[Congressional Record (Bound Edition), Volume 155 (2009), Part 16]
[Senate]
[Pages 21045-21047]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. McCAIN. Mr. President, today Congress returns from the August 
recess. Perhaps one of the most important issues of recent times 
affecting one-sixth of America's gross domestic product and rising to 
as much as one-fifth, the issue of health care and health care reform, 
will be front and center, including a highly unusual appearance 
tomorrow night before a joint session of Congress by the President. The 
last time such a joint session of Congress was called for, aside from 
the regular one, was by former President Bush concerning the events 
surrounding the attacks on the United States of 9/11.
  During the recess, I had, similar to all my colleagues, a very busy 
schedule of meetings addressing various issues, including travel to 
Iraq and Afghanistan. That visit will be the subject of other 
statements on the floor. But in Arizona, I hosted townhall meetings 
with my constituents. I also attended meetings and forums with health 
care providers in Missouri, North Carolina, and Florida so I could, 
along with my colleagues, better understand America's thoughts and 
ideas on reforming our Nation's health care system. I have no doubt 
there is a peaceful revolution going on out in America. I have not 
seen, in the years I have been a Member of Congress, such anger and 
dissatisfaction with the way the Congress and we in Washington are 
doing business. We all know the President's approval numbers continue 
to fall.
  The unruly and sometimes disruptive behavior at townhall meetings has 
been an exhibit of the anger and dissatisfaction Americans feel. I 
would like to make it clear that I think the townhall meetings should 
be conducted with respect. They should be conducted in a way that is an 
American tradition, that all Americans can be heard from as well as 
their elected representatives. But there is no doubt people attended 
townhall meetings that never before in their lives have been engaged in 
any debate in America. There is something going on out there. I 
certainly got the message. I hope the majority of my colleagues did as 
well.
  It is more clear to me that we have to reform the way health care is 
provided, but we have to do it in the right way, without a government 
takeover of the health care system. The problem with health care is not 
the quality of health care. The problem with health care in America is 
the cost of health care and almost double-digit inflation that takes 
place annually which deprives more and more Americans of their ability 
to acquire and keep health insurance.
  Among other places I visited recently, one of them was a place called 
M.D. Anderson, a cancer treatment facility in Houston, TX. There were 
patients there from 90 countries around the world. Why? Because it is 
the highest quality health care.
  The fundamental difference we have here between those of us who want 
to reform health care to reduce the cost and maintain the quality is 
the argument from the President and the other side of the aisle that 
they want a government option. They refuse to address the issue of 
medical malpractice reform. They refuse to allow someone to go across 
State lines and acquire the health insurance of their choice, and they 
continue to allow practices to go on that breed fraud, abuse, and waste 
in Medicare, which are well documented to the tune of hundreds of 
billions of dollars a year.
  We must reform health care. We can't do it with a government solution 
that is advocated by the other side. That is why we have been unable to 
reach agreement--because we have two fundamental philosophical 
differences between ourselves and those who want to have a government 
option, who want to have greater and greater intervention in the health 
care system.
  On the way over I read this:

       Washington (AP)--A top senator is calling for fines of up 
     to $3,800 on families who fail to get medical insurance after 
     a health care overhaul goes into effect.

  Do we want to do that to the American people, a $3,800 fine? That is 
why we also need to step back and examine the 600-page bill passed 
through the HELP Committee, without a financing provision, the 1,000 
pages or so bill passed through the House before they left, and figure 
out what else we have added in this bill.
  Why are Americans angry and upset? They are angry and upset because 
of this, because we spent $787 billion on the stimulus, which is $1.1 
trillion with interest; $700 billion on TARP; $410 billion with 9,000 
earmarks in it on the Omnibus appropriations bill; $3.5 trillion on the 
budget resolution; $83 billion to bail out the auto companies; $33

[[Page 21046]]

billion to expand the Children's Health Insurance Program; and a $1 to 
$2 trillion cost associated with the HELP Committee's plan that went 
through the HELP Committee, according to the Congressional Budget 
Office, which would not bend the curve, according to the Congressional 
Budget Office.
  What have we gotten for all this? We have gone to 9.7 percent 
unemployment. We have gone to 9.7 percent unemployment in this country, 
after the President and all his economic advisers said that if we pass 
this stimulus bill, unemployment will be a maximum of 8 percent. As 
they say: You can look it up. It is now at 9.7 percent. The public debt 
is $11.7 trillion. Sometime in October, we are going to have to 
increase the Federal debt limit which is going to go beyond $12.1 
trillion.
  We are all responsible for what we say. In 2006, the current 
President spoke in opposition to raising the debt limit to $9 trillion 
saying:

       Washington is shifting the burden of bad choices today on 
     to the backs of our children and grandchildren. America has a 
     debt problem and a failure of leadership.

