[Congressional Record Volume 155, Number 163 (Wednesday, November 4, 2009)]
[Senate]
[Pages S11066-S11070]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. McCONNELL. Mr. President, the American people are paying close 
attention to the ongoing debate over health care, and they have noticed 
a worrisome trend. The longer this debate goes on, the further 
Democrats in Congress seem to drift from the original purpose of 
reform.
  At the outset of this debate, the American people were told reform 
would lower costs, a goal all of us supported. The administration is 
right when it says the rising cost of health care in this country is 
unsustainable. Costs must be reined in. But the proposals we have seen 
so far don't address that problem. In fact, they make it worse. Instead 
of reining in costs, the proposals they have advanced are expected to 
drive costs even higher, costs that will then be shifted onto families 
and small businesses.
  Yesterday, I pointed out the absurdity of the situation we are in. 
Reform that was meant to lower costs is now independently confirmed to 
make health care more expensive. Reform that was meant to make life 
easier is now expected to make life harder for families, businesses, 
and seniors from one end of our country to the other.
  Let's focus on Medicare a moment, a program tens of millions of 
America's seniors rely upon. How is this program doing financially? It 
is not a pretty picture. Medicare started running a deficit last year, 
and the Medicare trust fund is expected to run out of money in less 
than a decade. Looking a little further ahead, Medicare is slated to 
spend nearly $38 trillion that it doesn't have. Simply put: Medicare is 
broke. For the sake of our seniors, we need to fix it.
  But the advocates of this legislation look at Medicare and they see 
something else. They do not see a problem to be fixed, they see a giant 
piggy bank. Rather than fix it, they want to use it to fund an entirely 
new set of government-run health care programs.
  Medicare was an attractive target for the people who wrote this bill. 
They

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were in a bind. At a time of shrinking government revenues, nearly 10 
percent unemployment, and record deficits and debt, the bill writers 
looked around for the money to cover the cost of their health care plan 
and they couldn't find it. So they decided on massive cuts to Medicare, 
cuts that will have serious consequences for millions of American 
seniors.
  I am sure they didn't want to resort to cutting Medicare when they 
started out, but the fact is they are now proposing massive cuts that 
will inevitably lead to fewer services. Here is what they plan to cut: 
$8 billion from hospice, more than $40 billion from home health care 
agencies, more than $130 billion from Medicare Advantage, and more than 
$130 billion in Medicare cuts to hospitals that care for seniors.
  At the outset of this debate, all of us knew Medicare faced 
significant challenges that needed to be addressed. A program that is 
already spending more than it is taking in, a program that is expected 
to be insolvent in just 8 years, should be fixed, not raided. Just 
about every day I receive letters in my office from Kentuckians who 
have Medicare. They are counting on this program. They are worried 
about its future. We have an obligation to our seniors, an obligation 
to keep our promises.

