[Congressional Record Volume 156, Number 35 (Thursday, March 11, 2010)]
[Senate]
[Pages S1421-S1426]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. Madam President, the Senator from Arizona and I and 
Senator Barrasso, who will be here in a few minutes, had the privilege 
of

[[Page S1422]]

being invited by the President to a lengthy health care summit a couple 
of weeks ago at the Blair House, a historic location right across from 
the White House.
  Over the 7\1/2\-hour discussion, there were some obvious differences 
of opinion. In fact, my friend, the majority leader, said: Lamar, you 
are not entitled to your own facts. I think he is right about that. We 
want to use the real facts. But the American people, once again, seem 
to have understood the real facts.
  In the Wall Street Journal yesterday, March 10, there was an article 
by Scott Rasmussen and Doug Schoen. Mr. Rasmussen is an independent 
pollster, and Mr. Schoen was President Clinton's pollster. Here is one 
of the things they said. We were saying, with respect to the President: 
Mr. President, your plan will increase the deficit. This is a time when 
many people in America believe the deficit is growing at an alarming 
rate and will bring the country to its knees in a few years if we do 
not do something about it. The President and his Democratic colleagues 
said: No, the Congressional Budget Office says we do not increase the 
deficit.
  The American people do not believe that, according to Mr. Rasmussen 
and Mr. Schoen. They say:

     . . . 66 percent of voters believe passage of the President's 
     plan will lead to higher deficits.

  They are right about that. Why do I say that? Because not included in 
the comprehensive health care plan that the President has yet to send 
up--we do not have a bill yet. We have an 11-page memo which is 
suggested recommendations in a 2,700-page Senate bill. We do not have a 
bill. But the plan does not include what it costs to prevent the 
planned 22 percent pay cuts for doctors that serve Medicare patients 
over the next 10 years. According to the President's own budget--and 
Paul Ryan, the Congressman from Wisconsin, brought this up at the 
summit--that costs $371 billion over 10 years.
  Let me say that once more. What we are being asked to believe is, 
here is a comprehensive health care plan that does not add to the debt, 
but it does not include what it costs to prevent the planned 22 percent 
pay cuts for doctors that serve Medicare patients. That is akin to 
asking you to come to a horse race without a horse. Does anybody 
believe a comprehensive health care plan is complete and comprehensive 
if it does not include what you actually are going to pay doctors to 
see Medicare patients? Of course not. You have to include that in 
there. That adds $371 billion to the President's proposal, and that, by 
itself, makes it clear the proposal adds to the deficit.
  The Senator from Arizona is here, and I say this to the Senator. Also 
in the article in the Wall Street Journal it said:

       Fifty-nine percent of the voters say that the biggest 
     problem with the health care system is the cost. . . .

  That is what we have been saying over and over again. Let's don't 
expand a program that costs too much. Let's fix the program by reducing 
costs.
  According to the survey--remember this is an independent pollster and 
a Democratic pollster:

       Fifty-nine percent of voters say that the biggest problem 
     with the health care system is the cost: They want reform 
     that will bring down the cost of care. For these voters, the 
     notion that you need to spend an additional trillion dollars 
     doesn't make sense. If the program is supposed to save money, 
     why does it cost anything at all?

Asked the pollsters.
  I ask the Senator from Arizona that question. If this program is 
supposed to save money, reduce costs, why does it cost anything at all?
  Mr. McCAIN. Madam President, I say to my friend, obviously, the 
answer to that question is, they continue to go back to the 
Congressional Budget Office with different assumptions in order to get 
the answers they want when the American people have figured it out.
  Again, I know my friend from Tennessee saw yesterday's news, which 
has to be considered in the context of the cost of this bill, which 
Congressman Ryan estimates at around $2.5 trillion with true budgeting 
over 10 years. But we cannot ignore the fundamental fact that ``the 
government ran up''--this is an AP article yesterday:

       The government ran up the largest monthly deficit in 
     history in February, keeping the flood of red ink on track to 
     top last year's record for the full year.

  The Treasury Department said Wednesday that the February deficit 
totaled $220.9 billion, 14 percent higher than the previous record set 
in February of last year.

       The deficit through the first 5 months of this budget year 
     totals $651.6 billion, 10.5 percent higher than a year ago.
       The Obama administration is projecting that the deficit for 
     the 2010 budget year will hit an all-time high of $1.56 
     trillion, surpassing last year's of $1.4 trillion total.

