republican bill last year actually cut Medicare premium assistance for 
low-income seniors, and here I want to spend a little time saying that 
there is a relationship between Medicare, which is the health care 
insurance program for all seniors, and Medicaid, which is the health 
care insurance program for poor people, for people of low income.
  Under the current Medicare law, if a senior citizen in eligible for 
Medicaid because of their low income, then their part B premium per 
month for their doctors bills is actually paid for by Medicaid. Well, 
the Republican proposal that came before the House last year would have 
eliminated that and essentially said that there was not going to be any 
guaranteed coverage to pay for the part B premium if you were a senior 
that was below a certain income.
  There were other Medicaid changes that the Republican leadership had 
proposed that also would have had a negative impact on senior citizens. 
First, they suggested repealing the Federal nursing home quality 
standards, so basically the Federal Government would not have any say 
over the quality of care in nursing homes. They also put homes and 
family farms of elderly couples at risk for nursing home care, because 
under current Medicaid law the home of the senior citizen or the spouse 
who is in the nursing home is basically insulated from the Government's 
ability to take it or sell it and use it to pay for their nursing home 
coverage. Well, they would have changed that. It was one of the 
proposals they put forward in their change to Medicaid last year.
  They also made the change in Medicare that would have forced adult 
children to be financially liable for their parent's nursing home 
bills. Right now, under current law, if a parent or grandparent is 
placed in the nursing home under Medicaid, the Government cannot go 
after the children or the grandchildren to pay the cost.
  Some people may say, well, gee, why not let them pay the cost. But 
the bottom line oftentimes is that money is used by younger people to 
pay for their own children's college or their own children's education 
or other purposes and to say that we want to change the law and that 
they have to take care of their parents or grandparents I think does a 
lot of mischief.
  Now, those were the proposals, those where the aspects of the 
Republican Medicare bill and Medicaid bill changes that I though were 
the most negative and had the most impact in last year's proposal on 
Medicare and Medicaid. But this year again we have new Republican 
leadership proposals on Medicare and Medicaid, and I think that the 
gist of it is essentially the same. Let me just highlight some of the 
things that I consider the most negative.
  First of all, eliminating doctor and hospital choice by forcing 
seniors into

[[Page H8805]]

Medicare managed care plans. Now, again, they take a different tact on 
how to do this. They will say, my colleagues on the other side will say 
we are not forcing seniors into managed care. They can still choose 
between the traditional fee-for-service plan, where they have their own 
doctor and their own hospital or then can go into managed care. They 
have the choice. But what this new Medicare proposal does is to say if 
you stay in the traditional Medicare plan, where you choose your own 
doctor, then you can have unlimited what we call balance billing. In 
other words, the doctors can charge you an unlimited amount over and 
above what Medicare pays.
  Obviously, we can see that the senior does not really have a choice, 
because if they have to pay all that extra money they will go to a 
managed care system because they cannot afford the extra money out of 
pocket. So again the seniors are forced into managed care, where they 
do not have a choice of doctors. The way of doing it is different from 
last year, but the effect is the same, the long-term effect is exactly 
the same.
  I see my colleague from Connecticut, Congresswoman DeLauro, is here 
to join me, and I know she has been out there every day for the last 18 
months basically bringing up how terrible these changes in Medicare are 
that the Republican leadership has proposed, and I would like to yield 
to her at this time.
  Ms. DeLAURO. Mr. Speaker, I want to thank my colleague very, very 
much for carrying the discussion and the debate on this critically 
important issue, and I know he shares what I do today, a sense of 
history, a sense of great accomplishment on the part of this great 
Nation of ours, when 31 years ago the Medicare system was signed into 
law by President Johnson.
  It truly is a day of real historical value for all of us, and we 
congratulate those who put their vision, their commitment, their 
compassion, their view of what the values of this Nation is all about, 
they put that forward and said what we need to have to do in this 
Nation is that seniors need to have health insurance. Nation is that 
seniors need to have health insurance.
  The facts spoke for themselves. In 1959, only 46 percent of seniors 
had any kind of health insurance. We hear the tales all of the time 
about there being no place to go. Families had to be the sole support 
for their loved ones if they were ill and that they did not have any 
help in doing any of that, and so many people's health was put into 
jeopardy.
  Today what we have is a direct reversal of that problem back in 1959.

