[Congressional Record Volume 155, Number 156 (Monday, October 26, 2009)]
[Senate]
[Pages S10722-S10725]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. KYL. Madam President, first of all, let me associate myself with 
the remarks of the Republican leader just now. I came to the floor 
because I wanted to reflect a little bit on what the majority leader 
said a few moments ago at a press conference. He announced that as a 
result of the efforts of a couple weeks of discussions behind closed 
doors--namely, in his office--he and a few other Democrats in the 
Senate have decided on what will be in the health care reform 
legislation. That is the first matter I wished to discuss, briefly.
  The American people were told by the President they would be a full 
participant in the development of the legislation. They would know what 
it says. They would all be on C-SPAN. They would get to see everybody 
hash out all the details, and they would understand what the Senate was 
about to do. On the contrary, what has happened is, a small group of 
Senators on the Democratic side went behind closed doors in the 
Democratic leader's office, and they have been working now for many 
days to put together this piece of legislation. We still don't know 
exactly what it says, but the majority leader has described it very 
generally, and he has described one of the most contentious pieces. It 
will have government-run insurance, he assures us. Well, government-run 
insurance is a very controversial concept. Obviously, that is going to 
be the subject of a lot of debate. But the American people have a right 
to understand what this is all about, what it means.
  I think the first thing I would like to do is to say that Republicans 
are going to stand for certain principles in the consideration of this 
legislation. The first thing is we are going to want to know what it 
says. The American people have a right to know what it says. So as we 
find out, little by little, as the majority leader trickles out details 
about what is in here--or maybe one of these days we will actually get 
a written copy and we can read it and understand what is in it--we will 
share that information with the American people.
  They have a right to know what it says. They have a right to know 
what it costs. Obviously, one of the things that has to happen is that 
the Congressional Budget Office or CBO, which has this responsibility, 
needs to examine the legislation, do all of its cost estimates and 
revenue estimates, and tell us what they think it costs. The American 
people have a right to know because they are very concerned about 
passing on the costs of this legislation to the next generation--to our 
kids and grandkids.
  That brings up the third thing: How much will this increase the 
deficit? Does anybody believe that a $1 trillion health care bill is 
not going to increase the deficit? I don't know of anybody who doesn't 
believe that it is going to increase the deficit. But by how much? A 
week ago, we had the first vote on the health care debate, and it was 
on a bill to borrow $247 billion in order to ensure that physicians 
fees would not be cut. I am all for paying physicians. We need to pay 
physicians. My personal view is we need to pay them more, not less. But 
this legislation should have been part of the health care reform 
debate, because it is part of the overall cost of Medicare--for 
example, how much we reimburse physicians to take care of Medicare 
patients. No, that was going to be inconvenient because it would 
actually result in creating a larger deficit and, therefore, adding to 
our national debt. So we take that piece out and try to run it through 
as a separate bill--and by ``we'' I mean the majority leader. And he 
got a rude surprise. All of the Republicans said, of course, no, we 
should not do it that way, and 13 of his Democratic colleagues agreed. 
They cared about the deficit. They said: We don't want to add to the 
debt and, therefore, this is the wrong way to go about it. We need to 
find a better way.
  Another question the American people need to have answered is not 
only how much will it cost but how much will it add to the deficit, and 
then how much will it add to the debt that our children and 
grandchildren will have to pay? Republicans believe that any 
legislation should provide protection to all patients, whether they be 
seniors on Medicare, folks relying on Medicaid, or people in the 
private sector. Nobody should interfere with their physician or get 
between them and their physician. That is a very sacred relationship--
the doctor-patient relationship--and the government should not get in 
between that. But that is what government-run insurance is all about.
  Republicans are going to insist on protection of the American people 
from a delay and denial of care. Why do we raise delay and denial of 
care? Throughout the legislation considered by the committee so far, 
there have been numerous provisions that will result in the delay and 
denial of care and, in the long run, rationing of health care. I have 
talked about that on the Senate floor. We will examine the legislation 
that has now come out from behind the majority leader's closed doors 
and see what kinds of protections they have built in. If it is not much 
different than the bills already considered, my guess is there won't be 
any protections. Republicans will have to again present better ideas, 
our alternatives, that include protections for patients from having 
their care delayed and denied to the point that it is even rationed.
  Another thing Americans are going to want to insist on with this new 
spending is they are not going to pay for it indirectly in the form of 
higher taxes or premiums. I think No. 5 or 6 on my list is that 
Republicans will want to provide protections so that the increased 
costs of the legislation are not passed on to the American consumer in 
the form of higher taxes or in the form of higher premiums.
  Why am I concerned about that? Because, again, the CBO, which 
examined the legislation before the committees already, has said that 
the costs imposed on the insurance companies and others in the form of 
higher taxes will be passed through to their customers, to the 
beneficiaries, in the form of higher premiums. It is inevitable that 
when you have these taxes imposed among competing companies, in order 
for them to stay in business, they are going to have to pass some of 
these taxes on, and they are going to pass some of the increased fees 
on, and they are going to pass on the premium increases that will be 
required for them to satisfy the various government mandates.
  Another question is, exactly what are the government mandates here? 
What

