[Congressional Record Volume 157, Number 91 (Thursday, June 23, 2011)]
[House]
[Pages H4511-H4517]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HANDS OFF MEDICARE
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 5, 2011, the gentleman from New York (Mr. Tonko) is recognized
for 60 minutes as the designee of the minority leader.
Mr. TONKO. This evening I will be joined by my colleague from
California, Representative Garamendi. He and I will discuss for this
next hour the issue that deals with a program that is tremendously
popular in this country, that deals with our senior population as they
have the resources through a program dubbed ``Medicare'' that enables
them to enjoy with dignity their senior years and to be able to have
the security of knowing that there is affordability and accessibility
for their health care needs. Obviously, as our senior population
continues to grow and the longevity curve continues to climb upward,
our senior population has reminded us that their dignity and their
quality of life has been addressed in a very strong way as the
calculated curve for life expectancy continues to mount, which is a
positive force in the lives of all Americans.
The efforts that we see afloat in this House at this Capitol range
across a number of cuts and reforms that people are proposing for the
future budget for this country. There is this Ryan Roadmap which has
been developed and dubbed the ``path to prosperity'' by the author and
by the Republican majority in the House. However, many of us have seen
it for its true value and its attempts to end Medicare, so much so that
we have dubbed it the ``road to ruin,'' a situation that would undo a
Medicare program, and it is why signs such as this next to me here
would greet many of us when we arrive in our district for district work
period or on weekends as we break from session here in the House of
Representatives: ``Hands off my Medicare.'' It's very bold, it's very
straightforward, and it's very understood. The message is real, and it
has reached us because it talks about an attempt here to end Medicare
in this House. It would force seniors to find their own insurance in
the private market. They would be asked to shop with a coupon in hand.
The money that the government would kick in for coverage, part of that
coupon would not nearly keep pace with the actual costs--the costs that
seniors would be forced to pay.
Of course, as 32 cents--which has been the on-average expectation of
the coupon--for every $1 of premium costs would be the outcome, that
means that the risk would shift from our senior population to have them
dig into their pockets, and the risk would be removed from government
and placed in the hands of seniors. It would take away what is a
stable, dependable system and put a profit-driven insurance arena of
companies in charge of rationing care for our seniors.
This is a very unacceptable outcome, Representative Garamendi, and
I'm glad that you have joined us this evening in this Special Order,
where we'll focus on the Ryan Roadmap and what it really means, what it
calculates to do, and the impact it has on so many elements of the
population out there. And thank you, Representative Garamendi, for
joining us this evening as we talk about this attempt to end Medicare
and shift the risk from government to seniors.
Mr. GARAMENDI. Representative Tonko, thank you so very much for the
opportunity to join you this evening on this critical issue. We often
call this the Ryan Roadmap, but it really is the Republican budget
proposal. It's not only the chairman of the budget committee that put
this out, but every Republican in this House voted for it. So they
really have adopted this as their roadmap, as their solution to the
problems that face this Nation.
{time} 1850
You spoke very eloquently about the way in which this proposal would
change who pays and how it's going to be paid for. It shifts the burden
away from all of us. It shifts the burden onto individual seniors.
One of the things that I found very interesting was: How much does it
cost an individual senior?
Now, recognize that those who are seniors today also suffer. It's not
just those who will become seniors but those who are seniors today, and
I'll
[[Page H4512]]
come back to that during this discussion because that's a very, very
important part. Our Republican friends have often said this doesn't
affect anyone on Medicare. Well, the Medicare portion doesn't, but the
Medicaid does because it does cut Medicaid. We'll come back to that.
What I want to focus on is the shift of responsibility here and what
it's going to cost an individual.
If you are not yet 55, then you're going to be in a system that is
not Medicare. As you say, it's a voucher program. It's a program in
which the government will give you a voucher, a ticket, and say, ``Go
buy your insurance.'' What's going to make up the balance? The
individual is going to make up the balance, and this little chart lays
it out pretty clearly.
If you're 55, then you'd better start finding $182,000 right now
because, when you become 65 and go on the non-Medicare program, you're
going to have to come up with $182,000 in order to be able to buy the
insurance that you need. Similarly, if you're 50, you're going to have
to have $231,900 in order to be able to purchase the private insurance
coverage. It goes on. If you're 40, you'll need $343,800. So you've got
to put that money away because, when you become 65 and the Medicare is
not there for you, you'll be having to make up the difference.
The bottom line on all of this is--I love this one. I think you'll
recognize it, Mr. Tonko. We used this some time ago. It's the
tombstone. ``Medicare, 1965-2011, Created by LBJ, Destroyed by GOP?''
They are destroying Medicare.
Medicare is a program that has been around since 1965. It guarantees
that every individual in America who has turned 65 will have this
health insurance policy--a policy that guarantees them benefits,
doctors' visits, hospital visits, and under the new Affordable Health
Care Act, an expansion of services, a whole series of preventative
services available without cost to seniors. It actually saves us money.
It's very, very interesting that if you spend money up front for
prevention, as we do in the Affordable Health Care Act, which,
incidentally, every Republican voted against and voted to repeal, that
benefit that goes to seniors free saves taxpayers money and keeps
seniors healthy.
