[Congressional Record (Bound Edition), Volume 155 (2009), Part 12]
[Senate]
[Pages 15803-15805]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. CORNYN. Mr. President, health care reform is very much in the 
news and very much on the agenda of the Senate, as the American people 
know. So far, they have learned very little about how Congress plans to 
address what is broken in our health care system.
  As the Presiding Officer knows, two committees in the Senate are 
primarily given the responsibility for writing a health care reform 
bill. Of course, the HELP Committee--the Health, Education, Labor and 
Pensions Committee--chaired by Senator Kennedy, the Senator from 
Massachusetts, and the Finance Committee, chaired by Senator Baucus. 
The ranking member, of course, is Senator Chuck Grassley from Iowa. 
These two committees, as well as the President of the United States, 
are considering numerous proposals that deserve the careful attention 
of the American people and of Congress, because this legislation, 
however it turns out, could fundamentally affect the relationship 
between patients and their doctors as well as the relationship between 
the individual and our government.
  In the Kennedy bill, which has been proposed and which is pending now 
before the Health, Education, Labor and Pensions Committee, there are 
several troublesome provisions. One, a government-run plan which would 
compete, allegedly, with the private sector. But as we all know, the 
government is the 800-pound gorilla, and there is no true competition 
when government is involved. In fact, one projection is that as many as 
almost 120 million people would ultimately find themselves in a single-
payer, government-run system, because essentially the Federal 
Government would undercut those private health plans to the point where 
individuals would find themselves with no choice other than to have the 
government direct their health care.
  Another troublesome provision is the so-called pay or play mandate. 
It goes without saying, almost, but I will say it anyway, that small 
businesses create the vast majority of jobs in America. Yet this 
proposal, I think mistakenly, would impose a punitive tax on small 
businesses that are unable to keep their doors open and provide health 
insurance for their employees. We want to allow small businesses to 
provide health care to their employees by bringing down the costs, and 
we have a number of mechanisms to do that. But the idea that we are 
going to impose a punitive tax on small businesses that do not provide 
a health care plan for their employees will destroy jobs, so people 
will not only be without insurance, they will be without jobs, period--
a bad idea.
  Third, the Kennedy bill would provide new Federal subsidies to 
individuals making as much as $110,000 a year--astonishing. At a time 
when we are looking at spending or borrowing as far as the eye can see 
and deficits up to $2 trillion, unfunded liabilities in the tens of 
trillions of dollars, there is actually a proposal before the HELP 
Committee that would increase the size of Federal entitlement programs 
and increase the tenuous position of this Medicaid Program which would 
then fund health insurance for people making up to $110,000 a year.
  Fourth, the Kennedy bill would impose a medical advisory council.
  I always get a kick out of the innocuous names given to some pretty 
sinister stuff up here. I would say it is sort of akin to calling the 
former Soviet Union's politburo an advisory council. In fact, this 
medical advisory council--comprised of unelected and unaccountable 
bureaucrats--would have the power to dictate personal health decisions.
  I don't know anybody who thinks that is a good idea; certainly nobody 
I have talked to. This Kennedy proposal, with all due respect to our 
friend and colleague from Massachusetts, is chock full of bad care 
policies. The worst part of it is, they will not lower health care 
costs for people who have health insurance now. In fact, they will make 
our debt burden and the debt burden of our children and grandchildren 
much worse.
  The price tag on government programs keeps growing and growing and 
growing here in Washington, DC. In fact, the President's proposal for 
his budget this year projected a ``downpayment on health care reform.'' 
Well, I have told people that where I come from we don't make 
downpayments on something unless we know exactly what it is we are 
buying. So far the American people don't know what they are being asked 
to buy.
  Indeed, the other part of that--and this just staggers my 
imagination--is that we already spend almost twice as much as the next 
closest industrialized nation on health care per capita. We spend 
roughly 17 percent of our economy--our gross domestic product--on 
health care. Why does anybody think it is a good idea to spend even 
more? If we were getting a good value for that spending, that would be 
one thing, but we know this current level of spending is full of fraud 
and waste and other problems. So why in the world would we want to make 
matters worse by spending more money on top of a flawed health care 
delivery system?
  Talking about money--and I know it is hard to imagine how much we are 
talking about--it used to be that $1 million was a lot of money; then a 
billion dollars seemed like a lot of money--and it is--and now we are 
sort of becoming increasingly immune to these big numbers when people 
talk about trillions of dollars and more. For example, earlier this 
month, the proposal that Senator Kennedy made--that is pending now in 
front of the Health, Education, Labor, and Pension Committee--was 
scored by the Congressional Budget Office, which is responsible for 
giving us good numbers in an impartial, nonpartisan way, so we can make 
sound policy decisions. They said the Kennedy bill would cost more than 
$1 trillion over the next 10 years. The problem is, that was only for 
part of the bill. In other words, that was not the complete cost of the 
bill proposed by our friend and colleague from Massachusetts, Senator 
Kennedy.
  To make matters worse, the Congressional Budget Office said the bill 
would only cover one-third of the uninsured. Ironically, it would 
ultimately chase millions of people off the insurance coverage they 
have right now. So it strikes me as a very bad answer to a very real 
problem.
  Last week, we also learned of the Congressional Budget Office's 
estimate for the Senate Finance Committee proposal--the second 
committee that is dealing with health care, and the committee on which 
I am privileged to serve. Here again, the Congressional Budget Office--
the number crunchers, the folks with the green eyeshades who try to 
call them as they see them so we can take that into account in 
determining policy decisions--said the proposal coming out of the 
Finance Committee would cost $1.6 trillion more over 10 years. So on 
top of the 17 percent of our gross domestic product, we are talking 
about proposals that would spend $1 trillion to $1.6 trillion of 
additional money on top of a broken system.
  Well, two things are becoming increasingly clear so far; that is, it 
seems like there is less concern in Washington about lowering health 
care costs than shifting those costs to the taxpayers. The costs 
related to a Washington takeover of health care keep going up and up. 
You would think these huge price tags would convince some folks in 
Washington we ought to call a time out, to back up and come back with a 
different idea. You would think it would cause Senators and Congressmen 
and other leaders here in Washington--the President--to come up

