[Congressional Record (Bound Edition), Volume 155 (2009), Part 11]
[Senate]
[Pages 14754-14756]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. CORNYN. Mr. President, I want to spend a few minutes talking 
about the importance and challenge of health care reform, something 
that is on the fast track in the Senate.
  Recently, as I traveled my State of 24 million people, I heard many 
similar themes from my constituents. What they told me is that our top 
priority ought to be reducing the cost of health care because, of 
course, by reducing the cost it becomes more affordable by more people 
and we attack what is one of the other principal concerns, and 
certainly one of mine, and that is too many people who are uninsured in 
this country.
  We know cost is one reason why 46 million people are not insured in 
this country, some of whom have good jobs that pay well, but if they 
are young they would rather put the money in their pocket than pay for 
health care. Others have different circumstances, maybe small 
businesses that are priced out of the market.
  It is a fact that American families have seen their health care 
premiums double over the last 10 years. My constituents and the 
American people generally are also very concerned about our future. As 
they see so much borrowing and so much spending here in Washington, 
they worry about the fact that Medicare, which is the health care 
program for seniors, has an unfunded liability of $38 trillion. So, to 
understand, while we have roughly $2 trillion in annual deficits 
running, we also have $38 trillion in unfunded Federal liabilities for 
Medicare and the trust fund is anticipated to go insolvent by the year 
2017, less than 8 years from now.
  I appreciate the urgency of focusing on health care reform. We have 
been working under Chairman Baucus and Ranking Member Grassley on the 
Finance Committee. I know other Senators have been working hard at this 
as well--Senator Kennedy and Senator Enzi on the HELP Committee.
  I urge us to keep working very hard to work through all the 
complexities and moving parts of this very challenging problem. I also 
want to say that I think how we discuss health care reform is very 
important, but I am also concerned that some voices are greeted with 
derision or even implicit threats that suggest they better keep quiet 
if they know what is good for them.
  A tremendous amount of work has gone into the series of three Finance 
Committee roundtables and walk-throughs. But I am disturbed by some 
reports that perhaps Senators, certainly staff, have urged key 
stakeholders in the health care reform debate to keep their mouths 
shut. Every American citizen has a right to petition their government. 
This is a right every American citizen has, and no American should be 
told to keep quiet on the subject of health care reform, in particular. 
We know reforming health care is an urgent priority, as I said, and 
more than 300 million Americans have a stake in our success.
  The Congress needs to take the time given the fact that this 
represents 17 percent of our gross domestic product and is so complex. 
We need to take the time and get the input from everyone who has 
something to offer as we undertake this massive task. We have a highly 
complex, $2.6 trillion system, and we need to take time to get the 
reforms done right. I am not talking about peddling in place, I am not 
talking about wasting time, I am talking about doing what the American 
people expect us to do; that is, get it right, not try to rush 
according to some arbitrary timetable.
  So I am pleased to say that some stakeholders are standing up against 
this notion that this deal ought to be cut in a closed back room 
somewhere. The American Medical Association, for example, has announced 
its opposition to a government-run plan. The U.S. Chamber of Commerce 
and the National Federation Of Independent Businesses have expressed 
concerns about some aspects of the legislation that has been proposed 
by the President and by leadership here in Congress. But more voices, 
not less--indeed all voices--deserve to be heard on something of such 
fundamental importance to our country. The American people deserve a 
transparent and open debate about the reforms, the various proposals 
that are on the table, so they can judge for themselves whether 
Washington elites have their best interest in mind or, to the contrary, 
whether they believe something else is going on.
  I also express my appreciation for the professionals at the 
Congressional Budget Office for refusing to compromise their integrity 
and for continuing to provide objective analysis of all reform 
proposals. That is their job. Their job is not to make policy, but it 
is their job to give us unvarnished, objective information about costs 
so we can determine what policy makes sense and what policies we can 
afford.
  In particular, I commend the Director of the Congressional Budget 
Office, Dr. Doug Elmendorf, who I read was

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quoted as saying that the Congressional Budget Office ``will never 
adjust our views to make people happy.'' That demonstrates the kind of 
integrity and objectivity we would want to inform our decisions. We are 
the ones who are elected to make those decisions on the part of the 
American people. We are the ones who should be held accountable for 
those policies. But we have to get good, objective, unbiased 
information from professionals with integrity such as Dr. Elmendorf and 
his staff at the CBO.
  Some, it has been suggested, do not like the big price tag the 
Congressional Budget Office has put on some of their proposals. But the 
solution is not for the Congressional Budget Office to get creative, it 
is for Senators to get real and deal with the reality and to use that 
information in order to craft decisions that work.
  I wish to speak in particular about the only bill that has actually 
been rolled out, more or less, or provisions, and that is the bill 
proffered by our colleague, Senator Ted Kennedy.
  Senator Kennedy has been a leader in the health care reform debate 
for more than four decades. I appreciate the fact that he is the first 
Democrat on either end of Pennsylvania Avenue who has actually put out 
a proposal with some detail for us to evaluate and react to. While more 
details are certainly needed, and I hope they will be forthcoming, we 
already know there are some red lines, some hot spots, some areas that, 
if embraced by the Democratic leadership, will result in failure, not 
in success. I think we all should be invested in the goal of bipartisan 
success. In fact, there are some provisions in the Kennedy bill that 
would make things worse, in my view and in the view of others.
