[Congressional Record Volume 155, Number 97 (Thursday, June 25, 2009)]
[Senate]
[Pages S7038-S7041]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                           Health Care Reform

  Mr. ENZI. Mr. President, I rise today to speak about the need to 
reform our Nation's health care system. If we are to be successful, we 
must undertake this effort with the greatest care and deliberation.
  When it comes to health care reform, we have started down this road 
before. Last Congress, I proposed legislation called Ten Steps to 
Transform Health Care in America in an effort to provide a blueprint 
from which we could begin to address the challenge of improving our 
health care system.
  I might mention the way that came about is that Senator Kennedy as 
the chairman of the Health, Education, Labor, and Pensions Committee, 
and I as the ranking member, worked together on a number of bills. In 
fact, I have quite a record for being able to work in a bipartisan way 
to get bills completed. We were very busy on the Higher Education Act 
and other education issues, so I took some leadership in the health 
area, and we talked about principles we wanted to achieve. Then I 
collected ideas from both sides of the aisle and put together this 
package of 10 steps that will transform health care in America as a 
blueprint to improve and address this challenge of improving our health 
care system. So it isn't something on which he or I just started 
working.
  After I introduced the bill, I took my message of health care reform 
directly to the people in my State. I traveled 1,200 miles and held a 
series of events in March of last year to provide the people of Wyoming 
with the chance to see what I was working on and to voice their 
concerns with our current system. Everywhere I went, I heard the same 
message repeated over and over, and that was that people want change. 
They want a system that will provide them with a health care system 
that is affordable, more available, and easier for them to access. 
Simply put, the people of Wyoming, as do people all across the country, 
want more choices and more control over their health care. That was the 
goal of my Ten Steps bill. It was drafted with the aim of leveling the 
playing field in tax treatment of health insurance. It was also 
intended to provide a helping hand to low-income Americans in the form 
of subsidies that would ensure access to quality, affordable health 
insurance.
  As I traveled through the State, I also heard from members of the 
small business community. They made it clear that they wanted greater 
equity and access to a plan that would allow cross-State pooling so 
they could band together with small business owners in other States and 
get better rates on the health insurance they provide to their 
employees.
  In the end, no matter whom I spoke with, they all had one message 
they wanted me to bring to the Senate: Keep costs down and under 
control. There have to be limits. That is why, as the only accountant 
in the Senate and as a member of the Budget Committee, I was and remain 
very concerned with the effect any health care reform proposal will 
have on our Federal budget, both in the short and the long term.
  I can't be the only one who heard those things when I was back home. 
I think my experience on the road was very similar to that of almost 
every one of my colleagues. Last year, whether they were campaigning 
for themselves or for other members of our party, we logged on a lot of 
travel miles. We met with and spoke to people from all walks of life 
who came from every imaginable background. Some were from large cities 
and towns with large populations and others came from the smaller 
cities and some very small towns with fewer people and resources. 
Whomever we spoke to and wherever we were, we all heard the same 
concerns: We need a better health care system, and we need it now.
  In response, I was pleased to join with several of my colleagues as 
we continued to work on health care reform this year. As the ranking 
member on the Senate Committee on Health, Education, Labor, and 
Pensions and in my service on the Senate Finance Committee, I have been 
working to foster and facilitate a constructive dialog with my 
colleagues on both committees. I have also met with the President and 
administration officials on numerous occasions so we could share ideas 
on how to best craft a strong, bipartisan bill. As the debate on health 
care reform proceeds, I continue to stand ready to work on this 
critical issue.
  This is likely to be the most important legislation we will ever work 
on as Members of the Senate, no matter how many terms we serve. How 
well we handle this crucial issue will have an impact not just today 
but for many tomorrows and countless years to come. If we fail to 
provide the change that is needed, it may be a long time before the 
Senate will ever try to do this again.

