[Congressional Record Volume 155, Number 135 (Wednesday, September 23, 2009)]
[Senate]
[Pages S9700-S9705]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. Mr. President, I commend my friends on the Democratic 
side for their interest in health care reform and their coming here to 
express their views. I can say to them very clearly there is 100 
percent agreement on the Republican side that we do not want the status 
quo, and there is 100 percent agreement on the Republican side that 
there would be one thing worse than the status quo and that would be 
higher premium costs, more debt for the government, and higher taxes.
  I am afraid that is what my friends are arguing for because they are 
continuing to say they want to insure at least 30 million more people, 
they want to improve the benefits for people already on insurance, and 
they want to reduce costs. That does not add up. So I think it is time 
we get down to some reality in this discussion about: How can we best 
achieve health care reform in this country?
  We, on the Republican side, want health care reform, but we do not 
want more debt, more taxes, and higher premium costs for people who 
cannot afford their insurance policies now. Yet the proposals we have 
seen on that side of the aisle do that.
  Our focus should be about one thing. Health care reform should be 
about one thing: reducing costs, reducing costs to individuals and 
small businesses who are paying for health care, and reducing the cost 
to our government, which is the responsibility of every single one of 
us taxpayers in this country.
  We have had several proposals from the Democratic side that increase 
the debt and increase the cost, and the President himself, in effect, 
rejected them in his address to Congress the other day because he said 
there cannot be one dime of deficit, not one dime. So the bill that 
came out of the HELP Committee in the Senate--it is out of here. The 
bill that is coming out of the House of Representatives that has been 
through several committees--it cannot be considered under the 
President's own standard that it cannot increase the deficit one dime.
  I am glad he is saying that. I am glad he is saying that because he 
is already proposing we increase our national debt by $9 trillion over 
the next 10 years--doubling our national debt, tripling it over 10 
years, spending more over the next 10 years, three times as much as we 
spent in World War II--amounts that have most people in this country 
alarmed about the debt of this government. So this should be a 
straightforward discussion about costs, reducing the cost of health 
care to you, if you are buying health care, and reducing the cost of 
health care to your government, which you are responsible for.
  So the President has done us a favor. He said do not worry about the 
Senate bill that came out of the HELP Committee because--in effect, he 
said this--it adds to the deficit, so it has to go. For the bills 
coming out of the House of Representatives, the Congressional Budget 
Office has told us it adds to the deficit in the first 10 years, and it 
adds to the deficit even more in the next 10 years, so it has to go.
  So now we have a new bill, and it is already a 250-page--I misspoke. 
It is not a bill yet. It is 250 pages of concepts. It is important for 
the American people to understand this. I think one of the things we 
have all heard, as much as anything, when we have gone home is: Did you 
read the bill? That is a pretty good question. It is a pretty big job 
because we have gotten in the habit around here of coming up with 
1,000-page bills that Senators and Congressmen do not read. So the 
American people are saying to us: At least read the bill. They are 
saying to us, second: At least know what it costs. So that is a bare 
minimum of what we should insist on as we are going forward.
  The bill introduced by the distinguished Senator who is the chairman 
of the Finance Committee is 250 pages of concepts. So everyone 
understands where we are in the process, the Finance Committee is 
meeting. They will be meeting all week. My guess is they will be 
meeting next week. They are trying to agree on what those concepts will 
finally be. The chairman has recommended what he thinks they ought to 
be, and now the committee is going to say what they think they should 
be.
  Then, as I understand it, the Democratic leader is going to try to 
fit this bill that came out of the HELP Committee--that the President, 
in effect, has rejected because he says no deficit--well, it has a 
deficit--and he is going to try to put that bill that raises costs with 
the Baucus bill and turn it into one bill. The bill that came out of 
the HELP Committee is already nearly 1,000 pages. I do not know yet 
what will be coming out of the Finance Committee.
  So in a week or two, we are going to be having another big bill we 
will have to read. Then the Congressional Budget Office, which is our 
official nonpartisan outfit that tells us what things cost--appointed 
by the majority

[[Page S9701]]

but still nonpartisan--told Senator Baucus yesterday it would take 
about 2 weeks for them to tell us how much it will cost.
  So the way I am adding up the weeks, I am saying a week or two for 
the Finance Committee to come up with a bill--maybe a week to write the 
bill--and the Congressional Budget Office says after the bill is 
written, it takes 2 weeks to know the formal cost. Then we ought to 
have several weeks to debate the bill. That is what we did with the 
Energy bill for 4 or 5 weeks and, of course, we should do just that. So 
we need the time to do it, and we need to be able to say to people when 
we go home: I read the bill and I know exactly what it costs and here 
is what I think about it.

