[Congressional Record Volume 154, Number 36 (Tuesday, March 4, 2008)]
[House]
[Pages H1210-H1212]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE CRISIS
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 18, 2007, the gentleman from Texas (Mr. Barton) is recognized
for 60 minutes as the designee of the minority leader.
Mr. BARTON of Texas. Mr. Speaker, in 1965 the hot car on the American
market was a Ford Mustang, which cost less than $2,000. The President
of the United States was Lyndon Johnson. The entire Federal budget was
less than $100 billion. The war that was on the front pages was the war
in south Vietnam. The Super Bowl didn't exist. Cell phones didn't
exist. If you wanted to use a computer, you typed out your program on
data index cards and submitted them in a batch to a mainframe computer.
I believe the dominant mainframe was an IBM 360. Gasoline cost
approximately 25 cents a gallon, and a little-noticed program was put
into effect to help our senior citizens with their health care costs
called Medicare.
Forty-three years later, that Medicare program is going to expend
over $400 billion to provide health care for over 45 million senior
citizens in every State and territory of the United States. If
something is not changed between now and the year 2018, in the year
2018, or 2019, the Medicare Trust Fund is going to be bankrupt.
If we look back in 1965 at how health care was provided and look at
how it's provided in 2008, you would see numerous differences. We now
focus, in Medicare, through the Medicare Advantage programs, which 20
percent of our seniors have chosen, on preventive care. A lot of
Medicare spending today is through drug therapy, as opposed to surgery,
things of this sort.
But the one thing that's constant has been the continuing escalation
in cost. Medicare has averaged double digit increases in cost the last
10 years, and it's expected, by the year 2018, to be over $800 billion.
Medicare spending this year of over $400 billion is going to exceed
by a factor of 4 the entire Federal budget back in 1965, the year that
was created.
So because of the increase in the population, the increase in the
complexity, the diversity of health care therapies, several years ago
the Congress put into place what's called the Medicare trigger. The
Medicare trigger says that in any year that Medicare spending or
Medicare revenues come from 45 percent or more of the general revenue,
i.e., the premiums that Medicare beneficiaries and the cost share that
companies and Medicare payors pay into the system, when more than 45
percent of the funds going into Medicare come from the general U.S.
Treasury, the Medicare trustees have to issue to the Congress a report.
And if this happens 2 years in a row, the President of the United
States has to submit a proposal to the Congress on how to bring
spending back below the 45 percent trigger. That happened for the first
time last year, in fiscal year 2006, and it's happened again this year,
in the fiscal year that just ended, fiscal year 2007.
So several weeks ago the President and the Secretary of Health and
Human Services presented to this Congress a report that did two things:
Number 1, it did announce that the spending had exceeded 45 percent of
the revenues of the general treasury, and Number 2, it put forward an
outline of the proposal on how to bring that spending back below the 45
percent trigger.
{time} 1945
The Congress does not have to act on the President's proposal. The
Congress can initiate one of its own. In fact, if 70 Members of this
House decide that they want a different proposal than the President of
the United States, if 70 Members will sign a letter, I believe, to the
Speaker of the House and also to the chairman of the Budget Committee,
those 70 Members will present their proposal to the Budget Committee.
If the Budget Committee holds hearings and certifies that the proposal
that's been submitted by the 70 Members does, in fact, meet the
requirements of the law, that proposal then is ordered reported to the
House of Representatives for an up-or-down vote.
So sometime in the next several months, you are going to hopefully
see a number of proposals submitted to the Budget Committee on how to
deal with the pending crisis in Medicare. And I would encourage all
Members of this body, since we all have Medicare recipients in our
congressional districts, to be a part of some group that tries to
address this problem.
Now, the President's proposal, again, it is not a definitive
legislative language developed proposal. It's more of an outline of
policy objectives, but the policy objectives are pretty straight
forward: number one, Medicare beneficiaries that have higher incomes
would pay slightly more in their premiums so you would begin to have a
graduated means-tested premium increase based on your ability to pay
the Medicare premium; number two would be a Medicare liability reform
proposal that has been talked about for years. That, by itself, would
probably save $180 billion over 5 years or so. There would be a
requirement for more pricing transparency and more openness, so that
Medicare beneficiaries could see what prices they're paying or are
being paid on their behalf. And also there are some proposals, I
believe, on quality indexing, quality of reporting so that, again,
before the beneficiary decides where to have a particular procedure
done or which doctor to use, he or she might have some data on the
quality of the health care that's provided by various Medicare
providers.