  I am convinced we have a perfect storm before us as we face this 
issue. The time is right, the political winds are with us, and we have 
the support and encouragement of the current administration and the 
people of this Nation to get something done. That is why a good bill 
and a bipartisan effort are well within our grasp.
  If we are to do the work that is before us and do it well, however, 
we can't have one side or the other try to grab the reins and lead the 
effort exclusively in their direction. The American people are looking 
for us to solve the problem, and they want to know we wrote this bill 
together, amended it together, and, most importantly, finished it 
together. They know no one side has all the answers, so they do expect 
us to put partisanship aside. This is too important an issue not to 
follow a path that will produce a bill that will have the support of 75 
or 80 Members of the Senate. I have every belief we can do that, and 
that is why I am so strongly committed to bringing massive change to 
the policies laid out in the recently filed Kennedy bill. I will 
continue to try to bring that change to the work being done by the 
Health, Education, Labor, and Pensions Committee and in the Finance 
Committee.
  Let me be very clear about what I believe we can do if we put 
partisanship aside and work together. We can draft a good bipartisan 
bill, one that will draw a large majority to its side, and we can get 
it done this year.
  Last week, the HELP Committee began to mark up a very flawed piece of 
legislation. I understand the difficult circumstances that brought 
Senator Dodd to chair this extraordinarily complex bill, and I 
appreciate Senator Dodd's willingness to take on the task, as he also 
chairs the Banking Committee. However, the legislation we are 
considering in the HELP Committee is broken, almost to the point of 
being beyond repair. It is too costly and it is incomplete. Of course, 
we are promised we will get the other pieces of the bill. Arguments 
made about the unfairness of estimating the cost of an incomplete bill 
show that in the race to revamp our health care system, this bill was a 
false start. In order to get this right, we should slow down, and in 
some areas we need to start over.
  This shouldn't be a matter of speed. To stay with the analogy of 
health care, no one goes to a doctor or a surgeon based on how fast 
they can operate or conduct an examination. It never matters how long 
it takes. All that matters is that they get it right. We should do the 
same.
  I am not suggesting that we come up with a new process to develop 
this legislation. All I am saying is that we need to make better use of 
the one we already have in place, the way we have always done things in 
the Senate when we want to make sure we get it done right.
  For instance, it wasn't all that long ago that we had to do something 
about our Nation's pension system. We worked together. We talked about 
what we had to do together. Then we came up with a way to get there, 
together.

[[Page S7039]]

The result was a bill that when it came to the floor was over 1,000 
pages long and it had the immense involvement of two committees--the 
same two committees we are talking about with health care, the HELP 
Committee and the Finance Committee. Those two committees came together 
on a bill of over 1,000 pages. When it came to the floor, we already 
had an agreement between the two committee members which was taken to 
the leaders, which meant we had an agreement with everybody in the 
Chamber that there would be 1 hour of debate, two amendments, and a 
final vote. I asked the Parliamentarian when the last time was that 
there was a bill of that complexity that had that kind of an agreement 
before we even debated it, and that person said: Not in my lifetime. 
That is what is possible around here if we work together. That is what 
we did with the Nation's pension system.
  I think we were talking about the Pension Benefit Guaranty 
Corporation being short a drastic $24 billion. Boy, that doesn't look 
like much money anymore, does it? No. We are talking about some errors 
on this one that are over $58 billion. That pensions bill wasn't so 
long ago. We worked together, we talked about what we had to do 
together, and then we came up with it together. The result was a bill 
that only had the two amendments offered to it because the agreement on 
both the illness and the remedy was so strong.
  As we prepared to begin the markup of this bill last week, we 
received a troubling preliminary analysis from the Congressional Budget 
Office and the Joint Committee on Taxation regarding the costs and 
coverage figures associated with the legislation. In its review of the 
proposal, the CBO found that enacting the proposal would result in an 
increase in spending of about $1.3 trillion, with a net increase to the 
Federal budget deficit of about $1 trillion over the 2010-to-2019 
period. This cost estimate did not include the promised ``significant 
expansion of Medicaid or other options for subsidizing coverage for 
those with an income below 150 percent of the poverty level.'' As the 
markup continues, we will be asking the CBO for an official analysis of 
the impact of the addition of such a policy on the Federal budget 
deficit.
  We are having more and more seniors moving into the category of long-
term care--and we have a proposal before us, which we will debate when 
we get back. The Senator from New Hampshire, Mr. Gregg, ranking member 
on the Budget Committee, pointed out that the only part of that 
proposal that gets scored are the premiums people would pay in over 
that first 10 years for their long-term care, which comes to about $59 
billion, which shows a surplus of $59 billion. But what it doesn't take 
into consideration is the obligation to those people who are paying in 
those premiums that they will get long-term care.
  The expected cost of that long-term care to those people paying in 
that $59 billion is $2 trillion. The proposed payment doesn't match the 
proposed costs, and it would not be sustainable beyond the 10 years. 
Whether or not people actually start taking long-term care benefits 
right away, we will have another Federal Government program with a 
budget deficit. At the same time we received notice of the preliminary 
analysis of the Kennedy bill, we got word the Finance Committee was 
postponing the markup on health care legislation, after reports 
surfaced that the CBO was preparing an estimate of its legislation that 
projected an increase to the Federal deficit of $1.6 trillion over the 
next 10 years. All of this was on the heels of President Obama's speech 
last week at the American Medical Association, in which he said:

