[Congressional Record (Bound Edition), Volume 158 (2012), Part 12]
[House]
[Pages 16152-16157]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              {time}  1440
                      ADDRESSING THE FISCAL CLIFF

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 5, 2011, the gentleman from California (Mr. Garamendi) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. GARAMENDI. Mr. Speaker and colleagues and the general public, 
there has been a lot of discussion in the last several days about what 
to do with the fiscal cliff. Is it a cliff? Is it not a cliff? Is it a 
slope? Is it the end of America as we know it, or whatever. But in this 
debate, there are a few things that are absolutely critical--tax 
policy, the President has laid it out very, very clearly, as did the 
election. We're going to do tax reform, yes. And it's time for those at 
the upper end of this wealthy country to pay their fair share. So the 
President has made it very clear: we're going to raise the rates on 
those making over $250,000 a year. And by the way, we ought to be very 
clear understanding what that means. That means 100 percent of 
Americans get a tax break on the first $250,000 of income. Over that, 
yes, they'll pay a higher rate, marginal rate, for that over the top.
  Hey, but what I really want to talk about today with my colleagues 
who will be joining me in the next few minutes is another part of this 
debate, and that is on the reductions in Federal expenditures. What's 
the best way to do it? How are we going to reduce Federal expenditures? 
There are those that say take on the entitlements. Make the seniors pay 
more. End Medicare as we know it. Turn it into a voucher program. Or 
maybe turn it into a premium support program which, as a former 
insurance commissioner, I know exactly what that means. That means if 
you're over 65, hey, you're going to get to go buy insurance from the 
rapacious health insurance companies. Good luck. Premium support, just 
another way to end Medicare as we know it. Voucher programs, another 
way to end Medicare as we know it.
  In the last election, this was a central part of the debate here in 
America. And it was clear: no way, no how are we going that way. There 
are others who proposed, well, why don't we just raise the age to 67? 
Interesting, very interesting proposal. Well, it will save Medicare a 
little bit of money, but what does it do to those people who are 65 to 
67 years of age? It denies them the opportunity to get affordable 
health insurance in the Medicare program and simply throws those people 
off to the wolves, again, to the rapacious health insurance companies. 
And by the way, those are exactly the people that the health insurance 
companies don't want. They're the people who have higher expenditures. 
They're the ones who are beginning to get health issues, so the health 
insurance companies don't want them. How are they going to get 
insurance? They're going to get insurance at a very high cost, if at 
all.
  And, oh, by the way, there are those that want to do away with the 
Affordable Health Care Act. In the Affordable Health Care Act, there's 
this thing called the Patients' Bill of Rights. The Patients' Bill of 
Rights guarantees that insurance companies cannot deny you based upon a 
preexisting condition. However, they can charge differential rates 
based upon age. So that notion of somehow saving Medicare by keeping 
people from getting Medicare is the back way to go, and it is a 
nonstarter, at least with me and I think many of my colleagues.
  There are things that can be done in Medicare, and we're going to 
talk about those things that we can do here with our colleagues today. 
We also want to pick up the issue of Social Security. Let's be very 
clear: the deficit situation faced by the United States is not a Social 
Security problem. It is not a Social Security problem. Social Security 
is stand-alone. It is not part of the American deficit. It's an issue 
that over the years has come back before the American public. The 
Congresses in the past have dealt with it, extended the viability of 
Social Security for years and years, and this Congress does not need to 
deal with this problem this year or even next year in the 113th 
Congress. Down the road it must be dealt with--and there are numerous 
ways it can be--but to bring Social Security into the deficit debate is 
only to cloud this debate and to make it far more difficult for us to 
find a solution.
  Now, my Democratic colleagues and I and the President have made it 
very clear we understand the necessity of solving this problem and 
we're willing to compromise. The President has put on the table a very 
complete, detailed program about how we can deal with the deficit both 
in the short term and in the years ahead. And we need to proceed with 
that. Unfortunately, it was just simply dismissed and a new--well, not 
a new--actually a rebaked, redone, rehashed proposal was put on the 
table by our Republican colleagues yesterday, one that really doesn't 
move us toward a compromise. We need to get there. We need to get a 
compromise under way. So let's see if we can figure out how to do it.
  I see several of my colleagues here. I'm not sure which one was first 
up, but it looks like it might be Florida.
  Ms. BROWN of Florida. I'm Corrine Brown from Florida, and I'm from 
the home of Claude Pepper. He was a House Member and a Senator, but he 
was Mr.