[[Page S10723]]

are people going to be required to do that they don't have to do today? 
Most people have insurance today. It works for them and they don't want 
it interfered with. Under this legislation, every single American will 
be required under law to buy a product, an insurance product--not just 
any product, but the product defined by the Federal Government. If the 
government has the authority to make you buy something and has the 
authority to tell you what has to be in it, it also has the authority 
to tell the people who create that what they can and cannot put in 
their product. Sure enough, that is what they have done with the 
insurance companies. They have said to them that you all have to offer 
the exact value--four different kinds of policies; you have to offer at 
least the middle two, and you may offer the other two, but you cannot 
offer any less or any more, and they all have to have the same value, 
and we will mandate what they have to cover. Since we are going to have 
a ``one policy includes everybody'' product, the same insurance policy 
will have to provide the benefits I need, the benefits you need, the 
benefits the occupant of the chair needs, and the benefits the American 
people watching this need. Some of us are old, some are young, some are 
male, some are female, some have illness, and some don't. You have all 
kinds of conditions. If we can buy our own insurance, usually we can 
find a policy tailored to fit our needs, and it doesn't cost as much 
money because it doesn't cover as many things. When you have to have 
one policy that covers everything for everybody for any conceivable 
issue, you will have a huge policy with all kinds of things covered and 
with the concomitant costs--namely, costs that cover all of those 
things--meaning a premium. That is one of the reasons premiums will be 
increased.
  I think another thing we are going to have to find out about this 
legislation is, does it do what the other bills do, which is cut 
Medicare? This is important, because we have made a promise to 
America's seniors, and a lot of us have a lot of seniors in our States. 
I certainly do in Arizona. We have made a promise to seniors that we 
will provide basic care in the form of Medicare. They will have to pay 
a certain amount and the government will pay a certain amount, and it 
will provide certain benefits. Well, the seniors have said: But we 
think maybe our benefits are going to be cut. The President, Senator 
Baucus, and others have said: No, no, don't worry, your benefits will 
not be cut. The people who tell you that are trying to scare you.
  Let me quote a couple of things. Last week, a USA Today-Gallup poll 
showed that Americans overwhelmingly oppose cutting Medicare to pay for 
health care reform. Sixty-one percent of Americans oppose it--almost 2 
to 1 in opposition to cutting Medicare in order to pay for health care 
reform.
  How do we know it will cut benefits and that, therefore, seniors do 
have a right and a reason to be concerned? Let's go again to the 
nonpartisan CBO. What does it say about the legislation that has been 
debated so far? It estimates that the cost of the most moderate bill--
and there are five bills all told, and now we have a new one coming out 
of the leader's office we have not read yet. But of the five bills, the 
most moderate is the so-called Baucus bill. According to the CBO, it 
would cut Medicare by nearly $\1/2\ trillion--about $450 billion. What 
do these cuts go to?
  Here are the specifics: $162.4 billion in permanent reductions for 
most Medicare-covered services, such as services supplied by hospitals, 
nursing homes, and hospice. Those are real benefits; $117.4 billion in 
cuts to private Medicare plans, known as Medicare Advantage. Well over 
30 percent of the people on Medicare in Arizona have this Medicare 
Advantage-type plan. And $32.5 billion in cuts to home health care. 
This is something a lot of people count on, and that is a significant 
cut. There will be $22.3 billion in savings from a new Medicare 
commission that will propose automatic cuts. A lot of people laugh and 
say these commissions always propose cuts and Congress never ends up 
adopting them. That may well happen here. I know that one of two things 
will happen: Either we are not going to reduce expenses and we won't 
have enough money to pay for the new entitlement programs created by 
the legislation, because Congress won't follow the recommendations and 
adopt them, or it will and there will be real cuts in Medicare 
benefits. One of those things is true, and neither is a good result.

