[Congressional Record Volume 157, Number 79 (Friday, June 3, 2011)]
[House]
[Pages H4027-H4031]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
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HEALTH CARE
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 5, 2011, the gentleman from Texas (Mr. Burgess) is recognized
for 60 minutes as the designee of the majority leader.
Mr. BURGESS. This afternoon, the Congressional Health Care Caucus
wants to talk a little bit about the future of the government's role in
health care in this country.
I recognize, for those of you studying your Constitution as of this
very moment, you don't find the government's role for controlling
health care in this country, but we will do our best to help you
understand why we are where we are and perhaps where we are going with
some of the Federal programs that are run by the Federal Government.
Again, the Congressional Health Care Caucus, the Web site
healthcaucus.org.
This hour, I am grateful to the leadership of the Republican Party
for the use of this hour. I and my cochair, Mr. G.T. Thompson from
Pennsylvania, will be leading the discussion.
We have had a lot of talk over the past 4 weeks about the future of
Medicare in this country. Certainly, if you look at the three plans
that are on the table right now--and I understand you may be scratching
your head and saying, Wait a minute. I thought there was only one plan
out there. I thought there was only the Republican plan. But the
Medicare Trustees Report that was issued some 2, 2\1/2\ weeks ago, came
forward and articulated how the Medicare trust fund would be exhausted
in the year 2023 or 2024. This is a significant fact that right now
this Congress and the White House are trying to ignore, but it can't be
ignored, and that's why the responsible Republican budget passed in
April would deal with this fact.
One plan would be to continue on the current course and make no
change at all, and that is what the trustees' report articulated. The
trust fund is exhausted by 2023 or 2024. That means, then, all funds to
pay for part A, part B, and part D of Medicare, hospitalizations,
physician payments, and pharmaceutical payments would all come from the
Federal Treasury. The trust fund would be depleted at that point.
What are the implications for that? As we sit here even now and talk
about things like expansion of the debt limit, the implications are
that all of the funding for Medicare for the hospitalizations, for the
physicians part, for the pharmaceutical part, all of the funding would
come strictly out of the general revenues, that part that is paid by
the taxpayers every year.
Are there things that could be done under the trustees' report to
prevent this from happening? There are. And one of those things would
be to raise the tax on the payroll tax that is paid by individuals for
their Medicare. All of us pay a 1.2 percent tax. The employer matches
with a similar amount, so that comes out of our paychecks every 2 weeks
or every month. However we are paid, there would be a way to increase
that tax to perhaps sustain Medicare farther into the future.
[[Page H4028]]
But I must remind the Speaker that this law, which was signed by the
President in March of 2010, the Patient Protection and Affordable Care
Act, already had a Medicare tax increase included therein. So there is
a .9 percent Medicare payroll tax that is included in the Patient
Protection and Affordable Care Act, which leaves us very little room to
maneuver unless the payroll tax goes up even further.
Many people argue that the payroll taxes are some of the least
progressive and most regressive taxes in this country because they are
administered across the board without regard to income, so this is a
potential problem. It is one that perhaps could have been solved with a
payroll tax increase, but that payroll tax increase has already
occurred. You say, well, but okay, if there is a payroll tax increase
in the Medicare trust fund, that's good news, because that means that
Medicare goes on farther.
Unfortunately, under this law, the money that is taxed on the
payroll, collected by the Medicare trust fund, makes a very short stop
in the Medicare trust fund and then goes to fund a very different
program, a program that, in fact, does not exist today but will start
in 2014, a program of subsidies for entitlement for people to purchase
private health insurance in the non-Medicare years in what are called
the State exchanges.
So the money goes from the Medicare trust fund to fund a new
entitlement. That money will have to be paid back to the Medicare trust
fund, make no mistake about it. It is money that we are borrowing from
ourselves, but it is not money that is there to save Medicare today.
But as the administration argues that, hey, within the Affordable
Care Act we have already done some things to sustain Medicare into the
future, nothing could be further from the truth. In fact, they have
probably poured gasoline on the fire that was already in existence.