  I say to my friend from Tennessee, these are numbers that in our 
younger years we would not believe. We would not believe we could be 
running up these kinds of deficits. Yet we hear from the President and 
from the administration that things are getting better--certainly not 
from the debt we are laying onto future generations of Americans.
  May I mention also in this context--I wonder if my friend from 
Tennessee will agree with me that there is so much anger out there over 
porkbarrel spending and earmark spending that the Speaker of the House 
said they are going to ban earmarks in the other body for for-profit 
companies. I think that is a step forward. Why not ban them all? 
Immediately they would set up shadow outfits.
  Chairman Obey says that would be 1,000 earmarks. In one bill last 
year, there were 9,000 earmarks. So why don't we take the final step 
and put a moratorium on earmarks until we have a balanced budget, until 
there is no more deficit? I think that is what the American people 
wanted to get rid of--this corruption that continues there.
  But I would also mention to my friend from Tennessee very briefly 
that the President, when he and I sat next to each other at Blair 
House, and I talked about the special deals for the special interests 
and the unsavory deal that was cut with PhRMA and how the American 
people are as angry about the process as the product, the President's 
response to me was--and there is a certain accuracy associated with 
it--the campaign is over.
  Well, I would remind my friend that before the campaign--even before 
the campaign--when the President was still a Senator, he said this 
about reconciliation:

       You know, the Founders designed this system, as frustrating 
     [as] it is, to make sure that there's a broad consensus 
     before the country moves forward. . . . And what we have now 
     is a president who--

  And there he was referring to President Bush--

     hasn't gotten his way. And that is now prompting, you know, a 
     change in the Senate rules that really I think would change 
     the character of the Senate forever. . . . And what I worry 
     about would be you essentially have still two chambers--the 
     House and the Senate--but you have simply majoritarian 
     absolute power on either side, and that's just not what the 
     founders intended.

  That was a statement by then-Senator Barack Obama. Then he went on to 
say:

       I would try to get a unified effort saying this is a 
     national emergency to do something about this. We need the 
     Republicans, we need the Democrats.

  Just yesterday, of course, at rallies around the country, he said: It 
is time to vote.
  It is time to vote, is his message, which certainly is attractive. We 
will be glad to vote. But we want to vote preserving the institution of 
the Senate and the 60-vote rule.
  In the interest of full disclosure, Republicans, when they were in 
the majority, tried to change it, as the Senator from Tennessee 
remembers. But the fact is, if we take away the 60-vote majority that 
has characterized the way this body has proceeded, we would then have 
just what then-Senator Obama said:

       You essentially have still two Chambers--the House and the 
     Senate--but you have simply majoritarian absolute power on 
     either side, and that's just not what the founders intended.

  I wonder if my colleague from Tennessee would like to comment on 
whether the President still believes that is not what the Founders 
intended.
  Mr. ALEXANDER. Madam President, I appreciate the Senator from Arizona 
bringing this up, and I think it is important for the American people 
to be reminded that the Senator from Arizona has a certain amount of 
credibility on this matter because about 4 years ago--when we were in 
the majority and we became frustrated because

[[Page S1423]]

Democrats were blocking President Bush's judicial appointments--it was 
the Republicans who said--I didn't, but some Republicans said--well, 
let's just jam it through. We won the election, let's get it with 51 
votes. Let's change the rules.
  But Senator McCain and a group of others said: Wait just a minute. He 
said then what he has said just today. He said the U.S. Founders set up 
the Senate to be a protector of minority rights. As Senator Byrd, the 
senior Democratic Senator, has said: Sometimes the minority is right. 
And it was Alexis de Tocqueville who said, when he wrote his 
observations about our country in the 1830s, that potentially the 
greatest threat to American democracy is the tyranny of the majority.
  This is supposed to be a place where decisions are made based upon 
consensus, not just a majority. As Senator Byrd has said: Running the 
health care bill through the Senate like a freight train is an outrage. 
It would be an outrage.
  I would ask the Senator from Arizona whether he believes it is not 
just the higher premiums and the higher taxes and the extra costs to 
States; that, in the end, the reason this health care bill is so deeply 
unpopular is because of the process because, first, there were 25 days 
of secret meetings, and now they are jamming it through by a partisan 
vote. Something this big, this important ought to be decided by 
consensus in the Senate.
  Mr. McCAIN. I would also remind my friend from Tennessee of Senator 
Byrd's comments regarding reconciliation and health care reform.
  Madam President, I ask unanimous consent to have printed in the 
Record Senator Robert Byrd's statement on the floor of the Senate from 
April of 2001.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 Senator Byrd on the Use of Reconciliation for the Clinton Health Plan