[[Page 16153]]

Social Security. He was here during the time of Ronald Reagan, and he 
made sure that Social Security, which was enacted under the Democrats, 
and I will never forget, Newt Gingrich said that he wanted it to 
``wither on the vine.'' That's been their philosophy.
  Now, I feel that Medicaid, Medicare, and Social Security is the 
difference between us and many of the Third World countries. In fact, 
it has been the bedrock of American politics as far as helping to raise 
the standards.
  You know, many of my colleagues often talk about the Bible. Well, the 
Bible says--I've never heard them say let's help the rich--the Bible 
always talks about the poor and what we need to do to help raise the 
standards. That's what we're supposed to be doing in the people's 
House. During the campaign, they constantly confused the American 
people, talking about the $715 billion that was in both proposals that 
was savings, that we put back into the system that helped people that 
were receiving their prescription drugs. We were helping to lower the 
cost. In fact, we were plugging the doughnut hole. So that argument is 
over. And the fact is that it will be 434-1. I will never vote to do 
anything with Social Security as we speak.
  And when you talk about Medicaid and Medicare, many of those people 
are in nursing homes that cannot speak for themselves. They only have 
us as their voices. And as we negotiate and discuss, let's look at one 
group, African American men. Most of them don't live long enough to 
benefit, and everything is not equal. When we look at jobs and 
professions, many of you have these nice cushiony jobs, and so we don't 
even have to worry about raising the age. But when we look at people 
who actually work for a living, whether we're talking about bridges or 
whether we're talking about driving trains or trucks, you want to raise 
the limit for them? So there are many issues that need to be discussed 
as we move forward.
  But when President Clinton was in office, he left this country in the 
black. The people have weighed in. They've indicated that we want to 
move forward, put people to work; but we want to do it through a fair 
method of doing it, and that is not cutting programs that impact the 
working poor in this country.
  Mr. GARAMENDI. Well, you're absolutely correct about that. The 
proposal to cut Medicare benefits is a nonstarter. There are things 
that can be done in Medicare to reduce the cost, and much has already 
been done.
  I would like to ask my colleague from the great State of Michigan to 
join us. Mr. Curson is a new Member of Congress, came in a special 
election about a month ago. Welcome. We are delighted to have you join 
us.
  Mr. CURSON of Michigan. Thank you, and I agree wholeheartedly with 
what's been said so far, and what I really want to say is Medicare is 
run more efficiently than nearly any insurance company in the world.