  Here is what CBO said about Medicare benefits. Remember, $117.4 
billion is being cut from Medicare Advantage. CBO spoke to that. It 
confirms in writing, and also to the members of the Finance Committee 
when Dr. Elmendorf appeared before us, that the value of the extra 
benefits offered by Medicare Advantage will drop from $135 per month to 
$42 per month by 2019. It gradually goes down from $135 to $42 per 
month. What are these benefits? They include dental care, vision care, 
preventive screenings, chronic care management--a whole host of things 
that are important for America's seniors.
  What is the annual value of the reduction in benefits per enrollee? 
It is only $1,116. We are not cutting benefits for seniors? Only to the 
tune of $1,116. We are cutting benefits, and seniors have a right to be 
concerned.
  Those who argue that Republicans should not be pointing this out to 
seniors--those who want to muzzle or gag us from telling seniors this 
will happen I suggest should consult CBO and realize that what they are 
asking seniors to do is beyond what they should be required to do, 
which is to take these kinds of cuts for a new entitlement.
  Let me share some comments from some of my constituents who have 
actually written to me about the kinds of cuts they will suffer under 
this legislation. I have gotten a lot of letters. I asked my staff to 
compile a few so that I could share with my colleagues where they are 
concerned about losing drug coverage, preventive care, and a decline in 
the overall quality of their care. This is what they talk about. They 
realize you cannot cut nearly $\1/2\ trillion dollars and not cut care. 
That is what it is all about.
  One patient wrote that the Medicare Advantage plan helps him afford 
the seven medications he takes every day. He said:

       I have been on Medicare now for four years and . . . my 
     Medicare Advantage plan is the best deal around for seniors. 
     The benefits for my prescriptions are a lifesaver. I could 
     not afford my prescriptions without my Medicare Advantage 
     plan. Having numerous medical problems and taking over 7 
     prescriptions per day--that can add up.

  Another senior wrote this, again, talking about the savings and 
preventive care that would be lost under the plans for Medicare 
Advantage:

       Please do not cut Medicare Advantage. It provides me with 
     so many savings on doctor visits and prescriptions, including 
     preventive care and the Silver Sneakers fitness program.

  Let me digress for a moment. We hear a lot of talk about trying to 
get people healthier, to take care of their own bodies, as it were, and 
to provide incentives for people to eat better, have a better diet, to 
lose weight, not to smoke, and to go to the gym and work out a little 
bit. When we have a program that incents seniors to do these kinds of 
things, we should be happy to support that program and cut it only 
after great consideration, if at all. I suggest that we don't cut it. 
This constituent talks about that kind of preventive care. He says:

       I will be 77 in a few weeks. I have not had any major 
     surgery or hospitalization (thank God) and go to the fitness 
     center three or four times weekly--something I could not do 
     if Medicare Advantage is cut. I urge you not to cut this very 
     important aid to senior citizens.

