[Congressional Record (Bound Edition), Volume 155 (2009), Part 21]
[Senate]
[Pages 28345-28348]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. GRASSLEY. Madam President, we have been waiting for many weeks 
while the Democratic leadership worked behind closed doors to write a 
new health care reform bill. Rather than trying to build consensus for 
a bill that could get broad-based support, they toiled in secret, but 
at long last this new health care reform plan is finally public. They 
have come forward to at last reveal the legislative language for a 
health care reform bill that the Democrats intend to bring to the 
floor.
  We know where they started. We know the changes they made along the 
way. Those in this Chamber will recall that we worked for months in the 
Senate Finance Committee on health reform. Senator Baucus and I worked 
very carefully in committee to try to develop a bipartisan reform plan.
  Health care, as everybody knows, is one-sixth of the economy. If that 
economic fact is obscure to people, $1 out of every $6 in the United 
States is spent on health care.
  We are, of course, to spend upward of $33 trillion on health care in 
this country over the next decade--$33 trillion. Already our health 
care system is on an unsustainable path. Our current health care 
entitlement programs, at least the two, Medicare and Medicaid, are both 
on very unsound financial footing. Not only are both programs in 
jeopardy financially, but the magnitude of the problem is a real threat 
to the Federal budget.
  Starting in 2008, the Medicare Program began spending more out of the 
hospital insurance trust fund than it is taking in. That deficit 
spending at the trust fund is the beginning of the end of Medicare 
unless Congress steps in and does something to maintain that trust 
fund. The Medicare trustees have been warning us for years that the 
hospital insurance fund--the trust fund, that is--is going to go broke. 
They now predict that year of going broke is 2017. To keep Medicare 
going for future retirees means finding a way to bridge the gap for the 
$75 trillion of unfunded liability, and this must be done in a manner 
that does not worsen the health care quality or access for 
beneficiaries.
  Likewise, the Medicaid Program, which serves 59 million low-income 
pregnant women as well as children and the families, is on a very shaky 
financial ground.
  We have the Government Accountability Office reporting to Congress 
that States--meaning the 50 States--are reaching a crisis with their 
part of the Medicaid Program. The Government Accountability Office 
models predict that State spending will grow faster than State revenues 
for at least the next 10 years. The impact of declining revenues is 
very clear. I quote what the GAO has said about this situation:

       Since most state and local governments are required to 
     balance their operating budgets, the declining fiscal 
     conditions shown in our simulations suggest that, without 
     intervention, these governments would need to make 
     substantial policy changes to avoid growing fiscal 
     imbalances.