                              {time}  1450

  They devote less than 2 percent of its funding to administrative 
expenses, and you compare that to a private insurance company that 
costs up to 40 percent of premiums for individuals and small group 
plans for administration and to pay their executives six- and seven-
figure salaries to do the same thing that's administrated by Medicare 
officials.
  Also, the attempt to move Medicare eligibility from 65 to 67 sounds 
like an easy fix. Well, not only, as was spoken earlier, the 
recipients, those people that are 64, 65, 66, going into that category 
are people that possibly are already struggling, lost their jobs, they 
need that health care, they have a preexisting condition, and now their 
very life is threatened having to wait that much longer.
  We all look to take care of small business and private insurance 
funds, such as VEBAs and those types of institutions that money is 
forecast to pay for various health care, and you stretch out 2 more 
years of their coverage, small business now has to pay higher premiums 
to cover those employees that last those 2 more years. And they either 
have to make a choice: They reduce what they give in coverage or they 
eliminate it altogether, or they shift those premium costs to the 
worker. It's happened over and over and over again, and we need to 
avoid that in this coming legislation.
  Mr. GARAMENDI. Mr. Curson, thank you so very much for your thoughtful 
discussion of the age issue--it's a profoundly important one--and also 
bringing up the issue of what is the cost of Medicare administration 
compared to the private health insurance companies. You're quite 
correct. Medicare is a very efficiently run program, very efficient in 
collecting the money and paying the bills, far more than you would ever 
find in the private health insurance sector, perhaps by a factor of 4-
3, 4, maybe even 5 in some cases. Also, Medicare has had an 
extraordinary run of keeping the costs down.
  I'd like now to call upon Mr. Joe Courtney of Rhode Island--
Connecticut. I've made two mistakes today about my colleagues' locale.
  Joe, it's yours.
  Mr. COURTNEY. Thank you, Congressman Garamendi. And I realize there's 
congressional districts in California that are probably bigger than 
Rhode Island and Connecticut combined, so I won't hold it against you 
too hard.
  Thank you for taking time on the floor today to spend some time 
talking about Social Security, Medicare, and Medicaid. This really is 
the moment of truth right now.
  Yesterday, the Republican leadership came out with their package in 
terms of trying to deal with the so-called fiscal cliff, and even 
though, for months, they have not really fleshed out with great detail 
where they wanted to see savings, yesterday they did. They came out 
with a proposal which talked about raising the eligibility age for 
Medicare from 65 to 67.
  They talked about recalculating the cost-of-living-adjustment for 
seniors who are on Social Security. It's the so-called chained CPI, 
which would lower the year-in and year-out increase for people on 
Social Security in terms of keeping up with the cost of living.
  These proposals really need a full, vigorous debate before the 
American people before we move in that direction, which I would argue, 
and certainly you and others here this afternoon, would be the wrong 
direction for middle class and working family Americans.
  You know, in terms of Medicare, I think it's really important, 
historically, to review how Medicare came into existence.
  In 1965, when it was signed into law by President Lyndon Johnson on 
the porch of Harry Truman's house in Independence, Missouri, only half 
of America's seniors had any insurance whatsoever. Because of age, 
because of preexisting condition, because the insurance company, 
frankly, just viewed them as too high a risk, and because of cost, only 
half of America's seniors had any insurance whatsoever. Life expectancy 
in America in 1965 was 70 years old.
  With that stroke of a pen by Lyndon Johnson, the genius of Medicare 
was created, which created a pool for people above the age of 65 and 
people on disability, a pool which could spread risk out and make the 
challenge of covering people at that age much more manageable. And for 
the following 47, 48 years, we have had a system which now has brought 
life expectancy for Americans up to age 78. In other words, having 
people in a situation where they can access needed medical care, in 
fact, lengthened people's lives and, in some instances, actually added 
to the economy because some people even continued to work, to a degree, 
who are on Medicare.
  It has really accomplished its mission which was visualized the day 
that President Johnson signed it into law. It does face challenges. 
There's no question that demographics, with the baby boom coming on the 
horizon, is going to increase the number of people in the program, but 
the way you solve that problem is just make it smarter and more 
efficient.
  When President Obama signed the Affordable Care Act in March of 2010, 
last year there were some really solid,

[[Page 16154]]