  Another Medicare Advantage patient wrote to explain how the extra 
benefits she gets help her. She said:

       I have never written to anybody in Congress because I 
     didn't feel it necessary. Now I do because of the threat to 
     cut my Medicare Advantage Plan.
       When I turned 65 three years ago, I opted for a Medicare 
     Advantage plan. I have been well taken care of and truly like 
     my Health Net Ruby 3 plan and want to continue on it. For a 
     small amount of $38 extra a month, I not only get dental 
     coverage, but also vision and benefits for a fitness program. 
     These extra benefits have been a great savings for me, and I 
     do not want to have them taken away. Please do not vote for a 
     cut to my Medicare Advantage plan. I want to keep my 
     benefits.

  One more letter. This one, I thought, was especially touching. It is 
from a gentleman whose wife has pulmonary fibrosis and relies on 
Medicare Advantage for her treatments. They worry that the quality of 
her treatments will

[[Page S10724]]

decline if Medicare Advantage is cut, as proposed by this legislation.
  Here is what he said:

       If we lose Medicare Advantage, we are in trouble. United 
     Healthcare Secure Horizons has provided us with great doctors 
     that understand the disease. . . . It would be disastrous if 
     she got a lung infection and had to go on a bureaucratic 
     waiting list rather than being able to call our primary 
     doctor as we do now. Please do not let them cut this great 
     program.