  This, too, is the crisis facing the Medicaid Program today. So both 
of the two major Federal health care programs are in very serious 
trouble. These are major problems with some of the most significant 
implications for our entire country and the 300 or more million people 
who live here. If reforms to health care are not done carefully--and I 
say ``carefully'' because I am not saying they should not be done--this 
is going to make the situation far worse, not better. Anyone listening 
would have no doubt of the ability of Congress to make it worse.
  These dire economic implications are not the only thing at stake with 
health care reform. Besides the significant economic implications of 
health care reform, this is a bill that affects everyone in another 
very important way. It affects everyone's health by changing the way we 
get health care in this country. It touches the lives of every family, 
every senior, every child, every student. In plain language, it affects 
everybody: the 306 million people who live here now and the many more 
people who will be living here in the future.
  It makes changes to health care that will be nearly impossible to 
undo. The reforms these bills contemplate will make long lasting 
changes to our health care system. These are changes all of us will 
have to live with for decades to come. Health reform presents this 
Chamber with a bill that has significant economic implications at a 
time when all eyes are focused on the economy, so focused on the 
economy that it almost reminds me of how President Clinton got elected 
on the campaign slogan, ``It's the economy, stupid.'' This health care 
reform bill is a bill that will make permanent changes to our system of 
health care.
  For all of these reasons, it makes it all the more important that 
changes of this magnitude be done with broad-based support in this 
Chamber and across the country. This broad-based support was something 
Senator Baucus and I focused on in our work on the Finance Committee, 
as we were trying to bring forth a bill that would be bipartisan.
  In the Finance Committee, we believed strongly that a bill of such 
significance should be done with broad-based support; in other words, 
health care is a life-or-death issue for every American, and it affects 
$1 out of every $6 spent in America. Because it is so big, that is the 
basis for that statement ``broad-based support.''
  Under the leadership of Senator Baucus, chairman of the Finance 
Committee, we started last year with a bipartisan health care reform 
summit. We held 20 hearings. We held three public forums this year on 
options for financing, coverage, and delivery system reform. We invited 
in experts from across the country. We invited anyone to submit input 
to the committee on those options, and we received over 600 sets of 
comments on the option papers.
  Senator Baucus and I developed the broad outlines of what we believed 
would be a good reform package. That broad outline reflected the input 
we had from that very open and public process. We took that outline, 
and we sat down with four other leaders on the issue of health care in 
this very Chamber. That group soon became known as the group of six. 
That group began meeting in June to take that framework and finish the 
important details. We met for untold hours. We consulted with experts 
at the Congressional Budget Office and the Joint Committee on Taxation. 
We invested a tremendous amount of time and effort to develop a 
bipartisan package.
  Then what happens around here too often? People get impatient. In 
this case, the Democratic leaders got impatient. They wanted the reform 
bill to be finished faster. They were more concerned with health care 
reform getting done right now rather than getting done right. We said 
we needed to give the process the time it needed. We said we were not 
going to be bound by arbitrary deadlines. We wanted to get the job done 
right. But when the first of September rolled around, they were not 
willing to give the group of six any more time.
  As a result, the Democratic leaders pulled the plug on that 
bipartisan work, and the hope for a bill with broad bipartisan support 
ended at that point. Ultimately, the Finance Committee reported out a 
bill that did not have that broad bipartisan support, the support we 
had hoped for earlier in the year. The bigger and far more liberal 
agenda driven by the White House and the Democratic leadership went 
beyond where the true consensus on reform exists.
  Now the next step in this process has been to merge together the 
bills from the HELP Committee and the Finance Committee. That job fell 
to the Democratic leader and the chairmen of the two committees. But, 
ultimately, their

[[Page 28346]]