  What about the Baucus concepts--not the Baucus bill; they don't have 
the bill yet--but the concepts. The Congressional Budget Office 
released an analysis of the impact of the Baucus budget plan on 
insurance. It shows that the premiums for those in the individual 
market under the Baucus bill don't go down, they go up. This is 
supposed to be about reducing the cost of premiums that Americans have 
for their health care, and under the Baucus bill so far, on its first 
day of consideration by the full Finance Committee, the premiums go up 
and taxes on insurers, drugs, and devices would be passed on to 
consumers in the form of higher premiums. This is not fearmongers 
saying that; this is not Republicans saying that; it is not the doctors 
saying that; it is the Congressional Budget Office appointed by the 
majority, the Democratic majority. Premiums go up under the Baucus 
bill. That means Americans will pay more, not less, for their health 
insurance under the bill as it is today.
  Here is what the Congressional Budget Office said:

       Under current law, premiums on employment-based plans would 
     not include the effect of the annual fees imposed under the 
     proposal on manufacturers and importers of brand-name drugs 
     and medical devices, on health insurance providers, and on 
     clinical laboratories.

  These are new taxes.

       Premiums for exchange plans----

  These would be plans in the exchange that you might choose if you 
were an individual--

       Premiums for exchange plans would include the effect of 
     those fees, which would increase premiums by roughly 1 
     percent.

  That is the Congressional Budget Office about the Baucus concepts.
  CBO, the Congressional Budget Office, went on to say:

       At the same time, premiums in the new insurance exchanges--
     --

  These are the marketplaces where under this plan you would go to buy 
your insurance----

     would tend to be higher than the average premiums in the 
     current-law individual market.

  So the premiums under the new bill and the new exchange would be 
higher than you are paying today. CBO says:

       Again, with other factors held equal, because the new 
     policies would have to cover preexisting medical conditions 
     and could not deny coverage to people with high expected 
     costs for health care.

  CBO goes on to say:

       People with low expected costs for health care, however, 
     would generally pay higher premiums.

  So if you make a promise to improve the benefits, somebody else is 
going to pay for them. That is mathematics. That is the way the world 
works. Fortunately, we have the Congressional Budget Office to say 
under this plan premiums would go up. It continues:

       For families, premiums plus cost-sharing payments would 
     range from about $2,900 for those with incomes of $30,000, to 
     nearly $20,000 annually for premiums for those with incomes 
     above $96,000.

