[Congressional Record Volume 155, Number 115 (Tuesday, July 28, 2009)]
[Senate]
[Pages S8156-S8157]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. ALEXANDER. Madam President, some friendly person is exercising 
his or her constitutional first amendment rights in Memphis these days 
running television ads urging me to vote for the health care proposal 
that is currently pending before Congress. That person may be wasting 
their money, because we are getting a fair number of calls in my 
Memphis office congratulating me for suggesting that we ought to slow 
it down and come up with a better plan.
  We should start over in terms of what we are doing to try to find the 
right way to provide health care for the American people at a cost they 
can afford and, at the same time, provide a government they can afford. 
We are going in the wrong direction.
  I know a lot of good effort has been put into the plan that came out 
of the Senate HELP Committee, and to the plans that have come out of 
two of the House committees and currently are being discussed in the 
third. But the most charitable thing I can say about it is, very well-
intentioned people are working hard to try to find the best way to go 
in the wrong direction.
  When you are going in the wrong direction, is it not the best course 
to start over, especially when we are dealing with something as big and 
complex and as personal and as important as the health care of every 
one of 300 million of us? We all know we will only have one opportunity 
to get it right. And that opportunity is before us. So if we are headed 
in the wrong direction, let us start over and let us get it right.
  Who says we are headed in the wrong direction besides one Senator 
from Tennessee or maybe several members of the Republican Caucus?
  The Mayo Clinic said that in an opinion it released about 10 days 
ago. The Mayo Clinic is often cited as an example of what we ought to 
be doing more of--good results, lower costs. But it said, we are headed 
in the wrong direction. It did release an addenda after someone 
obviously called, probably from the White House, and said, what is 
going on here? So the Mayo Clinic said one thing the White House said 
did seem to be helpful, but fundamentally it said we are going in the 
wrong direction with the idea of a public option.
  A public option, as the President has said, is to help keep the 
insurance companies honest. That is like the President saying he is 
going to buy the rest of General Motors to keep Ford Motor Company 
honest, or to buy a drugstore to keep Walgreen's honest, or to have a 
government restaurant to keep O'Charley's honest. That is not the way 
our country works.
  Who else says we are headed in the wrong direction? Democratic 
Governors as well as Republican Governors as I mentioned here on the 
floor last week--the Governors of Colorado, Montana. My State Governor 
said, this is the mother of all unfunded mandates. These Governors are 
looking at the idea of dumping--I use that word carefully--another 20 
million low-income Americans into a failing government-run program 
called Medicaid, when 40 percent of the doctors will not see Medicaid 
patients.
  The proponents of these proposals call it health reform, and then 
they are going to shift the cost to the States after about 5 years. The 
Governors are appalled by this plan. The Congressional Budget Office 
says we are going in the wrong direction. Senator McConnell, the 
Republican leader, has said that the only bipartisanship thing about 
the health care debate is the opposition to it.
  So let me take each of those points one by one. There are seven big 
problems with the two health care plans, one in the Senate, one in the 
House, that are before us. One is it flunks the first test which is 
reducing cost.
  Two, it cuts grandma's Medicare and spends it on another program.
  Three, it would pass big, new Medicaid costs on to the States, 
causing big increases in State taxes.
  Four, despite what the President has said--or because the President 
said it, there is another reason to step back and take a different 
direction--millions would lose their employer-provided insurance.
  No. 5, millions more Americans would find themselves in government-
run health programs.
  No. 6, during a recession, we would impose new taxes and new fines on 
employers in order to encourage more health care.
  And, No. 7, with those government programs, you are more likely to 
wait in line and you are more likely to have your health care rationed.
  Let's take them one by one. Flunking the first test, reducing costs. 
We should start with the 250 million Americans who already have health 
care and make it more affordable. We know there are 47 million 
Americans who do not, but 5 million are college students, 10 million 
are noncitizens, 11 million are people making $75,000 a year or more 
who can probably afford it, 11 million are eligible for an existing 
program.
  Those are important things to do, but the idea here is to try to 
reduce the growing costs of Medicaid so you can afford your health 
care, and so that you can afford your government.
  The Congressional Budget Office said on the 17th of this month that 
the legislation before us significantly expands Federal responsibility 
for health care costs. Over the weekend, in looking at the next 10 
years, the Congressional Budget Office--that is our Congressional 
Budget Office--said: The proposal would probably generate substantial 
increases in Federal budget deficits during the decade beyond the 
current 10-year budget window.
  No. 2, it cuts grandma's Medicare. The New York Times yesterday, in 
describing the proposal in an editorial, said: Reformers are planning 
to finance universal coverage in large part saving money in the 
traditional Medicare Program, raising the question of whether all 
beneficiaries will face a reduction in benefits.
  If we are going to cut grandma's Medicare, we ought to spend it on 
grandma and grandpa.
  We ought not to take that money from that program, which the Medicare 
Trustees have told us may be broke by 2017, and spend it on a new 
program.
  Then there is the third issue, expanding Medicaid and increasing 
State taxes. As a former Governor, I am concerned that Congress hasn't 
got a real sense of how this will affect States--this plan to expand 
one government program, a failing, embarrassing program called 
Medicaid, into which we dump low-income Americans, and where we are 
going to dump another 20 million more. This is the reason the 
Democratic and Republican Governors, at their meeting in Biloxi a 
couple weeks ago, were up in arms about this. And after 5 years, we 
will shift the cost of that to the States. To expand it that much, to 
133 percent of the Federal poverty level, would cost our State about 
$423 million a year for the State share. If we really want to give 
people a bus ticket to a bus line that actually has buses, we will have 
to pay doctors more because today doctors, 40 percent of the time, 
don't see Medicaid patients. As a result, that adds another $600 
million. That equals a 10-percent new State income tax. It is inhumane 
to dump low-income Americans into a failing government program.
  Then there are the employer taxes and fines. I have talked to a 
number of