       U.S. Senator Robert Byrd on the Floor of the Senate in 
     April of 2001 explaining his objection to using 
     reconciliation to pass controversial health care legislation 
     (Clinton plan):
       ``The democratic leadership pleaded with me at length to 
     agree to support the idea that the Clinton health care bill 
     should be included in that year's reconciliation package. 
     President Clinton got on the phone and called me also and 
     pressed me to allow his massive health care bill to be 
     insulated by reconciliation's protection. I felt that changes 
     as dramatic as the Clinton health care package, which would 
     affect every man, woman and child in the United States should 
     be subject to scrutiny.
       ``I said Mr. President, I cannot in good conscience turn my 
     face the other way. That's why we have a Senate. To amend and 
     debate freely. And that health bill, as important as it is, 
     is so complex, so far-reaching that the people of this 
     country need to know what's in it. And, moreover, Mr. 
     President, we Senators need to know what's in it before we 
     vote. And he accepted that. He accepted that. Thanked me and 
     said good bye.''
       ``I could not, I would not, and I did not allow that 
     package to be handled in such a cavalier manner. It was the 
     threat of the use of the Byrd rule.''
       ``Reconciliation was never, never, never intended to be a 
     shield, to be used as a shield for controversial 
     legislation.''

  Mr. McCAIN. Let me explain his objection to using reconciliation to 
pass controversial health care legislation by quoting from Senator 
Robert Byrd:

       The Democratic leadership pleaded with me at length to 
     agree to support the idea that the Clinton health care bill 
     should be included in that year's reconciliation package. 
     President Clinton got on the phone and called me also and 
     pressed me to allow his massive health care bill to be 
     insulated by reconciliation's protection. I felt that changes 
     as dramatic as the Clinton health care package, which would 
     affect every man, woman child in the United States would be 
     subject to scrutiny.
       I said, Mr. President, I cannot in good conscience turn my 
     face the other way. That's why we have a Senate. To amend and 
     debate freely. And that health bill, as important as it is, 
     is so complex, so far-reaching that the people of this 
     country need to know what's in it.

  Let me note here what the Speaker of the House said on March 9:

       We have to pass the bill so that you can find out what is 
     in it.

  Now, continuing to quote from Senator Robert Byrd:

       And, moreover, Mr. President, we Senators need to know 
     what's in it before we vote. And he accepted that. He 
     accepted that. Thanked me and said good bye.
       I could not, I would not, and I did not allow that package 
     to be handled in such a cavalier manner. It was the threat of 
     the use of the Byrd rule. Reconciliation was never, never, 
     never intended to be a shield, to be used as a shield for 
     controversial legislation.

  I might also point out that the Senator from Tennessee mentioned the 
process. I don't think the American people understand that if the House 
passes the Senate bill, every one of these sweetheart deals that were 
included behind closed-door negotiations in the majority leader's 
office and in the White House will remain in that bill. We Republicans 
have all signed a letter, 41 votes, that we will not accept any change 
or amendment, whether it is good or bad, because we oppose the use of 
reconciliation, as Robert Byrd did so eloquently back in 2001.
  Mr. ALEXANDER. I wonder if the Senator from Arizona would agree with 
me that what is happening is the President is inviting the House 
Democrats to join hands and jump off a cliff and hope Senator Reid 
catches them.
  Mr. McCAIN. Will the C-SPAN cameras be in those meetings, I would ask 
my friend?
  Mr. ALEXANDER. Well, when they jump, they may be. But Senator Reid 
and his Democratic colleagues, I would say to my friend from Arizona, 
are not going to have any incentive to catch these House Members who 
vote for the bill because the President will have already signed it 
into law, and he will be well on his way to Indonesia, as the Senator 
from Arizona has just said. We have 41 Republican Senators who have 
signed a letter saying that you are not going to make new deals and 
send them over here and change them by reconciliation.
  Mr. McCAIN. Madam President, I ask unanimous consent to have printed 
in the Record an article entitled ``Health-Care Reform's Sickeningly 
Sweet Deals'' by Kathleen Parker, which appeared in the Washington Post 
on Wednesday, March 10.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               [From the Washington Post, Mar. 10, 2010]

              Health-Care Reform's Sickeningly Sweet Deals

                          (By Kathleen Parker)