       Health care reform must be and will be deficit neutral in 
     the next decade.

  The bill we have before us misses the target of this commitment by 
more than $1 trillion. Again, the bill is still missing language in 
three key areas.
  I will take a few moments to speak about our Nation's deficit and 
overall fiscal and economic condition. My concern about the runaway 
spending in the Kennedy bill--I should call it the Kennedy staff bill; 
I know the Senator, had he been able to work with me, would have come 
up with some different conclusions on the bill. My concern with the 
runaway spending in the Kennedy staff bill is not simply a concern that 
it breaks faith with the President's health care reform commitments. 
Rather, I am deeply troubled by the direction this bill would take us 
during a truly perilous fiscal age.
  I was elected to this body in 1996. In my first years in Congress, we 
moved from a budget deficit to a budget surplus. I am deeply 
disappointed that nearly 13 years later, our projected deficit for this 
fiscal year exceeds $1.84 trillion, and our national debt exceeds $11.4 
trillion. That is bad. People are starting to take notice, and that, 
unfortunately, includes our creditors. Add to this the losses to our 
gross domestic product and an unemployment rate heading toward 10 
percent and the news is worse. Again, there have to be limits. People 
have them in their families, municipalities have them, and most States 
have them. The Federal Government doesn't.
  According to the Federal Reserve, the level of debt-to-GDP ratio is 
estimated to reach the highest levels it has since immediately after 
World War II. The increasing spread between short-term and long-term 
treasuries is evidence that global investors are increasingly concerned 
about our Nation's level of debt and the real potential for future 
inflation.
  In recent weeks, Treasury Secretary Geithner traveled to China to 
attempt to ease growing concerns about our ability to pay off our 
growing debts. When Geithner told an audience of Chinese students at 
Peking University that ``Chinese assets are very safe,'' reports are 
that this statement drew loud laughter.
  It is really not a laughing matter for us. It is serious. Tough 
action, not ``I will tell you what you want to hear'' speeches, is what 
we need.
  On the State and local front, our economic indicators are equally 
troubling. On Thursday, the Rockefeller Institute of Government issued 
a report on State personal income tax revenues for 2009. They are 
falling fast; 34 of the 37 States in the report saw declines in tax 
revenue, indicating that it will be increasingly more difficult than 
expected for States to close their widening budget gaps. I can hear 
calls for more bailouts, but my question is, who is going to bail out 
the Federal Government?
  These numbers provide the critical backdrop as we consider the new 
deficit spending included in the Kennedy staff bill. Recently, Fed 
Chairman Bernanke stated that ``achieving fiscal sustainability 
requires that spending and deficits be well controlled.'' He went on to 
note that ``unless we demonstrate a strong commitment to fiscal 
sustainability in the longer term, we will have neither financial 
stability nor economic growth.'' For these reasons, the Kennedy 
proposal requires an entire rewrite with respect to its impact on our 
Federal budget deficit.
  Just as troubling as this bill's impact on the deficit is its failure 
to help tens of millions of Americans get the health insurance they 
need. The Congressional Budget Office estimates that, if enacted, this 
bill would only provide health insurance for one-third of the Nation's 
uninsured. Let's see, $1 trillion for 16 million people. This number 
falls far short of the President's stated goal of ``quality, affordable 
health insurance for all Americans'' in his recent letter to Chairmen 
Kennedy and Baucus.
  Of even greater concern, the CBO projects that about 10 million 
individuals who would be covered through an employer's plan under 
current law would not have access to that coverage under the Kennedy 
legislation. This figure breaks President Obama's often-repeated 
promise during both the 2008 campaign and since taking office that 
under his health care plan:

       If you like your health care plan, you will be able to keep 
     your health care plan, period. No one will take it away, no 
     matter what.

  Under the Kennedy plan, that promise rings hollow for millions of 
Americans, and that is simply unacceptable. I know the President has 
already scheduled an event on one of the networks to push his health 
care ideas. When it airs, I am sure we will hear him repeat the line 
over and over: If you like the health care plan you already have, you 
can keep it.
  If he makes that promise again, every time we hear him say that, we 
should remind ourselves that the White House has already admitted that 
such statements aren't to be taken literally. I think that means they 
are not true.

[[Page S7040]]

  I cannot recall ever hearing something like that from the White 
House, but those are their words. Maybe they should be applied to the 
whole presentation--that none of it should be taken literally.
  I know one thing that can be taken literally, and we ought to give it 
straight to the American people, and that is this: Under the Kennedy 
proposal being rolled out, you would not be able to keep the care you 
have right now. Washington bureaucrats will be able to deny you and 
your family the care you need and that you fully deserve.
  Unfortunately, that is not the only thing that we are in denial 
about. We are also in denial when it comes to the cost of the 
Democrats' health care plan and our ability to work our way out of a 
hole of debt that only promises to grow deeper and deeper for a long 
time and for many years to come.
  A lot of times we talk about how we are spending our kids' and 
grandkids' money. I really feel compelled to point out that we are 
already spending our seniors' money. Why is that? Well, normally, what 
happens in this country is that a little bit is taken--well, a bunch is 
taken--out of your check for Social Security, which is matched by the 
employer. That amount of money each month has always gone to pay the 
seniors who are retired, their pensions, and to have a little bit of 
surplus. But do you know what? It is not doing that anymore. We are 
having to take money out of the trust funds now to supplement that to 
be able to pay the people who are retired now--and we are not even to 
the baby boomers yet. So we have a problem.
  Unfortunately, that is not the only thing we are in denial about. 
Having shown the devastating impact of the Kennedy bill on the Federal 
deficit, and the failure of it to provide access to adequate health 
coverage for millions of Americans, I want to turn to one of the three 
foundational principles of my 10-step plan; namely, improving the 
quality of care.
  On this front, I think the Kennedy plan again fails to live up to the 
promise laid out by President Obama to ``improve patient safety and 
quality of care.'' That is very important--to improve patient safety 
and quality of care.
  I am deeply troubled by the real possibility that comparative 
effectiveness research, which is mentioned in the bill and has been 
debated in the committee, and which has been held intact in there, will 
be used as a cost-containment measure to ration care under this 
legislation. The result would be, for millions of Americans, a Federal 
bureaucrat would dictate the type of care they receive and interfere 
with the doctor-patient relationship.
  As the Kennedy bill proceeds through Congress, I will fight to strip 
those provisions that will delay and deny needed health coverage to 
Americans. I spoke at length in committee about the truly horrible 
stories of rationing care that we hear about from the United Kingdom. I 
will continue to speak out to make sure this type of so-called care is 
not imported to the United States.
  Finally, I am deeply troubled with a number of other policies 
advanced in the Kennedy bill. I believe the community rating provisions 
will result in skyrocketing premium costs for younger Americans. I am 
troubled that the bill doesn't provide incentives to encourage 
individuals to make healthier choices. There are a lot of choices we 
can make to improve our health ourselves.
  As we complete the second week of the HELP Committee markup, we are 
still missing the guts of the Kennedy proposal. We expect that the 
final proposal will include a government-run plan, a mandate on 
employers to provide insurance, and a provision dealing with 
biosimilars. It is difficult to comment on these provisions until they 
are released.
  Proponents of the government-run option--including the President--
consistently argue that a public plan is necessary to keep the 
insurance companies honest and to foster competition. With respect to 
provisions dealing with preexisting conditions, rate bands, and other 
reforms, we are all committed to taking action to keep insurers honest 
and make sure people with preexisting and chronic diseases can get 
insurance. The creation of a new government program at a time when the 
experts and Medicare trustees tell us that Medicare stands on the brink 
of insolvency, does nothing to foster honesty; it fosters fiscal 
irresponsibility. We are borrowing to pay for the government-run 
programs we have now. If you already have trouble making your mortgage 
payments, why would you go out and buy a boat and an RV?
  With respect to the notion that we will be fostering competition with 
the creation of a government-run health plan, I think the public is 
growing tired of government intervention in our day-to-day lives. 
First, there was our involvement in the mortgage system and then the 
banking system and then we got more involved in our Nation's automotive 
industry. It is certainly more than a possibility that the government 
has taken on more than it can handle. We are operating at more than the 
maximum capacity already. Having government take over our Nation's 
health care system may be the last straw.
  Think about that--about all the things that just this year the 
government has decided to take over. The comment I get at home, and in 
other places I have traveled across the United States, is, doesn't the 
government have a little bit of trouble just running government?
  There is certainly a role for government as a strong regulator of 
free market enterprise, but the inclusion of the government as a 
principal player in our competitive markets is entirely inconsistent 
with our Nation's capitalist economic system. I will forcefully oppose 
the creation of a government-run health plan.

