[Congressional Record Volume 154, Number 111 (Tuesday, July 8, 2008)]
[Senate]
[Pages S6378-S6379]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                                MEDICARE

  Mr. DURBIN. Mr. President, after this debate on the history of our 
country and this institution, it is worth reflecting on the fact that 
were it not for this Chamber, this Senate, we may not be a United 
States of America. They couldn't reach an agreement on what to do with 
small Colonies when they became States. Would they be overwhelmed by 
some House of Representatives where the big Colonies with the big 
populations would dominate? So the small Colonies held back, and they 
reached a compromise. They said: We will create a Senate of small 
Colonies and large Colonies, soon to become States; they will each have 
two Senators. So even if you are small in population, you will have an 
equal voice as a large Colony and a large State. That is why today in 
the Senate, every State has two Senators regardless of its size, and 
that is why the Senate is of equal import in the legislative process as 
the House. That was the great compromise.
  Then the Senate wrote its rules consistent with that compromise and 
said: And then within the Senate, each of these States will be 
recognized and respected as a minority. So it takes more votes to do 
things in the Senate than it does in the House. It isn't strictly a 
majority rules.
  They created something called a filibuster. A filibuster, which some 
of you recall from Jimmy Stewart in ``Mr. Smith Goes to Washington,'' 
is when a Senator would stand and start to speak, hold the floor, stop 
the debate, and this Senator, by himself or herself, really controlled 
the Chamber. For the longest time, that is the way it worked or, in 
fact, didn't work. Any Senator could stop the train. Any Senator could 
stop the Senate.
  Then, in the early 1900s, they said: Well, there ought to be a way to 
stop one Senator from bringing the Senate to a halt. Maybe if we came 
up with 67 votes or a two-thirds vote of the Senate, then we could make 
that Senator stop filibustering and go on with our business. That was 
the rule for a long time. Then in the 1960s it was changed again to 60 
votes. Today that is the rule. If any Senator starts a filibuster to 
amend or stop any nomination, any bill, any treaty, it takes 60 votes 
to stop the filibuster and move forward on the bill.