                              {time}  1815

  Today 99 percent of seniors are covered for health insurance and it 
is a direct result of the Medicare system. So that this is a program, 
it is more than a program. It is not a program. It says something about 
what we value in the United States, what our values are, what our 
priorities are. That in fact, those who reach the age of 65, those 
people who have played by the rules, who have contributed so much to 
our society, who have paid their dues, if you will, they need this 
opportunity to have the benefit of being able to one more time pay 
again but to get some assistance and have a health insurance system 
that is available to them, that is guaranteed to them, and that makes 
them independent; that does not make them dependent on their children, 
and it gives them a sense of dignity and a sense of security in their 
retirement years.
  That is what is the historical value of this anniversary this, 31st 
anniversary of truly making health insurance for seniors one of those 
values on which this Nation stands.
  My colleagues from New Jersey joined with me yesterday in the 
Families First hearing on protecting Medicare, and it was one more 
instance of that highlighting of the difference that this program makes 
in the lives of 37 million people. And what we are concerned about and 
what he has expressed his concern about is one more time we are looking 
for the second year in a row, quite frankly, though this is not also 
without a historical past, we have known some folks, including the 
current candidate for the Presidency in the Republican Party, Bob Dole, 
who was out there and he goes back, saying he was proud that he cast 
his vote against Medicare because it was a program that did not work. 
So he has a history on this issue.
  But we have seen the unbelievable attempt to cut the Medicare Program 
in the last 2 years with this Republican leadership, first to the tune 
of $270 billion and if you juxtapose that with the $245 billion in a 
tax cut for the very wealthy that the Republicans wanted to provide, I 
do not believe that there is a coincidence in those numbers. We are now 
back again for the second round of cuts that talk about $168 billion 
and their tax package for the wealthy that runs around $176 billion. So 
again these numbers are not coincidental.
  What I think is interesting to find out is that we have a prelude of 
what we are talking about in the future, and in the immediate future. 
The Wall Street Journal yesterday indicated, there is an article there 
that describes Senator Dole's new tax plan, or at least what they view 
as his potential new tax plan, which is expected to be released next 
week.

  I want to read this because I think it is important about what 
portends for the future. Mr. Dole and his advisors now contemplate a 
tax cut of Reaganesque proportions. Fifteen percent across the board 
for individuals. That is almost five times as large as what the 
congressional Republicans included in their latest budget plan. Five 
times as large. It would cost more than $600 billion over the next 6 
years, this 15 percent tax cut.
  Now, there was another article in the Wall Street Journal that tried 
to figure out what happens, where this money begins to come from, and 
it is without question, I mean what they did not do was to say 
specifically this is the program that it comes from, but there was no 
indication from Bob Dole as to how he plans to pay for the massive tax 
break. And no one knows how he intends to pay for it, because that 
information is being held very closely. I hope next week, if he 
introduces the program that in fact what he will do is to let the 
public know how he intends to pay for it.
  But what is clear, and at our hearing yesterday was Lawrence 
Shimmerin, the managing director and chief economist at the Economic 
Strategy Institute. He said that you are going to have to take a look 
at a whole variety of programs from which there will be cuts. And that 
includes education, it will include infrastructure, roads, bridges, the 
construction of schools, a whole variety of programs, again which 
demonstrate some values when you talk about education and the 
environment and what we want to do to try to put people to work, that 
the money is going to have to come from there. Then when we asked him, 
he said in effect that the money is going to have to come from programs 
like Medicare.
  So that, in fact, we are looking at, with the introduction, the 
potential introduction of this tax plan by Bob Dole, what we are going 
to see is another round of cuts to the Medicare Program. And when you 
are looking at $600 billion over the next 6 years, our colleague from 
the other body, Jim Exon, said that we are potentially looking at $313 
billion in cuts in the Medicare Program.
  So that this is not something that is an idea that is not being 
nourished, and not being nurtured and prone to be moved. Bob Dole is 
going to introduce this plan in the next week or 2 weeks. So what we 
are going to do is to see an amazing escalation of those costs and cuts 
in the Medicare Program, because there are not going to be too many 
places to which you can go to make those kind of cuts.
  If we think about future direction and we look at the historical past 
where we have Bob Dole saying that he was happy to fight the fight and 
be 1 of 12 and vote against Medicare because it did not work, we can 
understand the move to this massive tax cut and what that means to the 
Medicare Program.
  Now, I will stand here and tell you as I know my colleague is, I am a 
believer in tax cuts. Let us make sure that working families are the 
beneficiary of those tax cuts. If we provide people with the 
opportunity to take a tax deduction of $10,000 a year in order to 
finance the education for their children or to have the opportunity 
themselves to get skills training and education, if they need that in 
order to further their