  Before I conclude, I would like to say a few words about the current 
process of health care reform in the Senate Finance Committee. I said 
at the outset that I am committed to working toward bipartisan health 
care reform. As a member of the Finance Committee, I have witnessed and 
have been a part of at least the foundations of such reform. There are 
many hurdles to remain, but I thank Chairman Baucus and Ranking Member 
Grassley for their very hard work on this extremely complex, difficult 
issue. We have never had an issue that involved as many people in this 
country--100 percent of the people. It is important we get it right, 
that we take the time to get it right. Ranking member Grassley has been 
cooperative and Chairman Baucus has been open and that has been 
extremely helpful. We have spent hours upon hours in that committee 
receiving inputs and options from both sides on how to reform our 
Nation's health care system.
  This stands in great contrast to the partisan process that has, 
unfortunately, unfolded in the Health, Education, Labor, and Pensions 
Committee we have been tediously working through. There have been 
comments about how many amendments we turned in. We had 388 amendments. 
I had to remind them that if you don't get any piece of the drafting, 
you have to get your opinions in somehow and you do it through multiple 
amendments. Probably half those amendments were to fix grammatical 
errors, punctuation, typos--about half of them. Those were accepted.
  It is my hope that the difference in process will result in a 
difference in substance between the Health, Education, Labor, and 
Pensions Committee legislation and the Finance Committee legislation. I 
will continue to work in the Finance Committee to shape legislation 
that improves the quality of our health care, reduces costs, is 
responsible in its budgetary impact, and increases access to care for 
all the American people.
  As I have said, there is a long way to go on that committee and many 
differences to resolve, but I continue to work in good faith and hope 
for bipartisan, responsible health care reform. I am holding out hope a 
better, more inclusive process will emerge as we continue our work in 
the HELP Committee. I hope that a change will come about soon, but the 
bill we currently have before us is a clear sign that just as we have 
been excluded early on in the health care reform effort, it looks like 
we will continue to be excluded as the process continues. There is time 
to get us included. There is an important reason to get us included. 
But we will see.
  In the end, for me and many people across this country, our 
discussions

