[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[Senate]
[Pages 24422-24424]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. Mr. President, I congratulate the Republican leader 
for his comments. If it weren't so serious, he and I and the Senator 
from Texas would probably all be amused to hear the Democratic leader 
come here day after day and say the Republicans don't have a health 
care plan and then attack our plan. That is typical of the kind of talk 
we are getting about health care reform from the Democratic side. We 
are getting double-talk.
  It reminds me, a few years after I was Governor of Tennessee--it must 
have been the early 1990s--I was driving along in Nashville as a 
private citizen. I had the radio on. It might have been an Arkansas 
radio station, but I think it was a Nashville station. The announcer 
said: Big news. The Tennessee legislature has passed a new law creating 
a Medicaid program called TennCare. Here is what it will do. It will 
cover twice as many people for the same amount of money.
  Everybody was happy about that. Nobody had to raise taxes. Nobody had 
to pay any more money. Twice as many people get health care. I remember 
what went through my mind: I bet that doesn't happen. That sounds too 
good to be true.
  The same idea went through my mind when I picked up a paper this 
morning and read: The Senate Finance Committee has finished its work. 
We are going to give 29 million more Americans health care. It is going 
to cost hundreds of billions of dollars more, and it is going to reduce 
the Federal deficit all at once. What went through my mind was: That 
sounds too good to be true. It sounds like the TennCare story.
  Let's remind ourselves what the Republican leader said a minute ago. 
The focus is reducing cost. We all know there are people who don't have 
health care and who need it. We would like to extend it to them. But we 
can't afford to do that until we reduce the cost of the health care we 
have. It is going to bankrupt us as individuals if we don't reduce the 
cost of our health care premiums. It is going to bankrupt our 
government if we don't stop the growth of health care. Our first goal 
is reducing cost, which is why the Republican plan for health care is 
to take several commonsense steps in the right direction--reducing 
cost--that will get us where we want to go. We have said those on the 
floor time after time after time.
  They include allowing small businesses to pool their resources so 
they can offer insurance to more of their employees. They include 
taking steps to stop junk lawsuits against doctors, which are driving 
up malpractice premiums and causing problems for patients. For example, 
many women who are pregnant in rural West Tennessee counties have to 
drive all the way to Memphis to see a doctor because doctors would not 
practice there anymore because of the high cost of medical malpractice 
premiums, which is driving up the cost of health care. We could create 
exchanges in each State so people could shop for individual insurance. 
We could allow people to buy their insurance across State lines. We all 
believe that if we did a better job of encouraging technology, we could 
reduce cost and reduce paperwork. All doctors and nurses and medical 
assistants know that.
  Those are five steps we could take together to reduce cost, and we 
could begin to add to our rolls the 11 or 12 million people who are 
already eligible for programs we have today. That would make a big 
difference.
  Instead, what our friends on the other side want to do is transform 
the system at a cost of closer to $1.6 to $1.8 trillion, when fully 
implemented. The question will be, Will it reduce our costs? That is 
why we want to read the bill. We want to know what it costs. This is 
not a bill. This is some pages of concepts. This is not a formal, 
complete estimate of its cost. That only comes when we have a bill.
  We have had 8 Democratic Senators who have written to the majority 
leader and said what all 40 Republicans have said. The legislative text 
and the complete budget scores from the Congressional Budget Office 
that are going to be considered should be available on a Web site for 
72 hours prior to the first vote. Democrats voted that down in the 
Finance Committee. They voted down the idea of allowing 72 hours to 
read a 1,000-page bill and to find out what it costs. Apparently, some 
Democrats are coming to their senses and saying: No, we would like to 
have the bill. We would like to read it. We would like to have a 
formal, complete score--their words--of what it costs, and then we will 
start voting. This is not a bill. These are concepts.
  Then the majority leader is going to put this all together into 
another bill or create a bill. Then it will take a couple weeks to find 
out what that costs. We have some questions to ask in the meantime. 
First, we would like the Democrats to join us in step-by-step solutions 
to reduce cost. Next, we want to know whether it is going to reduce the 
cost to government and whether it will reduce the cost to each of us 
who is buying health insurance. As I look at the outlines, I think it 
might not. For example, as the Republican leader said, we know it is 
going to cost about twice as much as the $800 billion advertised 
because it doesn't start taking effect for a few years. The taxes start 
right away, but the benefits don't start for a few years. That is the 
first thing.
  The second thing is, it is going to put 14 million more people into 
the Medicaid Program--not Medicare, this is the Medicaid Program. This 
is the program States operate that is paid for two-thirds by the 
Federal Government and a third by the States, about which