[[Page H8806]]

own job, their career ladder, we ought to target those tax cuts. But if 
we are looking at using Medicare as the piggy bank to finance those tax 
breaks, then it really is unconscionable and it is wrong and it is an 
outrage.
  I will just make one or two other points to my colleague, as I say, 
to say that we have an historical legacy here. We have the Speaker of 
the House talking about wanting to see the Medicare Program wither on 
the vine, and that people will voluntarily leave it, though he is 
trying to walk away from those comments. But you cannot walk away from 
what you have said. Your actions and your words are there for people to 
take a look at.
  We even have had Bill Thomas, who is on the Health Subcommittee, 
refer to Medicare as a socialist program. The kinds of language in 
which people talk about the Medicare system. Dick Armey said he would 
not want to be a part of such a system in a free world. And these are 
the folks who come to tell us and to tell the American people, whether 
they are our seniors or whether they are the families of seniors that 
trust us, what we want to basically do is to slow the rate of growth. 
In fact, what they are doing is cutting the Medicare Program, 
jeopardizing the health care of seniors and putting them in a position 
where they will have to pay more, or that they will lose the choice 
of doctors. And in some places in this Nation, we will watch hospitals 
close down and, in fact, people who deserve to have health insurance 
and health care at this time of their life will not have the benefit of 
that.

  It is hard, as I said, to walk away from the commentary that people 
have made over the recent past and the more further past and to have 
them now come forward and say that they are going to try to make the 
program a better program. Their goal truly is to dismantle this program 
which works. My constituents believe it works. They believe it needs to 
be fixed. Sure they do, and it does.
  The trustees said there was $90 billion that we needed in order to, 
in the short term, make the program solvent. We need to have a 
bipartisan commission to take a look at the long term, whatever that 
means. Nobody disagrees with that. What they do disagree with is ending 
a Medicare Program, of leaving people behind, taking that 99 percent 
and beginning to move it back to the 46 percent of seniors who had 
health care in this country. That is what cannot happen.
  What we ought to be debating on this floor, what we ought to be 
talking about is how we make the Medicare system stronger; how, in 
fact, we do something about long-term care for people in this country; 
how we do something about the cost of prescription drugs; how we deal 
with home health care. And that is what direction we ought to be going 
in.
  We ought to be building on what we have, not unraveling what we have 
in this great country of ours. And as my colleague was talking about, 
this whole notion of overcharging today, of removing the restrictions 
on hospitals and doctors that prohibit them today from overcharging 
Medicare recipients, how can we in good conscience stand here and talk 
about that as a way to fix this program?
  What is wonderfully interesting, though, is that I think in your 
community, in my community, the folks see through what is going on 
here. And that in and of itself is rewarding because they are fighting 
the battle against what the Republican leadership is trying to do. They 
made that fight last year, and I know they are going to make the fight 
this year.
  But for today, it is happy birthday and it is happy anniversary to a 
health insurance system that works for the people that it was intended 
to help. And that is the Medicare system. And we need to once again 
pledge that we are going to make sure that the system stays here, that 
it is a better system and it is going to be a good system for people in 
the future, and I thank my colleague for his leadership on this issue.
  Mr. PALLONE. Mr. Speaker, it is not my intention to necessarily use 
all of our 60 minutes that is allocated tonight, but I do think it is 
important and I know that the gentlewoman from Connecticut stressed 
some of these points, but I think that it is very important for us as 
Democrats to point out that right now in 1996, on July 30, 1996, the 
Republicans still have a plan out there to cut Medicare and to make the 
drastic changes in the Medicare Program that effectively would destroy 
Medicare as we know it.
  I am afraid that not only our colleagues but certainly a lot of the 
American people do not really understand that at this time. There has 
not been that much discussion about Medicare on the Republican side in 
the last few weeks or months, but the fact of the matter is that there 
is a new plan out there to cut Medicare and to change it drastically. 
And I wondered if I could reiterate some of these things that are on 
the table right now because I think it is important to stress it.
  The gentlewoman mentioned that although in 1995 we had this 
Republican proposal that would have cut $270 billion from Medicare 
primarily to pay for tax breaks for wealthy people in 1996, the budget 
that we are now operating on that was passed here in the House by the 
Republicans, without Democratic support for the most parts, calls for 
essentially the same kind of Medicare overhaul plan that they put 
forward in 1995.

