[Congressional Record (Bound Edition), Volume 155 (2009), Part 12]
[Senate]
[Pages 15546-15547]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. ISAKSON. Madam President, for just a minute, I want to talk about 
health care. I am a member of the Health, Education, Labor and Pensions 
Committee. We began yesterday the opening statements on the bill that 
is pervasive in its coverage around the country as to the future of 
health care in America.
  I rise as one not to be a critic but to lay out the challenge this 
legislation portends for all of us and maybe to raise some points that 
thoughtfully will be considered before we make a serious mistake on the 
funding side, the expense side, and the borrowing side.
  A few weeks ago, in Georgia, at a Rotary speech, I referred to ``a 
trillion-dollars in debt.'' A gentleman stood up in the Q and A section 
of that time, and he said: Senator Isakson, I only got a high school 
education. Can you explain to me what a trillion is?
  I do not know how many of you have thought about that, but if you had 
to do it right now, could you explain what it is? I could not. So I 
decided to go home that night and figure out some easy way to 
demonstrate how much a trillion is. I thought maybe it would be good to 
determine how many seconds it takes for a trillion seconds to go by. So 
I did the math on the calculator. I thought I made a mistake and did it 
again. I had it checked.
  It takes 317,097 years, 11 months, and 2 days for a trillion seconds 
to go by. That is almost incomprehensible, but it does give you some 
idea of the issues we have to be concerned about in terms of spending 
and cost and savings.
  The CBO has scored the parts of the health bill that have actually 
been drafted--which is about two-thirds of it--at a potential cost of 
$1 trillion over 10 years. Obviously, we are going to have to pay for 
that. There have been some discussions in the last few days of 
suggested pay-fors. But I want to discuss for a minute how we have to 
be very careful not to use words such as ``a pay-for'' that in fact 
only move obligations around.
  For example, President Obama, for whom I have great respect, said to 
the medical association on Monday that one of the pay-fors, by having 
public coverage for everybody, would mean there would be no indigent 
patients; therefore, everybody would be getting paid for their services 
and that would save us $11 billion a year in DSH payments, which is the 
disproportionate share of treatments which charity hospitals in New 
York and Atlanta get through Medicaid because they take a 
disproportionate number of indigent patients.
  There is only one flaw in that analysis. Yes, we might not 
appropriate $11 billion a year for disproportionate share anymore, but 
we are not doing it because we are raising Medicaid coverage to 150 
percent of poverty and providing health insurance through a public 
plan. So the cost remains the same. It just moves from a cost to pay 
charity hospitals for disproportionate share to a cost of providing the 
coverage through Medicaid or through the private plan.
  The unintended consequence of removing disproportionate share would 
be taking the economic model through which charity hospitals are 
financed and turning it upside down. Because in my city of Atlanta, for 
example, where Grady Hospital exists--and Grady has gone through a 
reformation; we have created a foundation, and we have done everything 
we can to save the hospital--it gets a tremendous part of the DSH 
payment from Medicaid for disproportionate share because it takes a 
disproportionate number of the indigent patients because private for-
profit hospitals will not. But if private for-profit hospitals have 
indigent patients who now have coverage, and they are closer to the 
patient than Grady is, the patient will then go to the private 
hospital, so the DSH payment goes down or evaporates for the public 
hospital, and so does the funding mechanism upon which their public 
bonds and their public debt were financed. So we have to be careful 
about the unintended consequences.
  Secondly, on Medicaid, I am a product of the Georgia State 
legislature, and I know the distinguished Acting President pro tempore 
today is a product of the New York Assembly. We all dealt with 
Medicaid. Medicaid is a program where the Federal Government pays about 
two-thirds of it. The States pay about a third of it. And the States 
run it.
  When we got into this business of expanding Medicaid under this 
legislation to 150 percent of poverty--which is a 50-percent increase 
in eligibility--I thought back to my days in the legislature about how 
much money that was that my State then was going to have to come up 
with under the one-third match.
  In Georgia, in 1968--the first year we had Medicaid--the State's 
share of Medicaid for the year was $7,791,000. In 2008, the State's 
share was $2,468,376,258, which would go up by $1 billion if we raised 
the eligibility to 150 percent.
  I know the President has said that for 4 years the Federal Government 
will take over the entire obligation of that increase to 150 percent. 
But that is only putting off the inevitable for the States, which will 
be a percent of their budget they cannot afford.
  Medicaid, in Georgia, in 40 years has gone from 1 percent of our 
budget to 12 percent of our budget. With this proposal, it would go to 
18 percent.
  We must remember, in the economic stimulus bill, a significant amount 
of that money was Medicaid money to go to the States to fund what is 
already an existing shortfall.
  So I come to the floor to say this: I am for every goal of the 
preamble of the health care bill that has been introduced in the HELP 
Committee. I want to make policies more affordable, coverage more 
pervasive, access easier, and I want to lower costs. But as Acting 
Chairman Dodd said yesterday in the committee, history will not look 
favorably on you if you do not do something because it is hard. He is 
right. But neither will history look favorably upon you if you do 
something easy when it is hard. This is hard work, and we cannot take 
the easy way out to pile debt on the people of the United States of 
America.