[[Page S7041]]

about health care can be summed up in a short story with a simple 
moral. I was reading a book about a Wyoming doctor who came home and 
decided to settle in a town called Big Piney. He found some ranch land 
he liked, and he decided to make it his home. When he was attending a 
local rodeo, one of the cowboys competing in the contest looked at him 
and said: You aren't from here, are you?
  He said: Well, I am going to be, I am a doctor.
  Unable to control his enthusiasm, the cowboy walked away shouting to 
all within earshot: Hey, we finally got ourselves a doctor.
  That is what health care is all about in Wyoming, the West, and 
countless towns and cities all across our country.
  I have to tell you, this doctor spent most of his life in the Congo. 
He studied Ebola and established a lot of health clinics over there. 
When he retired, he did move to Wyoming. He did health care the old-
fashioned way. He made house calls. He sat with people while they were 
dying. He had a lot of friends over there. Incidentally, he did not 
take Medicare or Medicaid. He said there were too many strings attached 
to it. He set up a foundation, and people he worked with could make a 
donation to his foundation instead. That way he wouldn't violate any 
Federal rules about treating some people and taking money. He was a 
tremendous doctor. Unfortunately, we lost him this year. So that area 
is once again without a doctor. If you can send me one who likes 
rodeos, we would be happy to have him there. That is what health care 
in Wyoming is about.
  In the big cities and towns of Chicago, New York, Boston, and Los 
Angeles, it seems to me there is a hospital or doctor's office on 
almost every corner. In States such as Wyoming, however, they are few 
and far between, which makes health care a very precious commodity. I 
always tell people the statistics are we are short every kind of 
provider in Wyoming, including veterinarians, which always brings the 
comment: Surely, veterinarians don't work on people. We say: Yes, if 
you are far enough from a regular doctor, you are happy to have a 
veterinarian. You just hope he doesn't use the same medicines!
  If we are not careful with this legislation, it will not make health 
care more plentiful and abundant, it will make it even more rare and 
difficult to obtain, and when health care gets more expensive and less 
available in places such as the big cities in this Nation, imagine what 
it will be like in the small towns of Wyoming and the West. People back 
home know what it will be like--another one-size-fits-all policy that 
did not fit so well into the rural areas of this country to begin with. 
That is why people are worried right now. The only way we can assure 
them they do not have to worry is if we take the time to make sure we 
get it right the first time. Then, and only then, will the American 
people feel like they will be getting what they said they wanted during 
our campaigns last year--not just change but change for the better.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. INHOFE. Mr. President, I ask unanimous consent to be recognized 
as in morning business for the time I consume.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. INHOFE. Mr. President, let me say of my friend, the senior 
Senator from Wyoming, he does articulate this issue well. He has spent 
countless hours working on it. When you listen to him, his depth of 
knowledge and trying to work out something that would give improvements 
and avoid a total socialization of medicine, he knows what he is 
talking about.
  When I go back to my State of Oklahoma, it is not all that different 
than from when he goes back to his State of Wyoming and people ask the 
question: If government isn't working well now, why do we want to put 
all the rest of these things in government, whether it is health care 
or the banking industry, the insurance industry, oil and gas and the 
other takeovers we are witnessing right now?
  I do think you can summarize what he said very simply by merely 
saying, if there is a government option, of course, this is a moving 
target. For those of us who are not on a committee that is dealing with 
health care reform, we are not sure what is going on there, and I am 
not sure anyone else does either because it is a moving target. From 
one time to another, we hear different things that are going to be in 
the bill, and then they change their mind.
  One thing we know, though, they keep saying there is going to be a 
government option. If there is a government option, we are going to see 
a huge impact on insurers, private companies that offer insurance, and 
you will see that market dwindling. You can't blame them for that.
  The other thing that is a certainty in this whole issue of the 
Kennedy bill and what they are trying to do, what the administration is 
trying to do with the health delivery system in America is they would 
be putting Washington between the patient and the doctor. That gets a 
response when I am back in Oklahoma of we don't want that to happen.
  So we have right now a lot of invasions on the systems that have 
worked well in America.