  That was from the then-Senator from Illinois, now President of the 
United States. Where did we go? Where did we go from 11 to 12 and now, 
of course, a few weeks ago, a small rounding error, the 10-year deficit 
was raised $7 to $9 trillion, just a $2 trillion rounding error. That 
is what the American people are worried about, the commission of 
generational theft on our children and grandchildren. No one in the 
administration has a plan for bringing the budget back into balance. I 
think the American people at least deserve it.
  Yesterday the President spoke in front of union allies in a partisan, 
campaign-style speech, where he questioned the motives of those who 
raise concerns about too much government control over our health care 
economy and instead wrongly criticized our side for having no ideas of 
our own. We have plenty of ideas. None of them have been considered in 
the HELP Committee or by the Senate or by the House of Representatives. 
The HELP Committee bill was written only by the Democrats. There was no 
input from this side of the aisle. Every meaningful amendment proposed 
was rejected, including malpractice reform. How can we possibly look 
the American people in the face and say: We are going to bring down the 
cost of health care without medical malpractice reform.
  Ask any physician and they will tell you physicians are required to 
practice defensive medicine because of the fear of being sued. 
Unnecessary tests and procedures are performed time after time after 
time. I was in Miami at the Palmetto Hospital, a fine institution. I 
asked one of the surgeons: How can you afford your health insurance 
premiums? He said: We don't keep insurance anymore. We can't afford it. 
We will probably not get sued because they know we only have so much in 
assets.
  Now we are putting physicians and care providers in a position where 
they basically cannot afford, nor can they get, malpractice insurance 
because the premiums are so high, and they are targets for the trial 
lawyers.
  We have a number of alternatives. Most of them are market based. Most 
of them have to do with preserving the quality of health care yet 
bringing down the cost, which should be our goal. Why don't we have 
insurance reforms to improve access? That means someone can go across 
State lines. If a citizen of Arizona wants to go to North Dakota and 
get health insurance there, why can't they? Why can't that family do 
that? Why can't they? They cannot today.
  Why is it we cannot reform medical malpractice? Let's have tax 
reforms. Let's have incentives to purchase insurance either in the form 
of tax credits for families in America or--or--why don't we give the 
same tax treatment to families that businesses get in the provision of 
health insurance? Why don't we have real competition in any State? Why 
don't we set up the risk pools that are necessary to ensure those who 
were previously uninsurable or for those with ``preexisting 
conditions''? Let's set up those risk pools. Yes, that will take some 
taxpayer dollars.
  Why don't we allow the insurance companies to compete so they can 
provide insurance, so we can provide affordable and available health 
care to all Americans? Why don't we look at cost reductions? Why don't 
we look at incentives for wellness and fitness? One of the most famous 
corporations in America recently is Safeway. We have heard from their 
CEO. They reward people financially for wellness and fitness. And--
guess what--their costs for health care have gone down because there 
are incentives to do so.
  Here is a small idea: Why don't we see what the school lunch program 
is in our local schools? Why don't we see what the physical education 
requirements are in our local school districts? Why don't parents do 
that? I was appalled, and I am sure my colleagues and all Americans 
were, to see recently there is one State in America where one-third of 
the population suffers from obesity. We know what obesity does to 
health care costs, not to mention the lives of individuals.
  Why don't we also look at what has been tried and done before: an 
outcome treatment of patients. A patient has diabetes. You pay that 
provider for 6 months or a year or 2 years and say: OK, here is the 
amount of money, and if you keep that patient well, you will receive a 
reward at the end of that treatment period, rather than to pay for 
every single test and procedure.
  My friends, there are cases of abuse of Medicare that stretch into 
the hundreds of billions of dollars. We have to go after these people 
who abuse health care, Medicare, and Medicaid.
  And a practical question: Suppose we adopted what passed through the 
HELP Committee and through the House. There are dramatic increases in 
State Medicaid payments. What States can afford the additional burden 
of Medicaid that is envisioned by this legislation? Not many. Not many, 
my friends.
  So we do have legitimate, workable, doable, viable alternatives to 
the government option. When the President of the United States stands 
up and says we do not, he either is not paying attention to what we are 
saying--which has been one of the big problems with this debate--or he 
willfully ignores the fact there are solutions we can move forward with 
to reduce health care costs in America and preserve the quality.
  I wish to make a comment about the so-called co-op approach. My 
friends, you can call it the government option. You can call it a co-
op. You can call it a banana. But the fact is, it is government 
intervention into the free marketplace, which will lead to crowding 
out, which over time will lead to government control of health care in 
America.
  A co-op can exist today. They do not have to wait for legislation. 
They can exist today. Yet very few do. If there was a pressing need for 
more co-ops, wouldn't more of them have been created? Under the co-op 
approach, the Federal Government would design, fund, and foster their 
creation. But let's not kid ourselves. Creating a new, massive 
government plan designed in Washington is still Washington involvement 
in health care. And if we did not learn any lessons from the Fannie Mae 
and Freddie Mac co-ops, nobody has been paying attention.
  Let me talk about the ``trigger'' for a second. The trigger in the 
bill would implement the public option only if private insurance 
companies failed to meet certain benchmarks, such as lowering overall 
health spending or shrinking the number of the uninsured.
  The Wall Street Journal stated yesterday:

       Liberals should love the idea because a trigger isn't a 
     substantive concession; it merely ensures that the public 
     option will arrive eventually, instead of immediately. 
     Democrats will tweak the tests so that private insurers can't 
     possibly meet them, mainly by imposing new regulations and 
     other costly burdens.

  Additionally, this trigger appears to blatantly and patently violate 
the Constitution's delegation of lawmaking powers to Congress and not 
the executive branch. We must decide whether to implement a 
``government option'' or not. I vote to not do so and oppose any 
suggestion that abdicates my duties as a lawmaker and allows the 
executive

[[Page 21047]]

branch to create a ``government option'' based on a trigger.
  Mr. President, I ask unanimous consent that the Wall Street Journal 
column entitled ``Whoa, Trigger''--a good name--be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

             [From the Wall Street Journal, Sept. 8, 2009]

                             Whoa, Trigger

       President Obama has decided that another oration will 
     rejuvenate his health-care agenda--despite having given 27 
     speeches entirely on health care, and another 92 in which it 
     figured prominently. We'll see how tomorrow night's 
     Congressional appeal works out, but the important maneuvers 
     are taking place in the cloak rooms, as the White House tries 
     to staple together a majority.
       The latest political gimmick is the notion of a ``trigger'' 
     for the public option: A new government program for the 
     middle class would only come on line if private insurance 
     companies fail to meet certain benchmarks, such as lowering 
     overall health spending or shrinking the number of the 
     uninsured. This is supposed to appeal to Maine Republican 
     Olympia Snowe, who could end up as ObamaCare's 60th Senator, 
     while still appeasing the single-payer left.
       Liberals should love the idea because a trigger isn't a 
     substantive concession; it merely ensures that the public 
     option will arrive eventually, instead of immediately. 
     Democrats will goose the tests so that private insurers can't 
     possibly meet them, mainly by imposing new regulations and 
     other costly burdens.
       Keep in mind that every version of ObamaCare now under 
     consideration essentially turns all private insurers into 
     subsidiaries of Congress. All coverage will be strictly 
     regulated down to the fine print, and politics will dictate 
     the level of benefits as well as premiums, deductibles and 
     copays. Under the House bill, a ``health choices 
     commissioner'' will have the final say, no doubt with 
     Democrats Henry Waxman and Pete Stark at his elbow, if not 
     another part of his anatomy.
       The same bill also rewrites the 1974 federal law known as 
     Erisa that lets large and mid-sized employers offer insurance 
     with little regulation. Many businesses--including Safeway, 
     General Mills and Marriott--are finding innovative ways to 
     drive down spending, largely with worker incentives to live 
     healthier and be more sensitive to the costs of care. Many 
     Democrats call this discriminatory.
       In the individual insurance market, Democrats intend to 
     outlaw medical underwriting: Everyone must be charged the 
     same rate or close to it for the same policies, regardless of 
     health status or history. But this ``community rating'' tends 
     to price younger and low-risk consumers out of the market. In 
     a 2006 NBER paper, Bradley Herring of John Hopkins and Mark 
     Pauly of the University of Pennsylvania found that community 
     rating results in an overall increase in the uninsured in the 
     individual market, maybe as high as 7.4%. For that reason, 35 
     states have no community rating at all, and another six allow 
     very wide variations.
       The larger reality is that private insurance won't be less 
     expensive until overall health-care costs go down. Democrats 
     may be confused on this point because government, which paid 
     nearly 47 cents of every medical dollar in 2007, simply sets 
     lower prices when Congress feels like it. On average, doctors 
     and hospitals are forced to accept 20% to 30% less for their 
     services in Medicare. That's another reason insurers wouldn't 
     meet a trigger's thresholds, given that providers shift costs 