  How often are filibusters used? In the history of the Senate, rarely. 
But now there is a new game in town. The history of the Senate tells us 
that the largest number of filibusters in any 2-year period in the 
history of the Senate has been 57 filibusters.
  Look at the record for this session of Congress. We have had 79 
Republican filibusters, and we are still counting. In other words, 79 
different times the Republican minority Senators have tried to stop the 
business of the Senate, stop the debate, stop the amendment, and force 
this vote, the 60 votes to resume business in the Senate.
  Of course, every time we have to come up with 60 votes, we have to 
burn 30 hours off the clock. So we waste a day and a few hours. And 
every time we need 60 votes to move something forward, we need at least 
nine Republican Senators joining the 51 Democrats. That is the math of 
the Senate today, 51 to 49.
  On many occasions, when 79 Republican filibusters were initiated, the 
matter before the Senate came to a halt. We could not come up with 60 
votes. The filibuster prevailed. We had to move on to another item of 
business.
  You say to yourself: How do you ever get anything done? If any 
Senator can stand up and stop the Senate, and 79 times in the last year 
and a few months this has happened, how do you ever get anything done? 
The answer is, there are some Senators who do not want anything to get 
done. They are determined that the Senate not take up controversial 
issues, that the Senate not pass legislation, and they are the dominant 
voice in the minority today.
  The most recent issue that brought this before the Senate is one that 
affects 40 million Americans directly. I am talking about senior 
citizens under Medicare and another 8 or 9 million Americans under 
TRICARE, which is the health insurance plan for those members of the 
military and their families and some veterans. Here is the issue.
  On July 1, there went into effect a provision that reduced the 
reimbursement for doctors who treated Medicare patients by 10.6 
percent. We knew this was coming. We have tried to address it. Many 
doctors have said: This would be a disaster. If you reduce our 
reimbursement for Medicare, many of us cannot afford to take Medicare 
patients. We will reduce our caseloads, which means senior citizens 
will not have the choice and doctors they want.
  Some of the doctors they trusted will say: I am sorry, we have to 
reduce the number of Medicare patients because we are not getting paid 
adequately by the Federal Government.
  We had a provision before the Senate, and we said let's stop the 10-
percent reimbursement cut from going into effect. That is what it said. 
The House considered that same provision, and the House passed it by a 
margin of 6 to 1. A majority of the Republicans joined the overwhelming 
number of Democrats and said: We don't want the pay cut for physicians 
treating Medicare patients to go into effect. It passed 6 to 1.
  Then it came over here, and we thought it was fairly routine. Guess 
what. Filibuster No. 79. The Republicans stood up and said: We don't 
want you to consider this issue. You will need 60 votes to move forward 
on this Medicare issue. So we called it for a vote before the Fourth of 
July recess, and we lost. How many votes did we put on the board? We 
needed 60. We put 59 on the board. Of course, Senator Kennedy is 
recovering. He was not here. But all the other Democrats--including 
Senator Clinton who was back from the Presidential campaign, and 
Senator Obama came back--voted in favor of suspending this cut in 
Medicare reimbursement for physicians. But only nine of the Republicans 
crossed the aisle. We needed the 10th Republican, and we could not get 
it. We could not get 60 votes. As a result, we went home.
  We are back because the issue is back because across America we are 
hearing from doctors, we are hearing from seniors, the American Medical 
Association, the American Association of Retired Persons, and scores of 
other health and senior groups that are saying to us: This is 
irresponsible. The Senate has a responsibility to stop this cut from 
going into effect and jeopardizing the medical care for 40 million 
seniors and 8 or 9 million members of military families.
  So when the vote comes up tomorrow to strengthen Medicare, we need 
one more Republican vote. We need one more Republican Senator to join 
us. We are hoping that out of those who voted against this provision 
the last time, some have gone home and heard from seniors, heard from 
the doctors, and believe Medicare is important.
  What I have just described to you is the centerpiece of this debate. 
But there is another part to it which I have to mention. The way we pay 
for this reimbursement to Medicare physicians is

[[Page S6379]]

to slightly--slightly--reduce the compensation given to private health 
insurance companies which are offering Medicare coverage. They are 
called Medicare Advantage companies. These companies were given this 
right to compete with Medicare a number of years back. Some of them 
have never been fans of Medicare. Some of them believe the private 
insurance companies can do a better job than the Government's Medicare 
Program, so they said: Let these private health insurance companies 
compete. Let them offer Medicare coverage.
  They started offering it, and guess what happened. They started 
charging dramatically more for the same service that the Government 
Medicare Program was already providing. How much more? It was 13 to 17 
percent more in cost.

  Secondly, we found out they were not providing the basic health care 
they said they were going to provide to the Medicare people. And, 
third, they were using marketing practices that were unacceptable.
  We reduced slightly the reimbursement to these companies so we can 
pay doctors under Medicare, and many of the Republicans objected saying 
they were more devoted to standing by these private health insurance 
companies than providing reimbursement for Medicare physicians.
  The ACTING PRESIDENT pro tempore. The Senator's time has expired.
  Mr. DURBIN. Mr. President, I ask for an additional 30 seconds.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. DURBIN. That is the vote tomorrow. On the vote tomorrow, we need 
one more Republican Senator to join in this effort. We hope Senator 
McCain will be back. I don't know Senator McCain's position on this 
issue. I hope he is for Medicare. I hope he is against this physician 
Medicare cut. It is time for Senator McCain to make his position clear 
and return to the Senate for this critically important vote, this 
historic vote. We want to make sure tomorrow that Medicare's future is 
bright. We have confidence that the doctors will be reimbursed and that 
seniors across America can receive their Medicare services without fear 
of having them cut off. We need John McCain on the Senate floor 
tomorrow. We need to make sure we have enough Republican votes tomorrow 
to make this bipartisan measure the same success in the Senate as it 
was in the House.
  Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Maryland.
  Mr. CARDIN. Mr. President, I understand there is no Republican who 
will claim the time remaining in morning business. I ask unanimous 
consent that I may have the time until 11:30 a.m.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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