[Congressional Record (Bound Edition), Volume 155 (2009), Part 16]
[Senate]
[Pages 21445-21447]
[From the U.S. Government Publishing Office, www.gpo.gov]




                 REFLECTIONS ON THE PRESIDENT'S ADDRESS

  Mr. KYL. Mr. President, I wish to reflect on the speech President 
Obama gave on Wednesday evening. We have had time to reflect on its 
meaning, time to have the pundits give their views on it, time to see 
some reaction by the American people, and time to visit with colleagues 
about their reaction to answer the question of whether it moved us 
further along to a bipartisan solution to the health care challenges 
that we all acknowledge face our Nation.
  I must report this morning, with some disappointment, I do not 
believe it achieved that purpose. During the month of August, when we 
were back home talking with our constituents, they spoke to us about 
their concerns and their fears about the plans that have been put forth 
by the House of Representatives and Senate committees, and we brought 
those ideas back to Washington. I had hoped, with the thought that 
there could be a readjustment--a pressing of the restart button, as it 
were--to have these bills in the House and Senate more accurately 
reflect the will of the American people.
  The public opinion surveys are virtually unanimous that public 
opinion does not favor the plans that have been presented to the 
Congress. In fact, by roughly 52 to 42, the surveys say the American 
people disagree with or disapprove of those proposed solutions. But 
rather than reflecting on what the public has been saying, which the 
President did not do on Wednesday evening, it seemed he simply 
recharged the same program he has been pushing for all these many 
months now and criticized those who disagreed with him and effectively 
threw down the gauntlet and said it is going to be this way or no way.
  I don't think that is the way to reach a bipartisan consensus or 
reflect the will of the American people. I am especially disappointed 
because, in the President's comments, there seems to be no room for 
honest disagreement. I must tell you, after working with colleagues on 
both sides of the aisle for months, there are honest disagreements and 
some honest disputes about some of the facts. There has to be room for 
that honest debate, rather than simply calling each other by pejorative 
names or condemning anything they say.
  Let me quote some of the words the President used: ``partisan 
spectacle.'' The opposition's ``unyielding ideological camps''--trying 
to ``score short-term political points.'' He talked about the ``bogus 
claims spread by those whose only agenda is to kill reform at any 
cost.'' Maybe some people believe that, but that is not the people in 
this body or in the other body.
  In order to reach out to those with whom there are disagreements, I 
think the President has to use a different phraseology than suggesting 
the only reason people disagree with him is to ``kill reform at any 
cost.'' He talked about lies from prominent politicians and arguments 
that were false and said: ``To my Republican friends, I say that rather 
than making wild claims about a government takeover of health care, we 
should work together. . . .'' And so on.
  Well, I talked to my constituents, and they are very concerned about 
the role of government in their health care decisions and the decisions 
of their families and their doctors. When you read the legislation, I 
don't think they are wild claims to say the role of government would be 
much greater than it is today and, to many people, to an extent that 
causes great fear and concern.
  The President talked about the ``demagoguery and distortion'' and 
said: ``So don't pay attention to those scary stories.'' Of course, he 
had some pretty scary stories in his speech. There is nothing wrong 
with pointing out serious problems in order to spur people to action. 
But if it is OK for one side to do that, it ought to be OK for the 
other side--for those who disagree with him.
  Finally, he said he is not going to ``waste time with those who have 
made the calculation that it's better politics to kill this plan than 
improve it.'' Certainly, that isn't the motivation of the people in the 
other body or this body with whom we disagree. He also said: ``If you 
misrepresent what's in the plan, we will call you out.'' That is a 
threat and the kind of Chicago-style politics that I don't think has a 
place in the presentation in the House of Representatives, where I have 
heard five Presidents give speeches. Far and away, this was the most 
political. Therefore, I think it was the least effective in bringing 
people together for a bipartisan solution.
  Also, the most disappointing thing was what I would say is an 
inability to confront honest differences of opinion and have an honest 
debate about those disagreements. The President is very good at what I 
have called setting up a straw man. He sets up an argument that nobody 
has made and then knocks it down and declares success. That is a 
disingenuous way to make an argument.
  I will illustrate this with maybe five different points he covered in 
his speech. You have heard the President say for months that if you 
like your insurance, you get to keep it. How many times have you heard 
that? The problem is, it is not true--under either the House or the 
Senate bills. I will explain why in a moment. But it is not true. 
Eventually, I think the President's advisers must have told him you 
cannot say that. Let's reform the way you say it so that what you say 
is legally and technically true. Wednesday night, here is what the 
President said:

       Nothing in this plan will require you or your employer to 
     change the coverage or the doctor you have.