Mr. TONKO. You point out the line in the sand drawn for 55 and over
and 55 and under and that there is a different treatment. People would
try to suggest, if you're 65, say, and you're qualifying for Medicare,
if you go forward, the folks below 55 will never join the system, and
that will cause fluctuations in the crowd that's 65 and over today. As
that happens, as they grow older and as the life expectancy keeps
strengthening and going north, not south, there is no replenishing of
the younger eligible Medicare community. As you climb the age chart,
the correlation with health care and your need for services rises. So
the younger element within the Medicare eligible community was, I
think, providing stability in the fund. I think it disrupts even the
actuarial outcome of that universe as you no longer allow the entry of
new populations with time.
Mr. GARAMENDI. That's absolutely true.
I was the insurance commissioner in California for 8 years. Actually,
that's the way insurance works. It's a large pool, all of whom share
the risk. If your risk pool, as you just described it, becomes older
and older----
Mr. TONKO. With no younger seniors coming in.
Mr. GARAMENDI. Exactly.
Suddenly, you've got a very, very expensive pool.
Mr. TONKO. Right.
Mr. GARAMENDI. Now, on the other hand, the very same thing occurs on
the private insurance side.
On the private insurance side, we're going to see in the Republican
budget plan, the Ryan plan, a whole population of people who have
become 65 who are no longer eligible for Medicare. Now they're going
into the insurance sector, the private insurance sector.
Mr. TONKO. A community for whom we have not done insurance writing.
The actuarial science has not been applied. We've had 45 years of
reprieve.
Mr. GARAMENDI. Exactly. So will the insurance companies want to see
those people? No, they won't because those people are now 65. They're
at an age where they're going to have higher medical expenses.
You're asking the private insurance companies to take this whole new
population of older, more expensive people into their private insurance
companies, into that pool, the result of which is that private
insurance company's pool will become more expensive. They know those
people who are now 65 in the private insurance pool are going to get
ill, that they're going to be more expensive, and so their doors are
going to be subtly slammed shut. As to the availability, while
presumably guaranteed by law, advertising won't be there, and the
insurance agents won't be there to serve that population, and there is
going to be all kinds of not-so-subtle discrimination, making it not
only expensive for the individual but difficult to get quality
insurance. In fact, there is no guarantee about the benefits in the
Republican proposal.
Mr. TONKO. Right. If you'll suffer an interruption here and allow me
to just share what, I think, both of us have talked about, people at
home, because this is such a drastic proposal, can't believe that it's
a real proposal. We have to remind people it is very much alive and it
has legs, so much so today that the majority leader of the House, who
was at the Vice President Biden table for negotiations on the debt
ceiling bill today, walked, along with a Republican Senator
spokesperson for that House, for their conference, the Republican
Conference. They dropped out of the talks today simply because they
want certain revenues at that negotiating table to be exempt, or
certain proposals.
So we're saying, look, this has to be a bipartisan approach that has
a tender balance here: that you cannot drop out of that balance certain
impacts to the economy, like $800 billion worth, which is the price tag
for the wealthy in this country, where they want that dollar amount to
be absolutely cast in stone.
Mr. GARAMENDI. Let me see if I understand.
What you're saying is that, in the negotiations, the Republicans are
saying they are willing to cut services to seniors--Medicare. We also
know that there is a proposal by Mr. Sessions, a Republican, to
terminate Social Security. So they want to reduce the benefits to
seniors or even the availability of the programs to seniors, but they
don't want any new taxes on the super wealthy.
Mr. TONKO. Exactly.
We're saying as Democrats in the House and as Democrats on the Hill
what must be on the table. We need to have on the table discussions
about oil breaks, which trace their roots over a hundred years' worth
of policy decisions. Tax breaks for the wealthiest 2 percent of
Americans must be on the table. These are the important things. Big Oil
profits, which are historically the largest, are the reason, in order
to afford those sorts of handouts and wealthy tax cuts, they need to
carve into a program like Medicare. It's in order to make it all
balance. So we're saying no, no, no, that these things must be on the
table.
Mr. GARAMENDI. All that we do here is make choices. All of these laws
are choices about solving this international problem. Do we want to
solve it this way or that way? It's about choices. This issue of how
we're going to deal with the budget and the budget deficit is about
choices.
The Republicans have made a very clear choice. They are deciding that
their choice is to reduce the benefits to seniors--Medicare, Medicaid
benefits, an almost $900 billion cut in the Medicare program that
provides support for seniors who are in nursing homes--and to terminate
Medicare so that you're forced into a private insurance market. That's
the choice that they've made rather than to go and get our money back
from Big Oil.
{time} 1900
Choices, they have refused both here on the floor, refused to take
back the subsidies that were given to the big oil companies, I suppose
arguing that somehow these oil companies are hurting, that they're not
profitable. Well, not so.
Just take a look here just this last year. ExxonMobil saw a 69
percent increase in their profits, $10.7 billion profit; Oxy, 46
percent, $1.6 billion; Conoco, 43 percent increase, $2.1 billion;
Chevron, 36 percent, $6.2 billion; BP, 16 percent increase, $7.2
billion.