                              {time}  1830

  I think the gentlewoman mentioned that the budget contains $168 
billion in cuts in the Medicare Program over 6 years in order to pay 
for $176 billion in tax cuts, again targeted primarily on the wealthy. 
So I mean it really is not any different. I want to stress that because 
I think it is important to make it known.
  Ms. DeLAURO. The gentleman is absolutely right. If we take a look at 
it in terms of percentages, they were talking about $270 billion over 7 
years. They are now talking about $168 billion over 6 years. It went 
from a 19-percent cut to 17-percent cut, which is just the same as you 
have said. So, they are doing the same exact thing that they did last 
year, when there was such an outcry. People really truly do need to 
understand that.
  I want just one more point which I believe it was the pundit or the 
journalist Morton Kondracke asked the third person in charge of this 
Congress, the gentleman from Texas [Mr. DeLay] said: You know, the 
public thinks that the Republican leadership has been extreme or at 
least there is the view out there by some that the Republican 
leadership has truly been extreme over the last 18 or 20 months. If you 
are back in the majority again, will you be engaged in the same kinds 
of initiatives that you were in the 104th Congress?

  He talked specifically about Medicare, and he said that they would 
once again do the same thing. So it is 270, it is 168, it is the same 
thing.
  It was not only in this Congress, their intention is, if they get 
back to the leadership here again, to do the very same thing again in 
the future. So it is the very, very same argument. My colleague is 
right to point out that we cannot lose sight of that.
  Mr. PALLONE. The other thing, too, that I want to stress is that 
these cuts are not needed to save the program. Again, we are not 
hearing much from the other side about Medicare anymore, so we do not 
hear much about their effort to save the program anymore either. But we 
know that this level of cuts is not necessary to save the program. 
Again, it is being used primarily to pay for tax breaks, and those tax 
breaks are primarily for wealthy Americans.
  In fact, according to the Congressional Budget Office, the Medicare 
cuts, and again not to stress it, but there was a level of cuts much 
less that was proposed by the Clinton administration. And they would in 
fact have extended the life of the Medicare trust fund for virtually as 
long as the GOP Medicare plan.
  So, if we simply adopted the suggestions that the Clinton 
administration made, which would not have made those deep cuts to 
finance these tax breaks for wealthy people, we would have extended the 
life of the Medicaid trust fund and eliminated all the questions that 
have been raised about potential insolvency of Medicare. Those could be 
brought to the floor today if the other side was willing to accommodate 
and go along with what the President has said. They do not want to do 
it because they want to keep out there those tax breaks.

[[Page H8807]]

  Ms. DeLAURO. The trustees, which were, as my colleague will remember, 
there were so many on the other side of the aisle that held up the 
trustees report day in and day out. The trustees said $90 billion for 
the short-term solvency of the program. As I have suggested, I think we 
need to have a bipartisan commission look at the long-term solvency. We 
did that on Social Security. We can do that here.
  The President, I think he has talked about $116 billion, that you 
could extend the life of the program, as my colleague pointed out. But 
they are committed to these tax breaks for the wealthiest Americans, 
the wealthiest, the most privileged in our society, and they cannot get 
off that kick. That tax cut was what Newt Gingrich called the crown 
jewel of the Contract With America. And whether you take the $245 
billion in the tax cut or you take the $176 billion that they are 
talking about now, and if you take that a step further and you talk 
about what Bob Dole is talking about, which is $600 billion over a 6-
year period of time, we all know that we are going to look at another 
round of cuts to the Medicare Program. There is no doubt about that; no 
doubt, I think, in anyone's mind.
  Not only will it be Medicare, but I can tell my colleague that 
another area that you have great interest in is education and the 
environment. We are going to see massive cuts in those areas as well.
  I do not happen to think that that is what this Nation is about. I 
think this speaks, we can balance the budget. We can do that. The 
question is, what are the values that we espouse in that balanced 
budget. I think we have been given a very, very good indication of the 
kinds of values that our Republican leadership here in this House 
espouses.
  Mr. PALLONE. Again, we sort of touched on this again, but I just 
think it is important to stress that once again the Republicans are 
talking, leadership is talking right now this year about proposals for 
Medicare that would cost seniors a lot more out of pocket. I think a 
lot of people believe that because they have not heard about the 
increase in the Medicare part B premium.