  So costs go up to individuals under the Baucus concepts. 
Additionally, we should consider the cost to our government. Most 
Americans are very much aware--I think that is why they have been 
turning out in record numbers in town meetings--that the government is 
not some remote, abstract thing; we own it, and we own the debt too. 
According to the Budget Committee staff, the real 10-year cost of the 
Baucus concept when fully implemented will be $1.67 trillion because 
the main spending provisions won't go into effect until 2013.
  In other words, when we talk about 10-year costs around here, the 
next 10 years aren't an accurate picture because the bill isn't fully 
implemented until you get on down the road 3 or 4 years to 2013. So if 
you take a full 10 years--a full implementation of the bill--the Budget 
Committee says it is about $1.67 trillion in new costs. However, there 
are new taxes and fees to pay for that: $838 billion over 10 full years 
of implementation, and those new taxes and fees go into effect 
immediately.
  The long-term deficit reductions predicted in the bill depend on 
Congress--that is us--approving cuts year after year to Medicare 
providers. Medicare providers are doctors, hospitals, hospices, and 
home health agencies. In other words, to make this bill balance the 
budget and not add to the deficit, we are going to have to have cuts 
year after year to Medicare, cuts to doctors, cuts to hospitals, cuts 
to hospices, and cuts to home health agencies.
  I thought I heard the President say in his speech the other night 
there will be no cuts to Medicare. He did say that. It turns out not to 
be true in the Baucus proposal. It could be true if Congress were 
willing to support cuts year after year to Medicare, hospitals, 
doctors, home health agencies, and hospices, but we have never done 
that. In fact, a few years ago we Republicans tried to restrict the 
growth of Medicare by $10 billion a year--I think it was from 43 
percent to 41 percent over 5 years--and we had to bring the Vice 
President back from overseas to cast the deciding vote because 
everybody on the Democratic side wouldn't even vote for $10 billion in 
reduced savings to Medicare. Yet what we are proposing here assumes 
that suddenly we have all changed and we are going to allow cuts year 
after year to people who provide services to Medicare.
  CBO found that its projections ``assume that the proposals are 
enacted and remain unchanged throughout the next two decades, which is 
often not the case,'' it wisely said.
  CBO goes on: ``For example, the sustainable growth rate''--we call 
that the ``doc fix'' around here when we come in once a year and 
automatically--doctors' payments under Medicare, which is already only 
80 percent--doctors earn only about 80 percent under Medicare compared 
to what they earn when they see private patients--so we automatically 
cut their pay by 20 percent and we always come in and raise it back up 
to about what it was the year before.
  So CBO is telling us that the sustainable growth rate--the ``doc 
fix'' ``governing Medicare to physicians--has frequently been 
modified.'' That is an understatement. It has been modified almost 
every year ``to avoid reductions in those payments'' and that ``the 
long-term budgetary impact could be quite different if those provisions 
were ultimately changed or not fully implemented.''
  So unless we have massive cuts in Medicare, we are not going to be 
able to balance the budget with this bill.
  We don't know how much this bill will cost State governments. The 
distinguished Senator from Nebraska is on the floor. He was a Governor. 
I was a Governor. We have all struggled with Medicaid. I think our view 
is that dumping another 15 million low-income Americans into Medicaid 
is not health care reform. Doctors and providers are only reimbursed 
about 61 or 62 percent of their costs for providing services to 
Medicaid patients, so 40 percent of doctors won't see Medicaid 
patients. Dumping a low-income American into the Medicaid program is 
like giving them a bus ticket to a bus line that only runs 60 percent 
of the time. It is not health care reform. Even so, this will cost 
State governments, and all the Governors--Democrats and Republicans--
are opposed to the concept in this bill that transfers some of the cost 
of increased Medicaid to the States. Their view is--and I think they 
are right on this--if the Federal Government wants to expand Medicaid, 
the Federal Government should pay for it. I haven't been able to even 
get an estimate of how much this will cost Tennessee. We are trying to 
figure that out. Senator Cornyn said his estimate is about $2 billion a 
year for Texas.
  Additionally, the proposal cuts nearly $500 billion from Medicare to 
fund this new government program even though Medicare will start going 
bankrupt in 2017. Yesterday I heard the president of the Mayo Clinic on 
National Public Radio say that any public

[[Page S9702]]