One of the other things the trustees' report suggested was that
benefits could be cut in the future. And I daresay that if nothing else
happens and we get to the point where the trust fund is exhausted,
those benefit cuts will be enacted not by this Congress, not by the
next Congress, but by some Congress in the future, because of the
intergenerational strife that will occur because of the inability to
keep pace with the problems that were made by generations before, with
generations yet to come. The unfunded liabilities in the Medicare trust
fund will soon begin to outstrip every other activity of the Federal
Government. That is, there will be no money left for defense, no money
left for transportation, no money left for education. All of it will go
into health care in some way, shape, or form.
Well, did the President have a plan for sustaining Medicare? Well,
yes. You heard about the tax that he already enacted in the Patient
Protection and Affordable Care Act, but that may not have been so
helpful. In fact, that may have been more detrimental.
What other things has the President put out there on the table as a
plan for saving Medicare?
Now, bear in mind, there is no Presidential plan to save Medicare. We
have encouraged the White House to provide us with such a framework. We
would like to see such a framework. They could send it over to the
Congressional Budget Office and have it scored, have it compared to
Republican proposals that are out there, but this ask has not yet been
honored. So, as a consequence, what we are left with are the bits and
pieces that the White House has articulated, the administration has
articulated: Here is our plan for Medicare.
One of the big plans they have for Medicare is contained within the
pages of the compilation of the Patient Protection and Affordable Care
Act, on page 423, where it talks about a new board that is created that
is going to administer Medicare costs. This is the Independent Payment
Advisory Board.
Who will these individuals be? Well, they will be 15 in number. They
will be nominated by the President. They will be confirmed by the
Senate. They are to be made up of academics, of people who have worked
in government, people who have expertise in health finance and
economics and actuarial science, health facility management, health
plans, and integrated delivery systems. And way, way down at the bottom
of the page, yes, you might get a doctor or nurse on that board as
well. Fifteen people that are paid by the government to do nothing but
identify cuts in the Medicare system. Well, perhaps that's a good
thing. Perhaps that's something that's necessary.
Now, look, I am a Member of the United States Congress. The Speaker
is a Member of the United States Congress. We are the people's House.
It is our job to deal with the people's money, to tax the people, to
raise the money, to spend the money and be good stewards of the
people's money. It is not our job to hand off that obligation to the
executive branch or, worse yet, to a board that is appointed by the
executive branch and is accountable to no one. It is not our job to do
that. It is our job to have the oversight over the Federal agencies and
boards so that we can ensure that things are done properly with the
people's money.
In this case, the Independent Payment Advisory Board will be just
that. It will be absolutely independent of the legislative branch. Once
an action is taken by the Independent Payment Advisory Board, it
becomes very, very difficult for Congress to impact the decisions that
are thereby made.
Now, true enough, their job is to deliver back to the House and the
Senate their recommendations for cuts in the Medicare system, and it's
very detailed in here on those pages as to just how much they are
required to cut. It's very detailed as to the procedure for bringing
those cuts to the House and the Senate and which committees they go to
for evaluation.
But here's the deal. At the end of the day, Congress either votes up
or down on this menu of cuts that's provided by the Independent Payment
Advisory Board. And, yes, we can vote ``no.'' Yes, we can turn down the
recommendation of the Independent Payment Advisory Board.
What happens then? According to statute, we are not finished.
Congress then is required to produce the same level of cuts that was
recommended by the board, maybe taking it from different places. But
still the same amount of money has to come out of the same Federal
program, that is, the Medicare program.
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Well, what if Congress gets together and says, ``We don't like what
the board has delivered to us. We're going to produce a different menu
of cuts''? But then, wouldn't you know it; Congress can't agree on what
those cuts should be.
