[Congressional Record Volume 155, Number 144 (Wednesday, October 7, 2009)]
[Senate]
[Pages S10173-S10175]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          THE DEMOCRATIC PLAN

  Mr. McCONNELL. Mr. President, the latest trillion-dollar, 1,000-page 
Democrat plan raises some questions--questions such as: What happens to 
Medicare?
  Tens of millions of American seniors want to know.
  Here is what we can say for sure.
  The Democrat plan is a trillion-dollar experiment that cuts Medicare, 
raises taxes, and threatens the health care choices that millions of 
Americans now enjoy.
  We know the Democrat plan will make massive cuts to Medicare--$500 
billion worth--to fund more government spending.
  We know Medicare Advantage benefits will be slashed almost in half, 
causing many of the 11 million seniors enrolled in it to lose benefits, 
such as hearing aid coverage and dental care.
  We know it contains nearly $120 billion in cuts to hospitals that 
care for seniors, more than $40 billion from home health agencies, and 
nearly $8 billion from hospices.
  And we know this: Medicare is already on the path to bankruptcy. Yet 
instead of trying to fix it, the Democrat plan is to use it as a piggy 
bank to pay for new government-run health care programs.
  Republicans have tried to protect Medicare throughout this debate. 
Our amendments to do so were rejected in committee. We proposed an 
amendment to prevent cuts to skilled nursing facilities, long-term care 
hospitals, inpatient rehabilitation, hospice care and home health care. 
They rejected it. We offered an amendment to strike cuts that wouldn't 
improve Medicare. They rejected it. We offered an amendment to 
eliminate an unaccountable commission that would have the power to 
decide payments to Medicare providers. They rejected it. This isn't 
reform, and America's seniors know it.
  Americans are demanding that their voices are heard in this debate. 
They want their questions answered, particularly when it comes to 
Medicare. They don't want the status quo. But they don't want what 
Democrats are pushing either: a trillion-dollar experiment that cuts 
Medicare, raises taxes, limits choices, and makes health care more 
expensive. Americans have questions. They are not getting the answers 
they deserve.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Illinois is 
recognized.
  Mr. DURBIN. Mr. President, will the minority leader yield for a 
question?
  Mr. McCONNELL. I say to my friend from Illinois, I have an 
appointment in my office. I am happy to yield the floor.
  Mr. DURBIN. I was going to ask the minority leader for the Republican 
plan for health care reform. Unfortunately, there is not a Republican 
plan for health care reform. What we have is a litany of criticism, a 
litany of complaint. That is what we have received during the course of 
this debate.
  Senator Max Baucus, chairman of the Finance Committee, took three of 
the most likely Republicans--Senators Grassley, Enzi, and Snowe--sat 
with them literally for months saying: Let's do this on a bipartisan 
basis. Meanwhile, the rest of us were a little frustrated, if not 
upset. We wanted to get moving, get into the debate. Let's get into 
this. It is a big issue. Health care reform is important. But Senator 
Baucus said: I have to try everything I can to make this a bipartisan 
effort. And he did. He spent months at it, day after day after day. 
What does he have to show for it? In the end, two of the Republican 
Senators walked out saying: We are not interested. The other said: I 
will wait and see.
  So when they come to the floor critical of this debate on health care 
reform, the obvious question I would ask the Republican leader is: What 
is your plan? The status quo? You want to continue health care as we 
have it in America today? Do you want to try to defend what is 
happening to the cost of health care?
  I was with a businessman from Chicago last week, a good, 
conscientious businessman, a young man, a principled man who has made 
money in his life but understands that he owes at least the people 
around him and his employees to give back. He said: Do you know what is 
going to happen to health insurance premiums for my employees? They go 
up 18 percent in 1 year, 18 percent. He said: I don't know if I can 
keep doing this. Guess what? His situation is being repeated over and 
over again. Businesses across America are dropping health care coverage 
for their employees because they can't afford it. The cost is out of 
hand.