[[Page 15804]]

with a new approach, to be open to different alternatives where we 
could actually lower costs, not only for the taxpayers but for small 
businesses and individual consumers. Instead, we see proposals coming 
out of the White House and the Halls of Congress calling for more 
spending and more debt.
  Of course, one thing that happens around Washington when people don't 
like the news being delivered by nonpartisan agencies, such as the 
Congressional Budget Office, is they try to shoot the messenger. Last 
week, Speaker Pelosi accused the Congressional Budget Office of 
providing misleading analyses of health care reform bills. I don't 
believe that is the case. I actually believe the professionals at the 
Congressional Budget Office are doing very difficult but unpopular 
work. They are speaking truth to power here in Washington and making 
the folks who would pass these enormous unfunded bills and impose this 
huge debt on generations hereafter somewhat unhappy. But I think they 
are doing an important service by telling us the facts.
  Last week, I commended the Director of the CBO--Dr. Doug Elmendorf--
for saying that CBO will ``never adjust our views to make people 
happy.'' God bless Dr. Doug Elmendorf for his integrity and his 
commitment to telling the truth. We need to learn how to deal with the 
truth, not try to remake it or cover it up.
  The second part of these proposals that causes me grave concern is 
this notion that we actually need to spend more money in order to be 
able to save money in the end. We need to spend money to save money. I 
know the distinguished occupant of the Chair had a very successful 
business career, and maybe that is true in the private sector--
sometimes you have to invest money in order to make money or save money 
later--but I can't think of a single Federal Government program where 
that worked--you have to spend more money in order to save money. It 
does not happen around here.
  Let me cite somebody who perhaps is certainly more authoritative than 
I am: Professor Katherine Baicker of the Harvard School of Public 
Health. She said:

       Universal insurance is likely to increase, not reduce, 
     overall health care spending.

  Professor Baicker predicted months ago what the Congressional Budget 
Office has recently concluded. The Congressional Budget Office said:

       By themselves, insurance expansions would also cause 
     national spending on health care to increase, in part because 
     insured people generally receive somewhat more medical care 
     than uninsured people.

  The Washington Post recognizes this as well. In an editorial this 
morning, it said:

       It is quite likely that any legislation that emerges will 
     create a hugely expansive health-care entitlement with no 
     guarantee of the upward cost spiral being slowed.

  The Post also said:

       . . . given a national debt already growing out of control 
     and the risks that health-care costs won't be controlled, you 
     may worry about taking on a large new burden ($1.6 trillion 
     over 10 years . . . ).