All in all, the President's proposal is very modest, but it's
certainly one that needs to be seriously considered; and, again, the
need for doing something on Medicare is something that we need to
[[Page H1211]]
begin to address as a Congress. The Medicare trustees have reported
that if current policies are not changed within the next 11 years, the
Medicare trust fund will go bankrupt. What that means is if you are 54
years old or younger, when you retire there will be no money in the
Medicare trust fund to pay your Medicare benefits which you are, by
law, entitled to at age 65.
So this is a problem that we can't put off for 20 years or 50 years.
In my opinion, we can't put it off for any years. Again, we need to
begin to address it immediately, we need to address it in this
Congress, and we need to hopefully address it in a bipartisan fashion.
I now yield to the distinguished member of the Energy and Commerce
Committee, the ranking member of the Veterans' Affairs Committee, the
gentleman from Indiana (Mr. Buyer).
Mr. BUYER. Mr. Speaker, I want to thank some of my colleagues for
their vision back in 2003. They recognized that Congress does a good
job talking about Medicare and the concerns about the future, but they
realize that very few are very committed to addressing Medicare's
challenges.
We, as a Congress, came together and worked with President Clinton in
the 1990s when we did the Balanced Budget Act; and at that time, we
even realized that Medicare was growing, the growing senior population
was going to be a tremendous challenge to us; and in 2003 a small group
of Members of Congress, they put in trigger legislation, and now this
trigger, as the chairman said, goes into effect if the Medicare board
of trustees certifies in two consecutive years that 45 percent of
Medicare spending will come from general revenues in any of the
upcoming 6 years.
Last year, the trustees certified this Medicare spending level; and
again this year, they have certified that the spending is exorbitant
and that the trigger has now been hit.
As directed by law, the President had no choice. He sent legislation
to Congress to address this spending. We in Congress have a
responsibility to the American people to act on the President's
proposal. Unfortunately, last year my Democrat colleagues tried to
remove this trigger so that they can continue to put off addressing the
unsustainable cost of our Medicare program. Under their CHAMP
legislation, they slipped in a provision that would have removed this
trigger. In effect, it would have allowed Congress to continue to
ignore Medicare's growing cost.
Even worse, the Democrats decided to ignore Medicare's growing costs;
and when they do that, frankly it just shoves these challenges off into
the future and onto the backs of our children, and that is something we
should not be doing.
Last week, the majority leader and the minority leader introduced a
bill to move forward with the President's proposal to bring Medicare
costs back under the trigger level. That is the responsible thing to
do.
This Congress now should act on this legislation. According to the
Centers for Medicare and Medicaid Service Health Care Spending, the
United States will hit $4.3 trillion by year 2017, nearly double that
of 2007, equating to nearly 20 percent of our gross domestic product.
In 2007, health care spending accounted for 16.3 percent of our gross
domestic product. But more of that cost is expected to shift to
government agencies even as the Federal Government struggles to shrink
our own deficits.
Medicare spending alone is expected to grow to $844 billion in year
2017. That's up from the $427 billion we spent just last year in 2007.
So Congress must stop talking about Medicare and its potential
insolvency, and we must take action.
Medicare is the single largest purchaser of health care in the United
States; and within the next 11 years, the Medicare trust fund could
potentially go bankrupt. Our Nation is at risk to lose this important
health care program for seniors if we do not reform this program.
Future generations will not have access, and that would be unfortunate.
This trigger has forced Congress to be honest with the American
people about Medicare's dim future. The future of our Medicare program,
as I said, is at risk. I ask my colleagues to join with me to change
this trend and protect Medicare for future generations, and we can only
do that by working together.
Mr. BARTON of Texas. Mr. Speaker, I want to recapitulate why we are
here this evening taking this Special Order. As I pointed out earlier,
Medicare is a mandatory program for senior citizens over age 65. It was
established in 1965, which is 43 years ago. I don't exactly remember in
the first year how many citizens were covered and how much money was
expended, but my recollection is that several million senior citizens
were covered and expenses were in the order of a magnitude of 6 or $700
million. In the last year that we have numbers for, 45 million
Americans were covered and the costs were over 400 billion.
Now, it is a good thing that we have 45 million senior citizens in
this country. Those are our grandparents and great grandparents and
great aunts and uncles. They are certainly the generation that has been
pointed out that fought the great wars of World War II and Korea and
Vietnam. They have ushered in an amazing American economy unsurpassed
in the history of the world in terms of its ability to generate wealth
and economic prosperity. And they are well deserving of the benefits
that we are paying out for Medicare.
So the problem is not that our senior citizens don't deserve the best
health care in the world, and it is not that we are living healthier
and longer. The problem is, quite simply, how do we pay for it. Average
expenditures for Medicare are on the order of magnitude of about $7,000
per person per year. And to put that in perspective, that is more than
most families pay per person for their food or for their housing.