  The reason I quoted that letter is because another one of the things 
that is touted as a way to bend the cost curve and provide better care 
in the process is to coordinate the care from the primary physician 
right on through to any specialists and, Heaven forbid, if an 
individual has to go into a hospital, have surgery, or even have 
posthospital care in some kind of a facility. One can see how that kind 
of continued or coordinated care could be a real advantage to people 
and also end up saving money in the long term for the individual, for 
the insurance company that may take care of them, or the U.S. 
Government if we are paying for it as we do under Medicare Advantage, 
for example.
  So here is a woman who talks about the fact that this kind of plan 
has been made available to her and why would we want to take it away. 
It has always been puzzling to me that because Medicare Advantage is 
actually administered by insurance companies, there seems to be 
something evil about it that a lot of our friends on the other side of 
the aisle would like to get rid of. They talk about having a government 
choice or a government option in their health care bill, but when it 
comes to options or choices for Medicare patients, they are not for 
that. They just want government only. They don't want the Medicare 
Advantage plan because it is actually administered by insurance 
companies.
  What these companies do is provide a health maintenance organization-
type of coverage where we have the continuum of care from the primary 
physician all the way through to whatever care may be required. This 
individual is talking about his wife being benefited by that kind of 
care. Why would we want to do away with that simply to save money so we 
can create a new entitlement? At the very time Americans are asking for 
better care, to ensure their care is not taken away from them, that is 
precisely what is being proposed by the other side.
  Maybe I will be very surprised. Maybe we will finally have a chance 
to read the Reid bill or however the distinguished majority leader 
wishes to characterize it, and we will find they decided not to cut 
Medicare after all. If there are no Medicare cuts in the legislation, 
then I will be the first to come to the floor and say: Thank you. Thank 
you for not cutting seniors' Medicare. But if, in fact, as with the 
other bills that have been considered, this legislation ends up cutting 
Medicare anywhere from $450 billion to $500 billion, then I think the 
concerns that have been expressed to me by my constituents need to be 
taken into account, and Republicans will insist on protection for our 
constituents. People should not have to go through the difficulties 
that are projected by these real people if this legislation ends up 
cutting their benefits.
  We just talked about a few of the things. We have additional things 
we are going to talk about later on this week, about the tax increases 
and how the tax increases are going to be passed on to all Americans, 
even though they may, first of all, be levied against a device 
manufacturer.
  For example, if you have heart surgery and there is a stint that is 
used in your treatment, that is a very sophisticated device. There is 
going to be a tax on that device. You are going to get taxed on that 
device. It may be placed on the device itself. It will be in your bill. 
When you look at your hospital bill, I guarantee you they are going to 
be passing it on to you.
  There are other taxes. By the way, if you don't buy the insurance 
they require you to have, you are going to get a tax on that, too, 
administered by the friendly IRS, which raises a whole host of other 
problems. To have the Internal Revenue Service endorse a provision of 
this law is going to require a lot more folks down at the IRS to have 
the authority to look into your records and talk to your doctor and 
figure out whether you have bought insurance. If so, is it the right 
kind of insurance? Is it the kind of insurance the government says you 
have to have? If so, they will be happy to slap a tax on you, and you 
will have to pay for it. That is another tax you will be required to 
pay. There are others. As I said, we will talk about that later this 
week.
  Then there are the premium increases. There was a real dispute about 
this issue. Folks said: We are not going to increase premiums after 
all. The whole exercise is to reduce the cost of health care, to cut 
premiums.
  We said: That is a wonderful goal. We said: Let's see if you can come 
up with a goal that actually reduces health care premiums for people.
  After all this time, it turns out they cannot do it. The 
Congressional Budget Office--again, the nonpartisan group of 
accountants we in the Congress have hired to analyze the cost of all 
these things and the effect of them--concluded that under this 
legislation that has been considered in the committees, the cost of the 
legislation, the cost of insurance is going to go up for the average 
family, not go down, compared to what it is costing them today.
  There have been numerous studies on this issue. One of the studies 
broke it down by States and by region. They said the overall national 
increase, by the way, would be about $3,300 per year increase cost in 
premium. Think about that. We are sporting a bill, the idea of which is 
to make health care less costly, but our insurance premiums are going 
to go up $3,300 and our taxes are going to go up. Do you know the 
reason? You cannot spend $1 trillion and add a whole lot more people to 
the rolls and not have it cost more money, and it will cost more money. 
Should it?
  I think we can achieve these objectives, as I have said many times 
from this podium, with targeted solutions to the specific problems that 
exist without increasing taxes or premiums. We have demonstrated how we 
can do that. The study I spoke of, though, said in certain States, such 
as the State of Arizona from which I come, the cost is going to be far 
greater than $3,300. In fact, it is going to be, I believe it was some 
$7,400 per family per year increase. That is astounding. That is as 
much money as some people pay for their insurance to begin with.
  This study demonstrated that the increases could be as much as 95 
percent. I guess that makes sense. If it costs $8,000 for a policy 
today, and it is going to be increased by $7,400, that is almost a 100-
percent increase. It is incredible we would think about doing that on 
the American people. Yet that is the result of this absolutely 
nonpartisan study that was done by an entity that looked into all the 
different factors. They didn't cherry-pick the information. I know 
there was another group that was criticized because the insurance 
industry had hired them. That is not the study of which I speak. I am 
talking about the Oliver Wyman study.
  There are so many things about this legislation we are going to need 
to know and that the American people are going to need to know. We are 
going to have to have plenty of opportunity to both read the bill and 
know how much it costs. Then we need to know how much it puts us in 
debt.
  If the answer is it is not going to put us in any more debt or create 
a big deficit, we will just keep raising taxes until we have enough 
money to take care of it, that is not the answer either. It is not the 
way to get out of a recession, it is not the way to help hard-working 
families, and it is not the way to treat people we are trying to help 
by reducing their health care costs.
  I hope as the next several days unfold, we will be able to read this 
product, this bill that was written in the majority leader's office. 
Maybe we will be surprised that it does not raise taxes, that it does 
not raise premiums, that it does not reduce care or ration care, that 
it does not cut Medicare. But I am not going to hold my breath. My 
guess is it will do all of those things, and when the American people 
confirm that is the result of this so-called health care reform, I am 
not going to blame them for saying: Absolutely not. We want no part of 
reform if that is what you are talking about.
  I am reminded of a line. I haven't tracked down where it is, so I 
will not attribute it. I thought it came from Charles Dickens' ``A Tale 
of Two Cities.''