  At some point, the majority will have to work with Members to address 
this problem. When they do, we should focus on a solution to out-of-
control entitlement spending that Americans will embrace.
  Forty-four years ago, when President Johnson signed Medicare into 
law, he vowed that we would never refuse the hand of justice to those 
who have given a lifetime of service and wisdom and labor to their 
Nation. We have an obligation to fulfill that vow. We have an 
obligation to work together on solutions that both parties and the 
people for whom this vital program was created--seniors--will support.
  The health care plan we have seen is deeply flawed. Far from 
fulfilling the original goal of lower cost, the Democrats' bill would 
drive costs even higher--an outcome that has most Americans scratching 
their heads in confusion and disbelief. What is worse, the plan slashes 
Medicare, too, as a way to pay for new government programs.
  Clearly, the effort to reform health care has gotten off track. 
Higher taxes, higher premiums, and cuts to Medicare is not the reform 
Americans are looking for. They want commonsense, step-by-step 
solutions, not a health care experiment that makes existing problems 
worse. While some may want to move this bill as quickly as possible, 
Americans have a different message: They would like for us to start 
over.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida is recognized.
  Mr. LeMIEUX. Mr. President, I wish to follow up on the comments of 
Leader McConnell and Senator Crapo concerning Medicare. I don't think 
there is a State that is more affected by these potential cuts to 
Medicare than my home State of Florida, where we have nearly 3 million 
Floridians who enjoy the Medicare Program. Ultimately, the question in 
our health care debate is: How we are going to pay for this $1 trillion 
new program--this program that encompasses some 1,990 pages in the 
House proposal?
  As Leader McConnell said, it seems it is the opinion of the majority 
in this Chamber, and in this Congress, that the way we are going to pay 
for this new entitlement program is to take money from health care for 
seniors. Frankly, it amazes me that we would have this conversation; 
that we would take nearly $500 billion--$\1/2\ trillion--out of health 
care for seniors.
  It amazes me for a couple of reasons: One is that this money was paid 
into the system by seniors out of their paychecks for their entire 
lives. This was not some handout from government. This is a program 
they have paid into and they expect a return on it. It is a covenant 
with our seniors--our greatest generation, now retiring. We told them 
that if they paid into this system, they would have health care for the 
rest of their lives through Medicare. Now, even though this program is 
in and of itself, as Leader McConnell said, in jeopardy of going 
bankrupt in the next few years--because less people will be paying in 
and more people will be taking out--we are going to take $\1/2\ 
trillion out of this program to pay for a new program. That doesn't 
make any sense to me.
  I received a letter from one of my constituents, Shirley Anderson 
from Gotha, FL, which is right outside the Orlando area in central 
Florida, and she gets it. She says to me:

       I am writing to express my deep concern about the proposed 
     Medicare cuts in reimbursement for outpatient tests and 
     procedures. I understand that these cuts may force doctors to 
     either refuse to take care of me, as I have Medicare, or 
     leave the State of Florida altogether. It has taken me a long 
     time to find a doctor that I trust and I cannot afford to 
     lose him. If this happens I will be forced to go to the 
     hospital for these routine cardiac tests and procedures. My 
     waiting times are going to be longer and more importantly my 
     out of pocket expenses are going to be much higher and I 
     simply cannot afford this. I strongly believe this is going 
     to adversely affect my health care and well-being.

  What are we doing? We are going to jeopardize the promises we have 
already made to seniors in order to create a new program that is not 
going to reduce the cost of health care for Americans, a new program 
that is fraught with problems. It doesn't make any sense to me.
  As was stated before, the proposal in the House and what we think 
will be the proposal in the Senate--although we have not seen the final 
copy--cuts $135 billion from Medicare Advantage, $150 billion from 
hospitals that care for seniors, $51 billion from home health agencies, 
and nearly $70 billion in additional cuts or fee increases. What is 
this going to do to the process?
  I talked this morning to Ron Malone, who is the vice president of a 
health services company that provides home health care in Florida. They 
have 16 locations, they have 2,000 clinicians, they serve about 25,000 
patients. He told me this proposal, as written, is going to put half of 
the providers underwater and out of business. Half of the home health 
providers, in his estimation, will go out of business. Which ones will 
go out of business? The small companies, the companies we are trying to 
help in this economy where we have over 10 percent unemployment in 
Florida and nearly 10 percent unemployment in this country. We are 
going to put those small businesses out of business.