       ``Skipping through the Candy Land of the health-care bill, 
     one is tempted to hum a few bars of ``Let Me Call You 
     Sweetheart.''
       ``What a deal. For dealmakers, that is. Not so much for 
     American taxpayers, who have been misled into thinking that 
     the sweetheart deals have been excised.''
       ``Not only are the deals still there, but they're bigger 
     and worser, as the Bard gave us permission to say. And the 
     health-care ``reform'' bill is, consequently, more expensive 
     by billions.''
       ``Yes, gone (sort of) is the so-called Cornhusker kickback, 
     extended to Nebraska Sen. Ben Nelson when his 60th vote 
     needed a bit of coaxing. Meaning, Nelson is no longer 
     special. Instead, everyone is. All states now will get their 
     own Cornhusker kickbacks. And everything is beautiful in its 
     own way.''
       ``Originally, Nelson had secured 100 percent federal 
     funding for Nebraska's Medicaid expansion--in perpetuity--
     among other hidden prizes to benefit locally based insurance 
     companies. When other states complained about the unfair 
     treatment, President Obama and Congress ``fixed'' it by 
     increasing the federal share of Medicaid to all states 
     through 2017, after which all amounts are supposed to 
     decrease.''
       ``Nelson's deal might have escaped largely unnoticed, if 
     not for his pivotal role on the Senate vote last December. 
     The value of what he originally negotiated for Nebraska--
     about $100 million--wasn't that much in the trillion-dollar 
     scheme of things, but the cost of the ``fix'' runs in the 
     tens of billions, according to a health lobbyist who crunched 
     the numbers for me.''
       Other sweetheart provisions that remain in the bill include 
     special perks for Florida (``Gatorade''), Louisiana (``The 
     Louisiana Purchase''), Nevada, Montana, Wyoming, North Dakota 
     and Utah (``The Frontier States''). There may well be others, 
     and staffers on the Hill, who come to work each day equipped 
     with espresso shooters, magnifying glasses and hair-
     splitters, are sifting through the stacks of verbiage.
       Wearily, one might concede that this is, well, politics as 
     usual. But weren't we supposed to be finished with backroom 
     deals? Whither the transparency of the Promised Land?
       To his credit, Obama conceded McCain's point in a post-
     summit letter to Congress, noting that some provisions had 
     been added to the legislation that shouldn't have been. His 
     own proposal does not include the Medicare Advantage 
     provision mentioned by McCain that allowed extra benefits for 
     Florida, as well as other states. The president also 
     mentioned that his plan eliminates the Nebraska yum-yum (not 
     his term), ``replacing it with additional federal financing 
     to all states for the expansion of Medicaid.''
       More fair? Sure, but at mind-boggling cost to taxpayers. To 
     correct a $100 million mistake, we'll spend tens of billions 
     instead.

[[Page S1424]]

       Throughout the health-care process, the Democrats' modus 
     operandi has been to offer a smarmy deal and then, when 
     caught, to double down rather than correct course. The 
     proposed tax on high-end ``Cadillac'' insurance policies to 
     help defray costs is another case in point. Pushed by the 
     President, and initially passed by the Senate, the tax was 
     broadly viewed as an effective way to bend the cost curve 
     down. But then labor unions came knocking and everyone caved. 
     The tax will be postponed until 2018.
       And the cost of the union compromise? According to the 
     Congressional Budget Office, the original Cadillac tax would 
     have saved the Treasury $149 billion from 2013 to 2019. Under 
     the postponed tax, the savings will probably plunge to just 
     $65 billion, or a net loss to the Treasury of $84 billion.
       Regardless of what the CBO reports in the coming days, no 
     one can claim the bill is as lean as it could be. A spoonful 
     of sugar may indeed help the medicine go down, but even King 
     Kandy and the Gingerbread People can choke on too many 
     sweets.

  Mr. McCAIN. I think Kathleen Parker says it best, and let me quote 
from her article:

       Skipping through the Candy Land of the health-care bill, 
     one is tempted to hum a few bars of ``Let Me Call You 
     Sweetheart.'' What a deal. For dealmakers, that is. Not so 
     much for American taxpayers, who have been misled into 
     thinking the sweetheart deals have been excised.

  That is why I say to my friend from Tennessee, it is important the 
American people understand that the Senate bill cannot be changed 
without coming back to the Senate. Therefore, all these deals they have 
pledged to remove will be in the bill that will be voted on by the 
other body--the ``Cornhusker kickback,'' which, by the way, had to 
secure 100 percent Federal funding for Nebraska's Medicaid expansion in 
perpetuity, among other hidden prizes to benefit locally based 
insurance companies. When other States complained about the unfair 
treatment, President Obama and Congress fixed it by increasing the 
Federal share of Medicaid to all States through 2017, after which all 
amounts are supposed to decrease. But they didn't fix it.
  Anyway, I think it is important for us to understand that these 
sweetheart deals have not been removed and that we are in opposition to 
this entire reconciliation which would lead to the erosion and eventual 
destruction of the 60-vote procedure that has characterized the way the 
Senate has operated.
  I have been in the majority, and I have been in the minority, and 
when I have been in the majority, we have been frustrated by the 60-
vote rule and vice versa. Some of the people who are doing the greatest 
complaining and arguing about the fact that we have a 60-vote rule are 
the same ones who were the most steadfast defenders of it in past years 
when they were in the minority. That alone is enough argument for us to 
leave the process alone.
  I believe historians will show that there are times where the 60-vote 
rule, because of the exigency of the moment, averted us from taking 
actions; and later on, in perhaps calmer times, we were glad that we 
did not act at that time.
  Mr. ALEXANDER. Madam President, I congratulate the Senator from 
Arizona for his consistency, for 5 years ago saying to members of his 
own party that the Senate is a place where minority rights are 
protected. As Senator Byrd has said, sometimes the minority is right. 
It slows things down, yes; but it forces us to get it right.
  I ask unanimous consent to have printed in the Record the editorial 
from the Wall Street Journal to which I referred a little earlier.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                     [From the Wall Street Journal]

