[Congressional Record Volume 156, Number 37 (Monday, March 15, 2010)]
[Senate]
[Pages S1490-S1492]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. KYL. Mr. President, I wish to pick up on the comments of my 
colleague, the Republican leader.
  There is another distressing story in the paper today reported by the 
Associated Press. They report that all of the special deals that last 
week the President said he was going to try to remove from the 
legislation, now--except for the ``Cornhusker kickback''--they are 
going to leave them in there because they need the votes. If that is 
correct, this process is even sicker than we thought it was.
  Part of the reason for the Democratic leadership using the 
reconciliation provision to fix the Senate bill was to take all of 
these special provisions out, but now it appears, according to the 
Associated Press, that they are going to be kept in there because they 
need the votes.
  Let me detail what a couple of these are. Last week, there was a 
story in Politico that detailed six specific items. Of course, there 
was the ``Cornhusker kickback'' that got such bad publicity and 
everybody agreed it had to go, including the Senator who voted for the 
legislation after he was promised that in his State there would be no 
cost for the coverage of additional Medicaid patients. Now that is 
apparently going to be ``fixed,'' at great expense, I might add, to the 
taxpayers of the United States, but apparently unfixed are six other 
items, and there are more, by the way.
  Quote:

       ``We have defended it and we will defend it,'' said Senator 
     Bernie Sanders of Vermont, whose state picked up $600 million 
     in extra Medicaid funding . . .

  Again, I am quoting from a March 10 Politico story.
  Second:

       In a letter to congressional leaders last week, Obama 
     targeted the Nebraska and Florida deals for elimination. The 
     Florida provision could also shield some seniors in 
     California, New York, New Jersey, and Pennsylvania, according 
     to Senator Bill Nelson's office.

  This provision deals with Medicare patients. The reason it is 
important to me is because there are 330,000-plus Arizona seniors who 
have Medicare Advantage plans. These are the plans that would suffer 
under the legislation proposed by the President. Because they would 
have benefits they currently enjoy taken away from them, the seniors in 
all of the States are obviously complaining to their Senators. So 
Democrats have said: Well, OK, if seniors are upset about having these 
benefits taken away, then we will shield the seniors in our States who 
have these Medicare Advantage policies so that they don't have to give 
up their benefits--the biggest set of beneficiaries, and there are over 
800,000 of them in the State of Florida but apparently also some in 
California, New York, New Jersey, and Pennsylvania. All right. Special 
deal for them.
  If this bill, by the way, is so great, why do we have to protect our 
citizens from its provisions? But that is the way it works. However, my 
senior citizen constituents in Arizona don't get grandfathered as do 
those in other States. It just shows you how bad the bill policy is in 
the area generally that you have to protect your constituents from 
suffering the effects of the bill but also the bad policy that does 
that to the detriment of other constituencies. Apparently, now that is 
going to stay in the bill.

  Then there was the so-called ``Louisiana purchase,'' $300 million to 
Louisiana. Then there was the $1.1 billion

[[Page S1491]]

in extra Medicaid funding to Massachusetts and Vermont. This Politico 
article quotes Senator Patrick Leahy of Vermont:

       What I told Harry Reid is that Vermont does the right 
     thing, and I don't want Vermont to be penalized for doing the 
     right thing.

  Of course, that is the kind of argument that is made in response to 
provisions in the bill that are bad provisions because they hurt the 
people in your State. But the solution is not to exempt your State's 
constituents from the bad effects of the bill. Don't pass the bill. It 
is a bad bill.
  Here is a fifth example. There is a $100 million hospital grant 
program requested by our colleague from Connecticut, Senator Dodd, 
``who has acknowledged that the University of Connecticut would qualify 
for the money.''
  Here is a sixth one that is being promoted by the chairman of the 
Finance Committee, Senator Baucus, on behalf of the residents of Libby, 
MT.
  There is another one not mentioned here, but I am aware of it. It 
protects two insurance companies--Blue Cross/Blue Shield and Mutual of 
Omaha in Nebraska, again at the request of the Senator from Nebraska. I 
believe there is another company in the State of Wisconsin protected.
  My point is, first, if this bill is so wonderful, why do we have to 
have all these separate carve-outs, special deals, for Representatives 
or for constituents in the States of certain Democrats in order, 
presumably, in the House of Representatives, to help the Speaker of the 
House get her vote total up to where she can actually pass the bill? 
Why don't we just fix the bill in the first place so none of these bad 
effects are visited on the constituents whom I represent, for example, 
or anybody else's constituents for that matter?
  At a minimum, the President should follow through on his plan last 
week to try to get these provisions out of the bill. It turns out now 
that apparently this week, according to David Axlerod, during the 
rotations of the Sunday morning talk shows he was on, that is no longer 
part of the plan.
  The last thing I would like to do is comment briefly on a Washington 
Post column by Robert Samuelson this morning.
  Mr. President, I ask unanimous consent to have printed in the Record 
a Washington Post column by Robert Samuelson.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  (See exhibit 1.)
  Mr. KYL. Mr. President, I will briefly summarize it. The President is 
visiting in Ohio, I believe, today to highlight the case of a 
particular Ohio resident. I believe she is a breast cancer survivor. 
Her insurance eventually became too expensive for her to keep up. She 
now has a diagnosis of another disease, and the President is 
highlighting this type of case. I think it is important to highlight it 
for another reason.
  I presume the President or the Senators or Representatives of Ohio 
are finding an alternative way to ensure she is cared for. Frequently, 
we have constituents come to us with situations such as this. They 
represent very heartrending situations, problems with which you want to 
deal. The real question is how to deal with it. The answer to her 
problem is not to pass this health care bill. There are alternatives.
  For example, for those who cannot get insurance that is affordable to 
them because of preexisting conditions--Republicans have put ideas on 
the table, as have Democrats, but that is a specific kind of problem 
that can be solved with a specific solution rather than this entire 
health care bill the President is trying to sell to us.
  What Robert Samuelson points out in his article is there are a lot of 
different situations such as this, where people who are not insured 
nevertheless get care. In fact, the argument is made that we need this 
kind of health care bill because there are too many people who are 
uninsured and get expensive and ineffective treatment at the emergency 
room. He says: ``Unfortunately it's not true.''
  He quotes a study by the Robert Wood Johnson Foundation that finds 
that the insured population ``accounted for 83 percent of emergency-
room visits, reflecting their share of the population.'' In other 
words, there is not a difference of who visits the emergency room and 
who does not depending on whether you are insured.
  He goes on to say:

       After Massachusetts adopted universal insurance, emergency-
     room use remained higher than the national average, an Urban 
     Institute study found.

  The point is, even after you get the so-called universal coverage, 
you do not find any difference in terms of emergency room visits. If 
anything, with universal coverage, you had even higher emergency room 
visits. His point is, and I quote Robert Samuelson:

       If universal coverage makes appointments harder to get, 
     emergency-room use may increase.

  So you are not making the problem better; if anything, you are making 
it worse. My guess is, you are not affecting it much one way or the 
other. It is simply not an argument that because people who are 
uninsured go to the emergency room, therefore, we have to pass some 
kind of nationwide health care bill such as has been suggested to us.
  He goes on to point out:

       You probably think that insuring the uninsured will 
     dramatically improve the nation's health.

  He goes on to debunk that myth:

       I've written before that expanding health insurance would 
     result, at best, in modest health gains.

  He goes on to point out that studies have validated the fact it does 
not make a difference one way or another.

       Claims that the uninsured suffer tens of thousands of 
     premature deaths are ``open to question.'' Conceivably, the 
     ``lack of health insurance has no more impact on your health 
     than lack of flood insurance.

  He goes on to detail the reasons why that is so.
  He concludes with this point:

       Though it seems compelling, covering the uninsured is not 
     the health-care system's major problem. The big problem is 
     uncontrolled spending.

  That is a point Republicans have been trying to make from the very 
beginning, to point out we ought to first focus on dealing with what is 
driving up health care costs. That will, if we are successful, have a 
positive impact on getting people insured because it will reduce the 
cost of insurance they have to buy or their employer is buying on their 
behalf.
  That is what we should be focusing on rather than this rather elusive 
issue of coverage of the uninsured. To be sure, nobody is arguing we 
should not help cover the uninsured. That is not the argument we are 
making. The argument we are making is, it does not justify a $2.5 
trillion expenditure and that, in any event, if you focus first on 
dealing with costs, you are going to reduce costs, which is a good 
thing in and of itself, and, thereby, also enhance coverage because the 
cost is less expensive.
  Here is the penultimate paragraph in the piece. I will quote him and 
close. What Samuelson said is the President is:

     . . . telling people what they want to hear, not what they 
     need to know. Whatever their sins, insurers are mainly 
     intermediaries; they pass along the costs of the delivery 
     system. In 2009, the largest 14 insurers had profits of 
     roughly $9 billion; that approached 0.4 percent of total 
     health spending of $2.472 trillion.

  Four tenths of 1 percent.
  He goes on to say:

       This hardly explains high health costs. What people need to 
     know is that Obama's plan evades health care's major problems 
     and would worsen the budget outlook. It's a big new spending 
     program when government hasn't paid for the spending programs 
     it already has.

  His point is, instead of trying to make insurance companies the 
villain, the President should be honest about what their true cost is.
  Somebody pointed out--my colleague, Lamar Alexander--if you take all 
the profits of all the insurance companies, it pays for 2 days' worth 
of health care expenditures in the country. What about the other 363 
days? Nobody is defending the insurance companies, but you cannot say 
they are responsible for the high costs of health care in this country, 
since they are primarily just passing those costs on.
  The bottom line is, we need to be honest and explain to the American 
people what we are trying to accomplish or what we should be trying to 
accomplish is reducing health care costs. That will have the salutary 
effect of making access easier for people

[[Page S1492]]

because they will be able to afford the insurance that now may be 
unaffordable for them. But the idea that the insurance companies are 
the reason we have the problem or that emergency rooms are used more 
because of the uninsured are two myths that are dispelled in this piece 
by Robert Samuelson.
  I yield to my colleague from Oklahoma.