  There was a character, Madame Defarge, who may have said this.

[[Page S10725]]

Again, the question of the French Revolution was on their minds. This 
person said: ``Reform? Sir, don't talk of reform. Things are bad enough 
already.''
  That is apropos to this health care debate. We have costs going up 
right now. We don't need them to go up any more.
  As another wag put it: You think health care is expensive now, wait 
until it is free. We all know there is no such thing as a free lunch. 
The money has to come from somewhere. As it turns out, in these bills, 
it is going to come from seniors, people who have private insurance and 
subsidize those on government insurance, and it is going to come from 
all taxpayers, including those who make less than $200,000 a year, who 
the President said would not be taxed. A large percentage of the money, 
I think 87 percent in one case, will come from people making less than 
$100,000 per year. Some of the tax provisions specifically impact 
primarily people who make less than $50,000 a year. Health care reform 
should be about making it better for the American people, not making it 
worse.
  It is going to be very interesting when we finally have an 
opportunity to review the legislation that was created behind closed 
doors to see whether it is going to pass these tests. We want to read 
it. We want to know how much it costs. We want to know that it is not 
going to add to the deficit or the debt. We are going to want to know 
that it will not result in the delay and denial of our care. In effect, 
we are going to want to know that the protections that are important 
for our constituents are in place.
  I think there are some better ways to do this. Again, we will talk 
about those another day. We have already talked about them.
  In the event you are saying, what kind of ideas are the Republicans 
talking about, I will mention one and stand down here.
  We have been talking a lot about health care premiums and health care 
costs because doctors have to practice defensive medicine because if 
they are not careful, if they do not order a lot of tests, send their 
patients to a lot of different specialists, they are liable to get sued 
for malpractice. With this jackpot justice system we have, it costs a 
lot of money. The defensive medicine some have said can amount to $100 
billion or well over $100 billion a year. There are two studies that 
put it over $200 billion a year. Another study said just the cost of 
malpractice insurance premiums for doctors represents 10 cents on every 
health care dollar spent.
  If we could reform medical malpractice laws, we could not only make 
the delivery of health care less expensive, we could make it less 
difficult for physicians to do what they consider to be the right thing 
without fear of getting sued, and we could dramatically reduce the cost 
of health care premiums. This is a way to solve three problems that 
need to be solved, not cost a dime and, in fact, generate a huge amount 
of savings.
  Why wouldn't we want to do this? As former Governor Dean of Vermont, 
former chairman of the Democratic National Committee, said on August 17 
of this year at a townhall meeting in Virginia: The reason we haven't 
tackled medical liability reform is that we don't want to take on the 
trial lawyers.
  I understand that. He is right. The Democratic majority did not want 
to take on the trial lawyers. But that is exactly what is wrong with 
Washington today.
  We know what the problems are, we know what a lot of the fixes are, 
but we wouldn't want to take on the special interests such as the trial 
lawyers because that would not be good for us politically.
  Republicans are saying: Yes, we do. It is time to take on those 
special interests. It is time to focus solutions on specific problems 
rather than trying to reform the entire health care system, including 
with a big government-run insurance company, in order to solve a 
problem that can be solved in a less intrusive way, less government 
intervention, less government expenditure, more private freedom, more 
money left in our pockets, and a greater assurance at the end of the 
day that we are going to continue to receive high-quality health care 
and not have it denied to us because of someone sitting in Washington, 
DC.
  I urge my colleagues, as the days go forward, not only to review this 
legislation for themselves but to share those results with our 
constituents. They are the people for whom we work. They are the people 
we represent. They need to know what is in it. They need to know how 
much it will cost. They need to know it will not add to the deficit. 
They need to know it will not affect their health care. They need to 
know they will be protected and their benefits will not be cut, and 
they will be protected. It is up to us to provide that protection for 
them.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. SPECTER. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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