  Did we hear one word from the Republican leader about dealing with 
this cost escalation? No. The Republicans have no plan to deal with 
this. We are trying. It isn't easy. This is one-sixth of the economy. I 
love it when Senators come to the floor and call this a $1 trillion 
experiment. Let's put it in perspective. A trillion dollars is an 
enormous, almost unimaginable sum of money. But what will the cost of 
America's health care system be, for all of our health care, over the 
next 10 years? It will be $35 trillion. So $1 trillion in reform over 
10 years represents less than 3 percent of the amount we are going to 
already be spending if we don't change the health care system and make 
it better. One trillion out of thirty-five million dollars? In 
perspective, we understand that if we are going to bring about real 
reform, we do have to invest in it.
  Where will the trillion dollars go? The trillion dollars will go to 
help businesses with tax breaks to pay for health insurance for their 
employees. It will go to lower income working families so they can 
afford to buy health insurance. That is where the money will go.
  Ultimately, do you know where it goes? It means that more and more 
Americans have health insurance coverage. Today, this day, and every 
day in America, 14,000 people will lose health insurance coverage. 
Imagine waking up this morning, heading off to work and learning during 
the course of the day that you have lost your job. It is happening. But 
you are not only losing your job, you are losing your health insurance. 
You go home at night and say to your spouse: Bad news. I just got the 
pink slip. I will be laid off in 2 weeks. But even worse news, our sick 
child with diabetes is no longer going to have health insurance 
coverage.
  That is the reality for 14,000 families a day. When I hear the 
Republican leader criticize our effort to expand coverage of health 
insurance to the millions of Americans who are unprotected, to slow 
down this cancellation of health insurance for 14,000 Americans a day, 
my obvious question to him is: What is your alternative? What do you 
want to do? The answer is, nothing. Nothing except criticize.
  There is nothing wrong with being critical. That is what this Chamber 
is all about. Ideas are up for debate. People will disagree. They will 
come up with their own point of view. That is good. A good healthy 
debate is what our government is about, what our Nation is about, and 
what can generate in the end a solution to our problems. But when I 
hear some of the things that have just been said: a 1,000-page bill. 
Does that bring you up short? Can't breathe? Your heart skips a beat, 
1,000 pages? What if I told you this bill is addressing our health care 
system which consumes $1 out of every $6 in the American economy? One 
sixth of our gross domestic product deals with health care. Would it 
take 1,000 pages to address this in a responsible way? I am surprised 
it didn't take more. And how are we going to measure a bill in terms of 
its value? That bill is just too long. It is 1,000 pages long. I am 
sorry, maybe God got it right with the Ten Commandments and their 
brevity, but

[[Page S10174]]

for most of the rest of us, we struggle to make sure we get it right. 
And to make certain we get it right, we have to add some provisions to 
cover options and contingencies. It is 1,000 pages? So what. If it were 
100 pages or 2,000 pages, would that make it any worse or any better? I 
don't get it.
  Let me also talk about Medicare. Medicare was a creation in the 1960s 
of President Lyndon Johnson and a Democratic Congress, and by and large 
it was opposed by the Republican Party. The Republican Party in some of 
their criticisms will sound familiar. They argued that Medicare was 
socialized medicine. Medicare was a government health insurance plan 
and the government was going to get it wrong. In the end, they argued 
it would cost too much money, and it wouldn't provide good health care. 
Turns out, after 45 years, we can say conclusively they were wrong. For 
the 40 million Americans protected by Medicare, the results have been 
spectacular.
  Look at one basic yardstick. Senior citizens in America are living 
longer. That is a good thing. Life expectancy rates are better for 
seniors today. Does it have anything to do with Medicare? I think it 
does, because seniors have access to quality medical care. It gives to 
those at age 65 the peace of mind of knowing that an accident that 
occurs this afternoon or a diagnosis that occurs tomorrow morning won't 
wipe out their life savings. If you are not lucky enough to have good 
health insurance at age 65, Medicare is there to protect you, your 
health, and your life savings in the process. Those who called it 
socialized medicine, as they are calling health care reform now, mainly 
came from the other side of the aisle. That is why when I hear them 
saying they are going to defend Medicare today, I am glad they have 
converted to our side. It is a late-in-life conversion, but some of 
those work too.