  Then he repeated that. Well, nobody ever said there was anything in 
the bills that required you or your employer to change. We simply read 
the bills and observed that, as a result of the legislative language, 
they would change because their plans would no longer exist. Naturally, 
if your plans no longer exist or if your employer said: I am not going 
to cover you anymore because it is cheaper to go to the public option, 
then you would lose your coverage. So the President changed the 
language to be technically correct, leaving the impression that what he 
said before is still true when, in fact, it is not. Both the CBO and 
the Lewin Group--a totally objective analysis--demonstrate that for two 
separate reasons, it is still true if you like your insurance, you are 
not going to be able to keep it. Most people are not.
  The Lewin Group notes that of the over 100 million Americans--
probably close to 120 million Americans--who will go to the public 
option or government-run plan, as the President proposed, 88 million of 
those will lose their employer-sponsored insurance because it is 
cheaper for the employer to drop their coverage, pay the fine, and 
allow them to enroll in the government program--88 million.
  For senior citizens--and this is especially important in my State of 
Arizona--7 million seniors, according to CBO, will lose their private 
Medicare plan coverage, and that is because the President's plan, these 
bills, drastically reduces the support that is provided to insurance 
plans called Medicare Advantage, where their primary purpose is to 
serve people in more rural and less populated areas, but they exist in 
urban areas as well.
  Over 10 million seniors are enrolled in Medicare Advantage plans. In 
my State, we have one of the highest rates of enrollment, with about 39 
percent of Medicare beneficiaries in the Medicare Advantage plans.
  The President and the Democrats who have written this legislation 
would like to do away with those Medicare Advantage plans. As a result 
of the language of the bills, according to the CBO, at least 7 million 
seniors will

[[Page 21446]]

be moved off Medicare Advantage because those plans will no longer be 
available.
  The point being that while, of course, the President is correct that 
nothing in the plan requires you to leave your coverage if you like it, 
the reality is that over 88 million people who have insurance through 
their employer and 7 million seniors who have Medicare Advantage plans 
will lose their coverage because of the provisions of the bill.
  The fact remains it is still not true, if you like your insurance, 
you are going to be able to keep it--at least for almost 100 million; 
to be totally accurate, about 95 million Americans.
  The President made another argument. He said: I know you Republicans 
have been interested in medical malpractice reform, so I am going to do 
something about that.
  I have to characterize it as a very disingenuous proposal. Everybody 
knows there is a huge amount of money that could be saved in health 
care delivery if we did something to reform this jackpot-justice system 
that requires physicians to pay, by one estimate, about 10 cents of 
every health care dollar spent for their premiums for malpractice 
insurance.
  Another study demonstrated that over $100 billion a year is wasted in 
physicians and hospitals practicing defensive medicine in order to 
protect themselves from these liability suits, these malpractice suits.
  We have been pushing for malpractice reform for years. What was the 
President's response? He is going to ask the Secretary of HHS, Kathleen 
Sebelius, to look into an idea that the Bush administration was 
promoting after the Senate rejected, on almost partisan lines, medical 
malpractice reform proposed by Republicans.
  Secretary Sebelius was the director of the Kansas Trial Lawyers 
Association from 1978 to 1986. Some kind of encouragement to the States 
to develop some kind of alternative dispute resolution mechanism is 
hardly tort reform.
  Given the fact that this is a huge problem, a lot of money could be 
saved if we have meaningful tort reform. We believe it would be better 
to develop real tort reform and include it in the legislation rather 
than simply direct the Secretary to look into something I think is 
bound to result in virtually nothing.
  A third point I think is highly misleading--and this received a lot 
of publicity because of the unfortunate comments by a Member of 
Congress in a very uncourteous comment to the President--the President 
said:

       The reforms I am proposing would not apply to those who are 
     here illegally.