  Last year that was the crying call because so many seniors knew that 
the Republicans had proposed these big increases in part B premiums 
that they would have to pay per month. This year with the balanced 
billing provisions and with the level of cuts in Medicare, we will end 
up paying a lot more out of pocket. I think the figure right now is 
that under current law the physician can only charge patients up to 15 
percent above what the fees are that Medicare sets. But if you stay in 
a traditional Medicare, under the current Republican plan that is on 
the floor now, that figure is unlimited.
  In addition, I know that the gentlewoman has pointed out previous 
times on the floor that with the cuts in the level of services that 
would come from this level of cuts in Medicare, we are going to see 
tremendous increases in Medigap insurance because Medigap is going to 
have to cover more because of the lack of funding available for 
Medicare. So seniors would be faced with these overcharges by the 
physicians, higher Medigap premiums, and the list goes on.
  Ms. DeLAURO. Mr. Speaker, I think there is one point that my 
colleague made which I think we need to remake. It is not so much 
sometimes people do not understand the term balanced billing. It is the 
overcharging. Right now there are prohibitions on hospitals and doctors 
that they cannot charge the individual recipient for the difference in 
what Medicare will reimburse to the physician for their service. So 
that in fact the recipient cannot have that burden of the extra charge 
as put on them. That is lifted. Those prohibitions are gone, which 
means that doctors and hospitals can charge the individual, the 
Medicare recipient, for what they view as what their fee is over and 
above what Medicare will reimburse them for.
  This is direct out-of-pocket costs, direct out-of-pocket costs.
  That is real. That is what is in this proposal right now. And we 
cannot, people cannot lose sight of that, because it is not so much 
that the part B program is going to double the way they had it going 
last year. but this is kind of hidden in the language as to what is 
going on here. People truly do need to be educated and made aware of 
what risk they are for out-of-pocket costs.

  Mr. PALLONE. I yield to the gentleman from Ohio [Mr. Brown].
  Mr. BROWN of Ohio. Mr. Speaker, I echo the comments of my friend from 
Connecticut, especially when instead of Gingrich Republicans cutting 
Medicare to pay for tax breaks for the wealthiest people in this 
country, cutting it to the tune, originally they started out at $270 
billion and finally reacted, when the public reacted so much against 
these major Medicare cuts in order to pay for tax breaks for the 
wealthy under the Gingrich Medicare plan, instead of letting the 
Gingrich Republicans make those cuts to do that, we should be going 
after fraud in Medicare, the whole balanced billing issue that Ms. 
DeLauro mentioned that will cause more waste in Medicare and will cause 
more Medicare beneficiaries to have less services at higher cost.
  What they tried in the Medicare and the Medicaid bills, what the 
Gingrich bills on Medicare and Medicaid said last year and this year, 
that to allow physicians to refer for any kind of services, diagnostic 
services, MRI's or others to facilities that those physicians own, we 
have in this body, long before any of the three of us were here, tried 
to go after some of those fraudulent aspects of Medicare anyway, to 
make sure that people really were getting their dollars' worth and 
doctors were paid properly, that hospitals were reimbursed properly and 
that patients had an opportunity to get good health care at the lowest 
cost possible.
  Now we are opening the floodgates, when there is already, according 
to the GAO, already something like $100 billion in fraud in Medicare 
over 7 years that we could recover, they are opening the floodgates 
more so we could have maybe twice as much fraud.
  The fact is, instead of giving these tax breaks, instead of cutting 
Medicare and giving tax breaks to the wealthiest people in the country, 
as Speaker Gingrich and the Republicans want to do, we should be going 
after these in a variety of different ways, some of these fraudulent 
practices that have happened in Medicare, go after some of the double 
billings and some of the problems that we have seen, not opening up the 
floodgates so there can be more.
  It is clear that that is the way to deal with the Medicare, that is 
the Medicare solution for now, rather than making major cuts and 
saying, you are trying to save it, when clearly it is almost comical, 
if it were not so serious, when Speaker Gingrich and the leaders in the 
other body stand up and talk about, we are going to cut Medicare $180 
or $270 billion, whatever their number of the day is in order to save 
it, it is almost comical, if it were not so serious, except that in the 
sense that these are the people that voted against Medicare when it was 
created. These are the people that have never tried to fix the program 
when it has needed minor fixing. These are the people that called it a 
socialist, no-good program. Citizen Dole has said that Medicare, he was 
proud of being one of 12 people that voted against Medicare because he 
knew it would not work, he said.
  Speaker Gingrich has said over and over that Medicare will wither on 
the vine under the Gingrich Republican proposals. It is clear they have 
never had any interest in this program. They are not trying to save it. 
They are trying to privatize it and ultimately turn it into a welfare 
program that simply will not serve the 99 percent of the senior citizen 
population of this country that Medicare now services.
  Mr. PALLONE. I am really pleased that you brought this up because a 
lot of times when I talk to senior groups they will say to me, why do 
the Republicans want to make these changes. People generally feel that 
elected representatives that come down here want to help them. They do 
not assume the opposite.
  And I say, well, on the one hand it is the tax breaks for the 
wealthy. But on the other hand it is the special interests. There are 
changes in this legislation that the Republicans proposed, changes in 
the Medicare program that are strictly special interest oriented for 
their friends. And one of them you mentioned is with regard to fraud.
  One of the things you remember in the Committee on Commerce, one of 
the things that most upset us last year