              Why Obama Can't Move the Health-Care Numbers

                  (By Scott Rasmussen and Doug Schoen)

       One of the more amazing aspects of the health-care debate 
     is how steady public opinion has remained. Despite repeated 
     and intense sales efforts by the president and his allies in 
     Congress, most Americans consistently oppose the plan that 
     has become the centerpiece of this legislative season.
       In 15 consecutive Rasmussen Reports polls conducted over 
     the past four months, the percentage of Americans that oppose 
     the plan has stayed between 52% and 58%. The number in favor 
     has held steady between 38% and 44%.
       The dynamics of the numbers have remained constant as well. 
     Democratic voters strongly support the plan while Republicans 
     and unaffiliated voters oppose it. Senior citizens--the 
     people who use the health-care system more than anybody else 
     and who vote more than anybody else in mid-term elections--
     are more opposed to the plan than younger voters. For every 
     person who strongly favors it, two are strongly opposed.
       Why can't the president move the numbers? One reason may be 
     that he keeps talking about details of the proposal while 
     voters are looking at the issue in a broader context. Polling 
     conducted earlier this week shows that 57% of voters believe 
     that passage of the legislation would hurt the economy, while 
     only 25% believe it would help. That makes sense in a nation 
     where most voters believe that increases in government 
     spending are bad for the economy.
       When the president responds that the plan is deficit 
     neutral, he runs into a pair of basic problems. The first is 
     that voters think reducing spending is more important than 
     reducing the deficit. So a plan that is deficit neutral with 
     a big spending hike is not going to be well received.
       But the bigger problem is that people simply don't trust 
     the official projections. People in Washington may live and 
     die by the pronouncements of the Congressional Budget Office, 
     but 81% of voters say it's likely the plan will end up 
     costing more than projected. Only 10% say the official 
     numbers are likely to be on target.
       As a result, 66% of voters believe passage of the 
     president's plan will lead to higher deficits and 78% say 
     it's at least somewhat likely to mean higher middle-class 
     taxes. Even within the president's own political party there 
     are concerns on these fronts.
       A plurality of Democrats believe the health-care plan will 
     increase the deficit and a majority say it will likely mean 
     higher middle-class taxes. At a time when voters say that 
     reducing the deficit is a higher priority than health-care 
     reform, these numbers are hard to ignore.
       The proposed increase in government spending creates 
     problems for advocates of reform beyond the perceived impact 
     on deficits and the economy.
       Fifty-nine percent of voters say that the biggest problem 
     with the healthcare system is the cost: They want reform that 
     will bring down the cost of care. For these voters, the 
     notion that you need to spend an additional trillion dollars 
     doesn't make sense. If the program is supposed to save money, 
     why does it cost anything at all?
       On top of that, most voters expect that passage of the 
     congressional plan will increase the cost of care at the same 
     time it drives up government spending. Only 17% now believe 
     it will reduce the cost of care.
       The final piece of the puzzle is that the overwhelming 
     majority of voters have insurance coverage, and 76% rate 
     their own coverage as good or excellent. Half of these voters 
     say it's likely that if the congressional health bill becomes 
     law, they would be forced to switch insurance coverage--a 
     prospect hardly anyone ever relishes. These numbers have 
     barely moved for months: Nothing the president has said has 
     reassured people on this point.
       The reason President Obama can't move the numbers and build 
     public support is because the fundamentals are stacked 
     against him. Most voters believe the current plan will harm 
     the economy, cost more than projected, raise the cost of 
     care, and lead to higher middle-class taxes.
       That's a tough sell when the economy is hurting and people 
     want reform to lower the cost of care. It's also a tough sell 
     for a president who won an election by promising tax cuts for 
     95% of all Americans.

  Mr. ALEXANDER. Madam President, I ask unanimous consent that the 
Senator from Wyoming be allowed to lead the colloquy in our remaining 
time.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. McCAIN. Madam President, may I ask the Senator from Wyoming if is 
he aware of a letter written to House leadership, representing, I 
believe, 85,000 physicians who oppose this legislation?
  Mr. BARRASSO. I am not aware of that article, but I look forward to 
hearing about it from my colleague from Arizona.
  Mr. McCAIN. Let me quote a little for my colleague, Dr. Barrasso:

       The undersigned state and national specialty medical 
     societies--representing more than 85,000 physicians and the 
     millions of patients they serve--are writing to oppose 
     passage of the ``Patient Protection and Affordable Care 
     Act.'' The changes that were recently proposed by President 
     Obama do not address our many concerns with this legislation, 
     and we therefore urge you to draft a more patient-centered 
     bill that will reform the country's flawed system for 
     financing healthcare, while preserving the best healthcare in 
     the world.