option that looked like Medicare would bankrupt the country overnight, 
since trustees have said that Medicare is likely to go broke in 2015 to 
2017.
  I am afraid we need to start over. I admire Senator Baucus's effort, 
but we don't do comprehensive very well here. A 1,000-page bill is not 
likely to solve the problem. It is time to bring an end to the era of 
these 1,000-page bills that are so complicated no one can understand 
them or have time to read them. Instead, I believe we should move step 
by step to lower health care costs and re-earn the trust of the 
American people.
  I see the Senator from Nebraska and I will soon defer to him, or to 
the Senator from South Dakota, whichever one is next. But in 
conclusion, these are the things we can start doing today to move step 
by step in the right direction to lower costs: allow small businesses 
to pool to reduce health care costs; reform medical malpractice laws; 
allow individual Americans the ability to purchase health insurance 
across State lines; ensure that Americans who currently qualify for 
existing programs such as Medicaid and SCHIP who are not enrolled to be 
signed up; create health insurance exchanges so you can find coverage; 
and incentivize health reform technology. We can agree on those things. 
We can take those steps and we can reduce the costs of health care to 
each American family and to our government.
  I thank the President and I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota is recognized.
  Mr. THUNE. Mr. President, I wish to thank the Senator from Tennessee 
for very effectively making the arguments that many Americans want to 
hear voiced in this debate about health care and a whole range of other 
issues. The Senator from Tennessee has pointed out as a former 
Governor--and we have another former Governor, the Senator from 
Nebraska, here today as well--the impact that many of these proposals 
would have on State budgets. The former Governor of Tennessee has 
described it as ``the mother of all unfunded mandates.'' I think that 
is a view that is shared by many other Governors across this country, 
about the impact some of these expansions would have, not just on 
Federal budgets but on State budgets.
  I have had numerous discussions with the Governor of South Dakota 
about this and he last suggested that the minimum amount, the 
conservative amount of additional funding that would be required each 
year to meet some of these expansions of Medicaid that are called for 
in these various health care reform bills would be about $45 million a 
year. Around here that doesn't sound like a lot of money, but in the 
State of South Dakota that is real money. That is a real impact and it 
would require higher taxes or significant cuts in their budget in my 
State of South Dakota. So that is one aspect of this argument.
  I might say that like some of my colleagues who over the month of 
August were out in their individual States listening to their 
constituents, I was doing the same thing. I conducted a series of 
townhall meetings in my State and I heard from people all across my 
State in every geographic region. Of course, as is typical in the 
Midwest, people were very respectful and it was a very civil 
discussion. But one could not miss the intensity people felt on not 
only the health care issue, because that happened to be the main 
subject of debate, but a range of other issues. I think it comes down 
to two fundamental issues. I think at least in my State of South Dakota 
this seems to be the case--as it was in some of the other meetings 
around the country in other States--that people were concerned about 
two issues. One was the issue of control and the other was the issue of 
cost.
  With the issue of control, it is a question of who has the power when 
it comes to the debate about health care and when it comes to the 
debate about higher energy costs. Is all this sort of consolidation and 
expansion of the Federal Government here in Washington, DC going to 
mean people in this country have less control when it comes to their 
own health care? Is the government going to be stepping in and 
intervening more and making a lot of these decisions and dictating out 
of some bureaucracy in Washington, DC what happens in the world of 
health care, which for most people is very personal to them? That is 
why I think there was such a visceral reaction across the country to 
some of these proposals.
  I think the other issue is cost. People have a sense that things are 
sort of spinning out of control. I think there are a couple of sort of 
basic principles that are fairly pervasive in the mindset of most 
people where I come from in the upper Midwest and that is, No. 1, you 
can't spend money you don't have; and No. 2, when you borrow money, you 
do have to pay it back. They see this incredible borrowing spree and 
this incredible spending spree here in Washington, DC and they are 
wondering, How is this all going to end? What does it mean not only for 
me and for my family but for future generations? Are we borrowing at 
levels that are not sustainable into the future? I think that has 
really gripped people across this country as they have looked at not 
only the health care debate but also the question of all of these 
government takeovers of financial services and insurance companies and 
auto manufacturers, and the list sort of goes on and on.
  The most recent example of that would be student loans where, again, 
we see the Federal Government trying to pull the reins in and move all 
of the guaranteed loan programs that currently operate in this country 
through the financial services industry and commercial banks into the 
Federal Government. The Federal Government would be the entity that 
makes all of these loans directly. Well, that ends up adding several 
hundred billion dollars to the Federal debt which we are already 
talking about raising here in the middle of next month. In the middle 
of October the debt limit is going to have to be raised. So we have all 
of that student loan exposure now, liability coming on to folks from 
the Federal Government. We have TARP which is said to expire at the end 
of this year, on December 31, unless Secretary Geithner certifies to 
Congress that he is going to extend it.
  I wrote a letter--and last week 39 of my colleagues signed it--asking 
the Secretary of the Treasury when TARP expires on December 31 not to 
extend it because, there again, there are unobligated balances in TARP 
funding that could be used that would reduce the overall amount of the 
debt, the overall amount of the deficit.
  And the truth be known, I don't think any American wants to see the 
TARP funds becoming a slush fund to fund other types of endeavors the 
Federal Government might undertake. They want to see this program that 
was temporary and was designed to prevent imminent financial collapse 
and provide stability to the financial services industry expire. Now 
that that purpose has been served, we should not continue to have 
hundreds of billions of dollars of taxpayer dollars out there that 
could be recycled or put into some other industry the government 
decides to select.
  I hope the Secretary will heed the suggestion made by myself and 39 
colleagues in our letter and let the TARP program expire. I say that 
because this paints a broader picture, a narrative, that I believe is 
of great concern to the American people, which is the reason we saw so 
much intensity at many townhall meetings over the break.
  The health care debate is occurring right now in real time. We have 
had four of the five committees record bills that have jurisdiction 
over health care in the Congress--three in the House and one in the 
Senate. The Senate Finance Committee is marking up their bill this 
week. We expect that will be completed and that this could be put on 
the floor sometime in the next few weeks. That seems to be a very fast 
schedule considering the consequence of what we are doing. We are 
talking about one-sixth of the American economy, about reorganizing 
one-sixth of the American economy. Mr. President, $2.5 trillion 
annually is spent on health care in this country. I think we better 
make sure we do it right. All we have seen so far in the Finance 
Committee is a 220-page summary, which we assume, when translated into 
legislative language, is going to be more than 1,000 pages. That is 
something many of us will want to have time to digest, and we would 
like our constituents to look at it to see whether it makes sense to 
them.