I know, I know, Madam Speaker, you'll find that hard to believe that
Congress could ever get to a point where it didn't agree with itself on
very much, but it could happen at some point in the future that things
could be so contentious in Washington and so contentious in the House
and the Senate that we couldn't agree with each other on what those
cuts would be. Well, what happens then?
What happens then is the cuts recommended by the Independent Payment
Advisory Board are, in fact, delivered to the Secretary of Health and
Human Services; and that person, whoever he or she may be, the
following April, will enact those cuts. There is no getting away once
those cuts are recommended. Again, they are dictated in statute. Once
they are recommended, they are going to be enacted. There is almost no
way around that.
We've got kind of a similar situation today with a different formula
that deals with only part B. That's only the part that reimburses
physicians. It's called the sustainable growth rate formula. It is a
very complex set of figures and numbers that deals with some Federal
targets, that deals with conversion factors, and that deals with update
adjustment factors. But suffice it to say that it requires a reduction
in reimbursement for patients' visits to doctors, and it does this
every year.
Now, Congress, historically, has come in at the last minute and
rolled those cuts back and said that we won't enact those cuts. The
problem is, with the formula as written, every year that we come in and
say, ``okay, doctors and patients, we're not going to actually cut
reimbursement rates this year,'' that aggregate number that should have
been cut is added to the sum that ultimately must be cut.
So, right now, we are existing on a gift, if you will, done in the
lame-duck
[[Page H4029]]
session of the last Congress where the cuts in Medicare were given a
13-month reprieve. But, if Congress doesn't act by December or January,
December of this year or January of 2012, an almost 30 percent cut goes
to physicians who practice in the part B part of Medicare.
Now, I know you can say, well, doctors probably make too much money
anyway and the government needs to save money, so what could that hurt?
Where that hurts is that doctors are having a tough enough time keeping
up with their expenses. When we cut them 30 percent, the nurse that
works in the front office or the company that delivers the electricity
that keeps the lights on in their practice doesn't say, ``Gee, Doc. We
know you're having a tough time and the government cut your
reimbursement, so we're going to give you a break on your electricity
bill.'' That does not happen. The good people in the municipality that
allow the doctor to practice don't come up and say, ``Doctor, we know
this is tough on you. We're going to give you a 30 percent reduction in
your school taxes this year on your business property.'' That does not
happen. Those fixed overhead expenses occur, and the Federal
reimbursement rate for Medicare in the part B program reduces year over
year. That is why you have doctors leaving the Medicare program.
As a consequence, that is why you have people who are entering the
Medicare program, turning 65 or older, who move to a new location, call
up a doctor's office and say, ``I need to be seen for my whatever,''
and the answer is, ``We are not taking new Medicare patients.''
That unfortunate reality is hitting people today. The Independent
Payment Advisory Board is theoretical. That's in the future. The SGR is
the ``here and now'' that Congress is dealing with even this year.
Now, I'm very fortunate to have been joined by my counterpart on the
Congressional Health Care Caucus. Again, healthcare.org is the Web
site.
Glenn Thompson from Pennsylvania, thank you for being with us this
afternoon. Let me yield to you such time as you might consume.
Mr. THOMPSON of Pennsylvania. I thank my good friend, Dr. Burgess
from Texas, for yielding and also for being able to work with him in
terms of our Congressional Health Care Caucus. We cover the health care
industry from both important aspects--you as a physician and all of
your experience specifically in the medical field.
My background came up through therapy. Most of my almost 30 years of
working in nonprofit community health care was really on the
administration side; some as a therapist, but largely in administering
programs in hospitals, in comprehensive rehab centers, and nursing
homes. I was licensed as a nursing home administrator towards the end
of my career there. And, frankly, I dealt very, very closely with
Medicare out of necessity because Medicare is, on the in-patient side,
at least 60 percent in terms of market share, in terms of payment. So
Medicare is very important.
I have to say to my good friend, I was pretty naive when I came to
Washington in January 2009. That's when I was sworn in. I won election
in 2008. I thought everybody knew that one of the impending crises had
to do with the insolvency and the eventual bankruptcy of the Medicare
program, only to get here and find out that that was not on the agenda
under the previous leadership. And, frankly, it has emerged because it
is a truth.