[[Page H4513]]
Oh, by the way, you know who's billion dollars those are? Those are
the folks that buy gasoline and diesel at the pumps. That's money right
out of the pockets of consumers, and, in addition, they get billions of
dollars of our tax money that you and I pay in addition to the gasoline
tax. They get that for additional profit.
It is wrong. It's about choices. The Republicans have made a very
clear choice here: take away from the seniors, take away their
Medicare, and make sure that the oil companies continue to receive
their subsidies.
Mr. TONKO. You know, you talk about choices, and the choices are do
we continue Medicare--and obviously the Democrats in the House want to
improve, they want to strengthen Medicare, not deny it, not end it--
make it more stable, make it an even stronger program. There's a
choice. Their choice would be to have tax earmarks for what sort of
things? For corporate jets, for golf bags, for snow globes. These are
the choices. And beyond choice, there are contrasts.
Now, this chart here somewhat incorporates what you're talking about
there with Big Oil. We have $131 billion that is given away yearly to
Big Oil and millionaires, handouts, tax cuts.
Mr. GARAMENDI. How much?
Mr. TONKO. $131 billion.
Mr. GARAMENDI. A year?
Mr. TONKO. Yes. Contrasted with the $165 billion that are yearly cuts
to Medicare. So it's almost an equal swap. And we see that you need to
end Medicare in order to provide for the wealthy tax cuts for
millionaires and billionaires and handouts, mindless handouts to oil
companies sitting on historic record profits. This year alone, in the
first quarter, we're at about $36 billion in profits.
So why, if we'd done just this mindlessly for nearly a century's
worth, why would we continue that and put at risk a program that will
be celebrating its 45th anniversary in a few days? Why would we do that
when the quality of life for the many, many, the many in the masses of
Medicare eligibility are being put at risk for the far fewer who are
going to get the millionaire, billionaire tax cuts and the oil
handouts?
Mr. GARAMENDI. It's about choices. It's about where do you stand. Do
you stand with the seniors and Medicare and the continuation of
Medicare and the benefits that they need literally to survive or do you
stand with the Big Oil companies? It's very, very clear.
Just look at the way the votes come down here on this House floor.
Over the last 5 months, we've seen vote after vote after vote where the
Democrats have suggested that we eliminate these subsidies, all of
them, the subsidy to Big Oil, that we install the higher income tax for
the superwealthy. We're not talking about the working stiff out there
in the plant. We're talking about the superwealthy, those that have an
adjusted gross income--that's after all of the deductions--of over
$250,000. Take it to a million. But just raise their tax rate on that
upper income above $250,000 3 percent, not talking about a huge
increase, a 3 percent increase, and yet our Republican friends say, oh,
no, we can't do that. We have to whack the elderly. We've got to go
after the elderly. We've got to take away their Medicare benefits.
This is unconscionable. It is terrible economic policy. It is
unconscionable that anyone would make such a choice--give the wealthy
more; take it away from the seniors. What would lead a person to do
that?
Mr. TONKO. Not only do they talk about these choices over and above
the senior community, but they've made it clear that their negotiations
at the table begin and end with this destruction of Medicare while
protecting subsidies for Big Oil and to include the tax breaks for
millionaires. That, you know, is very clear. That is the directive.
That is part of a line drawn in the sand on negotiations, which makes
it very difficult, because what it tells us is that they're willing to
put at risk the full faith and credit of these United States on the
line.
And we know we have just struggled to crawl out of a situation, a
recession that's found 8.2 million jobs lost in America. We're just
climbing that hill to recovery, and they're willing to put the full
faith and credit of the United States at risk and perhaps, most likely,
cause a new economic calamity.
Mr. GARAMENDI. We often talk about this, and what you're referring to
is the deficit reduction negotiations that are going on between the
Vice President and the leadership of the House and the Senate, and
that's good. Negotiations have to take place. But in the negotiation,
it's very clear where the two parties come down. You've described it so
very, very well that in those negotiations, it appears as though our
Republican colleagues are willing to put the full faith and credit of
the United States--this is our worthiness, our financial worthiness as
a Nation--on the line so that they can cut benefits to seniors, so that
they can cut programs that provide food for pregnant women and
children, so that they can make cuts in the school lunch programs, so
that they can make cuts in the infrastructure, in the education
programs that keep this country moving forward, in exchange for no
taxes on the wealthy. They're willing to put this entire Nation's
financial strength at risk so that they can reward the superwealthy in
this country.
Mr. TONKO. And if someone could at least rationalize the benefit of
that program, if they could at least quantify good, societal good that
comes with that sort of thinking. In recent history, twice over in
recent history we've witnessed that relief, that that top income strata
has not caused and inspired a trickle down that produced jobs, that
enabled people to see investments made in an economic recovery. In
fact, the reverse was true. We saw what happened. They reduced these
taxes for millionaires and billionaires, 8.2 million jobs lost, and the
American economy brought to its knees, when in fact, now, the people
have said, look, our top priority is jobs. We heard it. All of us that
serve in this wonderful Chamber heard it in the last election of
November of 2010. It couldn't have resonated more boldly, more clearly.
It's about jobs. It's about growing the economy.
Stop shrinking the middle class. Start growing the economy. That was
the directive, and so what they wanted was to make certain that we
would allow for dignity to continue, that health care costs would be
contained. As we did the reforms to health care, we included
improvements for Medicare. They wanted that Medicare program to
continue. And when you listen to the American public out there--and
we'll talk about this in a minute--the polling, most recent, today that
was released indicates there is strong support for continuing Medicare.