[[Page S9703]]

  I think probably the biggest reaction I saw during the August break 
in the discussions I had with constituents in South Dakota was a 
negative reaction in opposition to the notion of a government plan, 
that the government would create this public plan option--essentially a 
government plan. A lot of people who derive health care coverage in the 
private marketplace today would by default be pushed into that 
government plan, and you would have the government involved at a much 
higher level in driving a lot of the health care decisions in this 
country. There was a real reaction to that.
  The point I made earlier as to what I think people were reacting to 
is the issue of control, power. Who has the power? Is the Federal 
Government trying to buy this expansion, create more power in 
Washington, and take away some of the power and decisionmaking that 
should occur between patients and their doctors? That was the one 
issue. The Finance Committee plan, to their credit, has done away with 
that--at least for the time being. They decided to proceed in a 
different direction.
  That being said, the issue remains that people were responding to 
during August; that is, the issue of cost. According to the 
Congressional Budget Office, the overall cost of this, for the 
immediate 10 years, is a little under $1 trillion. When fully 
implemented, the cost of the plan is still $1.7 trillion, which has to 
be paid for somehow. They said they are not going to add to the 
deficit. The proposal is to reduce Medicare by $500 billion. The 
balance will be raised in the form of tax increases, revenue raisers.
  People are looking at this and saying: OK, a $1.7 trillion expansion; 
what do we get in exchange for that? People will be covered who are not 
currently covered, but a lot of people who don't have insurance still 
won't be covered under the proposal the Finance Committee is currently 
considering. But it is still going to cost $1.7 trillion.
  If you are a taxpayer saying: OK, what is this going to cost and how 
may it impact my insurance premiums if I already have health insurance 
coverage, I think the answer was given by CBO Director Doug Elmendorf 
in response to a question. Senator Cornyn posed the question, and it 
had to do with: Will this lead to higher premiums? If you read from the 
letter, it says:

       Senator, our judgment is that that piece of the legislation 
     would raise insurance premiums by roughly the amount of the 
     money collected.