When you look at the situation today with the Medicare system,
Medicare is in jeopardy. And what we're trying to do, what the
Republicans are trying to do, is to save Medicare. The thing that would
hurt Medicare the most is to do nothing, to further kick that can down
the road.
Just by coincidence, I was off the Hill and stopped by, and I picked
up a prescription earlier today. The only prescription to save Medicare
is a Republican prescription. I have to tell you, on the Democratic
side, they're just willing to pull the plug and let it die, because if
you don't make changes to the Medicare program, that's exactly what
happens. And that's not political rhetoric. That's coming from some
pretty credible sources that you talked about.
Last Friday, the Medicare trustees' report confirmed that the
Medicare program is already contributing to the Federal deficit and
will continue to do so for the next decade and that, since 2008, the
program has run a cash flow deficit. That's a fact that has been
largely ignored in Washington. Still there are those of our colleagues
who choose to pretend it's not true, but it is the truth. In fact, in
2011, it exceeds $32 billion. That's a program that, if we don't make
the necessary reforms to save, will go bankrupt.
And what an injustice that will be for all of us, all the people
across this Nation who have paid into that program, who are looking
forward to hitting those retirement years to be able to access and
utilize that benefit. If we allow it to go insolvent, if we don't
reform it, if we don't save it, it goes bankrupt.
The only thing keeping the program afloat financially, really, is the
sale of Treasury bonds in the Medicare trust fund. And when those bonds
are cashed, that increases the deficit.
The President's plan, I guess, is to let it go insolvent, because I
read today he's restated he doesn't want to do anything about Medicare,
leave Medicare alone, which essentially says let's let it go bankrupt,
and let's let it go away.
In fact, the measures--and you did a great job of, I think, talking
about one in particular, the Independent Payment Advisory Board, which
essentially takes the decision-making out of the hands of those of us
who are accountable, of those of us who are elected every 2 years to
make decisions about Medicare. Those decisions will not be about what
benefits to expand in this financial situation. This will be about
where to make cuts, where to ration care.
The Federal Government already does that. Under part B, if you are in
a nursing home and you need to receive rehabilitation therapy, the
Federal Government has already put a cap on how much therapy that
you're able to receive. It has nothing to do with what your need is. It
has to do with how many dollars have been spent. So if Americans think
the Federal Government would not do rationing, it already happens. It
already happens.
You talked about the board. What the President has done, I think, in
his plan, which really is going to pull the plug on Medicare, a program
that is already financially insolvent and challenged, is cut $575
billion from the Medicare program to fund his health care initiative.
He cuts over $200 billion for Medicare Advantage and forces over 7
million seniors out of their current Medicare plans. The projection
from the CMS actuary--this is the person who is responsible for really
crunching the numbers for the Medicare agency--Richard Foster, in April
22, 2010, said that 15 percent of hospitals, nursing homes and home
health will close because Medicare pays less under ObamaCare.
We have an opportunity here to do the right thing and to reform
Medicare and to save Medicare. The President has an obligation to do
that. Under the Medicare trust fund--and what a lot of folks don't
know--is there is a requirement, a statutory requirement, that at
whatever point the Medicare trust fund reaches a 45 percent level for
more than 2 years, the President is required--is required--to put forth
a plan essentially to save Medicare, to be able to address Medicare.
We are way past that trigger, and President Obama knows that. I
assume he knows it. It's part of his job. So he has chosen to ignore
his responsibilities to really put a plan forward. In fact, when we
were at the White House just earlier this week, the President said that
he was not going to put a plan forward for dealing with Medicare.