  In one sense, that is a true statement because there is not a 
provision that says we are going to cover illegal immigrants. By the 
same token, on repeated occasions when Members of the House of 
Representatives sought to ensure that illegal immigrants would not be 
covered, amendments to ensure eligibility requirements and confirmation 
of eligibility by assuring only U.S. citizens would receive the 
benefits of the program, those amendments were defeated.
  So it has been proposed that maybe we can just resolve this question 
of who is right by agreeing to a simple amendment that says illegal 
immigrants will not have the benefits of this program, and there is 
going to be enough confirmation of their eligibility or noneligibility 
to ensure that is the case. That is how we could resolve it.
  We could do the same thing with regard to funding of abortions. There 
is an argument, are they or are they not? There is a very simple 
answer. Instead of rejecting the Hatch amendment, which was done in 
committee, adopt the Hatch amendment that simply says no funding of 
abortions.
  I think we are going to know pretty clearly if there is an intent to 
deceive, to have the language seem to prevent illegal immigrants or 
funding for abortions but in reality it ends up that they get the 
coverage or that abortions are funded.
  There is a very simple solution: adopt the Republican language that 
makes it very clear. But, no, that has not been done, and we will see 
whether it will be done.
  I thought one of the most unfortunate phrases the President used was, 
in speaking to America's seniors:

       Not a dollar of the Medicare trust fund will be used to pay 
     for this plan.

  The President acknowledged in his speech that about half of the cost 
of the almost $1 trillion expense of this plan will be by virtue of 
cuts in Medicare. I think he used the word ``savings'' in Medicare. The 
question is, what exactly are those cuts? What is that savings? What 
the President said was, ``Not a dollar of the Medicare trust fund will 
be used to pay for this plan,'' as if that answers the questions and 
seniors should not be worried.
  First of all, nobody said the trust fund is going to be used. Does 
anybody know how much money is in the trust fund? I will tell you. Zip. 
The trust fund is broke. Medicare is in big financial trouble. There 
isn't any money in the trust fund to pay for anything. Nobody ever 
suggested that was the problem.
  Here is the problem, twofold: One, they are going to get somewhere a 
little less than $200 billion by reducing the allocations to the plans 
that provide Medicare Advantage. I talked about that earlier. They 
don't like Medicare Advantage because it is a private alternative, so 
they want to get seniors off Medicare Advantage. That is why seniors 
who like Medicare Advantage are out of luck because they reduce the 
support for those plans by almost $200 billion. That is where part of 
it comes from. The rest of it, $300 billion or so, comes from getting 
rid of waste, fraud, and abuse. That is when I heard some laughter in 
the Chamber because we have been trying to get rid of waste, fraud, and 
abuse for years, and it is very hard to do.
  The President provided absolutely no specifics. None of the bills 
have any specifics about this point. Nobody knows how this is going to 
be done. It is very unrealistic to expect it will occur in any way 
except what some have acknowledged, which is that the payments to 
providers--that is to say, doctors, hospitals, nurses, and others--will 
be reduced. That is how we will ``save'' that money. Bear in mind, 
these are providers who today receive on the order of 70 percent of 
reimbursement from Medicare, 70 percent of what it costs them to 
provide the services. That is why those who buy private insurance have 
to pay more than 100 percent. They have to subsidize the other 30 
percent or thereabouts that Medicare does not cover.
  What happens when that is reduced even further, when that is cut down 
to 60 percent, let's say, or 50 percent? It is going to raise the 
premiums of everyone else who has to increase their subsidy for the 
government program, and it ends up reducing the care available for 
seniors. There are not as many doctors, the waiting lines get longer, 
the care that is available decreases, and we end up with rationing. 
That is what seniors are concerned about.
  This is not a wild charge. This is not a falsity. It is in the bills. 
The President attempts to distract attention from it by saying we are 
not going to spend any money in the trust fund to pay for this. So 
what. There isn't any money in the trust fund.
  The question is, are you going to hurt seniors' care by cutting 
physician and hospital payments under Medicare and eliminating the 
support for Medicare Advantage bills? That is what is in the two bills. 
That is what is going to hurt seniors.
  There are a lot of arguments that do not really match up to the 
claims made. They set up a straw man and knock down the straw man, but 
still standing is the fact that the bills that are in the Congress will 
give the government a much greater role in our health care decisions, 
will increase premiums for millions of people, will result in rationing 
of care, and will put the government in charge of decisions with 
respect to treatment. All of these are concerns people expressed during 
the month of August and some before that need to be addressed.
  Instead of simply doubling down, as some folks said, and saying: It 
is going to be my way or else we will call out those who disagree with 
us--I think we