 leader even excluded the chairmen from the process. That process began 
on October 2. So the rest of the Senate has been waiting ever since 
that time to see what would emerge from behind closed doors just across 
the hall.
  But then people started to complain about how long it was taking to 
develop the merged bill. When that happened, lo and behold, we started 
to hear from the Democratic leader what the group of six had been 
saying. That leader, too, started saying he was not going to be bound 
by any artificial timeline. He, too, started saying he was going to 
take whatever time he needed. Imagine our shock and dismay when we 
heard this. All the impatience we heard about how long our bipartisan 
process was taking, the criticism we took.
  So they pulled the plug on that effort out of impatience. My 
suspicion is that only now is there a realization of how hard it is to 
assemble a comprehensive health care reform plan. Now at long last, 
that merged bill is before us. Now we know what is in it. The bill has 
undergone many changes since the Democrats decided to do a partisan 
bill. They are not positive. They have moved more and more to not only 
a partisan agenda, they have moved to an extreme agenda. It is an 
agenda so extreme, they are having difficulty finding votes among 
Democratic Members. They have 60-vote control of this body. They have 
an overwhelming majority in the House. Yet they are trying to blame 
Republicans for slowing down the process.
  Surely they don't expect 100 Senators to get this done faster than it 
took a leader behind closed doors to get the bill done, to put together 
the two bills between the Finance Committee and the HELP Committee, 
what we have before us or will eventually have before us. But it is not 
Republicans who are slowing this down. It is not because of Republicans 
that it took so long to merge these two Senate bills. It is not because 
of Republicans that it took the House so long after July to finally 
vote on the bill.
  The reason for the difficulties is that their leftwing is driving the 
health reform agenda so far to the extreme left. It is so far to the 
left that they are having trouble getting everyone on their side to 
support that agenda? In the other body, 39 Democrats voted against 
Speaker Pelosi's plan, and you can be sure that we would have seen a 
bill in the Senate much sooner than now if all Democrats were lined up 
behind this effort.
  But this is where we are. Now let's look at what has been produced, 
what changes have been made to produce the merged bill. I will 
highlight a few of the changes I find most disturbing. As I highlight 
these issues, it will be clear that this bill is already sliding 
rapidly down the slippery slope to more and more government control of 
health care. It still has the biggest expansion of Medicaid since the 
program was created in 1965. It still imposes an unprecedented and 
intrusive Federal mandate for coverage backed by the enforcement 
authority of the Internal Revenue Service. It still increases the size 
of the government by $2.5 trillion when fully implemented. It has 
gotten even more expensive since the Finance Committee started. It 
still gives the Secretary of Health and Human Services the power to set 
prices and define benefits for private health plans. That is a lot of 
government power in Washington over people's lives. It still will cause 
health care premiums for millions to go up.
  As I said when this process started, the bill released by the Finance 
Committee was an incomplete but comprehensive, good-faith attempt to 
reach bipartisan agreement. But ever since that moment, the bill has 
moved further and further away from that approach on several key 
issues. Now we can see clearly that the bill continues its march 
leftward. It continues to take shape into an extreme agenda driven by 
the far left. This far left partisan change is precisely what my party 
feared would occur at later stages in the legislative process.
  Today we see these fears were legitimate and justified. Nevertheless, 
I still hold out hope that at some point the doorway for bipartisanship 
will again open. I hope at some point the White House and leadership 
will want to correct the mistakes they made by ending our 
collaborative, bipartisan work of 3 months during the summer. I hope at 
some point they will want to let that bipartisan work begin again. Then 
they need to back that effort and give it the time needed to get it 
right rather than getting it done right now. It is clear that today is 
not the day that is going to happen.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. McCaskill). The Senator from Colorado.
  Mr. BENNET. Madam President, I am pleased to be here today with my 
colleague from New Hampshire to talk about fiscal accountability in the 
context of the health care reform discussion we have been having.
  Back in Colorado, people are not talking about far-left or far-right 
or Democratic or Republican. That is not what concerns them. What 
concerns them is that for the last 10 years they have seen double-digit 
increases in the cost of their health insurance, year-in and year-out, 
at a time, by the way, when their incomes actually declined.
  Even before we were in the worst recession since the Great 
Depression--which we are in today--during the last recovery, the Bush 
recovery, it was the first recovery in the history of the United States 
when median family income actually declined. It was, in effect, for a 
working family a recession, and they are now having to recover not just 
from the greatest recession since the Great Depression but from a 10-
year period when they actually fell behind in terms of their income. 
What was happening at the same time their income was going down? The 
cost of health insurance was going up, by 97 percent in my State. By 
the way, higher education was going up by 50 percent during this same 
period.
  What we have said to working families before this recession and now 
in the depths of this recession is that they are expected to do more 
with less. They are threatened by politics in Washington that for 
decades has allowed special interests to get in the way of our passing 
meaningful health care reform for working families and small 
businesses. At the same time, we have tripled our Federal budget 
deficits and added to the national debt, as we have been unable to 
deliver for families all across the United States.
  Well, today we are closer than ever to meaningful health care reform 
that lowers costs, reduces the Nation's long-term deficits, and 
improves access to quality, affordable care for Colorado's families. 
With the release of the Patient Protection and Affordable Care Act, we 
have taken a major step forward. This bill will help put our Nation 
back on a track to fiscal responsibility.
  There is much more we need to do to get us where we need to be. I am 
the father of three little girls who are 10, 8, and 5, and I am 
desperate about the amount of debt we have loaded up on our Federal 
Government, about the size of our Federal budget deficit. While 
reforming health care is not sufficient to fix that problem, it is a 
very important step forward. Our Nation's annual deficits are enormous 
and our debt is staggering. Health care reform, as I said, must help 
solve that problem, not make it worse.
  I, for one, have said from the very beginning of this debate that I 
would not support a health care reform bill that added a dollar to our 
deficit. I am very pleased to see that the bill the leader has produced 
does not do that.
  We must pass effective reform that will rein in skyrocketing costs in 
both the public and private sectors and help to solve the fiscal 
problems that threaten our economy and our kids' futures. Without 
reform, if we just hold on to the status quo, if we listen to the siren 
call of special interests, out-of-control health care costs will place 
an ever higher burden on government expenditures and create structural 
deficits that could persist for decades as a drag on economic recovery 
and growth, with deficits and debt for as far as our eyes can see.
  Rising health care costs--especially Medicare costs--are the largest 
driver of our deficits. Our Nation's health