[[Page 24423]]

all the Governors have said: If Washington is going to expand the 
Medicaid Program, Washington ought to pay for it. I suspect when we 
start asking questions, we will find Medicaid Program costs are 
underestimated. All the Governors think so. We had one of the most 
painful letters I have ever read from the Democratic Governor of 
Tennessee. Senator Corker put it in the Record. He talked about how 
Tennessee's condition was similar to the condition of most States.
  He said: For example, by 2013, we expect to return to our 2008 levels 
of revenue. We will already have cut programs dramatically. We will 
have to start digging out. We haven't given raises to State employees 
or teachers for 5 years. Our pension plans will need shoring up. Our 
rainy day fund will have been depleted. We would not have made any 
substantial investments in years. There will be major cuts to areas 
such as children's services.
  We are going to expand a program that is already causing the State of 
Tennessee and most other States to go toward bankruptcy. That is the 
way we are going to achieve reform. That is half the reform. Most 
Governors who have had anything to do with the Medicaid Program say 
that dumping low-income Americans into the Medicaid Program, where 40 
percent of the doctors would not see them, is not health care reform. 
Medicaid costs are underestimated.
  Also, I don't think the Congressional Budget Office estimate of these 
concepts we saw includes what we inelegantly call the doc fix. Every 
year the system we have reduces payments to doctors who work on 
Medicare patients. So we come back and raise the amount of money. If we 
only pay doctors 10 years from today what we are paying them today to 
serve Medicare patients, it will cost $285 billion, and that is not in 
this bill. When we ask our questions and read the bill and find out 
what it costs, we will find it doesn't reduce the deficit. Even if it 
did, it is going to cost $1.6 or $1.8 trillion. Who is going to pay for 
it? Half of it is going to come from cuts in Medicare, which serves 
seniors. Instead of putting any savings in Medicare to strengthen that 
program, which is going bankrupt in 2015-2017, we are going to spend it 
on a new program. Eight hundred billion will come in new taxes. Our 
insurance premiums are likely to go up instead of down because we will 
all be buying new government-approved programs.
  If Speaker Pelosi is successful in adding the government-run option 
into the bill before it finally gets through, millions of Americans 
will be losing their insurance because employers will be paying a fine, 
instead of the insurance, because their employees can go to the 
government program. We are going to be paying for it. If you are a 
Medicare beneficiary, if you pay taxes, if you are a State taxpayer, if 
you buy insurance, you are going to be paying for this program. So it 
is important for the next 3 to 4 weeks that as we debate this, we ask 
these questions.
  Mr. President, I see the Senator from Texas on the floor, and I 
wonder, as I conclude my remarks, whether he has thought a little bit 
about whether it is going to be possible to ensure 29 million more 
people, spend hundreds of billions of dollars, and still reduce the 
deficit and reduce costs to the American people who are trying to 
afford their insurance premiums today.
  The ACTING PRESIDENT pro tempore. The Senator from Texas.
  Mr. CORNYN. Mr. President, I would respond to the distinguished 
Senator from Tennessee, of course not. The American people are smart. 
They can understand that these numbers are not going to add up. As our 
Republican leader said this morning, this bill that was reported in the 
newspaper and scored by the Congressional Budget Office yesterday will 
never see the light of day. So this is a work in progress.
  We are committed, I think on a bipartisan basis, to reform our health 
care system. But the goal--and we need to keep our eye on the goal--is 
to bring down the cost and to cover people who currently are not 
covered. This bill, unfortunately, does not accomplish those goals. But 
we are going to keep working with our colleagues, if they will be open 
to our suggestions. But I have to tell you, as a member of the Finance 
Committee, virtually every suggestion Republicans made during the 
amendment process to this bill was voted down on a party-line basis.
  I came to the floor to talk about one of those amendments the Senator 
from Tennessee mentioned, where we asked merely that the bill--once it 
is reduced to legislative language and the cost is determined--be put 
on the Internet for 72 hours. That was voted down along a party-line 
vote. But I thank the Acting President pro tempore and other folks on 
the other side of the aisle, eight of whom have written to the majority 
leader saying that makes sense to them. So I hope we will build a 
bipartisan consensus for more transparency in the debate.
  I have also come to the floor to talk about how it makes no sense to 
cut Medicare benefits for 11 million Medicare beneficiaries who happen 
to be engaged in the Medicare Advantage Program in order to pay for 
this bill. Why would you take $\1/2\ trillion from Medicare, which is 
on a pathway to bankruptcy by 2017, in order to create a new government 
program? It can only make sense inside the beltway and if you 
voluntarily suspend your powers of disbelief. It does not make sense 
across the country. That is why it is so important to have these 
discussions, ask these questions, have transparency.
  Today I wish to ask another question: Will the health care proposals, 
such as the Finance Committee proposal and others, break the 
President's promise of not raising taxes on families making less than 
$250,000 a year? Unfortunately, the Finance Committee bill does, in 
fact, raise taxes on families making less than $250,000 a year. So the 
President cannot keep his promise if we pass this particular 
legislation.
  For example, this bill imposes a penalty on individuals who do not 
meet the Washington-imposed mandate that will be enforced by the 
Internal Revenue Service. The Internal Revenue Service is going to 
impose a penalty on you if you do not have health insurance that meets 
the Washington-imposed mandate.
  According to the Joint Tax Committee, the penalty initially included 
in the bill would especially hit middle-class families hard. They found 
that at least 71 percent of the penalty would come from people earning 
less than $250,000 a year.
  The bill also increases the penalty from 10 percent to 20 percent for 
Americans who use a portion of their health savings account for 
purposes other than qualified medical expenses. It seems to me we ought 
to be encouraging more people to use their health savings accounts 
rather than less. But as I discussed yesterday on the telephone with 
the CEO of Whole Foods, John Mackey, he said the health savings 
accounts--they call them wellness accounts, which are overwhelmingly 
successful and voted on every year with the satisfaction rate of some 
85 percent or more by the employees of Whole Foods, headquartered in 
Austin, TX--will be an illegal plan under this mandate. Insurance 
premiums, of course, will go up in the process.
  This bill also raises the floor on deductions of medical expenses to 
10 percent from its current level of 7.5 percent. So you will be able 
to deduct less of your medical expenses if you have serious health care 
expenses, which means your taxes will go up. If you can deduct less, 
your taxes will go up.
  The committee did, I would point out, consider an amendment that was 
intended to bring the bill in line with the President's promise not to 
raise taxes on people making less than $250,000 a year, and it was 
voted down along party lines. Republicans were for it and Democrats 
were against it. This amendment would have protected families who earn 
less than $250,000. But, as I say, it was voted down.
  In addition to imposing taxes on people the President promised not to 
impose taxes on, this also imposes additional so-called industry fees, 
which experts have said will ultimately be passed down to consumers in 
higher insurance costs. So instead of making insurance more affordable, 
this bill