They support strengthening Medicare, and they have denounced this
attempt to bring an end to Medicare. They are angry about it, not just
for their generation. And I'm saying ``they'' as seniors. They are
concerned because they want their children and grandchildren to enjoy
that same order of security that has served them so well with their
health care needs.
Mr. GARAMENDI. How well you've said it, Representative Tonko. The
choices are very, very clear. We do have a deficit problem, and you and
I should spend some time talking about how we got into that in the
first place and how we can get out of it.
But to put this Nation's financial strength on the table and say, as
Republicans are, they are willing to let this Nation go into default on
its obligations, first time ever, and if that were to happen, it would
kick off another financial crisis around the world because the rest of
the world depends upon the willingness of the United States to pay its
debts, because that's the security in the banks around the world.
{time} 1910
And if the United States isn't willing to do that, suddenly, this
Nation's going to be in deep trouble, and the world economy along with
it. And guess what? It's going to cost us a lot of money because the
interest rates will go up. If the United States isn't trustworthy, it's
risky; therefore, you have to pay higher interest.
So we need to understand that this is a default crisis. It's not the
debt ceiling. It is a default crisis that we're facing. And to use it
as a lever to harm seniors is unconscionable. But yet that's what
they're doing as they continue to call for cuts in Medicare and the
Medicare program. We shouldn't let it happen.
We do have--well, before we go there, I keep coming back to this. In
1965, the
[[Page H4514]]
United States decided that we were going to end poverty among the
seniors. The seniors were the most impoverished part of the American
population. And added to the Social Security program was a health
insurance program called Medicare, an extraordinary expression of the
American compassion, an extraordinary expression of the American desire
to take care of their parents and to provide the necessary health care
services. Here we are in 2011 with a proposal by the Republican Party
to terminate Medicare. How can it be? How could we have come to this?
And to say that it's the deficit that's causing this to happen is, I
think, wrong.
Before we turn to the deficit, I just think that we--you and I have
talked about this, Representative Tonko, and we should cover it. We've
talked about it a little bit. We know that the cost of Medicare is
going up. And it is something that is of concern to you and me and, I
think, to everybody in this Nation. But Medicare costs go up along with
the total inflation in health care. It's the whole health care system
that goes up, and Medicare rides along in that inflation. It is not the
cause of the inflation. There are many other causes of the inflation in
health care.
In order to deal with the cost to Medicare, you don't destroy
Medicare and throw Medicare into the insurance market. What you have to
do is to control the underlying costs of health care. There are some
things that you can actually do in Medicare.
For example, Medicare part D, which is the pharmaceutical portion of
Medicare, passed by the Republican Congress in 2003 without any way to
pay for it, all borrowed money. Well, okay. So much for the
Republicans' desire to pay as you go. But it was all borrowed money.
And into the law the Republicans wrote a provision that prohibited the
Federal Government from negotiating drug prices. The Federal Government
is a price taker. Whatever the drug companies want to charge, the
Federal Government has to pay. We could save tens, hundreds of billions
of dollars over 10 years by simply allowing the Federal Government to
negotiate the prices of drugs for seniors.
Mr. TONKO. And you know, you are so right. That preclusion that came
in that measure was an outright avoidance of providing a benefit to the
senior community. I know the number because we talked about it today in
another session. It's $156 billion that could be saved over that 10-
year stretch just by bulk purchasing the pharmaceutical needs for the
Medicare program.
Mr. GARAMENDI. But the Republicans wouldn't allow it.
Mr. TONKO. Exactly.
And it's not just a savings to the government, but it's also a
savings of $27 billion to individual seniors. So right there is an
opportunity to provide for stability and to rein in costs within the
Medicare program. But it takes the sort of compassion and the
determination and the outright leadership to make certain that we make
it stronger. What they've said today--I was in a hearing on the Budget
Committee--is that, well, look, the way we're going to do this is
sharpen the pencil. There is going to be this competition, and
everyone's going to fight to serve the senior citizen for her or his
health care needs. With the market taking over, they're going to drive
down the costs and provide the benefits.
Since Medicare was initiated, the private sector premium costs have
risen by 5,000 percent. Medicare is far below that curve. There isn't
that marketing program. There isn't that administrative overcharge that
really has driven these prices to go out of sight. And what we have
here is an attempt to put the insurance company into the driver's seat.
Mr. GARAMENDI. Well, as the insurance commissioner in California for
8 years, let me just pick that issue up.
The insurance companies are extraordinarily inefficient compared to
Medicare. I know that a lot of people think that government is
inefficient. It is not the case in Medicare. Medicare collects the
money and distributes, pays the bills for about 3 percent of the cost.
The private insurance companies are about 30 percent.
Now, on the other end, you've got the cost of administration. It may
be another 7, 8 percent administrative costs for the doctors and
hospitals for Medicare. But on the private insurance side, because
there are so many different policies, so many different forms, so many
different coverages--this is covered, that's not covered; this is
exempted; this is the copay for this and a different copay for that--it
is utter chaos for the provider. So about 15 percent of that 30
percent, about half of that 30 percent is administrative costs and
commissions and sales and advertising on the part of the insurance
companies, and the other 15 percent is the administrative costs on the
part of the providers, the hospitals and doctors.