{time} 1510
He was going to just not take the leadership on that issue. We have,
and I am very pleased with the plan we have put forward. It has to do
with putting premium supports. Our plan would direct Medicare to go out
and to bid out for many different vendors health care plans that
seniors could then shop through. Medicare sets the standards, and these
companies that would put these products forward would have to meet
Medicare requirements. It is not a new concept. It is what we do under
Medicare part D today, and Medicare part D is probably one of the few
government programs which has actually
[[Page H4030]]
come in under budget. Most government programs come in way over budget,
but Medicare part D has come in under budget. It also will put an
emphasis on prevention and wellness. We are keeping people well. That
is what we need to do. Obviously, that is the best thing for
individuals, for folks to remain as healthy as possible.
We are not talking about voucher programs. We are not talking about
privatizing Medicare. Those are concepts. That is just not true when
people claim that we are. We are talking about providing people the
choice of quality products that meet minimum standards and that the
Medicare agency will ensure are there, because they are the ones who
will bid this out and manage the process.
Then we're going to provide premium supports that allow our seniors--
and we're talking about just impacting people that are younger than 55
years of age. If you are 55 years or older, there won't be any change.
Although, I have bumped into a few who wonder why they can't have this
opportunity. They think that it sounds like a really good thing. We are
holding those harmless aged 55 and older. I think it is important that
we have this debate, and it is a debate that brings forward all of the
facts and the realities of what we are talking about.
We are talking about doing something that will improve Medicare, just
like Medicare part C, which is Medicare Advantage. It has been shown
that seniors on that, because of the emphasis on prevention and
wellness, have been hospitalized for fewer days and smaller length of
stays, which has saved money in the long run. So we are talking about a
positive investment in the health care of our seniors, in saving the
country money and, frankly, in saving Medicare.
So I appreciate the opportunity to join my good friend from Texas.
This is a conversation that I think is going to be very important that
we continue throughout the rest of the spring and well into the summer.
Mr. BURGESS. Well said, because that is exactly the point of this
exercise this afternoon. These are difficult concepts. They are very
easy to demagogue; they are very easy to demagogue against the
Republican plan. The President himself may choose to do this. Certainly
the Democratic leadership in this House has chosen to do that. They do
that in the absence of putting forward their own plan.
But let's be realistic. We talk about things like premium support.
Now, in the 1990s, I'm just a regular guy practicing OB-GYN in Texas,
and President Clinton recognizes that Medicare is going to be headed
for difficulty in a few years. He convenes a big commission, the
bipartisan Medicare commission that is going to save Medicare.
Senator Frist, who at the time was relatively new in the Senate, was
a heart surgeon from Tennessee. At that time, he was recognized as one
of the thought leaders and forward thinking in health care reform. So
Senator Frist was on that commission. Senator Breaux from Louisiana, a
well-respected conservative Democrat, was on the commission; Bill
Thomas, who subsequently became chairman of the Ways and Means
Committee in the House, was on the commission. The Breaux-Frist
Commission came up with a series of recommendations to the Clinton
administration on how to sustain Medicare into the future.
The Breaux-Frist Commission had a number of recommendations, but the
centerpiece of what they recommended to President Clinton was this
concept of premium support. It was not necessarily new with them. It
had previously been described by the Brookings Institute, certainly not
a conservative think tank, probably regarded more as a moderate to
somewhat left of center think tank, but the Brookings Institute had
come up with the concept of premium support. People liked to try to
describe what the Republican budget produced as a voucher system. That
is, in fact, incorrect.
I will tell you, I was a little bit surprised that members of the
administration, when the Republican conference was called down to the
White House earlier this week and had a discussion with the
administration, required some instruction as to what premium support
actually was and what the history of premium support actually
represented: that it was in fact developed by a moderate think tank,
that it was embraced by a centrist to center left Democratic
administration in the Clinton administration, and that the Clinton
administration essentially took this idea, evaluated it and put it on
the shelf and said we are not going to consider it because there were
too many special interest groups on the left who did not like the
concept of Medicare moving away from central Federal control.