  Home health care saves costs. Home health care is the more affordable 
option than a nursing home. Plus seniors like it better because they 
get to stay in their own homes. We are going to put these people out of 
business. As Senator Crapo said, where is this home health care most 
important? In areas where there is not a hospital or nursing home 
available, out in the rural areas, not only in places in Idaho but 
places in Florida. So we are going to make it harder for seniors to get 
the care they want, and we are going to do something that ultimately is 
going to be more expensive.
  I want to also talk about Medicare Advantage. This is a program that 
was started to give seniors more options under Medicare. It is not a 
requirement, it is voluntary--they can choose it--and it is more like a 
private program, more like a program in the private sector where the 
companies actually cater to the seniors, provide them with more 
benefits, such as eyeglasses and dental care and hearing aids and flu 
shots. They have someone on the other side of the equation who is 
trying to give them some service, unlike government usually does.
  Now we are going to cut that program. We have 915,000 Floridians in 
Medicare Advantage, and we are going to take $150 billion out of it. So 
what is going to happen? They are going to get less services. We cannot 
get blood from a stone. When the money comes out of the program, the 
program is going to suffer. Who is going to suffer? Our seniors.
  These are increasingly popular programs in Medicare Advantage. It is 
also important to note that 40 percent of African Americans and 53 
percent of Hispanics who do not have Medicaid or employer-based 
coverage are now enrolled in Medicare Advantage. Our minority 
populations enjoy this program also.
  As a Senator from Florida, the State with the highest per capita 
population of seniors, the second highest total population of seniors 
in America--3 million seniors on Medicare--who made this country what 
it is, who are our greatest generation, who paid into this

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system and now are going to see less benefits and less care, I can't 
stand by and let that happen.
  What I am afraid of is we are going to have two classes of health 
care in this country. If we pass a bill like this, what worries me is 
that fewer providers are going to be in the Medicare system because 
their reimbursement rates are going to have to go down. So our seniors 
and our disadvantaged are not going to get the best doctors. In fact, 
someday I don't think a lot of these doctors are going to take 
insurance. So we will have one quality of health care for the rich and 
one quality of health care for everybody else. That is not American. 
That is not what we promised our seniors, and it is not something we 
should be doing.
  The Hippocratic Oath tells doctors: ``First, do no harm.'' This 
proposal, from all we can read about it, first does harm. It harms our 
most vulnerable people, our seniors, whom we owe and should respect.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Tennessee is recognized.
  Mr. ALEXANDER. Mr. President, I thank the Senator from Florida for 
his insightful remarks. I listened with interest to the Republican 
leader describe the congressional Democrats' bill, which is now about 
2,000 pages. We know we do not have a Senate bill yet. It is being 
written behind closed doors somewhere, I think in the majority leader's 
office. We are not sure who is writing it. We will have it sooner or 
later. But we do know some things about the health care bills.
  Today what I would like to talk about is just one of those things. 
Then I want to suggest what the Republican plan is because we have a 
very different approach toward dealing with health care than the 
Democratic bills that we have seen. Today I want to talk about 
Medicare.
  Medicare is very important to about 40 million Americans and to a lot 
of other Americans who are about to be of the age to depend on 
Medicare. To get it down into a nutshell, here is what all of the plans 
we have seen so far from the Democratic side propose to do: to take 
about $\1/2\ trillion over 10 years from Medicare--in other words, cut 
Medicare by $\1/2\ trillion, not to put into the Medicare Program to 
make it more solvent but to start a big new entitlement program called 
government-run health insurance for other people.
  We hear from the other side the Republicans are scaring people about 
Medicare. The Republicans aren't scaring anybody about Medicare, it is 
these Democratic bills that are scaring people about Medicare. And they 
have a right to be worried about them because the Medicare trustees 
have told us this program, that 40 million seniors depend on, is going 
to become insolvent between 2015 and 2017. That affects the 40 million 
of us who are already eligible and a part of Medicare, and it affects 
tens of millions more who will become eligible for it.
  The idea would be, if these bills are passed, to pay for new programs 
by cutting that $\1/2\ trillion from this program that is going broke. 
The Senator from Kansas, Mr. Brownback, described it this way. He said: 
This is a lot like writing a big check on an overdrawn bank account to 
buy a new car.
  He said: Your bank shouldn't let you do that, and the American people 
should not let us do this, and I don't think they will, which is why we 
are glad a number of the Democratic Senators joined with all 40 
Republicans and said to the Democratic leader: We want two things about 
this health care bill by the time it gets to us. No. 1, we want to know 
what it does; and, No. 2, we want to know what it costs.
  What that means is, it should go up on the Internet for at least 72 
hours, the complete text--that is what the letter from the Democratic 
Senators, as well as Senator Bunning in the amendment he authored, 
said--and, No. 2, we want a complete formal estimate from the 
Congressional Budget Office about what the bill costs because the 
American people are significantly worried about health care reform. 
That, as the Republican leader said, is supposed to reduce costs, 
reduce premiums, reduce the government's debt. But, instead, everything 
we heard about it so far makes it look like it is more likely to 
increase the cost of premiums, to increase taxes, and one thing we know 
for sure, it will cut Medicare. So let's talk about Medicare for a 
moment.
  A couple of weeks ago we had the first vote on health care reform. 
For the country, it was a fortunate vote because we saw a bipartisan 
act in the Senate. The proposal by the Democratic leader was to run up 
the debt another $\1/4\ trillion in Medicare spending. But 13 Democrats 
and all 40 Republicans were not going to do that. We have too much debt 
today. We had a deficit this year of $1.4 trillion, which is as much as 
the entire debt of the United States from the days of George Washington 
until 1990. So we all said: No, slowdown. It may be a worthy thing to 
do.
  It is important to deal with the physician reimbursement problem. But 
we are not going to start off the health care debate by borrowing $\1/
4\ trillion for more Medicare spending.
  The Washington Post wrote about that proposal:

       A decade ago, Congress passed legislation designed to limit 
     health-care costs by slowing the growth of Medicare payments 
     to doctors. Each year, Congress passes a patch to prevent 
     the cuts from taking effect. [The Senator from Michigan] 
     proposed to make this system ``honest'', [in her words] by 
     eliminating the cuts permanently . . . it's a strange 
     interpretation [the Washington Post said] of honesty to 
     separate this $250 billion cost from the health-care bill 
     and then claim that the other bill doesn't raise the 
     deficit.

  Fortunately, the Senate came to its senses and said no. We are not 
going to raise the debt $\1/4\ trillion for more Medicare spending. But 
the House Democrats--who came up with a 2,000-page bill they say they 
may be voting on in the next few days--apparently did not get that 
message. Their 2,000-page bill did not include the fix, or the 
physician reimbursement, which we all know is a part of health care 
reform. It is a part of the Medicare system. It has to do with the 
amount of money doctors are paid for seeing Medicare patients. It has 
to be dealt with. Yet they have left it out to the side and, again, we 
have a proposal that adds to the deficit $\1/4\ trillion.
  A Wall Street Journal editorial this week, appropriately titled ``The 
Worst Bill Ever,'' notes this absence by saying:

       The House pretends [as some Senators did] that Medicare 
     payments to doctors will be cut by 21.5 percent next year and 
     deeper after that, ``saving'' about $250 billion.

  According to the Wall Street Journal, making those kinds of 
assumptions means the 2000-page bill that has been written in the House 
is more likely to cost closer to $2 trillion over 10 years instead of 
$1 trillion. So we know the era of the 1,000-page bill is over because 
we have a 2,000-page bill; and I guess the era of the $1 trillion 
legislative proposal is over because we have a $2 trillion health care 
proposal being considered in the House.
  The article in the Wall Street Journal goes:

       All this is particularly reckless given the unfunded 
     liabilities of Medicare--now north of $37 trillion over 75 
     years.