It is absolutely the most inefficient way to deliver medical services
and to pay for them. Medicare is one-half the administrative cost both
for the provider as well as for the collection and the payment of the
bills.
Mr. TONKO. And I think it's probably what underlies the thinking of
Americans out there, because when they were polled just recently with
the poll that was shared with people today, there is overwhelming
opposition to the GOP plan to end Medicare. So much so that in that
effort by the GOP to convert Medicare to a voucher system, 57-plus
percent said ``no'' to that idea. And when you look at independent
voters out there as a separate bloc of measurement, it closes into 60
percent, at 58-point-some percent.
So people are saying overwhelmingly, We do not want to convert this
into a voucher system, where you get 32 cents on every dollar that you
need. And they're saying very clearly: Hands off my Medicare. The
message couldn't be clearer: Hands off my Medicare.
Mr. GARAMENDI. I want to pick up one more issue. I know my Republican
friends over here are constantly saying, oh, but in the Affordable
Health Care Act you took $500 billion out of Medicare. Let's understand
what that's all about.
In 2003, in that program, the Medicare part D program, two programs
were actually put in place. One was the drug benefit. Another is what
is called Medicare Advantage. This is the supplemental program for
Medicare. The Medicare Advantage program, when it was put in, to entice
the insurance companies, the private insurance companies to
participate, they were given a 16 percent bonus over and above their
cost. So for 8 years or 7 years, they enjoyed a built-in additional
profit of some 16 percent, which----
Mr. TONKO. Just to get the concept up and running.
Mr. GARAMENDI. Just to get it up and going.
And they continued to receive that additional 16 percent, additional
profit, guaranteed profit. When we did the Affordable Health Care Act,
we said, Wait a minute. They don't need that any longer. The program is
up. It's going. The advertising and everything else is in place, the
administrative system. So we want to take back that additional profit
given to the insurance companies.
That's where the $500 billion is over a 10-year period. That's money
that was saved by creating an efficiency and, once again, ending an
unnecessary supplement. It did not in any way, shape, or form change
any of the benefits that seniors received in the Affordable Health Care
Act. There was a sentence. It said, ``No benefit changes,'' period.
Mr. TONKO. Right.
And where we saw overpayment for services provided, where there was
unnecessary profit accrued in certain areas, we said enough is enough.
The taxpayers shouldn't pay for adding to the profit column beyond
reason for those private sector types that said they can do it cheaper,
which was the claim. We can do it cheaper. Let us have this Medicare
Advantage model, and we will show you how we can provide benefits. It
didn't require such vast overpayment.
{time} 1920
Mr. GARAMENDI. No more subsidies.
Now that I'm on a roll, in that Affordable Care Act, there was
additional money for the Internal Revenue Service, the IRS,
specifically to go after Medicare fraud. We know it's a problem. In the
previous years, the Republican budgets reduced the effort of the
Medicare program to go after fraud. So we put money into the Affordable
Health Care Act to go after fraud. Guess what happened when the
Republicans came to power. They eliminated
[[Page H4515]]
the money that the IRS needed to add additional agents to go after
Medicare fraud.
Mr. TONKO. Right.
Mr. GARAMENDI. What's that all about?
Mr. TONKO. In situations where we found recently--and there was an
article in a major paper, The New York Times, that reported that there
were CT chest scans done two times over at many locations where they
were recovering those dollars through Medicare and found that to cost
some $25 million worth of waste, of fraud in the system. Now, that's
just one small example of one small bit of opportunity and activity in
the health care field.
Think of it. If you have the agents, as you suggested, and if they
are funded in a way that produces dollars of savings simply by having
the infrastructure, the human infrastructure, to go out and chase this
fraud down, we can then benefit. There are systems here that we
developed that have the checks and balances, that have the bells and
whistles, that have the preventative element. Even the efforts that we
made in the Affordable Care Act to not require copayments or
deductibles for any of the screenings and the annual checkups for our
seniors--wonderful concepts to, again, contain the costs of health care
within the Medicare model, which we thought was a wonderful thing to
do.
And you're right, there's no move here. When you end Medicare and
make no adjustments and just hand it over to the private sector and
say, Keep on your trend of being much more expensive than Medicare and
go out there and sharpen the pencil, without changes that they want to
induce into the program, nothing changes; but the cost increases for
the seniors.
Mr. GARAMENDI. So if you're looking at the deficit and dealing with
the deficit, you don't have to destroy Medicare to save money. In fact,
it will cost us more money, not directly in taxes but out of the
individual pocket. No doubt about it.
The other thing is that there are many, many ways to bring down the
cost of health care. Many of those are in the Affordable Care Act,
which our Republican friends want to repeal. And let me just go through
them:
There's the end of the subsidies for the insurance companies, which
we just talked about. There's the money for the IRS agents to go after
fraud. There is in the legislation a provision that says that hospitals
will not be paid for reinfections. One of the most expensive things in
the hospital system is when a patient gets an infection in a hospital
and comes back into the hospital. These are very, very simple things
called ``cleanliness'' and ``hygiene'' at the hospital to bring down
the infection rate. And in the Affordable Care Act, it said, no, no, if
there's a reinfection in the hospital, we're not going to pay you a
second time around, forcing the hospitals to keep it clean.