But what premium support represents is, in this case a purchaser, in
this case the United States Government, going out and negotiating with
insurers, saying we have a bank of patients that is going to require
care, i.e., our seniors on Medicare, and this is the type of claims
history they have had for the last several years, and we would like to
see if you would be interested in developing a proposal for what you
can do for our patients.
So it is essentially a request for proposals that goes out from the
Federal Government--yes, to private health insurance companies, some
for-profit, some not-for-profit. The only requirement is that they be
able to show that they can take care of the patients where the
government needs help with its seniors and produce a product that is
going to be cost effective and is going to deliver quality care to the
patients.
A voucher system--and, again, I was somewhat startled that members of
the administration required instruction in this regard. A voucher
system would be essentially giving a check to someone and saying: Go
out and negotiate and cut your best deal with an insurance company. A
premium support system is the government going out, negotiating with
the insurance companies and then saying: Come to us with your best
proposals for taking care of Medicare patients.
Some people would say: That is preposterous. That would never work.
Congressman Thompson, you were not here when Medicare part D was
passed. I was. Part D was built on that premise. It was let's see if
there is an interest out there in providing a prescription drug benefit
for seniors. Since we were criticized that no one in their right mind
would provide such insurance for seniors, we had a fallback position.
It was a Medicare prescription drug program exclusively, not one run
through a private intermediary. The fear was there would be parts of
the country that no insurance company would show up to make a proposal.
What we got was, indeed, a surprise. After being criticized for several
months that no one was going to show up to participate, we were
criticized by the other side because people said there are too many
plans out there from which seniors have to choose. In the State of
Texas, there were 45 plans available subscribing at different rates.
You could pick the one that most consistently met your needs for a
prescription drug program. But it really was a pleasant surprise.
Because of the competition between so many plans, the prices were
vastly under what had been projected by both the Congressional Budget
Office and the Office of Management and Budget, and one of those few
programs that came in on time and under budget where the satisfaction
rate is in excess of 94 percent. Very few seniors today would be
willing to give up their part D coverage under the Medicare
prescription drug program.
Yes, it has had some bumps and bruises along the way, but a lot has
been learned in the process. Now the concept of premium support is much
more developed in 2011 than it was in 2003 when the Medicare
Modernization Act passed.
So premium support--and again, I was surprised that members of the
administration required sort of remedial learning on this. But at the
end of the morning, I hope they understood better that it is not
necessary to demagogue against the Republican plan because, after all,
it is a reasonable plan that has been tested with Medicare part D
satisfaction rates high and the cost of delivering the care under what
was projected. Why in the world wouldn't we draw on that worthwhile
experience?
Now, what do you do about someone who is between the ages of 55 and
the end of their life? What do you do with someone who has reached that
point where they have basically made all of
[[Page H4031]]
their assumptions and plans based around what the government promised
they were going to do? For that individual aged 55 or older, nothing
changes. I happen to fall into that age group. As Mr. Thompson alluded
to, I would happily opt into the group that is going to have choices
because I would rather have choices than a prescribed benefit.
{time} 1520
Nevertheless, those individuals who are 55 and older will see no
change, the thought being that they have already structured their lives
and their retirements based on the fact that this promise had been
made. For individuals who are younger than that, when there is still
time to make some adjustments in your post-work years, your retirement
years, there will be a different program.
Now you ask: For people who are 54 years of age and younger, is that
fair to do this?
Well, I think both Mr. Thompson and I have articulated what ``fair''
will look like if you don't do something. What ``fair'' will look like
if you don't do something is either vastly restricted benefits, as has
been recommended by the Medicare trustees, vastly restricted benefits
as dictated by the Independent Payment Advisory Board, or perhaps no
Medicare program at all. After all, the makeup of the voting public in
10-to 15-years' time is going to be different than what it is today,
and the makeup of the voting population in 10-to 15-years' time may
feel significantly different about paying 60, 65, 70, 75 percent of
their paychecks in order to continue benefits that were promised by a
Congress 60 years before.