     onto private under-65 patients to make up government 
     shortfalls.
       Conceivably insurers could make their products more 
     affordable by cracking down on treatments and refusing 
     payment more often, much as HMOs held down spending in the 
     1990s. But both patients and doctors hated this ``managed 
     care''--and in any case, Democrats would find a new rationale 
     for the public option in the inevitable voter outcry about 
     private ``rationing.''
       It's true that there was a trigger in the Medicare 
     prescription drug benefit and the world didn't end. But 
     recall the dynamics in 2003: The GOP decided that private 
     stand-alone or Medicare Advantage plans should manage the 
     benefit. As a concession to Democrats, they agreed to trigger 
     a ``public option'' for drugs--in which the government would 
     have bought them directly, with its typical ``negotiating'' 
     tactics--if seniors didn't have more than two plans in a 
     given region.
       Today, there are 1,689 stand-alone and 2,099 Advantage 
     plans, and on average seniors have 50 to choose from--and 
     costs in 2007 were $26 billion lower than expected. For all 
     its problems, the Medicare drug plan created more choice for 
     seniors and more competition among providers to offer 
     packages that they found most attractive, holding down costs. 
     In short, it created the incentives for multiple ``private 
     options.''
       ObamaCare doesn't bother with incentives, instead merely 
     increasing government command and control of private 
     insurance while making it more expensive in the process. 
     That's why a trigger will inevitably lead to the public 
     option, and also why ObamaCare will make all of our current 
     health problems worse.

  Mr. McCAIN. So, Mr. President, let me summarize. I come back from 
this recess--and I see my colleague also from Arizona in the Chamber--
both of us come back, as a lot of my colleagues do, in the face of 
extreme unease, anger, and frustration on the part of the American 
people, not just over the issue of health care but over the issue, as I 
pointed out, of this massive spending and debt and deficit we have laid 
on future generations of Americans.
  They want us to act in their interests. So wouldn't it be appropriate 
for the President, tomorrow night, if I may be so bold, to say: My 
friends and colleagues, the citizens have spoken. They want us to sit 
down together, and they want us to do what is doable. They want us to 
fix this cost escalation of health care in America, which is making it 
less and less affordable to all Americans. But the message we have 
gotten is, they are very skeptical about ``government-run health care'' 
or a ``government option.''
  When the President says: If you like your health insurance policy, 
you can keep it, that is not true either. It is not true either. 
Because if you had a government option, and it looked more attractive 
to your employer, and your employer decided to select the government 
option rather than the health insurance policy you now have, then you 
cannot keep it. So it is simply not true that under the government 
option, if you like your health insurance policy, you can keep it.
  But the real point is, why don't we sit down--which we did not do; we 
did not do that at the beginning of this process--why don't we sit down 
with the smartest people on both sides of the aisle and say: OK, what 
can we get gone? What can we get done here together and go to the 
American people and say we are going to make significant progress in 
eliminating this problem of out-of-control costs in health care in 
America.
  I recall when I first came to the Congress of the United States--and 
it was pretty partisan then--Ronald Reagan had only been elected a 
couple years before that time, and Social Security was about to go 
broke. Social Security was going broke, and two old Irishmen--Tip 
O'Neill, a liberal Democrat from Massachusetts, and the conservative 
from California--sat down together and said: OK, we are going to sit 
together. We are going to fix Social Security. And they did. There 
American people were not only proud and grateful but they benefited.
  Let's go back to square one. Let's sit down together and get this 
issue resolved.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Republican whip is recognized.

                          ____________________