  Hopefully we will thoughtfully consider these ramifications I have 
discussed and others and move forward with a health proposal we can pay 
for and that accomplishes its goals rather than an easy answer that 
puts us in a desperate situation as a country and ultimately takes us 
to an economic demise in this country.
  Madam President, I appreciate the time and I yield to my colleague 
from the great State of Arizona.
  The ACTING PRESIDENT pro tempore. The Senator from Arizona.
  Mr. McCAIN. Madam President, I appreciate very much the wise words of 
the Senator from Georgia, who has been heavily involved in health care 
issues dating back to his time in the Georgia legislature and brings a 
unique perspective to the issue, that of a person who has had to, as an 
elected representative, wrestle with these issues

[[Page 15547]]

from not only the Federal level but also the State. So I appreciate his 
words.
  As the Senator from Georgia pointed out, this is probably the single 
most important domestic issue that will be taken up by the Congress of 
the United States, at least this year, and maybe in the next couple 
years, and maybe in a long time when you look at the fact that we are 
addressing an issue that basically consumes one-fifth of our gross 
national product, not to mention the fact that the system is broken, 
that the inflationary pressures are unsustainable, and there are 
millions of Americans who do not have access to quality, affordable 
health care.
  So where are we now in the Senate? I think it is time for a little 
status report.
  The Finance Committee--remember, there are two committees that are on 
parallel tracks taking up this health care legislation, the Finance 
Committee and the Health, Education, Labor and Pensions Committee--the 
Finance Committee yesterday announced they will delay their 
consideration until after the Fourth of July recess.
  The day before, the Congressional Budget Office came out with a 
report that was nothing less than stunning. It indicated that the 
proposal the Senate Health, Education, Labor and Pensions Committee is 
considering would have a cost of $1 trillion and only insure 
approximately one-third of the 47 million who are uninsured, which 
would lead one to the conclusion--doing the most elementary math--that 
if we were able to insure all of the uninsured in America, that would 
be a cost of $3 trillion. And we still have no proposal as to how we 
would pay for this dramatic expansion of the role of government in 
America's health care system.
  Never before in the years I have been here have I seen a ``markup,'' 
which means we begin the amending process of a bill through the 
legislature, as we teach our children in school, and yet three major 
policy pages are still completely blank--completely blank.
  We are told we will see these new policies at some point tomorrow. 
That is after we were told we would see them today. And then the 
majority, the Democrats, who are coming up with this language 
themselves--without any consultation with this side of the aisle--will 
give us a chance to review it. Those three areas are the most difficult 
aspects of reforming health care in America.
  Those policies, as we all know, concern the way we pay for the new 
language on employer mandates, the government plan, and the biologic 
drug regulation.
  There is a government option that will be part of this legislation, 
i.e., a government takeover eventually, in my view, of the health care 
system in America, something a majority of Americans have voiced their 
deep concern about--employer mandates, and biologic drug regulation.
  So here we are supposedly moving forward, and the administration 
spokesperson in the last couple of days said the bill that is being 
considered by the HELP Committee is not, ``the administration's bill.'' 
What is the administration's bill? Where is the administration's bill? 
We have no idea what the provisions I just mentioned will cost or 
whether they will create jobs and whether the American people will be 
called upon to pay an increase in taxes and, if so, who will pay them. 
I do not know how you move forward with legislation that, frankly, you 
do not know how you are going to pay for.
  How can the President and the majority expect the American people to 
take them seriously when they talk of wanting a bipartisan product that 
addresses their needs when, at the same time, majority members and 
their staff have written the entire bill without any input from this 
side of the aisle? I assure you, the American people would have much 
more confidence in this effort if both Republicans and Democrats were 
working together on health care reform. Instead of changing Washington, 
it sounds an awful lot like a one-sided effort to jam a bill through 
before the American people understand what is in it.
  This morning, there is some very interesting data. According to a 
CBS/New York Times survey, the President holds a 57-percent approval 
rating, which is very good. On health care, his approval rating is 44 
percent. That is way down, and it is down because the American people 
are beginning to figure out that we are going to have a proposal that 
will end in government control of American's health care, it will 
squeeze out competition, and it will be incredibly expensive. As I 
mentioned, the CBO preliminary estimate is $1 trillion, but insures 
only one-third of the American people, and it leaves 32 million people 
without health insurance.
  So we hear that the Finance Committee, as I mentioned, is in such 
disarray over the costs and policies in their bill that they have 
postponed their consideration until after the Fourth of July break. 
They obviously don't have their policies together enough to move 
forward. It appears to me, from my service on the Health Committee, 
that it does not either.
  I think the only reasonable thing to do is to go back to the drawing 
board. Let's go back to the beginning. Let's sit down together and work 
out a reasonable proposal that we can go to the American people with 
that says we will provide them with affordable and available health 
care. Every American knows the costs are out of control, everybody 
knows it needs to be reformed. But we will do so without a government 
takeover of America's health care system.
  Madam President, I yield the floor.
  Mr. HARKIN. Madam President, I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. HARKIN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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