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ought to listen to the American people. What I hear they have said is 
the following: First of all, rather than taking on a massive new 
spending program of close to $1 trillion, adding several trillion to 
the debt over the next couple of decades, rather than increasing our 
debt, rather than having another government takeover following all 
those that have occurred so far, let's focus on the most pressing 
problems facing Americans, and that is putting America back to work, 
getting the economy going again, reducing our debt, and making sure we 
don't have new taxes. That is what we would like to have you focus on.
  To the extent there are specific problems with health care, deal with 
those as well, but you can do that on a step-by-step basis in a way 
that targets specific solutions to specific problems.
  I mentioned the problem of defensive medicine costs, over $100 
billion a year in money we should not be spending but doctors force us 
to spend it, in fact, to protect themselves from this jackpot-justice 
system.
  All right, the way to resolve that is with real medical malpractice 
reform. We do not need a demonstration project. I will give you a 
couple--Texas and Arizona. By passing modest malpractice reforms in 
those two States, significant progress has been made in reducing 
medical costs, reducing premiums, and attracting doctors. I am told 
that something like 7,000 doctors have moved into Texas in the last 4 
years pretty much as a direct result of the more benign climate in 
which they can practice medicine as a result of this malpractice 
reform. Premiums have been cut to--I forget precisely--I think it is 21 
or 23 percent.
  We know what works. Let's target a specific solution to a specific 
problem. We don't have to worry about taking over the whole private 
sector system of health care delivery, putting at risk the insurance 
people already have that serves them well.
  Finally, I note that there is some discrepancy between what the 
President said about his plan and the bills that are pending in 
Congress. My colleague, Senator Corker, has written to the President 
and asked if we could get a copy of his bill because some of the things 
he described are not in either the House or Senate bill. At least they 
do not accurately describe those two bills.
  I will give one example. He said:

       I will not sign a plan that adds one dime to our deficits--
     either now or in the future. Period.

  That is great. Unfortunately, the House and Senate bills, according 
to the CBO, add to the deficit: the HELP Committee in the Senate about 
$750 billion worth, and in the House committee about $239 billion 
worth. Clearly, these two bills are not what the President is talking 
about. Obviously, he has something else in mind. If he is going to be 
selling that to the American people, we need to see it. So I encourage 
the White House to send up the legislation they have so we can see what 
it is they are talking about that is different from these other two 
bills.
  I said finally, but one final point. The President did not talk about 
how he was going to pay for it except for Medicare cuts. He did not 
mention the taxes on small businesses, the taxes on jobs, the taxes on 
employers, the penalties individuals would have to pay if they do not 
buy insurance as mandated here, even a tax on the chronically ill. 
Senator Baucus is proposing to limit flexible spending account 
contributions to $2,000, which would raise about $18 billion. What it 
would do is penalize those who have significant illnesses and would 
like to make larger contributions to their flexible spending accounts.
  Americans have a right to be concerned about the cost of this, the 
way it is paid for, the effect on their health care, and the effect on 
their family's future. I think we need to debate it in an honest and 
forthright way. I am not pulling any punches this morning, but I am 
hoping we can bring people together to recognize what the American 
people are asking for is a step-by-step approach that targets solutions 
to specific problems and does not try to do it in the kind of 
comprehensive way that results in a 1,300-page bill that, frankly, 
nobody will read except some staffers, and we won't know what is in it 
until well after the fact and which is very hard for Congress to get 
right.
  The unintended consequences of that kind of legislation are always 
enormous. The costs are always far greater than anybody predicted, and 
the impact on the American people can be very deleterious.
  So my hope is that we will listen to the American people on this, 
take our time to do it right, do it in a step-by-step approach, target 
our solutions, get away from this massive government intrusion--which 
is reflected in both of the bills that have been considered by the 
House and Senate--and, most importantly, focus first and foremost on 
what is most on the minds of the American people domestically; that is, 
the economic situation here that will be made worse if we impose new 
taxes on small businesses, for example. It will be made worse if we 
take on massive new debt. We need to focus on putting people back to 
work, not spending as much money, not adding to our debt, and then 
decide what kinds of solutions we can afford with respect to health 
care. If we do that, I think we will have complied with the request of 
our constituents, which, after all, is what we are here to do. We will 
have done something good for the American people, and we will not have 
violated that first principle of medicine, which is, of course, to 
first do no harm. I think the American people were pretty clear over 
the month of August that they wanted us to start with that proposition, 
and it would be a good place for us to start in the so-called health 
reform we are about to take up over the next several weeks.
  I thank the Chair.
  The ACTING PRESIDENT pro tempore. The Senator from Michigan.

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