[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.
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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
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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.
____________________