  I think there is one thing we should do; that is, take the 
Hippocratic Oath, the same oath medical practitioners take to ``do no 
harm.'' I think we should take a legislative Hippocratic Oath to first 
do no harm as we undertake this massive reform. For example, in the 
Kennedy bill, it describes a plan called ``a public health insurance 
plan operated by the Federal Government with a payment scale that is 
set in statute and based on Medicare.'' I believe ``Medicare for all'' 
or a government-run health plan is a disaster in the making for the 
millions of Americans who will depend upon us to get this right. Let me 
explain why.
  First, a government-run plan will ultimately take away the health 
insurance people have right now. Last year, President Obama campaigned 
on the promise that if you like what you have, you will be able to keep 
it. I agree with him. That ought to be our goal. But with a so-called 
government plan, that will not happen because we all know that the 
government is not just the regulator, but it is also the one paying the 
bills; that ultimately, the government cannot be calling the balls and 
strikes even as it takes to the field to be a so-called competitor.
  Let me put a finer point on it. One group of analysts, the Lewin 
Group, said a government plan would take away, ultimately, current 
health benefits from 119 million Americans and force 130 million into a 
Washington-run health care plan. How does that happen? Well, ostensibly 
you would have the government competing with the private sector to 
provide health care. But we know the government ultimately would 
provide a more generous package and could do so, of course, at taxpayer 
expense and save the difficulty of having to compete in the 
marketplace. Ultimately, as the Lewin Group concluded, it would 
undercut private competitors, leaving people with no choices and 
ultimately leaving everyone, or at least 130 million Americans, on a 
Washington-run health care plan--not a good idea, in my opinion.
  Secondly, we know a government plan would drive up costs for those 
who remain with private insurance. How does that happen? Well, we know 
there is a phenomenon in health care called cost shifting. That is 
because Medicare and Medicaid pay submarket rates and health care 
providers have to make it up somewhere else. Where do they make it up? 
They end up making it up from people who have insurance. And how do 
they do that? By people who have insurance paying more than they 
ultimately receive because the costs are literally shifted from 
Medicare and Medicaid onto private insurance.
  According to a respected actuary, Milliman, commercial payers 
subsidize the cost of Medicare and Medicaid by nearly $90 billion a 
year in cost shifting. This represents a hidden tax on American 
families and small businesses. Milliman estimates that the average 
private health care premium is more than $1,500 higher per family, more 
than 10 percent higher than it would be without this government cost-
shifting phenomenon. A new government program would increase this cost 
shifting dramatically and increase the health care premiums of every 
American family who continues on their private health insurance plan.
  Third, we know this Medicare-for-all or government-run plan would 
basically be like Medicare and Medicaid on steroids. Lest anybody be 
confused, that is not a good thing. I believe Medicare illustrates what 
happens when the government takes over health care delivery. For 
example, first of all, it is not fiscally sustainable. As I mentioned, 
Medicare is going to go insolvent in 2017 and currently has $38 
trillion in unfunded liabilities.
  Low reimbursement rates--and frankly, that is how Medicare and 
Medicaid try to deal with costs. They cut payments to providers--
hospitals and doctors--below the otherwise market rates. These low 
reimbursement rates reduce patient choice and increase wait times for 
the physicians they see. Many providers, as I am sure the distinguished 
occupant of the chair, in his State, knows--we know many doctors are 
not even taking new Medicare patients and new Medicaid patients because 
lower reimbursement rates are the problem. Every year, Congress has to 
come back and reverse the cuts to physician payments under the Medicare 
sustainable growth rate formula, and those cuts, unless we act to 
reverse them, will cut physician payments by 20 percent this January.
  According to the Washington Post last fall, taxpayers also pay up to 
$60 billion a year in fraudulent claims on Medicare. So in addition to 
being fiscally unsustainable, in addition to rationing or providing 
unrealistically low payments, denying people access to health care, we 
have $60 billion in fraud and waste in the Medicare Program--hardly a 
model for Medicare, for a government-run option.
  Well, Medicaid has even more problems. Medicaid provides coverage, 
but it does a poor job of providing access. In one way, this is really 
a ruse that is being perpetrated on the American people under Medicare 
and Medicaid. We say: Yes, you have coverage. But if you cannot find a 
doctor or a health care provider who will provide you access at that 
price, then their coverage does not do you any good.
  According to a recent Wall Street Journal article, Medicaid's low 
reimbursement rates, which are actually lower than Medicare, have 
resulted in 40 percent of physicians restricting access to patients in 
the program. So it is no wonder, as the journal Health Affairs said 
last month, that ``physicians typically have been less willing to take 
on new Medicaid patients than patients covered by other types of health 
insurance.''
  Medicaid reimbursement rates, as I said, are even lower than 
Medicare, more than 25 percent lower than Medicare. The story of 
Pediatrix Medical Group, which has a significant presence in my State, 
illustrates the problem.