[[Page H8808]]

in 1995 was the weakening of these antifraud and abuse provisions. 
Instead of using the opportunity to strengthen them, because we know 
there is a lot of fraud, the Republican leadership proposal actually 
weakened the antifruad and abuse provisions.
  Briefly, and then I will yield to the gentlewoman from Connecticut, 
there was the example that I could just cite where the GOP bill 
relieved hospitals and doctors of the legal duty to use reasonable 
diligence for ensuring that the claims they submit to Medicare are true 
and accurate. That sounds like a lot of legalese but it is very 
important, because if you weaken that standard, then it is much easier 
for doctors or hospitals to abuse the system. That was actually in the 
bill. We fought very hard to point that out and to stop it from 
becoming law.

  Ms. DeLAURO. My colleague is absolutely right. It is a question of 
who they want to help. We do come here to help, but it is a question of 
who they want to help. And you will hear the argument over and over 
again that what they want to do is to save the program, that they want 
to slow the rate of growth. And nobody suggests that we should not deal 
with the fraud and abuse pieces because fraud and abuse in the entire 
health care system is about 10 percent. We spend about $800 billion for 
health care in this country every year so it is about $80 billion 
roughly.
  There is fraud and abuse in the Medicare system. We ought to go at it 
and root it out. As both of you have pointed out, what they did was 
absolutely contrary to that goal by making it easier for people to 
abuse the system.

                              {time}  1845

  But what I find that is rankling in the argument that is made is that 
what we want to do is to hold the cost of Medicare down. Noble cause. 
Noble cause. However, why are we trying to hold the cost down of 
private insurance? Why are we not trying to hold the cost down of 
prescription drugs? Why are we not holding the costs down in every 
other section of our health care system but only want to hold the cost 
down and stick it to seniors?
  We tried in the last session of Congress to pass health care reform 
and we failed. I think the goal was good, but we may have moved too 
quickly, too fast, taken on too much. But the issue there, the single 
biggest issue, was to slow the rate of growth down for the entire 
health system, not just one piece of it, and everybody agreed that you 
could not just hold the costs down in one place while everything else 
was still rising.
  Why are we not going after some of the other parts of this health 
care system in the same way that they would like to go after the 
Medicare system and particularly the beneficiaries in the Medicare 
system by increasing their out-of-pocket costs, allowing them to have 
limited or no choice in their doctors and helping to close down health 
care facilities in this country, and all, all of that, not to save the 
system, but to provide a tax cut for those who through their own 
wherewithal have done very well; nobody takes that away from them, but 
the most wealthy and the privileged should not increase their wealth at 
the expense of people who are vulnerable and in the senior years of 
their lives.

  Mr. BROWN of Ohio. I would add, if the gentleman would yield, to what 
the gentlewoman from Connecticut said about the efforts to hold costs 
down or to cut the growth in Medicare. I mean I have heard over and 
over and over again from the most conservative people in this House, 
who on the Republican side have always opposed any program like 
Medicare, calling it socialism, saying it is a terrible program, it is 
big government, all of that.
  They have all said we are not cutting Medicare, we are slowing the 
rate of growth, and that is what they say over and over and over again 
and try to drum that into the heads of America's elderly, saying we are 
not threatening Medicare.
  The fact is slowing the rate of growth when more people are on 
Medicare means less money for each older beneficiary. It also means 
there is a higher cost for medicine which goes up and for health care. 
It means less per person, and third what it means, as the gentlewoman 
from Connecticut was alluding to, is as special interests cash in more 
and more on the Gingrich Medicare plan, it means less monies available.
  So you already have a shrinking pot of money for America's ever 
increasing number of elderly, and that pot shrinks even further when 
more people are, to mix a metaphor, when more people are at the trough, 
more special interest groups that have fought to have all of these 
antifraud provisions taken out.
  So we are going to see more fraud. While Gingrich is trying to cut 
Medicare, if he is successful, and the number of dollars does not go as 
far as they do today, we are also going to see more special interests 
feeding at the trough and taking even more dollars away, which will 
mean ultimately fewer dollars for Medicare beneficiaries. It will mean 
fewer services. It will mean higher premiums and copays and 
deductibles. It will mean ultimately a privatization of Medicare which 
spells the end, and that is why Speaker Gingrich talking to that group 
of insurance executives, talked about Medicare withering on the vine.