Electronic medical records, eliminated or attempted to be eliminated
by the Republicans. All of these things are good for health. The
preventative care.
Mr. TONKO. And the annual checkups. Don't forget those. And just
undoing the requirement for copayment or deductibles for those
screenings and annual checkups. There was this compassionate,
reasonable, thoughtful approach to contain costs, provide for the
continuation of a program that has grown immensely valuable in the
lives and the fabric of our senior community.
And you know what's interesting too? This ``hands off my Medicare''
is not just resonating with today's seniors. In the recent poll that I
just cited, 61 percent of those age 35, Representative Garamendi, and
older and 63 percent of those age 55 and older said they would be worse
off under this GOP plan. Worse off. So the more people check this out,
all age groups--under 55, under 35, over 65--are all saying, Hands off
my Medicare. It's no wonder that the message has been resoundingly
delivered throughout this country, no matter what region. You're on the
west coast. I'm on the east coast. We're hearing it from coast to
coast.
Mr. GARAMENDI. And everything in between, Hands off my Medicare,
Hands off my children's Medicare.
However, we're saying that. The public is saying that. Democrats say
we will not give an inch on Medicare. We will control the cost within
the total health care system, but we will not allow the destruction of
Medicare. Keep your hands off Medicare. The public is saying that.
And what are our Republican friends saying? They're saying, Keep your
hands off Big Oil subsidies. Hello. What's that all about? They're
saying don't touch the subsidies, the billions of dollars annually that
the oil industry gets, our tax dollars given to the oil industry. Don't
touch that. Keep your hands off those subsidies. But they want to put
their hands onto Medicare and literally destroy Medicare.
Mr. TONKO. So you're saying that--to quote your dollar figure from
earlier--if you're 54, 55 years old, save another $182,000 to cover
your health care costs with the end to Medicare because the system has
to pay oil subsidies to the historically profit-rich oil industry.
So they're saying, okay, garner up those dollars, save somehow the
$182,000 additionally that you will require for your health care
coverage because we have to give this mindless handout to the oil
companies. Or guess what, $6,000 more out of your pocket per year for
your health care coverage because we won't have the dollars if you
don't do that to pay the oil companies or to give the millionaires and
billionaires their tax cut.
These are the priorities that need to be addressed thoughtfully at a
negotiating table. And the ridiculousness of the empowerment of the
most powerful at the expense of the masses of those who have received
quality of care and dignity addressing their golden years, that has to
be sacrificed just so that this stubbornness of negotiation can
continue where you're going to have this Darwinistic outcome.
Mr. GARAMENDI. Representative Tonko, we do have a deficit problem. We
have to address that. We've talked about ways that that can be done in
the health care sector without harming Medicare. But one of the most
important things in addressing the deficit problem is to put people
back to work.
Americans want to work. They want to earn a living. They want to have
enough money to pay for their home or their rent and food and take care
of their children so their kids can go to school. We need a jobs
program. We need a jobs program in America. We need to be able to put
people back to work. We're into almost the end of the sixth month of
this session. Not one jobs bill put forward by the Republican Party.
Not one. They talk about cuts in taxes as though that's somehow going
to create jobs, and there's absolutely no evidence that it does.
Mr. TONKO. What does grow jobs is strengthening purchasing power so
that as the middle class of America, which is the engine that drives
the economy, has the available cash to purchase things, to be out there
and allow for the upper strata to have their products sold, purchased,
you're going to destroy purchasing power of many households, senior
households, those who have to save $182,000 before they qualify as
seniors. That's going to drain this economy.
Mr. GARAMENDI. That's money directly out of the pockets, and that's
money that has to be set aside.
What I would like to take a few moments on, with your permission, is
to talk about a program that you and I and our colleagues on the
Democratic side have been working on now for the last, almost a year
now, and we call it Make It In America. It's that great American middle
class, the heart and soul of this country, the men and women that went
to work every day and made something. They made cars. They made jet
airplanes. They made engines. They were out in the fields. They made
the tractors. America was the great manufacturing center of the world.
And in the last 20 to 30 years, we've allowed that to dissipate.
We want it back, and we know we can get it back. We have the ability
in this Nation to rebuild the manufacturing base of America; and when
we do, we will rebuild the middle class of America. We call this Make
It In America. And it's so important.
You come from an area that still is a great manufacturing sector and
was once the greatest center of it.
Mr. TONKO. Absolutely. The 21st Congressional District of New York,
in the capital region, Mohawk Valley of upstate New York, hosts the
original
[[Page H4516]]
infrastructure of the Erie and Barge Canals, the route that gave birth
to a necklace of communities called mill towns that became the
epicenters of invention and innovation that inspired a westward
movement, that inspired an industrial revolution.
{time} 1930
That pioneer spirit is the DNA of America. Give us the opportunity to
invest in ideas, and we turn that into manufacturing and we go forward.
