[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[Senate]
[Pages 25389-25391]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. Mr. President, first impressions are important. 
Depending on one's age, we remember different things. When I was a 
young teenager, the first college football game was broadcast on a 
television network. It was Tennessee versus Alabama with Lindsey 
Nelson, who had gone to Tennessee, and Mel Allen, who had gone to the 
University of Alabama, as the announcers. There have been a lot of good 
football games since that time, but everyone remembers the first 
broadcast.
  I can remember the first one-hour evening news program. I think it 
was ``Huntley-Brinkley'' on NBC. There have been a lot of distinguished 
newscasters before and since, but that was the first one-hour news 
program with two anchors.
  I can remember watching basketball games and getting a glimpse of a 
coach and forming an impression of the whole university from a short 
glimpse. An experience we've all had is meeting someone for the first 
time and getting a first impression that is usually a fairly accurate 
impression of that person. It usually lasts a long time, and it is hard 
to get over a first impression.
  Yesterday was the first vote on health care reform. I think the 
American people got a very strong first impression from that vote. What 
the majority leader, the Democratic leader, sought to do was add $\1/4\ 
trillion to the national debt on the first health care vote. The Senate 
said: No, we are not going to do that, even for a worthy cause, which 
in this case was fixing the doctors reimbursement procedure; which the 
Senator from Maryland just discussed and which we all agree needs to be 
attended to. But the Senate--all 40 Republicans, and 13 Democrats--said 
no, we are not going to start by adding $\1/4\ trillion to the national 
debt on the first vote of health care reform. Especially not at a time 
when we just finished a year which added $1.4 trillion to the national 
debt, three times as much as the year before, and as much as we added 
to the entire national debt in the first 200 years of the Republic.
  People are very worried about the growth of the debt, and that was 
reflected yesterday in the first vote on health care reform. I think 
that reminds us of the importance of reading the bill and knowing what 
it costs. That also is a bipartisan approach here. All the Republicans 
have said we want to be able to read the bill and know what it costs 
before we start voting. And even though Senator Bunning's amendment, 
which would have allowed this, was voted down in the Finance Committee 
by Democrats, eight Democratic Senators wrote the Democratic leader and 
said: We agree; put the bill on the Internet, the complete text, for 72 
hours and let's have a formal calculation of exactly what it costs 
before our first vote.
  We had a first vote yesterday, even before we have a complete bill. 
Because we had a chance to read this one provision and time to think 
about it, we came to the right conclusion and voted it down.
  In the next several months of discussion there will be many other 
issues such as this about how we reform health care. My view--and I 
think the view of most Republicans and I believe most Americans--is to 
reduce costs. We have to reduce the cost of health care to our 
government, otherwise it is going to go broke.
  The President hosted a summit on entitlement spending early in the 
year which I was invited to it. I appreciated receiving the invitation 
and I attended the summit. Everybody there said if we do not control 
health care spending, we are going to go broke as a government. Then 
millions of Americans are saying: I cannot afford my own health care; 
250 million of us have a health care premium we pay or someone helps us 
pay or some combination, and it is too expensive for individuals and 
for small businesses. So our goal is to reduce the cost of health care 
to government and reduce the cost of health care to Americans. Yet our 
first vote yesterday was to increase the debt, and we said no.
  Let's read this bill as it comes to us. Right now it is being written 
behind closed doors in the majority leader's office. With such a 
controversial issue I am not sure that is the best way to go about 
writing this bill. Usually it helps to have bipartisan support in the 
Congress, even if you have big majorities, so that you can get broad 
bipartisan support in the country any time you have a complex issue.
  When I was a young Senate aide in 1968, we had a very controversial 
issue before the Senate called the civil rights bill. Lyndon Johnson 
was President of the United States, and Everett Dirksen was the 
Republican leader sitting over where Mitch McConnell sits today. The 
Democratic majorities were bigger than they are today. President 
Johnson did not have the Democratic leader write the civil rights bill 
in a closed room in the Democratic leader's office. What did he do 
instead? He was very wise. He had it written in the Republican leader's 
office.
  So in Senator Everett Dirksen's office for several weeks in 1968, I 
recall, the bill was written in the full light of day, with Senators, 
staff members, and hangers-on going in and out. In the end, the bill--
more difficult than this health care bill--passed. Senator Dirksen, the 
Republican leader, got some of the credit. He deserved it. President 
Johnson got what he wanted. And the country supported it because it 
saw, looking at Washington, DC, a broad level of support and they felt 
better about that.
  I don't think people are going to feel as good about a bill that 
restructures one-sixth of our economy, that affects every single 
American's health, and the health care bill is being written behind 
closed doors, in the Democratic leader's office. We will see. But at 
least whatever emerges, we want to read the bill. We want the American 
people to be able to read the bill. And we want to know exactly what it 
costs before we go ahead.
  For example, what is it going to do to Medicare? The Republican 
leader has talked about that issue. If the concept paper is any 
indication we know what it is going to do to Medicare. It is going to 
cut Medicare by $\1/2\ trillion to pay for a new entitlement program.
  Some of my friends on the other side say: You are scaring seniors 
when you say that. It may be scaring seniors, but it is the truth. This 
bill, when implemented, is going to cost $1.8 trillion and $\1/2\ 
trillion is going to come from Medicare cuts. We are going to be 
cutting grandma's Medicare to spend on somebody other than grandma--a 
new entitlement program.
  We are doing that at a time when the Medicare Program, the program 
that serves more than 40 million older Americans, is going broke. We 
need to be careful in the Senate not to overstate issues. So let's not 
take my word for it. The Medicare trustees say that the Medicare 
Program, upon which more than 40 million seniors rely, is going to run 
out of money between 2015 and 2017. That is not too far away. The 
Medicare trustees--it is their job to watch out for these things--said:

       We need timely and effective action to address Medicare 
     financial challenges.

  I think what they are saying to us is if you are going to cut 
grandma's Medicare, you ought to at least spend it on grandma instead 
of spending it on somebody else. That is basically what we are doing. 
We are cutting Medicare

[[Page 25390]]

$500 billion, and instead of spending it to strengthen the Medicare 
Program, the proposal is to spend it to create a new entitlement 
program.
  What are the cuts? Nearly $140 billion in Medicare Advantage; $150 
billion in cuts for hospitals that care for seniors; $40 billion for 
home health agencies; and $8 billion from hospices.
  The President said that people who are currently signed up for 
Medicare Advantage are going to have Medicare at the same level of 
benefits. That is why we need to read the bill and know what it costs 
because something has been lost in translation between what the 
President said and what appears to actually be in the bill. The 
Director of the Congressional Budget Office, the nonpartisan 
Congressional Budget Office, said in testimony that fully half of the 
benefits currently provided to seniors under Medicare Advantage would 
disappear in the Baucus proposal. The same Baucus proposal which is 
being amended and written and merged with other bills behind closed 
doors in the Democratic leader's office. The head of the Congressional 
Budget Office said the changes would reduce extra benefits such as 
dental, vision, hearing coverage, that would be available to 
beneficiaries. Humana advised its customers who are Medicare Advantage 
beneficiaries that their benefits would be cut, causing the Obama 
administration to put a gag order on this large health care 
organization.
  I made a little speech on the floor yesterday talking about the 
dangers of developing an enemies list, of boycotting television 
networks, of calling out Senators with whom you disagree, taking the 
names of bondholders who do not go along with the General Motors or 
Chrysler bailout, threatening an insurance company for switching from 
supporting your proposal to opposing your proposal or a large health 
care company that tells its customers the truth--your Medicare 
Advantage is going to be cut.
  Another reason to read the bill is the provision that will make 
additional cuts to Medicare above and beyond the $500 billion that is 
specified. At least that is the assumption of the Congressional Budget 
Office when it looked over the bill and said that it was in balance, 
which it has turned out not to be.
  The Congressional Budget Office assumed that a Medicare commission 
would make even more Medicare cuts. Those do not seem to be realistic 
assumptions. We have had a provision in law since 2003 that would 
provide an automatic mechanism for making Medicare cuts. Nobody has 
ever wanted to use it.
  We saw what happened yesterday, recognizing that it was unrealistic 
to expect that doctors would take a 21-percent cut in their pay in a 
year. The Democratic leader tried to borrow $\1/4\ trillion to try to 
take care of that problem.
  If we read the bill and now what it costs we find out that either 
doctors are going to pay for a big part of this new Medicare Program or 
seniors are going to pay for a big part of it or our grandchildren are 
going to pay for a big part of it by increasing the debt. The 
Washington Post said this was a shell game.
  I think the lesson here is first impressions count. We got a good 
first impression yesterday of the direction of this health care bill. 
The proposal was: Let's borrow $\1/4\ trillion, and the Senate, in a 
bipartisan way, said: We are not going to do that, no. That was the 
correct vote.
  Now we see another reason to read the bill is because we want to make 
sure we know what it does to Medicare. What we have seen so far is that 
it will cut grandma's Medicare by $\1/2\ trillion, not to spend on 
grandma but to spend on some somebody else, even though the Medicare 
Program, its trustees say, will go broke in the year 2015 to the year 
2017. That is one more good reason not just to read the bill but to 
start over in this health care reform.
  We have been saying on the Republican side for months that we should 