[[Page S8157]]

businesspeople. If given the choice between paying $750 per person, 
which the Senate plan does, or providing every single full-time and 
part-time employee health care, they will take the $750 a person. And 
where are the employees going to be? They will be out of employer 
health care. That is not what the President said he wanted. Where are 
they likely to be? A lot of them will be in these government programs, 
one of which is being extended and one of which is being created.
  Then there is the problem of waiting in line and rationing. If we 
create government programs with government people in between ourselves 
and doctors, there is more of a chance that we will be waiting in line 
and that we will have our health care rationed.
  Republicans have offered a number of plans that make more sense. A 
number of us have joined with Senator Wyden in a bipartisan plan that 
makes common sense. That plan, to be specific, would take the subsidies 
which we now spend on health care and spend them in a fairer way, 
giving low-income Americans a chance to buy health care like the rest 
of us have. It wouldn't create any new government programs. According 
to the Congressional Budget Office, it wouldn't add to the debt. If we 
are starting over, that framework would be a good place to start.
  People at home in Tennessee, the Mayo Clinic, 1,000 local chambers of 
commerce that have made their announcement today, the Congressional 
Budget Office, and the Democratic Governors all say: Whoa, let's get it 
right. This has too many problems. Let's start over with something that 
Americans can afford in terms of their own health care plan and a 
government they can afford.
  I ask unanimous consent to have printed in the Record an article by 
Martin Feldstein, President Reagan's former Chairman of the Council of 
Economic Advisers, from the Washington Post of today.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                     Obama's Plan Isn't the Answer

                         (By Martin Feldstein)