                               Exhibit 1

               [From the Washington Post, Mar. 15, 2010]

                   Obama's Illusions of Cost-Control

                        (By Robert J. Samuelson)

       ``What we need from the next president is somebody who will 
     not just tell you what they think you want to hear but will 
     tell you what you need to hear.''--Barack Obama, Feb. 27, 
     2008
       One job of presidents is to educate Americans about crucial 
     national problems. On health care, Barack Obama has failed. 
     Almost everything you think you know about health care is 
     probably wrong or, at least, half wrong. Great simplicities 
     and distortions have been peddled in the name of achieving 
     ``universal health coverage.'' The miseducation has worsened 
     as the debate approaches its climax.
       There's a parallel here: housing. Most Americans favor 
     homeownership, but uncritical pro-homeownership policies (lax 
     lending standards, puny down payments, hefty housing 
     subsidies) helped cause the financial crisis. The same thing 
     is happening with health care. The appeal of universal 
     insurance--who, by the way, wants to be uninsured?--justifies 
     half-truths and dubious policies. That the process is 
     repeating itself suggests that our political leaders don't 
     learn even from proximate calamities.
       How often, for example, have you heard the emergency-room 
     argument? The uninsured, it's said, use emergency rooms for 
     primary care. That's expensive and ineffective. Once they're 
     insured, they'll have regular doctors. Care will improve; 
     costs will decline. Everyone wins. Great argument. 
     Unfortunately, it's untrue.
       A study by the Robert Wood Johnson Foundation found that 
     the insured accounted for 83 percent of emergency-room 
     visits, reflecting their share of the population. After 
     Massachusetts adopted universal insurance, emergency-room use 
     remained higher than the national average, an Urban Institute 
     study found. More than two-fifths of visits represented non-
     emergencies. Of those, a majority of adult respondents to a 
     survey said it was ``more convenient'' to go to the emergency 
     room or they couldn't ``get [a doctor's] appointment as soon 
     as needed.'' If universal coverage makes appointments harder 
     to get, emergency-room use may increase.
       You probably think that insuring the uninsured will 
     dramatically improve the nation's health. The uninsured don't 
     get care or don't get it soon enough. With insurance, they 
     won't be shortchanged; they'll be healthier. Simple.
       Think again. I've written before that expanding health 
     insurance would result, at best, in modest health gains. 
     Studies of insurance's effects on health are hard to perform. 
     Some find benefits; others don't. Medicare's introduction in 
     1966 produced no reduction in mortality; some studies of 
     extensions of Medicaid for children didn't find gains. In the 
     Atlantic recently, economics writer Megan McArdle examined 
     the literature and emerged skeptical. Claims that the 
     uninsured suffer tens of thousands of premature deaths are 
     ``open to question.'' Conceivably, the ``lack of health 
     insurance has no more impact on your health than lack of 
     flood insurance,'' she writes.
       How could this be? No one knows, but possible explanations 
     include: (a) many uninsured are fairly healthy--about two-
     fifths are age 18 to 34; (b) some are too sick to be helped 
     or have problems rooted in personal behaviors--smoking, diet, 
     drinking or drug abuse; and (c) the uninsured already receive 
     50 to 70 percent of the care of the insured from hospitals, 
     clinics and doctors, estimates the Congressional Budget 
     Office.
       Though it seems compelling, covering the uninsured is not 
     the health-care system's major problem. The big problem is 
     uncontrolled spending, which prices people out of the market 
     and burdens government budgets. Obama claims his proposal 
     checks spending. Just the opposite. When people get 
     insurance, they use more health services. Spending rises. By 
     the government's latest forecast, health spending goes from 
     17 percent of the economy in 2009 to 19 percent in 2019. 
     Health ``reform'' would probably increase that.
       Unless we change the fee-for-service system, costs will 
     remain hard to control because providers are paid more for 
     doing more. Obama might have attempted that by proposing 
     health-care vouchers (limited amounts to be spent on 
     insurance), which would force a restructuring of delivery 
     systems to compete on quality and cost. Doctors, hospitals 
     and drug companies would have to reorganize care. Obama 
     refrained from that fight and instead cast insurance 
     companies as the villains.
       He's telling people what they want to hear, not what they 
     need to know. Whatever their sins, insurers are mainly 
     intermediaries; they pass along the costs of the delivery 
     system. In 2009, the largest 14 insurers had profits of 
     roughly $9 billion; that approached 0.4 percent of total 
     health spending of $2.472 trillion. This hardly explains high 
     health costs. What people need to know is that Obama's plan 
     evades health care's major problems and would worsen the 
     budget outlook. It's a big new spending program when 
     government hasn't paid for the spending programs it already 
     has.
       ``If not now, when? If not us, who?'' Obama asks. The 
     answer is: It's not now, and it's not ``us.'' Pass or not, 
     Obama's proposal is the illusion of ``reform,'' not the real 
     thing.

  The ACTING PRESIDENT PRO TEMPORE. The Senator from Oklahoma.
  Mr. INHOFE. Mr. President, I thank the Senator from Arizona for 
yielding.
  I ask unanimous consent that I be recognized in morning business for 
such time as I may consume.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

                          ____________________