[[Page 24424]]

would actually make it less affordable and head in the wrong direction. 
The nonpartisan Congressional Budget Office and the Joint Tax Committee 
both confirmed these fees would be passed along to consumers and 
ultimately raise insurance premiums.
  So my question for today is: Will these proposed health care reforms 
break the President's promise not to raise taxes on those making 
$250,000 or less? Unfortunately, the Finance Committee proposal, which 
we will now apparently vote on on Tuesday of next week, does break the 
President's promise.
  But Republicans stand ready to work with our friends on the other 
side if they will accept some ideas on how to do this to bring down 
costs and to cover more people to make health coverage more affordable. 
But so far all those suggestions have been rejected along party-line 
votes.
  Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Utah.
  Mr. BENNETT. Mr. President, along with my colleague, I noticed, with 
great interest, the headline in this morning's paper that said the 
Congressional Budget Office has said the health plan that is coming out 
of the Finance Committee will not increase the deficit. I thought: That 
is a little bit hard to believe. Then I looked at the details, and all 
of this reminded me of a scene out of an old movie. The movie is not 
worth talking about, but the scene is worth talking about to describe 
what is happening.
  It was a circumstance where a spendthrift husband comes home to a 
frugal wife with a new car. The wife takes one look at the new car and 
says: Why in the world are we doing this? We can't afford a new car.
  He said: No. Remember, we got that windfall. There was an inheritance 
that came through. We got some extra money. We can afford the new car, 
and it will not add--to use the terms of politicians--a dime to the 
deficit because we have this windfall coming in and we can spend it on 
the new car.
  She said: Are you kidding? The roof is leaking. The college fund for 
the kids is empty. Our house payments are in arrears. We got that 
windfall. We could take care of some of these other problems. We don't 
need a new car.
  Well, he said: We got the money and I have already spent it on the 
car and there is nothing you can do about it now.
  As it turned out in the movie, the new car got repossessed later on 
because he had only made a downpayment on it, and they could not afford 
the payments to keep the car.
  Why do I say the health care debate reminds me of this scene from the 
movie? The Federal debt is rising. The deficits from the regular 
appropriations bills are enormous. We are wallowing in red ink in the 
Federal Government. But this bill is not going to add to the deficit 
because we found $1 trillion as a way to pay for it. We found $1 
trillion someplace else we can use to pay for this bill. We can buy 
this new car, and, OK, the roof is leaking, the college fund is gone, 
the house payments are in arrears, but somehow we have a trillion extra 
dollars that we think is best spent on the new car.
  If the new car is that much better than the old car, maybe the case 
could be made that we should take this $1 trillion and spend it on the 
new car. What do we get for $1 trillion from the Baucus bill? The $1 
trillion, which, if it is available to make this thing deficit-neutral, 
could very well be spent in balancing other budgetary problems and 
paying down the national debt and doing other things with it.
  If we do have $1 trillion to spend here, what are we getting for it 
when we are spending it entirely on the Baucus bill? Well, we are 
getting a continuation of defensive medicine because there is no 
significant malpractice reform, tort reform in this bill.
  In his speech to the Congress, President Obama said:

       I don't believe malpractice reform is a silver bullet, but 
     I have talked to enough doctors to know that defensive 
     medicine may be contributing to unnecessary costs.

  I do not want to argue with the President that much because I was 
delighted when he said that, and I was on my feet applauding with 
others for that particular statement. I would say, defensive medicine 
not ``may be'' contributing to unnecessary costs; defensive medicine 
``clearly is'' contributing to unnecessary costs. But we are not 
dealing with that in the Baucus bill. We are raising $1 trillion 
somewhere else so we can continue business as usual with respect to 
defensive medicine and malpractice awards within our present system. So 
the new car is no better than the old car. It is costing us a lot more 
money, but it is no better than the old car.
  Are we getting coverage of the 47 million Americans whom we hear 
about over and over again in the debate, when they say: Well, the whole 
purpose we have to undertake this is because we have 47 million 
Americans who do not have health care coverage. Are we getting them 
taken care of? Do we have room for them in the new car? Well, not 
really.
  According to the paper this morning, we are going to get 29 million 
of the 47 million taken care of, which means roughly 20 million left 
out. We can go into the details of who the 47 million are. As we do, we 
find out it is a very mixed bag of people who are just passing through 
that category, people who deliberately choose not to be there. If we 
are spending $1 trillion just to get to 29 million out of the 47 
million, we are not getting a very good new car. We are not getting an 
improvement over what we have already.
  Again, that $1 trillion could be spent in a much better and wiser 
way. If, indeed, we have an extra $1 trillion we can spend on health 
care--if, indeed, we do have an opportunity to buy a new car--this is 
the kind of thing we could get for the $1 trillion, if we said: All 
right, we have an extra $1 trillion lying around, let's put it in 
health care. We could double cancer research funding; we could provide 
treatment for every American whose diabetes or heart disease is going 
unmanaged; we could create a global immunization campaign to save 
millions of children's lives; and we would still have enough money left 
over to keep doing these programs for at least a decade and probably 
more.
  That is what we could get for a new car in the form of health care 
reform, if we were willing to spend the trillion dollars on trying to 
improve people's health. Instead of trying to improve people's health, 
we are simply trying, through this bill, to keep the present system as 
it is.
  I have heard my friends from the other side of the aisle say 
repeatedly: The present system is broken. The present system is not an 
acceptable alternative. The present system must be changed. I say: 
Hooray. I agree. I just wish the Baucus bill would deal with the 
present system. I just wish the Baucus bill would give us, in fact, a 
new car rather than simply replacing the old car with a duplicate of 
the old car that happens to cost an extra $1 trillion.
  So I am hoping that as we move things forward, we can make some 
significant changes in it because at the present time what we have here 
is a program that would spend Federal cash for a clunker.
  I yield the floor and suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Ms. MIKULSKI. 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.
  Ms. MIKULSKI. What is the pending order, Mr. President?
  The ACTING PRESIDENT pro tempore. The Senate is in morning business 
for another 27 minutes.

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