smart changes that were made to the Medicare system to make sure that 
the cost per patient would be moderated, but not that it would cut 
benefits or kick people off the program, which is what the Republicans 
are proposing to do, saying people who are 65 and 66 would no longer be 
eligible under their proposal.
  This chart which I brought along with me this afternoon is based on 
Standard & Poor's Dow Jones Index, which tracks the Medicare program 
every single month in terms of per capita spending, and it shows, 
again, back as recently as 2005, 2006, per capita expenditure for 
Medicare was actually quite high. It was over 7 percent per patient, 
and that, obviously, is an unsustainable level under almost really any 
circumstance, but over time it moderated.
  And then this red line shows the day that President Obama signed the 
Affordable Care Act, which put a number of really intelligent changes 
into Medicare, promoting preventive care services, prescription drug 
coverage, making sure people will get their colonoscopies and their 
cancer screenings, and also saying to hospitals, hey, if people show up 
at your emergency room 30 days after you just treated them, we're going 
to penalize you. You've got to do a better job of monitoring care in 
the community. And that change, by itself, is already promoting a lot 
more collaboration on a much more cost-effective, better way for 
people.
  Who wants to be in an emergency room? You want to be home with your 
care being provided, not sitting, again, in a hospital room waiting for 
life-or-death treatment.
  So since that date, when President Obama signed it into law, the per 
capita growth rate under Medicare is now down to its lowest level in 
the history of program--2 percent per capita growth. And the fact of 
the matter is we can do more. We can actually build on that success of 
the Affordable Care Act.
  Anybody watch ``60 Minutes'' on Sunday? They had a story about a 
hospital system which basically was threatening to fire doctors if they 
didn't admit patients according to certain quotas because they're, 
again, chasing that fee-for-service incentive that is in old Medicare. 
I mean, those are the kinds of, in that case, fraud, but in other 
instances, you know, changing that fee-for-service incentive can 
actually bring this number down even much more dramatically, and we 
don't have to touch a hair on the head of any Medicare-eligible senior 
in America for decades to come if we make those smart changes.
  So the fact of the matter is we're seeing great progress just, again, 
in the last 2 years, 2\1/2\ years. And the fact is that there are very 
good ideas about ways of making the system much more efficient.
  And I will tell you, and I know my Members that are here on the floor 
will agree with this. When you go and visit a hospital or when you go 
and visit medical groups, the changes in electronic records, the 
changes in terms of incentivizing preventive care have been embraced by 
the medical community. They actually understand how wasteful the high 
volume fee-for-service system is in terms of just not only taxpayers, 
but also the resources that are precious and should be really allocated 
to all Americans, not just those who have good insurance that can 
reimburse for those procedures.
  So the fact of the matter is we can do far better than kicking 65- 
and 66-year-olds out of the system as a way of protecting Medicare 
solvency, and that should be the direction that we go with these 
discussions over the financial future of the public finances of this 
government.
  Again, I want to thank Mr. Garamendi for organizing this discussion 
here today because it's important to get these facts out.
  Mr. GARAMENDI. Mr. Courtney of the great State of Connecticut, thank 
you very much for bringing this information to us.
  Your chart is a dramatic one, when you consider the period of time 
and the extraordinary reduction in the inflation rate in Medicare. If 
you had another line on that showing the general inflation in health 
care for the general population, it would actually be above Medicare, 
that entire slope all the way down.