  At this point, I want to ask my friend, the doctor, isn't it true 
that included in this legislation remains the so-called doc fix, and 
that there will be a 21-percent cut in doctors payments for treatment 
of Medicare enrollees? There is no one in America who believes that cut 
will actually be enacted, which then makes the comments by supporters 
of this bill false on their face--just that alone. I believe that is 
$371 billion; is that correct?
  Mr. BARRASSO. My colleague is absolutely correct. That is exactly 
what is happening. They call this a health

[[Page S1425]]

care bill. It doesn't seem to address the major issues that patients 
across the country are concerned about. My colleague is absolutely 
right, we need a patient-centered approach. It doesn't address the 
issue that doctors are concerned about, which is the issue of making 
sure a doctor and a patient can work together toward the best health 
for that patient.
  Doctors and patients alike are very much opposed to this bill. When 
Senator McCain talks about the doctor fix to make this bill work, they 
say they are going to cut doctors across the country 21 percent in what 
they get paid for taking care of patients who depend upon Medicare for 
their health care, and then keep that price frozen for the next 10 
years. That is the only way the Democrats can say, well, this actually 
saves money. In reality, in terms of health care in the country, it 
does not.
  This bill, if it passes, is going to end up costing patients more. It 
is going to interfere with the doctor-patient relationship. It is going 
to result in an America where people truly believe their personal 
care--and that is what people care about: What is in it for me? How 
will this bill affect me and my life and my children? If they are 
providing for adult care, how is it going to affect their parents? They 
believe the care they receive, in terms of the quality of care and the 
available care they receive, it is going to be worse. They believe it 
is going to end up costing more. That is why, in a recent poll this 
week, 57 percent of Americans say this plan, if it passes, will hurt 
the economy. We are at a time where we are at 9.7 percent unemployment 
in this country. People are looking for work, and the place people find 
jobs in this economy right now seems to be working for the government.