  If you remember what he said when he was talking to insurance 
executives who salivate in a sense over what he wants to do with 
Medicare so insurance companies can get more and more, as Medicare is 
privatized under the Gingrich plan insurance companies can get more and 
more involved in it. That is why the Speaker said:

       We didn't get rid of Medicare in round one because we don't 
     think that's politically smart. We don't think that's the 
     right way to go through a transition. But we believe it's 
     going to wither on the vine.

  And under his plan he is right. It will wither on the vine as more 
and more private interests, special interests, get involved in Medicare 
and take more money out leaving less money for the beneficiaries that 
have paid into Medicare their entire lives leading up to their 
retirement and continue to pay into Medicare through their whole lives 
into part A and part B.
  That is in the end; right. The Gingrich plan is bad for older people. 
It is bad for Medicare; ultimately bad for all of us as a country to 
just give up on our elderly like that, which is what will happen if it 
withers on the vine.
  Mr. PALLONE. Well, as my colleagues know, the best example I think of 
that is how they included, the Republican leadership included the 
provision for Medicare savings accounts. Because as we know, the MSA's 
is another word for them, I guess, were primarily touted by this one 
insurance company, Golden Rule Insurance Co., that had contributed over 
a million dollars to the Republican campaign.
  Ms. DeLAURO. If my colleague will just yield on that point?
  Mr. PALLONE. Sure.
  Ms. DeLAURO. The third largest contributor to the Republican Party, 
Golden Rule Insurance.
  Mr. BROWN of Ohio. And yield a moment further. Not only did that 
company give a whole lot of money to the Republican campaign funds, all 
of their different funds and all of their different guises that Speaker 
Gingrich has set up, but the Speaker has absolutely gone to the wall 
for this concept for this company, medical savings account, time after 
time after time when we have tried to pass legislation that would deal 
with preexisting condition.
  We have tried to pass legislation that deals with portability so 
someone can move from one job to another job and without losing their 
insurance. Every time we have tried to legislatively find a solution to 
that, which we have been able to do in both Houses in a bipartisan way, 
the Speaker is always saying we have to have medical savings accounts 
as part of this deal, and that is how it has failed because medical 
savings accounts do not work, particularly in Medicare they do not 
work, and it will ultimately cause the Medicare withering on the vine.
  The withering on the vine statement by Speaker Gingrich is because of 
medical savings accounts, and the reason that will work that way is 
Medicare beneficiaries that are particularly healthy, that are 80, 68 
years old and in very good health might leave Medicare temporarily to 
join a medical savings account, will not cost much to insure that 
person in those years, and the sickest people will stay in Medicare, 
and the Government will pay more for those people that are the most 
ill.
  Then, when that 68-year-old gets to be 75 and begins to get sicker, 
that woman or that man would go back into Medicare, and the Government 
would have to pay more and more money to

[[Page H8809]]

insure them while the insurance companies--company or companies that 
write these medical savings accounts will reap all kinds of benefits 
from the Medicare Program.
  So in addition to that $180 billion that Gingrich wants to cut 
Medicare, you are going to see more money of what is left going into 
these insurance companies through these medical savings accounts and 
the elderly and the beneficiaries for Medicare will have fewer and 
fewer dollars, will pay more and more for those benefits as they 
continue to decline and wither.
  Mr. PALLONE. I do not have the exact number, but I know that the 
Congressional Budget Office actually estimated that the medical savings 
accounts would cost the Medicare system billions, billions and 
billions, in extra dollars.
  So here we have a Republican plan that supposedly is cutting Medicare 
to save money for whatever reason we know as tax breaks for the 
wealthy, and the CBO is telling us it is actually going to cost more 
because of the special interests and the save provision.
  Ms. DeLAURO. The Consumers Union; those are the people who publish 
the Consumer Reports that so many people in this country rely on if 
they are going to buy an automobile or an appliance or, you know, they 
take a look at that and they can tell you what the best, you know, what 
the best buy is, has described the medical savings accounts as a time 
bomb and that it will just, you know--has a potential of skimming off 
the top the healthy, the healthiest and the wealthiest of seniors out 
of the system leaving the most frail, the most ill, and thereby driving 
the costs of premiums up. In addition to that, of shifting, helping to 
shift once again, the cost shifting argument of people who are in 
traditional programs having to pick up the costs of some of these, you 
know, the increased costs and these premiums.

