[Congressional Record (Bound Edition), Volume 155 (2009), Part 15]
[Senate]
[Pages 20823-20825]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. Madam President, we are concerned about the health 
care reform legislation that we have seen in the House and here in the 
Senate. It is headed in the wrong direction. The Mayo Clinic has told 
us so. The Democratic Governors have told us so. The CBO has told us 
so.
  We are hearing already from people around the country who fear that 
millions of people may lose their employer-based health insurance and 
may find themselves in a government-run plan, with new State taxes to 
pay for Medicaid.
  My purpose is to point out that as we go back to our States in 
August, there is plenty of opportunity to go in a new direction. I hope 
when we come back, we will start over in that direction.
  As an example yesterday, 12 Senators--7 Democrats and 5 Republicans--
wrote an op-ed in the Washington Post about the Healthy Americans Act, 
the bill that is sponsored by Senator Wyden, a Democrat, and Senator 
Bennett, a Republican. I am a cosponsor among the 5 Republicans on that 
bill.
  There are a number of things I agree with in the bill and some things 
with which I don't agree. I agree it is the right framework upon which 
we can build a bipartisan discussion. For example, the things I like 
about the bill and the reason I endorse the effort is that it has been 
scored as budget neutral. In other words, it doesn't add to the 
deficit, according to the CBO. It doesn't create a government-run plan 
to compete with private insurance plans. People would have choices 
among private plans just like most people have today. It replaces 
Medicaid and the Children's Health Insurance Program with private 
insurance plans. It doesn't replace all of Medicaid, but about 40 
million of the people who are on Medicaid today, which is the largest 
government-run program we have, would have a choice to buy plans like 
the rest of us.
  I think one of the worse things about the bills we are seeing is that 
it dumps low-income Americans into a government-run program that is 
failing--Medicaid--that 40 percent of the doctors will not see, and 
that none of us would want to join if we were forced to do so. This 
proposal takes away that problem. The Healthy Americans Act makes a 
fairer distribution of the government subsidies we already spend 
subsidizing health care by giving more

[[Page 20824]]

Americans a chance to benefit from that.
  It would give more Americans a chance to purchase the same kind of 
health insurance policy Federal employees and Members of Congress have. 
It provides a tax deduction for all American individuals and families 
to address the unfairness of our tax system. It includes an individual 
mandate. In other words, no free ride. We are all in this together. 
States that implement some sort of reforms against junk runaway 
lawsuits against doctors, which drive up the cost of malpractice 
insurance, will receive bonus payments.
  It also includes some of the insurance market reforms about which we 
are hearing so much from our Democratic friends. What they don't tell 
you is we are all for those changes. These are the insurance reforms 
that say you will have a right to purchase insurance without a physical 
examination, and if you have a problem when you go in to get the 
insurance, you cannot be denied insurance for that reason. These are 
insurance reforms that virtually all Republican plans I have seen, and 
all the Democratic plans, have already in there. Those aren't the 
issue.
  It provides a full subsidy to people living under 100 percent of the 
Federal poverty level to buy insurance, a private plan. This would mean 
roughly $5,000 for an individual and $12,000 for families to buy a 
plan. Americans earning between 100 to 400 percent of the Federal 
poverty level will receive subsidies on a sliding scale. After that, 
you pay for it yourself.
  There are some points I don't like about the bill, but I endorse the 
framework, as well. I will mention those. I don't like the employer 
responsibility provisions. During negotiations, if this were the bill 
we were discussing, I would urge to change that. I don't like the fact 
that plans are required to be at the higher benefit level of the 
Federal employee plans. That is a level higher than most Federal 
employees have, and we can save dollars if we use the basic plan and 
use that money to provide higher subsidies to middle-income Americans 
to buy health insurance. I don't believe the subsidies in this bill are 
enough for many middle-income families. I have suggested a place to get 
some of that money.
  We phase out the tax deduction at $62,500 a year, which may not be 
high enough to make this a fair proposal. I am concerned about the 
abortion provisions in the bill, although it doesn't provide government 
subsidies for abortion.
  The point is, there is a framework that is headed in a different 
direction, and it has the support of 12 Senators.
  I ask unanimous consent that the op-ed from the Washington Post be 
printed in the Record following my remarks.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  (See exhibit 1.)
  Mr. ALEXANDER. Madam President, I also ask unanimous consent that an 
article by Art Laffer in Wednesday's Wall Street Journal, which 
provides yet another reasonable option for providing health care 
opportunities for Americans without adding to the deficit, be printed 
in the Record following my remarks.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  (See exhibit 2.)
  Mr. ALEXANDER. Madam President, there is a way to do this if we want 
to head in a different direction.
  I yield the floor.