  Pediatrix has more than 1,300 physicians and 500 advanced practice 
nurses. They specialize in the care of newborns and other very 
vulnerable children. Pediatrix has noted that ``the lack of appropriate 
reimbursement is among the common reasons for physicians to refuse to 
accept new Medicaid patients.'' They have noted that within their own 
national neonatal and hospitalist patient population, the current 
government rates pay an average of 28.7 percent less than rates from 
private insurers. No wonder it is hard for Medicaid beneficiaries--
notwithstanding what Congress does, it is hard for them to find a 
physician who will actually see them at that kind of rate.

[[Page 14756]]

  Pediatrix has said, ``We believe a public plan structured [after 
Medicare and Medicaid] would ultimately erode the availability of 
private health and negatively impact patient access to needed health 
care.''
  The fourth problem I have with the plan in the Kennedy bill is that 
the government plan would ultimately lead to a rationing of health 
care. What does that mean? Well, that means delay or denying access to 
treatment. All we have to do is look at Canada.
  A recent op-ed by Dr. David Gratzer in the Wall Street Journal this 
last week talked about what a government-run plan in Canada has done. 
Thousands of our friends to the north, of course, come to America each 
year for lifesaving surgery, if they can afford it, after their 
government has told them they will just have to wait. Various studies 
indicate that Canadians, especially the poor, are less healthy under 
socialized medicine than those in our country. More and more Canadians 
want to reduce the role of government and expand private options for 
health care, even as the elites in Washington want to move America in 
the opposite direction.
  The fifth reason a government plan is not a good idea is it would 
lead to poorer health outcomes. Many Canadians are realizing that 
socialized medicine is not working for them, and so are many folks in 
Europe. According to a piece in the Washington Examiner this week, 
breast cancer rates in Europe, under nationalized health care systems, 
are significantly higher than they are here in the United States. 
European women are much more likely to have breast cancer than are 
American women. Currently, the United States leads the world in 
treating breast cancer. Women in our country with breast cancer have a 
14-percent better chance of survival than those in Europe. Compared to 
the United States, breast cancer mortality is 52 percent higher in 
Germany and 88 percent higher in the United Kingdom. This is not 
something we should want to emulate.
  We also see some poor health care outcomes in the United States under 
government-run health care. For example, numerous studies have 
documented the poor patient outcomes under the Medicaid Program 
relative to patients in private plans. For example, Medicaid patients 
are more than 50 percent more likely to die of coronary bypass surgery 
than patients with private coverage or Medicare.
  There are other problems with the bill that the distinguished Senator 
from Massachusetts has proposed. Again, I credit him with being the 
first one to lay out a plan. We have not yet seen one from any other 
source. But the fact is, the Kennedy bill is not paid for. We don't 
know how much additional borrowing or how much higher our taxes will 
have to go up in order to pay the price. It also includes a concept 
known as pay or play for small businesses. In other words, if you don't 
have health care coverage for your employees and are a small business, 
you will have to pay a punitive tax.
  The bill also provides very generous Federal subsidies to individuals 
making as much as $110,000 a year. We are all for a safety net for 
people who are low income and can't otherwise provide for themselves. 
But why should taxpayers be forced to pay higher taxes to subsidize 
health care for people making over $100,000 a year. It doesn't make 
sense.
  The bill also includes an innocuous-sounding council called the 
Medical Advisory Council, which in effect would give the government 
power over personal health care decisions, particularly to unelected 
and unaccountable bureaucrats. Of course, the bill creates new 
entitlements, which we have no hope of paying for, at the same time 
when unfunded liabilities for so much of our entitlement programs 
remain unpaid for. Frankly, while I applaud the distinguished Senator 
from Massachusetts and his leadership on this issue, I worry that this 
is a bill that has no bipartisan input. I applaud Senator Baucus, 
chairman of the Finance Committee, and other Democrats on that 
committee who said we need to come up with a bipartisan solution. When 
I raised this concern this morning in the Finance Committee, the 
Kennedy bill was described as more of a wish list than anything else.
  The bill reflects very few ideas from Republicans, which we have 
offered to discuss and would hope to include in any comprehensive 
health care reform. It includes several provisions which Republicans 
have made clear are off the table, if our colleagues want a truly 
bipartisan bill. I mentioned the government plan option which kills 
bipartisanship because Republicans cannot support a policy that will 
lead to a Washington takeover of our health care system. There are 
better alternatives, alternatives which empower individuals and 
preserve the individual choice each of us has to make health care 
decisions, in consultation with our physician or family doctor, in the 
best interest of our families. Empowering people rather than government 
is a much better solution than this proposal we see under the Kennedy 
bill.
  Innovators in both government and the private sector have learned 
that by empowering patients and providing them some incentives, they 
can actually see costs lowered.
  There are a lot of good ideas out there. Unfortunately, the partisan 
proposal we have from the HELP Committee is not one of them. We hope we 
can continue to work together, on a bipartisan basis, toward a 
successful outcome.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Udall of Colorado). The majority leader.

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