                              {time}  1500

  And it's significantly above it. So what's happened--in part, I 
think, you're correct; there may be other forces involved here, but 
certainly you can see the effect of the Affordable Health Care Act. And 
you identified very well some of the critical cost savings that are in 
that. And it's well worth repeating it, which I will do with you. And 
we ought to go back so the public comes to understand what was in the 
Affordable Health Care Act.
  For those over 65 that are in Medicare, those changes are critically 
important. First of all, stay healthy. If you want to save money on 
hospitals and doctors, stay healthy. And so you have an annual wellness 
visit. I think something like 50, 60 million Americans have been able 
to take advantage of that free annual visit. You've got high blood 
pressure? Well, let's take some blood pressure medicine. You're headed 
for diabetes? Here's a dietary program or exercise program. We can deal 
with those. You keep people out of the hospitals. The hospital 
infection rate, the other one you talked about, very powerful. I hear 
from hospitals in my district, and I'm sure my colleagues do also. They 
don't want that readmission because that comes right out of the 
hospital's pocket. And also there's a penalty.
  So there are many, many issues here that are involved in the 
Affordable Health Care Act that have caused that slope downward to 
continue. Enormous savings to Medicare. Because when you look at the 
Medicare issue, it's a projection for 10 years. And the projected rate 
2 years ago was 5, 6 percent. And where are you, down in the 2 percent 
range now? Those are multibillion dollars a year the American public 
will not have to pay in taxes and increases in expenditures. So these 
things begin to add up. But there are many, many more savings.
  I don't want to dominate all this time. I see that other of our 
colleagues have come and joined us.
  Peter Welch from Vermont.
  Mr. WELCH. Thank you. This is such an important issue about the 
future. We can get a deficit deal. The President is committed to doing 
it. It's got to be balanced. Balanced means there's got to be revenues. 
Our taxes, especially from the high-income, are at historic lows. We 
have to have health care reform, and that can get the cost of health 
care down, bring that rate of growth of spending down.
  In Vermont, that's what we're trying to do. We're a single-payer 
State. We're trying to move towards a single-payer. And the reason is 
that it's the best way to get our arms around health care so you can 
continue the access. And we know that there are reforms that we can 
make in Medicare. Just for example, if we purchase drugs wholesale, why 
do we pay retail? In the VA and in Medicaid, the government is a big 
purchaser and it negotiates price discounts with the pharmaceutical 
companies that are quite eager to sell their prescription drugs to 
Medicare.
  Mr. GARAMENDI. If I might interrupt you for a moment. Under the 
current law, the U.S. Government Medicare program, it is prevented by 
law.
  Mr. WELCH. It's illegal to be a smart shopper. That's exactly right. 
You can't make that up. It's illegal. It would be like telling you, if 
you went into CVS to buy some aspirin, and you knew you were going to 
use them for a year--you had a family, if you wanted to buy the bottle 
that had 100 and the per unit price is one-third of what it is if 
you're going to buy the bottle of 20, it would be illegal for CVS to be 
able to sell it to you at a lower price per unit. That's what we have 
in Medicare.
  Everybody understands you've got to pay for what you're going to get. 
But the fundamental debate here--and this is what was reflected in the 
Ryan budget with the voucher plan--is: are we going to try to address 
what are obvious failures in the system of the delivery of health care, 
like not allowing for prescription drug price negotiation?

[[Page 16155]]