This type of intergenerational anxiety is just around the corner, and
if we don't deal with it head on, if we don't take it as a serious
responsibility, then it, indeed, could set the stage for some
significant strife down the road between today's children and
tomorrow's grandparents. That is why it is so important that we address
this situation today.
G.T., I have said what I had intended to say today. If you have any
additional comments or closing thoughts, we'll wind down this hour a
little early.
Mr. THOMPSON of Pennsylvania. I appreciate that. Thanks again for
hosting this hour.
Whether we're talking about addressing the deficit or whether we're
talking about saving Medicare--frankly, both of those issues are
intertwined--we've got to save the country, and we've got to save the
Medicare program. What we cannot do is allow the politics of 2012 to
affect the problem-solving of critical problems in 2011. That's what we
have seen so far. Where the facts are evident and clear that this
country is facing a critical deficit that could bankrupt it and where
the numbers for Medicare are such that its insolvency is impending and
bankruptcy occurs and it goes away, these are critical problems, and
they shouldn't be demagogued as we bring solutions to the floor to
debate. That's what has been happening. So there is no way we should
allow the politics of 2012 to affect the critical problem-solving of
2011.
After the Balanced Budget Act of 1997, I had the privilege as a
health care professional to be recruited to serve on a technical expert
panel for Medicare. At the time, it was the Health Care Finance
Administration. Today, it's the Centers for Medicare and Medicaid
Services. Based on that experience, this is necessary. This is a
necessary debate. This is necessary in order to save Medicare, and it's
an opportunity for us.
We have had previous reforms. The most recent one I saw was under
President Bush where he created the waiver program. That was a reform
to an entitlement program that actually increased the quality of life
and decreased the costs of many people who were institutionalized,
living in nursing homes. Frankly, I like nursing homes. I think they
can be very quality facilities, and I was an administrator at one time.
Yet people should have the choice of where they live if they're living
with a significant disability. It was President Bush's waiver program,
a reform actually, that allowed that to occur.
So ``reform,'' I think, can be a word used to scare people, but we
need to talk about the specifics of why it is necessary and the
opportunities that we have, I believe, to increase the quality of care,
to decrease costs, to even increase access--all those--and certainly
choice since the health care consumers are making decisions. Those are
four principles that we share as a caucus as to whatever we do in
health care. In looking at Medicare reform, I think that our plan,
which is really the only viable plan, honors all four of those
qualities.
So I look forward to continuing this debate. We need to have a good,
transparent debate, but it needs to be a debate that is not based on
demagoguery. It's a debate that needs to be based on the facts. I thank
my colleague for hosting this Special Order time.
Mr. BURGESS. I think we'll look forward to having similar discussions
in the future, probably frequently, because it's important that we not
just have the debate with both sides of the Chamber. It's also
important that we have the conversation with the American people.
I would remind people that the Republican budget that was passed in
April was an aspirational document. It wasn't terribly long. If you
look at something that becomes an actual law, it can get fairly long
and intricate, but the budget was an aspirational document that set the
goals. In 10-years' time, we want to see Medicare on a sustainable
path. We want to preserve, protect and defend it for the future, and
this aspirational document sets the pathway for achieving that goal.
All of the work that will be done to actually develop the legislative
product will be done in the committees that Mr. Thompson and I are on
in the House and that Members of the other body are on in the Senate.
The actual work will be done on those committees, and there will be
ample opportunity for people to comment, for people to contact their
legislators. There will be periods of open comment at the Federal
agencies as those laws are written. They won't be written in the next
couple of months. They will be written over the next several years.
The point I would end with is that we are entering a phase of a long
conversation with the American people about what the future of this
program is, which arguably has been a good program in the past but,
left untouched, is headed for some significant problems in the future.
So what is the forward-looking path for our Medicare system and for
our seniors of both today and tomorrow? It will be a long conversation,
but we are both up to it, and we can talk for a long time without
pausing. I look forward to working with you on many afternoons on this
very subject.
Madam Speaker, I yield back the balance of my time.
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