       For the 85 percent of Americans who already have health 
     insurance, the Obama health plan is bad news. It means higher 
     taxes, less health care and no protection if they lose their 
     current insurance because of unemployment or early 
     retirement.
       President Obama's primary goal is to extend formal health 
     insurance to those low-income individuals who are currently 
     uninsured despite the nearly $300-billion-a-year Medicaid 
     program. Doing so the Obama way would cost more than $1 
     trillion over the next 10 years. There surely must be better 
     and less costly ways to improve the health and health care of 
     that low-income group.
       Although the president claims he can finance the enormous 
     increase in costs by raising taxes only on high-income 
     individuals, tax experts know that this won't work. 
     Experience shows that raising the top income-tax rate from 35 
     percent today to more than 45 percent--the effect of adding 
     the proposed health surcharge to the increase resulting from 
     letting the Bush tax cuts expire for high-income taxpayers--
     would change the behavior of high-income individuals in ways 
     that would shrink their taxable incomes and therefore produce 
     less revenue. The result would be larger deficits and higher 
     taxes on the middle class. Because of the unprecedented 
     deficits forecast for the next decade, this is definitely not 
     a time to start a major new spending program.
       A second key goal of the Obama health plan is to slow the 
     growth of health-care spending. The president's budget calls 
     explicitly for cutting Medicare to help pay for the expanded 
     benefits for low-income individuals. But the administration's 
     goal is bigger than that. It is to cut dramatically the 
     amount of health care that we all consume.
       A recent report by the White House Council of Economic 
     Advisers claims that the government can cut the projected 
     level of health spending by 15 percent over the next decade 
     and by 30 percent over the next 20 years. Although the 
     reduced spending would result from fewer services rather than 
     lower payments to providers, we are told that this can be 
     done without lowering the quality of care or diminishing our 
     health. I don't believe it.
       To support their claim that costs can be radically reduced 
     without adverse effects, the health planners point to the 
     fact that about half of all hospital costs are for patients 
     in the last year of life. I don't find that persuasive. Do 
     doctors really know which of their very ill patients will 
     benefit from expensive care and which will die regardless of 
     the care they receive? In a world of uncertainty, many of us 
     will want to hope that care will help.
       We are also often told that patients in Minnesota receive 
     many fewer dollars of care per capita than patients in New 
     York and California without adverse health effects. When I 
     hear that, I wonder whether we should cut back on care, as 
     these experts advocate, move to Minnesota, or wish we had the 
     genetic stock of Minnesotans.
       The administration's health planners believe that the new 
     ``cost effectiveness research'' will allow officials to 
     eliminate wasteful spending by defining the ``appropriate'' 
     care that will be paid for by the government and by private 
     insurance. Such a constrained, one-size-fits-all form of 
     medicine may be necessary in some European health programs in 
     which the government pays all the bills. But Americans have 
     shown that we prefer to retain a diversity of options and the 
     ability to choose among doctors, hospitals and standards of 
     care.
       At a time when medical science offers the hope of major 
     improvements in the treatment of a wide range of dread 
     diseases, should Washington be limiting the available care 
     and, in the process, discouraging medical researchers from 
     developing new procedures and products? Although health care 
     is much more expensive than it was 30 years ago, who today 
     would settle for the health care of the 1970s?
       Obama has said that he would favor a British-style ``single 
     payer'' system in which the government owns the hospitals and 
     the doctors are salaried but that he recognizes that such a 
     shift would be too disruptive to the health-care industry. 
     The Obama plan to have a government insurance provider that 
     can undercut the premiums charged by private insurers would 
     undoubtedly speed the arrival of such a single-payer plan. It 
     is hard to think of any other reason for the administration 
     to want a government insurer when there is already a very 
     competitive private insurance market that could be made more 
     so by removing government restrictions on interstate 
     competition.
       There is much that can be done to improve our health-care 
     system, but the Obama plan is not the way to do it. One 
     helpful change that could be made right away is fixing the 
     COBRA system so that middle-income households that lose their 
     insurance because of early retirement or a permanent layoff 
     are not deterred by the cost of continuing their previous 
     coverage.
       Now that congressional leaders have made it clear that 
     Obama will not see health legislation until at least the end 
     of the year, the president should look beyond health policy 
     and turn his attention to the problems that are impeding our 
     economic recovery.

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