But it begins and ends with a quality workforce. And the cuts
proposed in Head Start, with a quarter of a million children being
denied Head Start opportunities, the huge cuts to title I funding to
get resources to our schools, especially those in most difficult
situations, would destroy the workforce of the future. Without
investment in education, there is not a strong and vibrant workforce
that can continue to carry our strength as a Nation in this global
economy. So that is a start.
And then also, I have witnessed in my region, where we're the third-
fastest growing hub in this Nation for science and tech jobs, high tech
jobs, that when you start cutting away at R&D, you're going to destroy
the opportunity that we have as we continue to cluster with these
science and tech-related jobs.
Mr. GARAMENDI. Representative Tonko, I come from the San Francisco
Bay area. We are the first great science research technology. We'll let
you be number 3. But we're number 1.
Mr. TONKO. Not for long.
Mr. GARAMENDI. But the point here is that our strategy of ``Make it
in America'' includes a half a dozen different specific programs, one
of which you talked about, which is the education system.
Why in the world, when we need, as you just said, to build the
ability of the American worker to compete, smart, capable, would we
reduce the education funding? But that's precisely what our Republican
friends have done. They've taken money out of the Pell Grants for
college, very significant, Head Start. All of the Federal education
programs are being reduced by the Republicans at a time when we have to
build it. So if we're going to make it in America, we need a well-
educated work force.
This one up here we call trade. Listen, China's cheating. China is
cheating on their currency. And no matter how creative, how competitive
we are, how hard our workers work, it's virtually impossible to compete
against China because of their currency cheating. The Democrats want to
put on this floor, send to the President a demand that the United
States take action, against China on their currency issue so that we
could have a fair trade situation.
Mr. TONKO. Absolutely. The currency issue is epicenter to the
solution that's required. Fair trade is what really allows us to
compete effectively. This imbalance that's been able to continue is
very harmful to our economy, to the workers of this country.
You know, the working families have taken it on the chin. The middle
class of America needs that purchasing power, that enhancement of
purchasing power. Then you see economic recovery. Then you see people
putting people to work because, as that activity continues to grow and
snowball, you will require the investment in jobs in all, from service
sector on over to manufacturing on over to R&D. And where you plant R&D
as a center of invention, of ideas of innovation, there will come to be
next door to that planting the manufacturing elements that will allow
our manufacturing sector to prosper.
Mr. GARAMENDI. Well, R&D, research and development. In the continuing
resolutions pushed forward by the Republican party and successfully
enacted and signed into law by their intransigence to deal with any new
revenues, the research budgets of the United States were significantly
reduced at a time when we actually need more research.
Research into energy. We know we have an energy crisis. We know we
need to move to new energy sources. And yet the Republican budget
reduced the energy research for this Nation.
Automotive research. We're just now beginning to claw back and
rebuild our automotive industry, and so research into batteries and new
efficient automobiles--eliminated by the Republicans. What are they
thinking?
Mr. TONKO. And when you talk about battery manufacturing, advanced
battery manufacturing taking place in my district, you're talking about
the linchpin. You're talking about that connector to all of the
opportunities out there that transition us into alternative
technologies. It begins and ends with that battery development. And we
have those opportunities. We've invested in those. We need to continue
to take that curve northward so that you put the money down that will
grow jobs. That's investing.
There is the rightful expectation that there will be lucrative
dividends from that investment. And when you look at the global race,
this is much similar to the global race on space in the early sixties,
when we got knocked on the seat of our pants in the late fifties with
the Sputnik moment, and that woke us up, and we involved ourselves, and
we embraced with great passion getting that race done in winning style.
And we won it.
Today we have more competitors. You've got China, Brazil, India,
Germany, Japan, all investing in a global race on clean energy and
innovation, and we're going to tie our hands behind our back.
Mr. GARAMENDI. Take away the resource money and see what happens. We
lose the race.
We know we all get sick, right? Why would you ever put forward a
policy to reduce research in medical services and the basic
understanding of the human gene, of understanding how we can solve
medical problems? Why would anybody propose a reduction in the research
for medical care?
I don't know. But they did. And they succeeded in reducing the budget
for medical research.
So energy, medical research, automotive, transportation research,
they reduce it in the budget and they expect our economy to grow, to be
competitive? I don't get it, but that's what they have done.
Mr. TONKO. There are quantifiable benefits that come not just with
job creation, but with service delivery. If you provide for this sort
of basic research, you're providing for cures to illnesses that have
continued to haunt the fabric and quality of life of individuals. And
if we can discover and unleash that potential, there is a quality of
life that's addressed. There's hope that's delivered to the doorsteps
of families across this country. And so it goes well beyond job
creation. But you're absolutely right. These are jobs that are of high
quality, that require, again, the investment of America's know-how.
They are opportunities for intellectual capacity that we, as a Nation,
invest in higher ed, and this is putting that higher ed product to
work.
Mr. GARAMENDI. Let's take another example. And this comes up on the
energy policies of this Nation.
I think we all understand that the oil industry has done rather well,
and we continue to subsidize the oil industry. Efforts to eliminate
those subsidies and to shift those to the new green technologies have
been blocked by our Republican friends.
Now, we do have money going to subsidize, to provide incentives for
the clean energy industry, wind turbines and solar photovoltaic
systems. I have a bill in, actually two bills, that say that our tax
money must be spent on American-made equipment.