  In other words, over the next 75 years we have $37 trillion in 
obligations that the Medicare Program has, $37 trillion more than we 
have money coming in. How is that going to make you feel if you are 
part of the Medicare Program and some Member of Congress says: OK, we 
are going to take this program with $37 trillion in unfunded 
liabilities, a program on which you rely for your Medicare, and we are 
going to cut it by $429 billion in order to start a new program for 
somebody else? I think you are going to say: I don't like that very 
much. I don't like the sound of it. And, increasingly, as Americans 
read these bills and understand what it costs and understand what they 
mean to each American, they come to that same conclusion.
  So we wait with great interest to see what bill the Senate majority 
leader will bring from behind his closed doors when he takes the 1,500-
page Finance Committee bill and the 900-page--nearly 900-page--HELP 
Committee bill in the Senate and puts it together, I assume, with this 
2,000-page bill in the House, and all of them depend on cutting 
Medicare for about half of their costs.
  Any reductions in Medicare, any savings in Medicare, any elimination 
of waste, fraud, and abuse in Medicare should go to Medicare. We should 
not be cutting grandma's Medicare to spend money on somebody else. We 
ought to save money in grandma's Medicare to spend on grandma because 
grandma's Medicare Program is going

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broke. That is what the Medicare trustees have told us.
  What does this mean for seniors? The Senator from Florida outlined 
them: Nearly $140 billion in cuts to Medicare Advantage--one out of 
four seniors, I believe, has a Medicare Advantage Program--nearly $150 
billion in Medicare cuts to hospitals that care for seniors, more than 
$40 billion from home health agencies, nearly $8 billion from hospices.
  My understanding is the House bill also makes roughly $100 billion in 
Medicare cuts for hospitals that care for seniors--this is the House 
bill--$57 billion from home health agencies, and nearly $24 billion 
from nursing homes.
  The President stated that while ``people who are currently signed up 
for Medicare Advantage are going to have Medicare at the same level of 
benefits. . . .'' That was President Obama. Yet the Congressional 
Budget Office Director, the nonpartisan Congressional Budget Office 
Director, said after looking at the Senate Finance health care bill 
that fully half of the benefits currently provided to seniors under 
Medicare Advantage would disappear.
  The Congressional Budget Office Director said the charges would 
reduce the extra benefits, such as dental, vision, and hearing 
coverage, that would be made available to beneficiaries.
  What about the cost to the government? Remember, as the Republican 
leader said, we thought health care reform was about cost.
  I remember being invited--I appreciated it very much--to a summit 
President Obama had earlier this year on entitlement spending. The 
President said he needed to work on that, and every speaker who was 
there said that if we do not do something about health care spending, 
about Medicaid and about Medicare, we are going to go broke as a 
country and that almost all of our debt and deficit problems are 
related to health care spending.
  So our goal here is to reduce the cost of premiums to individual 
Americans and reduce the cost of government to individual Americans. 
That should be our goal. But according to the Congressional Budget 
Office, the cost of the 2,000-page House bill reflects a gross spending 
total of over $1 trillion. Now, who thinks we can spend another $1 
trillion without adding to the debt? I don't think many Americans do. 
This mainly includes outlays for Medicaid, children's health, and 
subsidies.
  According to the Budget Committee's staff, though, the real 10-year 
cost of the Senate Finance Committee bill when fully implemented would 
be closer to $2 trillion--$1.8 trillion--because the main spending 
provisions do not go into effect for another few years, starting in 
2013. The taxes and the fees--the new taxes, nearly $1 trillion in 
taxes--start right away, over the full 10 years, but the benefits don't 
start until 2013. They make some other assumptions along the way such 
as that there will be a Medicaid commission, which will cut Medicare 
more. Well, those procedures haven't worked so far. And if there are 
savings in Medicare, they should be spent on Medicare, not to start 
some new program.
  So Republicans--and, we hope, discerning Democrats--are not scaring 
seniors about Medicare; these bills are scaring seniors about Medicare. 
And they have a right to be worried. They have a right to be worried 
because they are the 40 million Americans who depend on Medicare. Just 
answer the question for yourself. If we are going to take $\1/2\ 
trillion out of your Medicare Program that the trustees say is going to 
go broke in a few years and spend it on someone else, what does that do 