If nothing is done on the current Medicare program in terms of its
policies and the way it's structured in 11 years, in 2019, the Medicare
trust fund is going to be bankrupt. As I pointed out earlier, if you
are 54 years young or younger, when you retire, there will be no
Medicare. Now I'm 58. So if I were to retire at age 65, in 7 years I
would have 3 years of Medicare benefits before the program went
bankrupt. My wife, Terry, who's younger than me, when she retires, she
would have no benefits. None of my children would have benefits. None
of my grandchildren would have benefits.
So this is not a program that we can just let go on automatic pilot.
We need to begin to fundamentally and in a focused way look at the
Medicare program as it exists today, not cut people off the program,
not change it so that there are fewer benefits. We need to look at
Medicare and try to bring our technology to bear, bring our management
processes to bear, all of the innovations that have happened in the
last 40 years.
As I pointed out earlier, if we were still making the 1964 Mustang,
that was a great car in 1964, 1965. But it's hardly the car that people
want to buy today. We didn't have cell phones in 1965. Today, everybody
in America has a cell phone. In fact, there are more cell phones than
there are hard line phones. If you look at computers, the computer in
1965 was a mainframe computer that you had to go to a central location
to use. I would guess that almost every American citizen has some
access to a personal computer today.
So a lot has changed in many fields since 1965. But in Medicare, we
have the same basic program funded the same basic way.
{time} 2000
So we need to look at ways to change that program and to bring it
into the 21st century. I think some of those ideas are going to be in
the form of preventive medicine, like we have in those seniors, about
20 percent of those 9 million that have chosen a Medicare Advantage
plan. There may be some ways in terms of sharing costs; as the
President has suggested, Medicare beneficiaries that are more well-to-
do could pay a higher share of their premium.
We have the whole issue of health information technology, or health
IT. It's suspected and predicted that if we would bring health
information technology to bear on Medicare, you could save tens of
billions, perhaps more, each year just by using that technology that's
currently in the private sector.
So, there are a number of great ideas, but because of this Medicare
trigger, this year, a certain percent of Members, I believe it is 70
Members, but a
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number on that order of magnitude, if they have a plan to restructure
Medicare, to reform it, to bring the spending in total below 45 percent
of general revenue, they can submit their plan to the chairman of the
Budget Committee. The chairman of the Budget Committee will hold
hearings to certify that the plan does, in fact, meet the Medicare
trigger recommendations. And if it does, my understanding of the law is
that those plans have to be brought to the floor; they have to be voted
on by the House of Representatives. Now, I'm not clear exactly the
procedure for the rules for bringing these proposals to the floor,
whether every proposal is given a vote on the floor or whether there
are only certain proposals that are certified by the Rules Committee,
but my understanding is that all proposals that meet the budgetary
cutoff do get an up or down vote on the House floor.
So, if you're a member of the majority, of the Democrat Party, and
you've got an idea and you can get 70 Members to support it, your plan
can be voted on. If a bipartisan group of Members bring a proposal,
that plan can be voted on. If the Republican leadership, whom I'm doing
this Special Order for, has a plan, it can be voted on. If the
President can get 70 Members to sign under his plan, it can be voted
on. I personally don't see any problem with having different plans on
the floor. The bottom line is to vote on some plan that begins to
restructure and reform Medicare. Again, not trying to cut people off
the program, not trying to tell our senior citizens we're going to do
away with Medicare; what we should be telling our senior citizens is
that we want Medicare to be there not just for another 11 years, but we
want it to be there for another 50 years, another 60 years, not for
people that are just now over 60 and over 70, but for our children and
our grandchildren.
This is a program that, again, in 1965, my recollection is it cost
less than $1 billion a year. This past year it cost over $400 billion.
And by 2018, it's going to cost over $800 billion. And by 2036, it's
going to cost more than the entire Federal budget today, which is over
$2 trillion.
So this is not something that we can just put on the back shelf and
not do anything about. It is something that we need to take action on.
And again, because of the Medicare trigger, we have the ability, under
expedited rules, to put these proposals to the Budget Committee, the
Budget Committee certifies its proposal will meet the cost savings
requirement, those plans will come to the floor and be voted on
sometime this year before we go home in October for the elections in
November.
So, Mr. Speaker, I want to bring to the attention of the House the
Medicare trigger language and that it does require the President to
submit a proposal. He has done so. It does require the Budget Committee
to meet on that proposal and any other proposals that 70 Members of the
body can put before the Budget Committee. And it does require that the
House vote on the bill, or the bills, later this year.
We need to address it. The Medicare trustees have pointed out that
for 2 years in a row the spending has exceeded 45 percent of the
general revenues going into the program, and so it is time for us to
begin to address it.
Mr. Speaker, I see no other Members present. So with that, I would
humbly suggest that everybody begin to think about what to do to
protect and reform Medicare.
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