For example, I have two big wind farms in my district, the Altamont
and the Solano wind farms. They're huge, huge pieces of equipment,
towers 400 feet high with blades that are a football field across, made
overseas in Europe and China. And I'm looking at it and I'm going, wait
a minute; our tax money's being used to help build these systems? And
yet they're not American-made? I said, no, no, no, no. If our tax
money's going to be used in this way, it's going to be used to buy
American-made equipment. That bill is in. It's now being slowed down,
blocked in the various Republican committees here. But it seems to me
foolishness to allow our tax money to be sent offshore.
We also, all of us, pay 18\1/2\ cents excise tax for gasoline. That
money is used to build roads, highways, bridges, and to buy trains and
buses and light rail systems. My legislation says that that money must
be used to buy American-made equipment. Those trains,
[[Page H4517]]
those buses, those light rails, the steel in the bridges, will be
American-made.
Why don't we bring those jobs back home? We can do this using money
that is already available, already being spent, but sometimes all too
often spent on foreign-made equipment.
Mr. TONKO. And talk about this sort of innovation economy where you
invest in America, you make certain that our infrastructure that moves
goods and people is as sound as it can be. But as we invest in the
growth of jobs and ``Make it in America,'' and you talk about the clean
energy economy, the alternative technologies, the innovation that comes
with advanced battery manufacturing, that stops the trail, eventually,
of dollars that are exported out of this Nation, going into the
Mideast, $400 billion plus a year to maintain this fossil-based economy
that has us gluttonously dependent on fossil-based fuels that are
imported from unfriendly nations to the United States.
{time} 1940
There has to be a cleaner way, a more innovative way, one that
embraces the American intellect and the ingenuity that enables us to
grow products that are not on the radar screen. That's how a great
nation continues its greatness; that's how it continues to become even
greater, by putting to work its brainpower and developing products that
are kinder to the environment, strong in their manufacturing element
that produces here in these United States and draws upon the workforce
and the R&D potential of everyone from trades up to the Ph.D.s involved
in that equation of success. I think it's a way to empower us across
the board.
Mr. GARAMENDI. As we come to the conclusion of this, the Make It In
America agenda is a powerful agenda to rebuild the American
manufacturing base to put middle class America back to work so that
they can have the home that they want, so that they can take care of
their children's education, so that they can have, once again, pride in
this Nation. We can do it. And these are the policies--a fair trade
policy in which we tell China, no, no, no, we're not going to let you
cheat on your currency any longer, where the tax policy makes sense.
This one. An example. Somewhere in the last 30 years, built into the
tax laws was an incentive for American corporations to shift jobs
offshore. They take a job; they send it offshore; they got a tax break.
I don't know where it came from. I know it was in the Codes. And what
we did in the tax bill last December was to eliminate that tax break
for American corporations sending jobs offshore. It passed. The
President signed it, but our Republican colleagues, to a person, voted
against it. They voted to keep that tax break for American corporations
to shift jobs offshore. Doesn't make sense to me, but it's gone. And
that's the kind of policy we want to put in place, where we take care
of Americans who are working in America.
Mr. TONKO. And you know, Representative Garamendi, just about an hour
ago we were talking about it all being about principles, values,
priorities, contrasts, and choices. Well, if we go with the choice to
not make it in America, not invest in innovation, research for medical
purposes, means that we may not be able to contain those costs of
medical needs, of health care, because we will avoid the discovery of
better treatments, new cures, prevention elements that all come with
the medical research and medical innovation that can be made in
America.
And then we have opportunities to keep Medicare alive, not destroy
it, by containing costs for health care and allowing for the dignity of
life and the quality of care to go forward without this treatment to
end Medicare. And the choice is to avoid powerful industries like the
oil industry, giving them mindless handouts, or do we invest in
education, higher education, job creation, quality of life issues,
housing opportunities? These are the choices we're talking about.
This hour has been, I think, an opportunity for us to exchange, with
a clearer expression, what the contrast is on the floor of the House of
Representatives and what it is between this Path to Prosperity that we
have seen as a Road to Ruin, one that would end Medicare, continue
handouts to record profit oil industries, to continue to advocate for
millionaire and billionaire tax cuts at the expense of America's middle
class that needs a stronger purchasing power and needs to know that her
children and grandchildren will have the opportunities, equal
opportunities for quality education and a college degree.
Mr. GARAMENDI. Thank you very much, Representative Tonko.
Our promise to the American seniors and those who want to become
seniors is that this tombstone that the Republican Party wants to put
out there--that is, the termination of Medicare--will not happen. We
will not let this happen. Medicare is part of the American agenda. It
is part of what is good about America, and it will not be terminated by
anybody. That's our promise. That's where we draw our line in the sand.
Thank you very much for this opportunity.
Mr. TONKO. Thank you very much, Representative Garamendi. It has been
a great opportunity to share this hour with you.
We only ask that thoughtfulness guide the negotiations--either on a
deficit ceiling bill or on budgets as we go forward--thoughtfulness and
a desire to grow opportunity for all Americans. We're at our best when
the inclusiveness of this process enables everyone to be empowered and
not just the special interests, the wealthy oil industry that has set
record profits 2 years in a row.
With that, I thank the Speaker for the opportunity, and I yield back
the balance of my time.
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