to your Medicare benefits? It puts them in more jeopardy, is the only 
obvious answer to that.
  So we have proposals that, so far, cut Medicare, raise taxes, raise 
premiums, add to the debt, transfer expenses to the State that 
Democratic and Republican Governors say will bankrupt some States--
these are the Medicaid Programs--and they create a new government-run 
program.
  I am already getting e-mails from businesspeople in Tennessee who 
said that if a bill like this goes through, they are out of providing 
health care to their employees, they can't stand the costs. And so 
millions of Americans will be losing their employer insurance and 
shifting over to the new government program which is being paid for by 
grandma's Medicare. That is the scheme that is being put together here.
  Mr. President, how much time is remaining?
  The PRESIDING OFFICER. The Senator has 14\1/2\ minutes remaining.
  Mr. ALEXANDER. I thank the Chair.
  So here is what we know about the Congressional Democratic health 
care plan which is 2,000 pages long: higher premiums, Medicare cuts, 
higher taxes, more debt. It is a government-run plan. When you put the 
whole scheme together, if you are one of the 177 million whose employer 
provides insurance to you, you run a great risk--let's say it this 
way--of losing your employer insurance because the employer says: I 
can't afford to provide it anymore, and plus, the government started a 
new program, so you go over to the government program. That could lead 
to rationing. Your Governor will tell you the States can't afford the 
costs being transferred to them, so that means either higher State 
taxes or higher college tuition to pay for the reduced payments to 
public higher education, and a $2 trillion cost over 10 years, 
according to the Wall Street Journal. That is not real health care 
reform.
  So what is real health care reform? What is the Republican plan or 
what hopefully could be a bipartisan plan that we could work on? We 
would suggest, and we have suggested this day after day, week after 
week, committee meeting after committee meeting: Let's start over. We 
are headed in the wrong direction. Let's go in the right direction. And 
the right direction is having the simple goal of reducing costs, costs 
to those paying for health care insurance, in their premiums, and the 
cost to the government, which we all have to pay for as well. And how 
do we do it? Instead of a big, comprehensive, 2,000-page, $2 trillion, 
full of surprises and mandates bill that terrifies everyone, let's go 
step by step in the right direction, which in this case is reducing 
costs.
  What would that mean? Well, No. 1, we could start with a small 
business health insurance plan. This permits small businesses all 
across America to pool their resources and leverage those resources.
  Let's say you are in a small business and there are 80 employees. Two 
people get very sick, and they use up all of the available money that 
small business has to help pay for employees' health care. The employer 
has to say, I have to reduce everybody's health care; or, I am sorry, I 
just can't offer it anymore. But if you allow that small business to 
join with small businesses all across America and pool their resources 
and leverage their money, then you have a different outcome. According 
to the Congressional Budget Office, that would mean 750,000 more 
Americans would be insured. It would mean three out of four people 
insured by small businesses would pay lower premiums. And it would 
reduce the cost of Medicaid, as those people went onto their own 
private insurance, by $1.4 billion. So more people insured at lower 
costs for premiums and less debt for Medicaid--that is one step on 
which we should be able to agree. Senator Enzi and the late Senator 
Kennedy worked on that for a long time, but we have not passed it. Why 
don't we pass it as the first step? That is 88 pages; that is not 2,000 
pages.
  Then a second step: Why don't we allow Americans to buy insurance 
across State lines? That increases competition. We have a number of 
bills that have been introduced that would allow that. Senator DeMint 
of South Carolina has one of those bills, and that is 30 pages, not 
2,000 pages.
  Junk lawsuits. Virtually everyone who has looked at it agrees that 
lawsuits against doctors add to the cost of health care that we all 
pay. Some States have taken some steps and shown it makes a real 
difference. Maybe it is a small part of the cost, maybe it is a large 
part of the cost, but it is a part of the cost. Anyone who is injured--
anyone who is injured by a negligent doctor should be paid 100 percent 
of the damage to that person. But this would begin to restrict the 
punitive damages that are often added to that which greatly benefit the 
trial lawyer and increase the cost to all of us. So why don't we take 
steps to do this?
  We know of examples in my State of Tennessee--and I am sure in 
virtually every State--where OB/GYN doctors