  For decades and decades, the engine that drives the economy of our 
Nation has been small businesses. That is who we rely upon to stimulate 
the economy and get job growth. That is who we should be relying on, 
not Washington, not the Federal Government. That is why 57 percent of 
Americans who are focused on the economy say we believe this economy 
will be hurt if this bill passes.
  People are focused on the debt and the cost, and 81 percent of 
Americans say it is going to cost more than estimated because of the 
fact, as Senator McCain has said, that doctors are going to be cut 21 
percent across the board and continue for the next 10 years with their 
Medicare fees. The people of America realize that is not going to work 
for health care. People are going to say how am I going to get to see a 
doctor? I am on Medicare. I want to see a doctor. That is why people 
believe Medicare in their own personal care is going to get worse if 
this bill passes.
  Then the President promised we are not going to raise taxes on 
anyone. Seventy-eight percent of Americans believe there will be 
middle-class tax hikes if this passes. That is why people are opposed 
to a bill that cuts $500 billion from Medicare for our seniors who 
depend on Medicare for their health care. It is not just cutting 
payments to doctors; it is to hospitals, to nursing homes where we have 
so many seniors across the country. It affects home health agencies, 
which is a lifeline for people who are at home, and keeps them out of 
the hospitals. They are even going to cut payments for people who are 
in hospice care, who are at the terminal point, who are in the final 
days of their life. They are cutting that out.
  All of these are reasons the American people say I am not for this 
bill and it is time to stop. Half of America says stop and start over. 
One in four says stop completely. Only one in four actually believes 
this is going to help. That is not a way to pass legislation in this 
country. That is not a way to find something the American people agree 
with. That is not the way to get successful implementation of a 
program. I spent 5 years in the Wyoming State Senate. On major pieces 
of legislation, we always sought broad bipartisan support because if 
you have broad bipartisan support, then people all around the community 
and the country would say this must be the right solution to a 
significant problem we are facing.
  We are facing a problem with health care in this country and we need 
health care reform. We just do not need this bill that cuts Medicare, 
raises taxes, and for the most part most Americans will tell you they 
believe their own personal care will suffer as a result of this bill 
becoming law. For whatever means or mechanism or parliamentary tricks 
are used to try to cram this bill through and cram it down the throats 
of the American people, the American people want to say no, thank you. 
They are saying it in a less polite way than just saying no, thank you. 
They are calling, they are showing up, they are turning out to tell 
their elected representatives that we do not want this bill under any 
circumstances. Let's get to the things we can agree upon and isolate 
those and pass those immediately, not an over-2,000-page bill that is 
loaded with new government rules and new government regulations and new 
government agencies and new government employees at a time when 10 
percent of Americans are unemployed and people are looking for work in 
communities around the country.
  One of the things I found so interesting and also distressing when 
the President says everyone will have coverage is he wants to do it by 
putting 15 million Americans on Medicaid. Having practiced medicine for 
25 years and seen all patients, regardless of ability to pay, I can 
tell you there are many doctors across the country who do not see 
Medicaid patients because what they receive in payment from the 
Government for seeing those patients is so little. Even the people at 
the Congressional Budget Office--who look at this health care bill with 
the cuts in Medicare and with so many people put on Medicaid--say one 
in five hospitals is going to be unable to stay open 10 years from now 
if this gets passed because they are not going to be able to even cover 
the expenses of staying open. The same applies to doctors' offices and 
to nursing homes.
  We need a program approach that is sustainable, not something like 
this, that we know is irresponsible and unsustainable. That is what we 
are going to do if we put 15 million more people on Medicaid by sending 
them a Medicaid card. But, as Senator Alexander has said, that is like 
giving somebody a bus ticket when a bus is not coming--because coverage 
does not always equal care.
  As a surgeon in Wyoming, I took care of people who came from Canada. 
They came to Wyoming from Canada for health care. They had coverage in 
Canada because Canada covers all the people, but they do not get care 
in Canada. That is why 33,000 Canadians last year came to the United 
States for surgery. Why? Because the waiting lines were so long in 
Canada. Even a Member of Parliament had cancer--and my wife is a breast 
cancer survivor--a Member of Parliament in Canada came to the United 
States for her cancer care because the survival rates for people 
treated in the United States are so much better. Why are they better? 
It is more timely care.
  People come for artificial hip replacements because they do not want 
to wait in Canada. In Canada, come Halloween--it is called trick-or-
treat medicine--they have spent the amount of money they are going to 
spend on a procedure, whether it is cataract surgery or total joint 
replacement, and they say: OK, we are done. Wait until next year. Go 
get in line again.
  I hear it time and time again in patients who come from Canada to the 
United States because they have coverage but they do not have care.
  Then we look at Medicaid and Medicare and we look at the model the 
President has lifted up as the one that is a good model for health care 
in America, and he pointed to the Mayo Clinic, which is a wonderful 
place with wonderful care. Yet the Mayo Clinic in Arizona said we can't 
take more Medicare patients. They said we have to limit the number of 
Medicaid patients we take. Why? Because, by taking care are of those 
patients in the past, the Mayo Clinic has said they have lost hundreds 
and hundreds of millions of dollars because Washington is the biggest 
deadbeat payer of all for health care.
  When it comes to actually rejecting patients' claims, the No. 1 
rejecter of claims in this country is Medicare. The highest percentage 
of claims rejected is Medicare, over other insurance companies. Having 
practiced medicine for 25 years, I have fought with Medicare and I 
fought with insurance companies, all on behalf of patients. When you 
are

[[Page S1426]]