not be trying to do this comprehensive, full-of-surprises, trillion-
dollar health care reform, that restructures one-sixth of our economy, 
in the middle of the greatest recession we have had since the 1930s. We 
should focus instead on reducing the costs of health care to the 
government and to Americans who pay for premiums, and go step by step 
to re-earn the trust of the American people to reduce costs. We 
suggested how to do that. We would start by allowing small businesses 
to come together, pool their resources, and offer insurance to their 
employees. It has been estimated that would produce at least coverage 
for 1 million more Americans and probably many million more Americans.
  Second, we have suggested saving money by reducing the number of junk 
lawsuits against doctors which drive up the cost of health care.
  Third, we have suggested allowing insurance to be sold across State 
lines. That creates more competition that should reduce costs.
  We have suggested creating health insurance exchanges--many of our 
Democratic friends agree with that--to make it easier to shop for 
health care. We have suggested enrolling individuals in existing 
programs. There are up to 11 million people who are already eligible 
for programs that we now have, and that is one way to add people 
without increasing cost in a huge way, or creating a great new program. 
We have suggested incentivizing health care technology, changing tax 
incentives, and expanding health savings accounts. These are steps we 
can take to reduce costs.
  It appears many of the American people agree with that Republican 
strategy. A new Gallup poll out yesterday said that 58 percent of 
Americans would generally prefer to see Congress deal with health care 
reform on a gradual basis--over several years--rather than to try to 
pass a comprehensive health care reform bill this year.
  So first impressions count.
  The health care debate was defined yesterday by the attempt to borrow 
$\1/4\ trillion to add to the debt. I am glad it failed. The health 
care debate, as the President himself said, is actually a proxy for a 
larger debate about the role of our Federal Government in American 
life. Increasingly, Americans are skeptical of this comprehensive 
trillion-dollar-plus, full-of-surprises proposal that is being written 
in the back room approach. Instead they hope we will focus clearly on 
reducing the cost of health care premiums, reducing the cost to our 
government, and then going step by step in the right direction to make 
health care affordable for all Americans.
  I thank the Chair, and I yield the floor.
  The PRESIDING OFFICER (Mr. Kirk). The Senator from Arizona.
  Mr. McCAIN. Mr. President, I want to thank again my colleague from 
Tennessee for the great work he has been doing on the issue of health 
care and the many other leadership issues. There are a lot of things 
going on. There are a lot of moving parts in the health care reform 
debate situation.
  I would like for us, however, to maybe pause and look back for a 
second as to what we heard and what has actually been going on. First, 
we heard the President say that if you like the insurance you have, you 
can keep it, period. Increasing mandates on employers, who today have 
difficulty affording health care coverage, and cutting Medicare by $500 
billion will ensure that millions of Americans will not be able to keep 
the coverage they have today. CBO and common sense tell us this. 
According to CBO, 3 million fewer Americans will be covered under 
employer health plans; and further, millions of seniors may lose the 
Medicare plan they have and that they want to keep. That is called 
Medicare Advantage.
  We also heard the President say that he won't support legislation 
that increases the deficit one dime. We now know that is not true. We 
saw yesterday an attempt at incredible gimmickry to do away with $247 
billion worth of debt that would have been associated with health care. 
Obviously, it is a way to get around the $\1/4\ trillion increase in 
the cost of health care that would have accrued if we had kept doing 
what we are doing. We all know that the true implementation cost of the 
proposal in the Senate Finance Committee is $1.8 trillion, once you 
look at the real numbers.