  Then listen to how they explain it. The Senator from Kentucky slipped 
up and used the term Medicare Advantage. That is what this is all 
about. Let me explain what Medicare Advantage is. Private health 
companies came to Republicans years ago and said: The government has it 
all wrong in Medicare. They are not handling it well. They are not 
administering it well. It costs too much money. Let us show you that if 
we use the private sector health insurance companies, we can provide 
Medicare benefits at a lower cost than the government and do a better 
job.
  They were given a chance to do it. They did it under the title 
Medicare Advantage, private health insurance companies competing with 
the government to provide Medicare benefits to prove they could do 
better and more cheaply. Some did, but most did not. At the end of this 
experiment, we find it is going to cost 14 percent more for the private 
health insurance companies to provide the same benefits the government 
is already providing. What it means is, we are subsidizing insurance 
companies to provide the same benefits the government already provides.
  People across America under Medicare Advantage plans say: I kind of 
like this. Well, it turns out that the government is subsidizing more 
than Medicare. Who pays for the subsidy? Ultimately, the taxpayers but, 
in particular, the Medicare system. The money is taken out of the 
Medicare system to provide a subsidy to health insurance companies that 
failed to prove they could do this more economically.
  This subsidy is something I think should end. I am prepared to phase 
it out in a reasonable way, but it should end. The private health 
insurance companies are being subsidized by our government to provide 
Medicare benefits which we can already provide at a lower cost. They 
have come to the floor criticizing this attempt to end the sweetheart 
deal with these private health insurance companies.
  Make no mistake, the 800-pound gorilla in the room in this debate is 
the private health insurance companies. They don't want to see this 
change.
  I quote my friend Dale Bumpers, a former Senator from Arkansas, who 
used to come to the floor and use this figure of speech. He said: They 
hate this like the devil hates holy water. They hate the idea of health 
care reform, health insurance companies do, because they are extremely 
profitable, when many other companies in America are failing. They do 
not want to rock the boat with anything like a not-for-profit health 
insurance plan that gives consumers a choice to leave private health 
insurance, if they personally choose. They do not want that to happen.

  They certainly do not want to end this $170 billion subsidy of 
private health insurance companies under the Medicare Advantage 
Program. They do not want us to tell them they have to change their 
ways and their practices, that they can no longer cut off people from 
coverage just because of a preexisting condition, which they dream up 
or find buried in some application of 10 years ago.
  We do not want them to be able to walk away from you when you need 
them, when somebody in your family is sick and needs care. We want them 
to be able to treat people fairly. We have to end this battle between 
doctors and insurance company clerks as to whether you are going to be 
hospitalized or receive a procedure.
  These are things that go on every day. The health insurance companies 
hate these reforms that are part of this bill. The critics of the bill 
will not come to the floor and say this. They will talk about 
eviscerating Medicare.
  Earlier, the Senator from Kentucky said we were going to cut $120 
billion from hospitals. Do you know what? We spend more money on health 
care in America by a factor of two than any other country on Earth. 
Hospital administrators, such as in my own hometown of Springfield, IL, 
have said to me: Senator, if you can create a plan that provides 
everybody health insurance, and we don't have to provide charity care 
for people who come in without health insurance, that is going to 
dramatically cut our costs.
  So can we save $120 billion in the hospitals across America over the 
next 10 years if more Americans have health insurance? Yes, without 
compromising the revenues for the hospitals or the quality of care. 
That is obvious. So when the Senator comes to the floor and says: They 
are going to take $120 billion from hospitals, he does not tell you the 
whole story. The rest of the story is: But if those 40 million 
Americans have health insurance, and the hospitals are getting paid 
through the health insurance, it is good for everyone. It is good for 
the people who are protected, it is good for the hospitals, and it is 
good for the rest of us who have health insurance and indirectly 
subsidize the care of the uninsured.
