[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]




                              {time}  1450
                              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.

                              {time}  1500

  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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