[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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