                               Exhibit 1

                [From the Washington Post, Aug. 5, 2009]

              How We Can Achieve Bipartisan Health Reform

                  (By Ron Wyden and Robert F. Bennett)

       We refuse to let partisanship kill health reform--and we 
     are proof that it doesn't have to.
       As 12 U.S. senators from both sides of the aisle who have 
     widely varying philosophies, we offer a concrete 
     demonstration that it is possible to find common ground and 
     pass real health reform this year. The process has been 
     rocky, and slower than many had hoped. But the reports of the 
     death of bipartisan health reform have been greatly 
     exaggerated. Now is the time to resuscitate it, before the 
     best opportunity in years is wasted.
       Democratic activists have long campaigned for universal 
     coverage and quality benefits. Republican activists zero in 
     on empowering individuals and bringing market forces to the 
     health-care system. Our approach does both. In our 
     discussions on the Healthy Americans Act, each side gave a 
     bit on some of its visions of perfect health reform to 
     achieve bipartisanship.
       The Democrats among us accepted an end to the tax-free 
     treatment of employer-sponsored health insurance; instead, 
     everyone--not just those who currently get insurance through 
     their employer--would get a generous standard deduction that 
     they would use to buy insurance--and keep the excess if they 
     buy a less expensive policy.
       The Republicans agreed to require all individuals to have 
     coverage and to provide subsidies where necessary to ensure 
     that everyone can afford it. Most have agreed to require 
     employers to contribute to the system and to pay workers 
     wages equal to the amount the employer now contributes for 
     health care. The Congressional Budget Office has reported 
     that this framework is the only one thus far that bends the 
     health-care cost curve down and makes it possible for the new 
     system to pay for itself. It does this by creating a 
     competitive market for health insurance in which individuals 
     are empowered to choose the best values for their money and 
     by cutting administrative costs and spreading risk across 
     large groups of Americans.
       First, we allow all Americans to have the same kind of 
     choices available to us as members of Congress. Today, more 
     than half of American workers who are lucky enough to have 
     employer-provided insurance have no choice of coverage. 
     Members of Congress who enroll their families in the Federal 
     Employees Health Benefits Program often have more than 10 
     options. This means that if members of Congress aren't happy 
     with their family's insurance plan in 2009 or insurers raise 
     their rates, they can pick a better plan in 2010. Our plan 
     would give the consumer the same leverage in the health-care 
     marketplace by creating state-run insurance exchanges through 
     which they can select plans, including their existing 
     employer-sponsored plan.
       Beyond giving Americans choices, our approach also ensures 
     that all Americans will be able to keep that choice. We 
     believe that at a time when millions of Americans are losing 
     their jobs, members of Congress must be able to promise their 
     constituents that ``when you leave your job or your job 
     leaves you, you can take your health care with you.'' Our 
     approach ensures seamless portability.
       Our point is not that our framework is the only way to 
     reform the system or to reach consensus. But our effort has 
     shown that it is possible to put politics aside and reach 
     agreement on reforms that would improve the lives of all 
     Americans. Insisting on any particular fix is the enemy of 
     good legislating. A package that will entirely please neither 
     side, but on which both can agree, stands not only the 
     strongest chance of passage but also the best chance of 
     gaining acceptance from the American people.
       We didn't undertake this effort because we thought it would 
     be easy; in fact, we started working together because we knew 
     it would be hard. Passing health reform is going to require 
     that we take a stand against the status quo and be willing to 
     challenge every interest group that is jealously guarding the 
     advantages it has under the current system, because health 
     reform isn't about protecting the current system or 
     preserving the advantages of a few. We can't forget that we 
     are working on life-and-death issues facing our constituents, 
     our families, our friends and our neighbors.
       It's time to stop trying to figure out what pollsters say 
     the country wants to hear from us and focus on what the 
     country needs from us. The American people can't afford for 
     Congress to fail again.
                                  ____


                               Exhibit 2

              [From the Wall Street Journal, Aug. 5, 2009]