  Whatever is collected in the higher taxes that are going to be put on 
somebody else--that is always the assumption--is going to be put, in 
this case, on the insurance companies. But does anybody believe for a 
minute that will not be passed on to the American consumer? It is going 
to be.
  So what does this legislation actually do to drive costs down? My 
whole argument in this health care reform debate has been that anything 
we do ought to bend the cost curve down, not raise it. Almost every 
proposal we have seen increases or raises the cost curve. This is 
another example, according to the CBO, of a plan that, in the end, is 
going to raise insurance premiums for most Americans.
  The other thing I think is important to note here--and the same 
response was given by the chief of staff of the Joint Tax Committee. He 
answered the question the same way: We analyzed this largely falling on 
the consumer, and that would happen in a couple of different ways. This 
is going to be eventually little paid by the consumer. It is a tax 
increase.
  The other point is that the assumption is that the portion that is 
not raised through revenue increases, tax increases, will be paid for 
in the form of Medicare reductions. Do we really believe $500 billion 
in Medicare reductions will be achieved by the Congress? And we know 
how difficult it is around here to talk about reducing Medicare. My 
view is, if we are talking about making Medicare more sustainable, we 
ought to look at how we can reform it and find savings. But this is 
going to take a new entitlement program and put it on top of a program 
that we are told will be bankrupt by 2017.
  I still think we can do health care reform here that does bend the 
cost curve down, lowers costs for most Americans, and provides access 
to more Americans as well. We have not seen a proposal yet that doesn't 
include a significant increase in the amount of Federal Government 
control, of power in Washington, DC, an expansion of the Federal 
Government. We have not seen a proposal that actually does anything to 
get costs under control for most consumers. For most consumers, that is 
the issue; it is a cost issue. Furthermore, we are looking at 
proposals, from a taxpayer's standpoint, that will increase spending 
and borrowing and it will pass more and more of that debt on to future 
generations.
  So we need to proceed slowly and get this right. We need to focus on 
ideas that actually reduce costs, such as allowing people to buy 
insurance across State lines or to join small business health plans, 
which is something we have tried to get through for a long period of 
time, unsuccessfully, or dealing with medical malpractice reform, so 
people can get insurance in the private marketplace.
  This level of government expansion, this level of spending and 
borrowing is unacceptable to the American people. That is why they are 
reacting so negatively. It comes down to control and who has the power. 
Is it the Federal Government or the American people? It comes down to 
costs. What are we doing to future generations with the amount of 
spending and borrowing we are doing?
  I hope we will take it slower and get it right and focus on 
initiatives and ideas that will get costs under control and that before 
Congress adopts health care reform, that will be the focus, not 
expansion of government in Washington, DC, at trillions of dollars in 
additional costs to the American taxpayer and no savings to the 
ratepayer out there trying to get their insurance premiums under 
control.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Nebraska is recognized.
  Mr. JOHANNS. Mr. President, I wish to start out this morning by 
complimenting the distinguished Senator from Tennessee and the Senator 
from South Dakota. They have raised some excellent points. As I have 
listened to them, I have to tell you, I think they have offered a lot 
to move the debate forward.
  I rise today to shine the light on what I consider budgetary gimmicks 
and omissions in the Finance Committee health care proposal.
  Both Republicans and Democrats should be able to agree that one of 
the things we need to do in accomplishing true health care reform is to 
do it in a fiscally responsible way. We all went back home in August, 
and I heard the message very loud and clear from Nebraskans. They want 
honesty and full transparency as we attempt to achieve health care 
reform.
  Americans believed the President when he said he wanted an open and 
transparent process. We all agree on that. Unfortunately, what we have 
is not transparent, and I argue that it is based on false assumptions. 
Honestly, an American family would have to hire a whole team of 
accountants to understand all that is hidden in the Finance Committee 
draft.
  While the CBO has scored the bill as $774 billion, the real cost of 
the bill--and that cost is moving up every day--is closer to $1.7 
trillion over 10 years, as the previous two Senators have pointed out. 
What its supporters neglect to tell you is that the main spending 
provisions in this proposal don't go into effect until 2013. That is 
right, the American public will have to wait 4 years before most of the 
new initiatives even get off the ground. So none of us should be 
surprised when the American people really laugh at an arbitrary 
deadline of the end of the week or the first of next week for 
finalizing committee action. They don't understand the need to hurry. 
The proponents claim it is such a crisis that we should rush through. 
Yet their fixes don't take effect for 4 years.
  You can understand the American public's frustration and skepticism. 
They must watch the evening news--whatever their flavor of news is--and 
look at the Capitol dome and ask the question: What is going on? What 
is happening out there? They have to be scratching their heads in 
amazement. If they ran their business or household this way, they would 
be in bankruptcy.
  If that weren't enough to fill an entire gymnasium full of townhall 
participants, there is, unfortunately,

[[Page S9704]]