  But there again that is all for, you know, the special interest 
effort of the Golden Rule Insurance Co.
  Mr. PALLONE. I know that we are running out of time here tonight, but 
I just wanted to thank the gentlewoman from Connecticut [Ms. DeLauro] 
and the gentleman from Ohio [Mr. Brown] for joining me and again all we 
are trying to point out on this 31st anniversary of Medicare is how 
important the program is and how the Republican efforts basically to 
cut Medicare to pay for these tax breaks for the wealthy and the 
changes that they are proposing in the Medicare program will 
essentially do what the Republicans have said they wanted to do from 
the beginning, either eliminate Medicare or change it so much that it 
really does not provide the quality of health care services and the 
level of health care services that senior citizens should have, and I 
just want to thank both of you for fighting this battle now.
  You pointed out to me, Congresswoman DeLauro, that it is actually 20 
months now; I am losing track of time. It is not 18 months, it is 20 
months that we have been fighting this battle, and, of course, so far 
we have been winning, but we do not want people to forget that the 
Republicans are still out there trying to essentially destroy Medicare 
as we know it.
  Ms. DeLAURO. And they will tell you that they are trying to save it, 
but let me just say this is a value, health insurance for seniors, that 
has stood the test of time. In fact, let us try to make it better. Let 
us build on the quality that has allowed for 99 percent of our seniors 
to have health insurance.
  Let us look at how we can make sure that we bring down the cost of 
prescription drugs, that we provide for home health care which can help 
bring down the cost of health care, look at long-term health care so 
people get some relief in that area.
  Why are we wanting to take the system that is truly working? Let us 
fix what is wrong, but let us not destroy something that people have 
come to rely on in their lives.
  Mr. PALLONE. You know, it is sort of ironic because when we started 
our health care task force, which all three of us are part of, our 
Democratic health care tax force last year, we established two basic 
principles. One was that we wanted to get more people insured, and the 
other was that we wanted to improve the quality of care, and it is 
unfortunate that that is not what the debate has been about. That is 
what we would like to see, but that is not what the debate has been 
about.
  Mr. BROWN of Ohio. All you have to do is look back 30 years, 31 years 
in the celebration today of the 31 years since Medicare was signed. 
Thirty-one years ago half the people in, half the elderly in this 
country had no health insurance. This is a Government program that 
works. Ninety-nine percent of America's elderly now have health 
insurance. We can make it better, but do not dismantle it, do not 
privatize it, do not turn it over to these special interest groups, 
these big insurance companies that have given a lot of money to 
politicians just so they can play with this huge program that has 
served the American public well.

  We have got to deal with costs, we have got to deal with some of the 
difficulties of Medicare, but it is a program that works. It is a 
program that has taken care of our parents and our grandparents, and we 
have got to make sure it takes care of them and it takes care of our 
generation and the next generation, and we can do that. But it works 
because it is universal. It works because it insures everybody. It 
insures black people, and white people, and brown people. It insures 
Republicans and Democrats. It does not matter, the rich and the poor. 
It insures everybody, and it works because it is a broad-based 
insurance program.
  Do not let insurance companies peel off the most healthy people and 
let them benefit from that and leave everybody else in a sinking ship. 
Medicare works because it is universal, because it helps everybody in 
this country, and we just should not mess with it that way.
  Ms. DeLAURO. We know that in order to bring the cost of health care 
down that more people have to be insured so that the costs are shared, 
and we are struggling with how we do that. One of the pieces that we 
have in the families' first agenda is trying to insure children from 
zero to 13 years old. But we are trying to get to a point where--
because when people are not insured, those, when they get sick, the 
cost of that health care goes someplace. It just does not evaporate, or 
disappear.
  It winds up that everybody else picks up a portion of it. That is 
this whole cost shifting idea, and sometimes it is mind-boggling to me 
that the one system that we have that insures 99 percent of the 
particular population which helps to keep the costs down is the one 
that they are going after to try to dissipate to break up, to 
dismantle, when what we ought to be doing is finding out how we can 
insure children from zero to 13.
  How do we get more people insured who are sharing the costs, not 
getting a free ride? Nobody should get a free ride, but are sharing the 
cost of picking up their health care costs or a portion of their health 
care costs so that those who are insured are not having to pay twice, 
their own and someone else's.
  That is what this is about.
  Mr. PALLONE. I think you are making a good point. The bottom line is 
we know if you see these cuts in Medicare that the Republican 
leadership is proposing, it is going to have a negative impact on the 
health care system in general. In my district, and I am sure in the 
gentlewoman's, I have so many hospitals that are over 50 percent, some 
over 60 percent, Medicare- and Medicaid-dependent. If you make these 
cuts you are going to hurt the health care system in general.

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