                  How To Fix the Health-Care ``Wedge''

                         (By Arthur B. Laffer)

       President Barack Obama is correct when he says that 
     ``soaring health-care costs make our current course 
     unsustainable.'' Many Americans agree: 55% of respondents to 
     a recent CNN poll think the U.S. health-care system needs a 
     great deal of reform. Yet 70% of Americans are satisfied with 
     their current health-care arrangements, and for good reason--
     they work.
       Consumers are receiving quality medical care at little 
     direct cost to themselves. This creates runaway costs that 
     have to be addressed. But ill-advised reforms can make things 
     much worse.
       An effective cure begins with an accurate diagnosis, which 
     is sorely lacking in most policy circles. The proposals 
     currently on offer fail to address the fundamental driver of 
     health-care costs: the health-care wedge.
       The health-care wedge is an economic term that reflects the 
     difference between what health-care costs the specific 
     provider and what the patient actually pays. When health care 
     is subsidized, no one should be surprised that people demand 
     more of it and that the costs to produce it increase. Mr. 
     Obama's

[[Page 20825]]

     health-care plan does nothing to address the gap between the 
     price paid and the price received. Instead, it's like a 
     negative tax: Costs rise and people demand more than they 
     need.
       To pay for the subsidy that the administration and Congress 
     propose, revenues have to come from somewhere. The Obama team 
     has come to the conclusion that we should tax small 
     businesses, large employers and the rich. That won't work 
     because the health-care recipients will lose their jobs as 
     businesses can no longer afford their employees and the 
     wealthy flee.
       The bottom line is that when the government spends money on 
     health care, the patient does not. The patient is then 
     separated from the transaction in the sense that costs are no 
     longer his concern. And when the patient doesn't care about 
     costs, only those who want higher costs--like doctors and 
     drug companies--care.
       Thus, health-care reform should be based on policies that 
     diminish the health-care wedge rather than increase it. Mr. 
     Obama's reform principles--a public health-insurance option, 
     mandated minimum coverage, mandated coverage of pre-existing 
     conditions, and required purchase of health insurance--only 
     increase the size of the wedge and thus health-care costs.
       According to research I performed for the Texas Public 
     Policy Foundation, a $1 trillion increase in federal 
     government health subsidies will accelerate health-care 
     inflation, lead to continued growth in health-care 
     expenditures, and diminish our economic growth even further. 
     Despite these costs, some 3o million people will remain 
     uninsured.
       Implementing Mr. Obama's reforms would literally be worse 
     than doing nothing.
       The president's camp is quick to claim that his critics 
     have not offered a viable alternative and would prefer to do 
     nothing. But that argument couldn't be further from the 
     truth.
       Rather than expanding the role of government in the health-
     care market, Congress should implement a patient-centered 
     approach to health-care reform. A patient-centered approach 
     focuses on the patient-doctor relationship and empowers the 
     patient and the doctor to make effective and economical 
     choices.
       A patient-centered health-care reform begins with 
     individual ownership of insurance policies and leverages 
     Health Savings Accounts, a low-premium, high-deductible 
     alternative to traditional insurance that includes a tax-
     advantaged savings account. It allows people to purchase 
     insurance policies across state lines and reduces the number 
     of mandated benefits insurers are required to cover. It 
     reallocates the majority of Medicaid spending into a simple 
     voucher for low-income individuals to purchase their own 
     insurance. And it reduces the cost of medical procedures by 
     reforming tort liability laws.
       By empowering patients and doctors to manage health-care 
     decisions, a patient-centered health-care reform will control 
     costs, improve health outcomes, and improve the overall 
     efficiency of the health-care system.
       Congress needs to focus on reform that promotes what 
     Americans want most: immediate, measurable ways to make 
     health care more accessible and affordable without 
     jeopardizing quality, individual choice, or personalized 
     care.
       Because Mr. Obama has incorrectly diagnosed the problems 
     with our health-care system, any reform based on his 
     priorities would worsen the current inefficiencies. Americans 
     would pay even more for lower quality and less access to 
     care. This doesn't sound like reform we can believe in.

  The ACTING PRESIDENT pro tempore. The Senator from Illinois is 
recognized.
  Mr. DURBIN. Madam President, how much time do we have?
  The ACTING PRESIDENT pro tempore. There is 6 minutes 12 seconds 
remaining.

                          ____________________