  I think that is exactly right. That is what makes people anxious 
about what they hear coming out of Washington under the name of health 
care reform.
  I think it is fair to say that the ``spend more to save more'' 
thinking is what resulted in the wasteful and counterproductive 
stimulus bill that was passed earlier this year--a bill that we got on 
our desks--the conference report--at 11 p.m. on a Thursday night and 
were required to vote on less than 24 hours later, when virtually no 
one had even had a chance to read it. I was comfortable with my vote, 
because I voted against it, for many reasons but one of them being I 
didn't know exactly what was in there.
  The stimulus bill was a very partisan bill, passed over the nearly 
unanimous opposition of congressional Republicans. But we were told 
something along the lines of what we now hear: Spend more to save more. 
We heard that spending was good, for its own sake, and that borrowing 
and spending was the quickest route to economic recovery. We were told 
we had to rush through this binge of spending--borrowed money--or else 
unemployment would rise to over 8 percent.
  Well, the results are in, and they are not very good. The national 
unemployment rate is now 9.4 percent--not 8 percent. In many States, it 
is well into double digits. A lot of stimulus money has been simply 
wasted, and the bulk of it is stuck here in Washington.
  I think what we ought to do is take it and return it to deficit 
reduction, so we can, hopefully, lower the burden we have imposed on 
our children and grandchildren under a ruse, under the pretense that we 
were actually going to use that money to get the economy back on track. 
It hasn't happened. While we are seeing some so-called green shoots of 
the economy beginning to spring up, with improved results on Wall 
Street, we know unemployment is very high and we are not out of the 
woods yet.
  Indeed, we are looking at the prospect of runaway inflation, unless 
the Fed does a very tricky balancing act as it contracts its balance 
sheet and unwinds a lot of lending it has done in the past. Because one 
result is that as the economy improves, inflation will be a great risk. 
Of course, the Fed has a tough balancing act to play, because if they 
crank up interest rates too soon, it may well kill the recovery and we 
will be back in the position we find ourselves in now.
  The bottom line is, we can't spend more to save more. It didn't work 
in the stimulus bill, and it is not going to work when it comes to 
health care. Proponents of a so-called public plan or government plan--
what I call a government takeover, or Washington takeover of health 
care--are saying that it works as well as Medicare at keeping costs 
low. As a matter of fact, that is the model they started out with. They 
said: Medicare for all, until they realized that wasn't a very good 
example because of the fiscal unsustainability of Medicare spending 
that we see now with tens of trillions of dollars in unfunded 
liabilities and also the fact that a lot of Medicare beneficiaries, 
while they have the promise of coverage--of Medicare--they can't find a 
doctor to see them. Medicare rates are so low that many physicians--for 
example, where I live, in Travis County, in Austin, TX, only 17 percent 
of physicians will see a new Medicare patient because reimbursements 
rates are so low.
  We need to fix Medicare, yes, but we don't need to take the current 
broken system and blow it up and make it the system for 300 million 
people and consider that we have done our job.
  I mentioned the $38 trillion in unfunded liabilities. It is estimated 
Medicare will go insolvent in the year 2017 unless we do something 
about it. In fact, many beneficiaries of Medicare know it is inadequate 
alone, so they buy supplemental policies. Medicare forces many 
providers, as I mentioned, to limit the number of patients they accept 
because reimbursement rates are so low. Here is another part of why 
Medicare is a bad model. The Washington Post estimates that $60 billion 
of taxpayer money is stolen or wasted or lost to fraud in Medicare each 
year. Surely, we need to fix that problem.
  Senator Martinez and I have introduced legislation that we believe 
will cut that figure down dramatically and make sure more of that money 
goes to treat Medicare beneficiaries rather than being stolen or 
defrauded by some unscrupulous health care providers.
  Medicaid only works as well as it does because of cost shifting to 
people with private insurance.
  Economists will tell us that cost shifting occurs when a health care 
provider accepts low government reimbursement rates but can only do so 
if it anticipates collecting higher rates from those with private 
insurance. This cost shifting acts like a hidden tax on millions of 
American families and small businesses. One respected actuary estimates 
that cost shifting increases the average American family's health care 
premium by more than 10 percent or $1,500. That means those listening 
who have private health insurance, their family will pay $1,500 more 
each year because of this cost shifting phenomenon because Medicare and 
Medicaid reimburse at below-market rates. So those are hardly a model 
for what we ought to be doing. Adding another new government plan on 
top of

[[Page 15805]]

the ones we have, of course, will only increase the costs. We will 
never lower health care costs by putting Medicare all in place or what 
some might call Medicare on steroids. We need new approaches.
  Mr. President, there are better alternatives. We have a bill that has 
been proposed by Senators Burr and Coburn on our side of the aisle. 
Several members on the Finance Committee, including myself, are working 
on a proposal that will empower patients and consumers, and not the 
government; that will not get between doctors and patients and will not 
rely on denying or delaying access to care in order to keep costs down. 
We believe innovation is one of the things that has made health care in 
America among the greatest in the world, and that is why we believe we 
need to retain, protect and nurture that innovation and that quality 
health care: to empower patients to use a market that plays by the 
rules to help lower their costs.
  I have seen that as recently as a few weeks ago in Austin, TX, when I 
visited with a number of employees of the Whole Foods Company that is 
headquartered in Austin--a grocery company--where these workers have 
health savings accounts or high deductible insurance. They call them 
wellness accounts. I was told that 80 percent of the employees at Whole 
Foods don't have to pay any money out of pocket for health care. Since 
they have wellness accounts, or money they control, they have been 
empowered to become good, smarter consumers in health care.
  So they will call health care providers and say: How much are you 
going to charge me for this? They will shop and compare different 
providers to make sure they are getting the best price for the best 
quality outcome. I think that kind of thing, which imposes market 
discipline but which requires transparency, is one way we can hold down 
costs and empower individuals rather than just turn it all over to 
Uncle Sam.
  Let me say, in conclusion, we keep hearing we must put health care 
reform on the fast track in Washington, DC, although we see the 
schedule slipping because of the sticker shock at the huge numbers 
coming out of the CBO. I have told folks back in Texas that we know the 
train is leaving the station, but we don't yet know whether that train 
will safely arrive with all of its occupants healthy and alive or 
whether what we are witnessing is, in essence, a slow-motion train 
wreck in Washington, DC.
  The more the American people learn about what is in these bills and 
how much they cost, they will want us to slow down so we can make 
better decisions and we can get this right.
  I think we owe them that. I yield the floor.
  Mr. DORGAN. Mr. 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. DORGAN. Mr. 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.
  Mr. DORGAN. Mr. President, we are to report the pending legislation.

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