much more. The proposal requires new taxes on everything from medical 
device manufacturers, health insurance premiums, and pharmaceutical 
manufacturers, topped off with additional Medicare cuts of about $500 
billion and, of course, unfunded mandates on the States in the form of 
the expansion of Medicaid, which I am all too familiar with as a former 
Governor.
  Let me translate this. Higher taxes will be passed on to the American 
people. All these taxes, these fees, and these mandates will only 
increase the cost of health care. They don't decrease it when all this 
is passed on to the American consumers.
  While the promised benefits don't kick in until year 4, the taxes and 
fees, interestingly enough, start right away, almost on day one.
  In effect, the bill is structured to impose 10 years and $848 billion 
worth of new taxes and fees, and you get in return 6 years of 
additional benefits under this bill. The creative accounting, 
unfortunately, only appears to get cheers inside the beltway. Yet the 
average American thinks we don't have a clue.
  Another hidden cost is the new mandate on States through an expansion 
of Medicaid. I wish to spend a moment on that.
  Partial costs to expand the Medicaid Program up to 133 percent of the 
poverty limit will be put on the States. This unfunded mandate will 
cost States--and estimates will vary--about $42 billion. Of course, 
that is not built into the cost estimate, not because the American 
people don't pay for it, because they will, but because it doesn't fall 
on the Federal budget. Who gets to pay the costs here? Well, obviously, 
once again, it will fall on the American people.
  I come from a State that is fiscally responsible. We have only two 
ways to deal with this kind of issue because our constitution prohibits 
us from borrowing money. What a unique concept; Nebraska doesn't borrow 
money. We have only two choices: we can cut programs or we can raise 
taxes. If we cut programs, things such as education, senior 
initiatives, infrastructure projects, prisons to keep the bad guys out 
of society, and other very valuable programs could find their budgets 
destroyed.
  In these times of tight budgets, States have already slashed their 
budgets. They are down to the bone, and they are trying to figure out 
how they will balance next year's budget. I suggest the Federal 
Government giving them another layer of spending is not the answer.
  The other alternative is to raise taxes, hit the consumer again. But 
that is not the right way to go either. But it seems that what we are 
doing with this mother of all unfunded mandates is making this choice 
inevitable.
  Folks in Nebraska and across the country are going to resent seeing 
their State paying higher taxes because the Federal Government put them 
in this fiscal straitjacket. In addition, one of the main pay-fors in 
this legislation is $400 billion, $500 billion in Medicare cuts. 
Despite the fact that the Medicare trustees report projects that 
Medicare will be bankrupt by 2017, none of the $400 billion goes toward 
shoring up our already pending fiscal crisis.
  The false promise being made is that we can both fund this new 
entitlement with Medicare money and keep our commitment to senior 
citizens. I am not naive enough to buy that bag of goods and neither 
are our seniors. We are asking them to choose the prize behind the 
curtain when the prize is a goat.
  I am deeply concerned that we are compounding the problem by not 
reinvesting these dollars back into Medicare. That is why I hope the 
Finance Committee will see the light today and adopt important 
amendments by the junior Senators from Kansas and Nevada.
  Even the nonpartisan Congressional Budget Office Director admitted 
yesterday that these cuts to Medicare will decrease current insurance 
benefits that our seniors now enjoy.
  Finally, this Finance Committee proposal is built on false 
assumptions when it comes to cost containment. The bill is based on the 
fantasyland assumption that scheduled sometimes double-digit payment 
cuts to medical professionals will be allowed to take place. The 
history is very much the opposite. We do the doctor fix on an annual 
basis.
  Any Senator who votes for this Finance Committee proposal should be 
required to publicly state their support for a 25-percent cut in 
physician reimbursement rates beginning in 2 years.
  Their proposals credit themselves free money by assuming savings in 
this area. Yet they know Congress waives the Budget Act, waives pay-go, 
and suspends these cuts year in and year out with a lot of support, I 
might add.
  In fact, the Congressional Budget Office states:

       These projections assume that the proposals are enacted and 
     remained unchanged throughout the next two decades, which is 
     often not the case for major legislation.
       For example, the sustainable growth rate, SGR, mechanism 
     governing Medicare's payments to physicians has frequently 
     been modified to avoid reductions in those payments.

  Therefore, I am not going to count on Congress acting any differently 
in the near future, and any cost estimate that assumes otherwise, I 
say, is not based on reality. We all know what they say about good 
intentions, but I still believe you do not spend money until you know 
from where the money is coming.
  The American public simply deserves a very transparent discussion 
about our current and future actions, what they are going to cost, and 
what they will lead to in terms of our health care system instead of a 
house of cards. The American people have asked us to be transparent. 
They know we have to make tough decisions. They just want to understand 
the ramifications of what we are deciding. That means they want us to 
read the bill. They want us to do that before we vote. They want us to 
have a full picture of how this will affect budget deficits and the 
fiscal outlook. And they want us to communicate that to them.
  The American people want to know how this proposal will impact them 
and what it will do to the current health care system and their costs. 
Basically, they want us to know all the details before we rush into a 
vote. That means we need the time to look at this bill. This is going 
to be a 1,000-page bill, a Senate Finance Committee with no legislative 
language that is working now, a plan to consider almost 500 amendments, 
and yet they want to get it done this week. Mr. President, it is time 
to call a timeout and get this right.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. BENNETT. Mr. President, as I listen to all of the discussion 
about health care, I have come to several conclusions. No. 1, there is 
a 100-percent bipartisan agreement that something has to be done. But 
No. 2, there is a growing strong bipartisan agreement that this bill is 
not the something that should be done.
  From the New York Times:

       The first big fight over the Senate Finance Committee's 
     health care legislation erupted Tuesday night: a rollicking 
     brawl over a deal that the Obama administration cut with the 
     pharmaceutical industry to achieve $80 billion in saving on 
     drug costs over 10 years, money that would help pay for the 
     legislation. Top House Democrats have hated the deal from the 
     get-go. Senate Democrats are now bitterly divided. . . .