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care spending today is 17 percent of our gross domestic product. It is 
slated to grow to over 20 percent in the blink of an eye. Health care 
will soon account for one-fifth of our economy. That might not be such 
a big deal if every other industrialized country in the world was not 
devoting less than half of that as a percentage of their GDP to health 
care. It is like having two small businesses, one across the street 
from the other, and one is spending a fifth of their revenue on their 
light bill and the one across the street is spending less than half 
that. You do not need an MBA to know which of those small businesses is 
going to be able to invest in their business plan and grow. If we 
expect to be able to compete in the global economy, we need to devote a 
smaller percentage of our GDP to health care.
  Since 1970, every year for almost 40 years--year-in and year-out--
Medicare spending per person has risen by over 8 percent a year and 
private insurance spending per person has risen by over 9 percent a 
year. We cannot expect reform to begin at the private or employer-based 
level. We must drive these costs down at the Federal level by 
reorienting our Medicare incentive structure.
  The Congressional Budget Office Director, Doug Elmendorf, has said 
that the ``rising costs for health care represent the single greatest 
challenge to balancing the federal budget.'' If you are embracing the 
status quo, you are embracing skyrocketing deficits.
  The White House Budget Director, Peter Orszag, agrees, saying:

       The single most important thing--

  ``The single most important thing''--

     we can do to put the nation on a sounder long-term fiscal 
     footing is to reduce the rate of growth of health care costs. 
     Period.

  Meanwhile, the cost of health insurance is eating into family budgets 
faster and faster. About 20 years ago, the cost of an average family 
health care policy was $4,700 in Colorado, representing 12 percent of 
the average family's income. Today, an average family's health care 
policy costs roughly $12,000, amounting to 20 percent of the family's 
income, going, by 2016, if we do nothing, to 40 percent of their 
income.
  Middle-class wages are not even close to keeping up with these rising 
insurance costs. In fact, median family income in this country fell by 
$300 as health care costs increased by 80 percent just while the last 
administration was in office.
  Looking outside the confines of the budget context, health care 
reform will contribute significantly to economic growth. Health care 
reform will rein in skyrocketing health care costs and achieve close to 
$2 trillion of savings through the entire health care system--savings 
that will result in real economic gains to families and businesses. The 
Council of Economic Advisers estimates that slowing health care costs 
will increase gross domestic product by 2 percent in 2020 and by 8 
percent in 2030.
  After 8 years of irresponsible deficit spending, this legislation 
will be budget neutral and will put us on course to reduce the deficit 
over the long term. It is no wonder that people doubt this is actually 
happening because it has been so long since this body was actually able 
to do something that was deficit neutral. In this case, we are actually 
going to improve our deficit situation.
  The Congressional Budget Office report confirms that the Senate bill 
is fiscally responsible and will reduce the deficit. Specifically, the 
report says the bill cuts the budget deficit by $130 billion over 10 
years; cuts the budget deficit by $650 billion in the second decade; 
extends coverage to over 94 percent of Americans, including a 31 
million-person reduction in the uninsured; costs $849 billion; and 
achieves almost $1 trillion in cost savings.
  Just this week, a bipartisan group of more than 20 leading economists 
released a letter urging passage of meaningful health reform. The 
economists said our provisions to improve delivery system reform and 
slow the growth of health care costs ``will reduce long-term deficits, 
improve the quality of care, and put the nation on a firm fiscal 
footing.''
  The challenges facing our health care system are not new. They are 
old. But if we fail to act, they will surely get worse, meaning higher 
premiums, skyrocketing costs, and deeper instability for those 
Americans who have coverage.
  Today, thanks to a lot of hard work from a lot of people, we are 
closer than ever to enacting solutions to these problems and getting a 
finished bill to President Obama's desk as soon as possible.
  Now is the time for us to set aside the childish politics that put us 
here. Now is the time to ignore the siren song of special interests. 
Now is the time for us to create a meaningful health care reform for 
working families and small businesses all across the United States.
  Madam President, I yield the floor and look forward to hearing the 
remarks of my colleague from New Hampshire.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mrs. SHAHEEN. Thank you very much, Madam President.
  I rise to join my colleague, Senator Bennet from Colorado, to express 
my strong support for moving forward to consider the Patient Protection 
and Affordable Care Act.
  My office has responded to thousands of letters and phone calls about 
health care since we began this debate. I have traveled all across my 
home State of New Hampshire, talked to small business owners, talked to 
families who are desperate for help and to health care providers who 
are frustrated with our current system. Time and time again, what we 
have heard is that our health care system is not working. Costs are too 
high. Access is too limited. The status quo is not sustainable.
  Now is the time to act. To put it very simply, our health care system 
is too expensive for families, for workers, for business owners, and 
for our Nation's economy. I think Senator Bennet laid out very clearly 
why, if we are going to be fiscally responsible, we have to address 
health care reform now. It is critical for the Senate to act.
  I thank Majority Leader Reid and Senators Baucus, Dodd, and Harkin, 
who have led the effort to bring forward the Patient Protection and 
Affordable Care Act. This is a very good starting point, and contrary 
to what we have heard, it incorporates many of the changes that have 
been offered by our Republican colleagues over these past months we 
have been working on health care.
  This bill will help ensure Americans have greater access to quality 
affordable health care, and it will help begin the transformation 
within the health care system that is necessary if we are going to 
contain costs to accomplish the fiscal improvements Senator Bennet 
talked about.
  I think particularly important is the fact that the Patient 
Protection and Affordable Care Act is fully paid for, so it will not 
increase the deficit one dime. In fact, by eliminating waste, fraud, 
and inefficiencies, by doing a more cost-effective job of providing 
health care, the bill is projected to reduce the deficit by almost $130 
billion over the next 10 years. That is what I want to talk about this 
afternoon--some of those ways in which we can provide health care more 
cost-effectively and also improve health outcomes for people.
  Research shows us that spending on health care does not necessarily 
translate into better health care. I am proud of the Dartmouth 
Institute for Health Policy, which is in my home State of New 
Hampshire, because it has been leading the way on some of this 
important research. What Dartmouth's research shows us is that when 
patients are engaged in their treatment decisions, they will choose the 
less invasive and less costly procedures 40 percent of the time. So 
almost half of the time, we know patients, when they are involved, are 
going to choose the less costly procedures--not only that, they are 
going to be happier about those treatment decisions. We know, based on 
this research, that the health care system can do better in so many 
cases for less and that we can recoup savings in our system.