  He talks about cuts--$40 billion--in home health care. I refer the 
Senator to an article which I have quoted on the floor before. It is an 
article entitled ``The Cost Conundrum,'' written by a surgeon in 
Boston, MA, named Atul Gawande, in the June 1 edition of The New 
Yorker. Please read it. Most Senators have. The President has. Most 
Members of the House have read it. It talks about McAllen, TX, where 
the cost of treating Medicare patients is one of the highest numbers in 
the Nation: $15,000 a year.
  Why? What about McAllen, TX, makes it so expensive? It turns out it 
is so expensive because, unfortunately, many of the providers there are 
heaping on the procedures and heaping on the costs because they take a 
profit from it. It does not have anything to do with the older folks in 
McAllen, TX, being sicker or needing special care. It is 
overutilization, overuse of the system, and one of the areas is home 
health care.
  Read this article about what is happening with much of--at least in 
that area of the country--home health care services. There is collusion 
between doctors and these home health care agencies. It is nothing 
short of an abuse of Medicare. It does not provide quality care. It 
just takes more money out of the system for care that is duplicative or 
unnecessary.
  How is that good for America? How can we defend that? Can we do 
better there? Yes. Can we do better to the tune of $40 billion over 10 
years? I think so. To argue this is somehow insidious and wrong is to 
ignore the obvious. We can find savings within the system that do not 
compromise quality.
  Let me also say this. This notion that Medicare is, as the Senator 
said, our piggy bank that we are going to use to pay for health care 
reform is just plain wrong. We know we can save money through 
eliminating the subsidy to Medicare Advantage, phasing it out,

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reducing it. But we also know we have a solemn obligation to those 
seniors on Medicare. They paid into it all their lives. They are 
counting on it. And they are counting on us.
  The Democratic Party has been there for Medicare from its creation. 
We are not going to let seniors down. We are going to provide for them 
the basic care promised, and we hope more. I think, with a modest 
effort, we could close the doughnut hole in the prescription drug 
program under Medicare, and we should. That was something that never 
made any sense and creates a real disadvantage for seniors on limited 
income. I think we should close that. I also think preventive care for 
seniors makes sense--regular physical checkups, things that can enhance 
their lives and let them live independently as long as they want to and 
can, with our help.
  I will tell you, this debate will continue. Now it gets into the part 
where the bill comes to the floor within the next week or so. We will 
entertain amendments from both sides. I hope, from the other side of 
the aisle, we have more than criticism. If they would step up and say: 
Here is our plan, it would be a much better debate. But so far they 
have not. They have decided to step to the sidelines and be critical of 
the game that is being played. That is their right to do under this 
democratic form of government, but it is a question of credibility.
  If they are defending the status quo, if they want to continue with 
what we have in America, if they want to ignore the escalation in the 
cost of health care for businesses and individuals, families and 
governments, if they want to ignore the fact that 40 million Americans 
do not have health insurance, that 14,000 will lose their health 
insurance today, if they want to ignore the reality of all these people 
without insurance and the abuses heaped on them by health insurance 
companies for those who have insurance, then, frankly, that is not a 
constructive position in this debate.
  We need to work together. We have tried to work together. We have 
invited the Republicans to come join us in this effort. But, 
unfortunately, they have taken the side of the insurance companies. 
They have taken the side of the status quo. They have not joined us.
  I do not want to put people's insurance at risk by allowing insurance 
companies to continue to drop insurance when people need it the most. I 
do not think we should be in a position where we allow this to 
continue.
  I hope, as part of health care reform, we can make a significant 
effort to change this, to bring real change to America. I am glad 
President Obama is leading us that way. I think together we can reach 
that goal. I know a lot of people are confused across this country 
trying to understand exactly what is going on in this debate. But a lot 
of people in good faith are trying to solve one of the biggest problems 
we have ever faced. I hope my friends on the Republican side of the 
aisle will do more than criticize. I hope they will join us in an 
effort to make a difference.
  Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Tennessee is 
recognized.

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