fighting with an insurance company you can always actually appeal that 
if they reject it. It is very hard to fight with Washington.
  This health care bill we have been debating in the Senate and is now 
before the House is the one where the American people say don't make me 
live under this. Don't cut my Medicare. Don't raise my taxes. Don't 
interfere with my relationship with my doctor. Don't make it tougher 
for me to get care. Don't lessen the quality of that care.
  I ask how much time I have remaining.
  The ACTING PRESIDENT pro tempore. The Senator's time has expired.
  Mr. BARRASSO. Madam President, I yield the floor and suggest the 
absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BARRASSO. Madam President, I ask unanimous consent the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. BARRASSO. Madam President, I ask unanimous consent to have 
printed in the Record the letter that Senator McCain referenced from 
the 85,000 doctors across the country opposing the bill.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                   March 10, 2010.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. John Boehner,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi and Minority Leader Boehner: The 
     undersigned state and national specialty medical societies--
     representing more than 85,000 physicians and the millions of 
     patients they serve--are writing to oppose passage of the 
     ``Patient Protection and Affordable Care Act'' (H.R. 3590) by 
     the House of Representatives. The changes that were recently 
     proposed by President Obama do not address our many concerns 
     with this legislation, and we therefore urge you to draft a 
     more patient-centered bill that will reform the country's 
     flawed system for financing healthcare, while preserving the 
     best healthcare in the world. While we agree that the status 
     quo is unacceptable, shifting so much control over medical 
     decisions to the federal government is not justified and is 
     not in our patients' best interest. We are therefore united 
     in our resolve to achieve health system reform that empowers 
     patients and preserves the practice of medicine--without 
     creating a huge government bureaucracy.
       There are a number of problems associated with H.R. 3590 as 
     passed by the Senate in December, including:
       The bill undermines the patient-physician relationship and 
     empowers the federal government with even greater authority. 
     Under the bill: 1) employers would be required to provide 
     health insurance or face financial penalties; 2) health 
     insurance packages with government-prescribed benefits will 
     be mandatory; 3) doctors would be forced to participate in 
     the flawed Physician Quality Reporting Initiative (PQRI) or 
     face penalties for nonparticipation; and 4) physicians would 
     have to comply with extensive new reporting requirements 
     related to quality improvement, case management, care 
     coordination, chronic disease management, and use of health 
     information technology.
       The bill is unsustainable from a financial standpoint. It 
     significantly expands Medicaid eligibility--shifting 
     healthcare costs to physicians who are already paid below the 
     cost of delivering care and to the states that are already 
     operating under severe budget constraints.
       Largely unchecked by Congress or the courts, the federal 
     government would have unprecedented authority to change the 
     Medicare program through the new Independent Payment Advisory 
     Board and the new Center for Medicare & Medicaid Innovation. 
     Specifically, these entities could arbitrarily reduce 
     payments to physicians for valuable, life-saving care for 
     elderly patients--reducing treatment options in a dramatic 
     way. Medicare payment policy requires a broad and thorough 
     analysis, and leaving these payment policy decisions in the 
     hands of an unelected, unaccountable government body with 
     minimal Congressional oversight will negatively impact the 
     availability of quality healthcare for Americans.
       The bill is devoid of proven medical liability reform 
     measures that have been shown to reduce costs in demonstrable 
     ways. Instead, it merely includes a grant program to 
     encourage states to test alternatives to the current civil 
     litigation system. We have ample evidence--as was recently 
     confirmed by the Congressional Budget Office (CBO)--that 
     reforms such as those adopted by California, Georgia and 
     Texas decrease costs and improve patient access to care. 
     Given the fact that costs remain a significant concern, 
     Congress should enact a comprehensive set of tort reforms, 
     which will save the federal government at least $54 billion 
     over 10 years. These savings could help offset increased 
     health insurance premiums which, according to the CBO, are 
     expected to increase under the bill or other costs of the 
     bill.
       Our concerns about this legislation also extend to what is 
     not in the bill. Two important issues include:
       The right to privately contract is a touchstone of American 
     freedom and liberty. Patients should have the right to choose 
     their doctor and negotiate fee arrangements for those 
     services without penalty. Current Medicare patients are 
     denied that right. By guaranteeing all patients the right to 
     privately contract with their physicians--without penalty--
     patients will have greater access to physicians and the 
     government will have budget certainty. Nothing in the Patient 
     Protection and Affordable Care Act addresses these 
     fundamental tenets, which we believe are essential components 
     of real health system reform.
       For healthcare reform to be successful, Medicare's 
     Sustainable Growth Rate (SGR) must be permanently repealed--
     something the Senate bill fails to do. The SGR needs to be 
     replaced by a new system that also establishes realistic 
     baseline for physician services. The CBO has confirmed that a 
     significant reduction in physicians' Medicare payments will 
     reduce beneficiaries' access to services.
       We are at a critical moment in history. America's 
     physicians deliver the best medical care in the world, yet 
     the systems that have been developed to finance the delivery 
     of that care to patients have failed. With congressional 
     action upon us, we are at a crossroads. One path accepts as 
     ``necessary'' a substantial increase in federal government 
     control over how medical care is delivered and financed. We 
     believe the better path is one that allows patients and 
     physicians to take a more direct role in their healthcare 
     decisions. By encouraging patients to own their health 
     insurance policies and by allowing them to freely exercise 
     their right to privately contract with the physician of their 
     choice, healthcare decisions will be made by patients and 
     physicians and not by the government or other third party 
     payers.
       We urge you to change the direction of the current reform 
     efforts for the sake of our patients and our profession. We 
     have a prescription for reform that will work for all 
     Americans, and we are happy to share these solutions with you 
     to improve our nation's healthcare system.
       Thank you for considering our views.
           Sincerely,
         Medical Association of the State of Alabama; Medical 
           Society of Delaware; Medical Society of the District of 
           Columbia; Florida Medical Association; Medical 
           Association of Georgia; Kansas Medical Society; 
           Louisiana State Medical Society; Missouri State Medical 
           Association; Medical Society of New Jersey; South 
           Carolina Medical Association; American Academy of 
           Facial Plastic and Reconstructive Surgery; American 
           Association of Neurological Surgeons; American Society 
           of Breast Surgeons; American Society of General 
           Surgeons; Congress of Neurological Surgeons;Daniel H. 
           Johnson, Jr., MD, AMA President 1996-1997; Donald J. 
           Palmisano, MD, JD, FACS, AMA President 2003-2004; 
           William G. Plested III, MD, FACS, AMA President 2006-
           2007.

  Mr. BARRASSO. I yield the floor and suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. MERKLEY. Madam President, I ask unanimous consent the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

                          ____________________