[[Page 28348]]

  One example of that, which I have worked hard on, along with Senator 
Collins from Maine, is something we call the Medicare Transitional Care 
Act. Experts estimate that we can save $5,000 per Medicare beneficiary 
if we can reduce costly readmissions. That is what our work shows. 
Medicare costs can be reduced and we can offer better support and 
coordination of care to Medicare patients if we keep seniors who are 
discharged from the hospital from unnecessarily returning. We know that 
30 percent of seniors who are discharged from the hospital, who are on 
Medicare, are going to get readmitted within 90 days because we do not 
do a good job of providing for that transition. If we add a benefit 
through Medicare that helps with that transition, we have a commonsense 
solution that will improve the quality of health care for our seniors 
and save taxpayers money. I am very pleased that this provision is 
included in the health care bill that is before us now or that we hope 
will be before us soon.
  We can also contain health care costs by improving access to lower 
cost generic drugs. Again, that is something that is in the health care 
reform bill we are going to be considering. It gives people access to 
those lower cost generic drugs in a way that saves, generally, anywhere 
from 25 to 35 percent for generic drugs. It also sets up a process to 
give people access to lower cost biologic drugs--something we do not 
yet have, the ability to set up a process to give people access to 
generic biologics. So that is going to be able to save people money.
  This legislation we hope to be able to work on will help Americans 
access lower cost medications. It will save taxpayers money. This is 
our opportunity to improve the quality of care available to Americans 
and to control costs at the same time. It is critical we achieve this 
for the citizens of New Hampshire and for all Americans. The Patient 
Protection and Affordable Care Act is a very important step forward. I 
hope all my colleagues will, as we debate this bill, look at the 
important changes we are making and decide this is our opportunity to 
get real, meaningful health care reform done.
  Thank you, and I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri is recognized.

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