[[Page 25391]]

  One of the more entertaining aspects of the protestations of cost 
savings is the approach that all of these bills take to medical 
malpractice reform. There is none. There is none. Before the joint 
session of Congress several weeks ago the President even referenced a 
grand initiative, that he was going to support medical malpractice 
reform. Consequently, we found out the announcement was that the 
administration was going to--get this; I am not making it up--the 
President was going to accept grant applications for demonstration 
programs. I say to the President and to my colleagues, there are 
already demonstration programs: One is called Texas and the other is 
called California. They have enacted medical malpractice reform and it 
has saved incredible amounts of money. CBO now estimates that real 
medical malpractice reforms can save the health care system $54 billion 
over the next 10 years. Real medical malpractice reform can save as 
much as $200 billion.
  My favorite example so far--and then we politicians wonder sometimes 
why the American people are a little cynical about the things we 
promise and the things we commit to during political campaigns; that we 
are going to do A, B and C and you can count on it, et cetera. My 
favorite so far is when the President was running for office. Three 
months before he was elected, President Obama vowed not only to reform 
health care but also to pass the legislation in an unprecedented way. 
He said:

       I'm going to have all the negotiations around a big table.

  He said that at an appearance in Chester, VA, repeating an assertion 
he had made many times. In referring to the debate on health care, he 
said the discussions would be--

       . . . televised on C-SPAN, so that people can see who is 
     making arguments on behalf of their constituents and who are 
     making arguments on behalf of the drug companies or the 
     insurance companies.

  Well, maybe the administration and the majority leader don't know 
where the C-SPAN cameras are. I can get them outside of Senator Reid's 
office at a moment's notice. In fact, they are televising this. I want 
to repeat what the President of the United States promised the American 
people specifically on health care reform. He said the discussions 
would be--

       . . . televised on C-SPAN, so that people can see who is 
     making the arguments on behalf of their constituents and who 
     are making arguments on behalf of the drug companies or the 
     insurance companies.

  It might be a little late for the drug companies. They have already 
cut a sweetheart deal with the drug companies. They have agreed to 
oppose importation of drugs from Canada and oppose competition amongst 
drug companies for Medicare patient recipients in return for some $80 
billion in supposed savings over 10 years, and $100-some million worth 
of advertising by the drug companies in favor of health care reform. I 
am not making it up.
  President Obama also said he didn't want to be--

       . . . negotiating behind closed doors but bringing all 
     parties together and broadcasting those negotiations on C-
     SPAN so the American people can see what the choices are. 
     Because, part of what we have to do is enlist the American 
     people in this process.

  The last I saw, they were trying to enlist the AMA by doing a $247 
billion unpaid for deal so that they could buy their support. They 
bought the drug companies. They couldn't buy the health insurance 
companies, so now they are going to retaliate against them by removing 
their antitrust exemptions.
  One thing I have to say for this administration, they know how to 
play hardball. They know how to play hardball. But they also don't seem 
to care about the commitments that the President made during his 
campaign for the Presidency.
  I see my colleague is here--Senator Barrasso--and he wants to speak 
also, but I say to my colleagues on the other side of the aisle, the 
American people are tired of this behind-closed-doors dealmaking, deal 
cutting, which none of us on this side of the aisle have had anything 
to do with and very few on the other side of the aisle. They are doing 
a multi-trillion-dollar deal which will affect the future and the lives 
of 300 million Americans eventually. It is not right. This process is 
not right.
  The process they should be going through is exactly the one that the 
President promised the American people when he was running for 
President of the United States.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.

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