  This resonates with the comment that the Republican leader made where 
he says the only truly bipartisan thing about this bill is the 
opposition to it. I think this demonstrates that we need to slow down, 
start over, and do it right.
  We have heard many speeches saying we can't wait. We see people 
carrying signs: ``Health Care Reform Now.'' We have just heard from the 
Senator from Nebraska that this bill will give us health care reform 
not now--4 years from now. Four years is a long time to wait. We can do 
it faster than 4 years, but we can do it faster only if we slow down, 
start over, and do it right. We can do it in this Congress if we slow 
down, start over, and do it right.
  What are the things on which we need to start over? The looming 
challenge in this whole debate is cost. The numbers that are being 
thrown around are astronomical, and we still don't know exactly what 
they are. These are still estimates. The Senate Finance Committee has 
not reduced their proposal to legislative language. The CBO says: We 
can't give it a score until we get legislative language, and by the 
time we get the language, it is at least

[[Page S9705]]

2 weeks before we can produce a score. Yet we are being told we must 
pass this bill next week? Slow down, start over, and do it right.
  We are going to pay for it, we are being told, by taking $500 billion 
out of Medicare. And every study of Medicare says at least $500 billion 
is being wasted, so that is easy. Let's take $500 billion out, and we 
will solve the problem.
  We can take $500 billion out of Medicare with a meat cleaver, and 
that means we are cutting the programs that are good in Medicare, the 
things about Medicare that work as well as the things that do not work. 
Maybe we should slow down, start over, and do it right by taking the 
$500 billion out of Medicare with a surgeon's scalpel rather than a 
meat cleaver and spend the time to find out where the money is being 
wasted, how it could be changed, where the incentives need to be 
altered so that the $500 billion comes out of the right part of 
Medicare instead of with a slash with a meat cleaver.
  Medicare is not the only one where more careful examination could 
produce significant savings. We are told that Medicaid in 2007 spent 
$30 billion improperly. If we extrapolate that over the 10-year period 
that we use to make these projections, that is $300 billion that could 
come from Medicaid. Are we going to take a meat cleaver to Medicaid and 
say we are going to arbitrarily cut $300 billion out of Medicaid in the 
next 10 years because there is a study that says that much is being 
wasted or are we going to listen to the Governors, bipartisan, Democrat 
as well as Republican, who are telling us: What you are doing in this 
bill on Medicaid is going to bankrupt the States because they simply 
cannot sustain the kinds of increases that are built into it and 
nothing will be done about the $30 billion of waste and abuse that is 
there.
  How are we going to get at it? How are we going to discover what that 
$30 billion is? How are we going to deal with it in a way that does not 
bankrupt the States? To answer that question, we need to slow down, 
start over, and get it right.
  If I can be provincial and parochial for just a moment, my home State 
of Utah has done a great amount of work on health care. They have been 
very entrepreneurial and innovative. They have come up with ideas to 
deal with health care, ideas from which we at the Federal level could 
learn a great deal, but we cannot learn anything from the 
experimentation that is going on in the States if we continue this rush 
to an arbitrary deadline, to get this thing done within a couple of 
weeks.
  The States have great experience with this. There is much the States 
can teach us. There is much the Governors need to tell us before we 
rush to spend this much money, which means we should slow down, start 
over, and do it right.
  As I talk with the businesses, as I talk with my constituents in 
Utah, I come back to the same thing I said at the beginning. There is a 
100-percent bipartisan agreement that something has to be done. Our 
long-term challenges with health care are absolutely unsustainable, to 
use a Washington word. That is another word for disastrous.
  We have to deal with this, and we have to deal with it in an 
intelligent way. The numbers are very large, and we have to recognize 
the stakes are very high. But that is, again, the message that comes 
from those who will be most affected by what we do, either in their 
businesses or their personal lives or their tax returns. It is very 
important that we get it right; and if we are going to get it right, we 
have to start over. If we are going to start over, we have to slow 
down.
  That is the wisdom this body should adopt as it deals with this 
challenge so that we can change the reality of where the bipartisan 
agreement is. Instead of the bipartisan agreement growing in opposition 
to the bill, we need a circumstance where a bipartisan agreement will 
grow in support of a bill that will solve our problem. The bill before 
the Finance Committee is not that bill, and a large number of Members 
of this body of both parties are increasingly coming to that 
conclusion.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Kaufman). The Senator from New York.

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