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have moved out of rural counties because their medical malpractice 
premiums have gone through the roof. They just will not practice 
anymore. So pregnant women are having to travel to Memphis, 60 or 80 
miles, for their prenatal health care and to deliver their babies. They 
do not have that service in the county where they live. This would help 
them, those women, and this would help reduce costs.
  So those are three steps we can take.
  A fourth step would be equal tax treatment for every individual on 
our health care tax policy. That is 21 pages.
  Information technology for health care--this may take a few years to 
actually reduce costs, but virtually everyone agrees that the record 
keeping in our health care system is a great drag on the productivity 
and an obvious addition to the cost. Democrats as well as Republicans 
have worked on legislation to change this.
  There is a 13-page bill introduced by Senators Coburn, Burr, and 
Enzi. I am sure there are good proposals on the Democratic side. We 
could take that step. And that would be five steps.
  Then we could help create more health care exchanges. That is in many 
of the bills. It is common to many of them. It is a supermarket in 
which any individual can go to buy, more easily, a health care plan for 
that individual or for that person's family. It just takes eight pages 
to create better health care exchanges across this country.
  And then waste, fraud, and abuse. Senator LeMieux from Florida, the 
new Senator, made his maiden address on waste, fraud, and abuse. It is 
a scandal that, in the Medicaid Program, for example, $1 out of every 
$10 is waste, fraud, and abuse. That is $32 billion a year. We can go 
to work on that in a variety of ways, which he talked about this 
morning. That is just 21 pages.
  So there are seven steps in the right direction which are reducing 
health care costs. We should be able to take those steps in a 
bipartisan way.
  So we have a choice of approaches here in the Congress. The American 
people want real health care reform, but they do not believe that 
raising taxes, raising premiums, cutting Medicare, increasing the debt, 
and 2,000-page bills full of surprises are real health care reform.
  The American people are properly skeptical of a grand and risky 
scheme that claims we are wise enough to solve everything at once. They 
know we are more likely to mess up everything at once if we try such 
risky schemes. So to re-earn the trust of the American people, we 
should go step by step. Here is the choice: a 2,000-page bill or a 200-
page bill.
  Sometimes, the assistant Democratic leader will come on the floor and 
say: Where is the Republican plan? I said to him yesterday, if he is 
waiting for Senator McConnell to bring a wheelbarrow in here with a 
2,000-page Republican alternative that costs $2 trillion and is just 
our way to spend $2 trillion and is full of surprises and our grand and 
risky scheme, he is going to be waiting a long time because he is not 
going to see it. We are going to bring up several steps which we know 
will reduce costs, which we know we can afford, which we know will help 
people, which we know we can implement, and which we believe will have 
significant Democratic support as well as Republican support.
  So is it 2,000 pages or 200 pages? Reduce premiums or increase 
premiums? Reduce debt or increase debt? Cut Medicare and start some new 
program with it or make Medicare solvent by taking any savings we can 
find in Medicare and use it to help Medicare?
  Higher taxes--I did not say much about that, but there is $900 
billion of new taxes in the program when it is fully implemented in the 
Finance Committee program. And the Congressional Budget Office Director 
said the obvious about that--by and large, most of those new taxes will 
be passed on to whom? Those of us who pay insurance premiums. So there 
is another reason your premiums are going up, and the cost.
  We should be able to enact a good health care plan this year. The 
country needs for us to do that. But we Republicans are offering a real 
choice to the American people. The American people are appropriately 
skeptical of risky schemes that run up the debt, cost $2 trillion, and 
are filled with higher premiums, more taxes, and Medicare cuts.
  To re-earn the trust of the American people, we should set a charge 
goal of reducing costs and move step by step in that direction. That is 
the Republican health care plan, and I believe that is a plan 
Republicans and Democrats can agree upon.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Kirk). The Senator from Ohio.

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