That would save $165 billion, and it wouldn't cut a single benefit. Or, 
are we going to go allow that system that makes no sense continue and 
instead take $165 billion worth of benefits out of Medicare so that if 
you go to the doctor, they may treat you for a broken wrist but not a 
broken forearm. It doesn't make sense. And it certainly doesn't make 
sense to start talking about benefit cuts before you have the system 
reform and can get savings that are literally right on the table in 
front of you.
  So we can deal with this debt situation that we have in this country. 
It is serious. Democrats understand that. The President understands it. 
It's a serious problem. It's a solvable problem. But to solve it we 
have to have a significant contribution from revenues. The top 2 
percent can afford have their taxes go up to the Clinton year rates. 
That's number one. And number two, we can have reforms in health care 
that would benefit not just Medicare sustainability but health care 
expenses, whether you get your health care at work through your 
employer or whether you're a private-pay person.
  The nice part of this is that we are all in it together. Thank you 
for doing this. We can solve this problem. And let's do it.
  Mr. GARAMENDI. Mr. Welch, we will do it.
  Mr. Courtney from Connecticut has some ideas about other things that 
we can do.
  Mr. COURTNEY. Again, I think it's important--and you touched on this, 
John--when the Affordable Care Act was passed in March of 2010, the 
Congressional Budget Office was projecting out some savings because of 
the ACA. But they were figuring about 4 percent per capita growth. 
Again, as you pointed out, this chart now shows we're down to 2 
percent. So they have actually been revising their estimates over the 
last 2 years. And the net savings, the recalculation just in the last 2 
years has been hundreds of billions of dollars of lower expenditure 
than they had first thought was going to be the case.
  When you compare that magnitude of savings with, for example, raising 
the eligibility age to 67, they're dwarfed. It is really just a small 
portion of what efficiencies in the system are capable of producing. 
And the fact of the matter is that raising the eligibility age, there's 
no free lunch. The fact is that even though these are people that will 
be challenged in the private insurance market, 65 and 66 are still the 
healthiest population within the Medicare pool. So the ones who remain 
in Medicare, their part B premiums are going to go up. And that's not 
just me saying it. It's the Kaiser Family Foundation, which analyzed 
the impact of raising the age to 67. You're going to raise premiums. 
You're going to, obviously, leave people in a horrible situation in 
terms of trying to find any insurance. In the private market, which you 
regulated, you know that is the roughest area of older working-age 
individuals. And the net effect in terms of overall health care costs 
in terms of the system is zero. In fact, there's some that would argue 
that it would actually add cost to the system.
  Mr. GARAMENDI. I think it really would add cost. We discussed earlier 
that the Affordable Health Care Act has a very powerful cost-saving 
mechanism called Staying Healthy. And that is the prevention programs. 
If you move that age from 65 to 67, you're going to have a significant 
population of seniors who will not have access to that preventative 
medicine program. It's not going to be there for them. So the potential 
for them to develop long-term, debilitating diseases increases. And 
when they get to Medicare, they will be much more expensive, to say 
nothing of what happens to them during that 2-year period when they 
can't get to Medicare.
  You said something earlier on and I'm going to go back to this. You 
talked about what happened before Medicare--the 50 percent of the 
population of seniors without medical insurance, the poverty rate. When 
you said that, my mind flashed back to when I was a young man in the 
1950s--actually, not even a teenager--my dad took me to the county 
hospital. We were ranchers out in the boondocks of California, and 
nobody had insurance who was in their senior years. The county hospital 
sticks in my mind as the reason for Medicare. It was beyond horrible. 
There was just a row of beds, the most horrible odor in that ward--
people dying. It was so compelling.
  And today, there are issues out there. But we have seen the 
population of seniors healthy, living longer--20 years longer than they 
were just 45 years ago--50 years ago now. This is so important to 
seniors. And it is the Democratic Party that has stood for Medicare all 
of these decades. And we're not going to let it go. We're not going to 
let Medicare go. It is a foundation of our humanity and our compassion 
as Americans for all because all of us want to live long enough to get 
into Medicare.
  Reforms are possible. We've talked about several of them here today. 
I know that our colleague from Michigan spoke earlier. If you'd like to 
come back in and talk about this, we'd welcome you. We'll go back here 
for a little longer.
  Mr. Curson.

                              {time}  1510

  Mr. CURSON of Michigan. Well, again, as we talked earlier, it seems 
to so many in the public that moving that age--particularly young 
Americans--that just going from 65 to 67 doesn't mean a lot; but if you 
look at the statistics of age in this country, that's the baby boomer 
generation. That's the greatest population this country has ever had is 
right in that area. I'm part of that, I'm 64. So many of my friends 
cannot wait 2 more years for health care. They can't afford the out-of-
pocket. Some have preexisting conditions. Without question, if we move 
this, it will be a sentence of death for many, many Americans who won't 
be able to get the health care that they need.
  As I went through and campaigned--I come from a district that was 60 
percent Republican--it didn't matter what forum I was in, what group I 
talked to. There was no great calling to change Medicare, to take 
benefits away, to raise the age. There was a lot of calling to take the 
corruption out of Medicare, to take the phony doctors and the phony 
bills and other systems. This is what we talked about: not having the 
ability to negotiate prescription drugs; millions and millions and 
millions and millions of dollars just to make that part of the system 
competitive. We can't do that by law; that's ridiculous. Those are 
things that easily we could go in, we could do, and we could make the 
system much better without touching a single benefit for any American.
  Mr. COURTNEY. You're mentioning the fact that there may be some young 
folks out there who might be of the belief that this is really not a 
big deal to bump that age up 2 years. The fact of the matter is that 
some of the folks who, again, analyze the impact of raising the 
eligibility age say that it would spill over to young Americans, and 
here's how:
  There are a lot of private employers that have health insurance plans 
that when people hit retirement age, 65--or their hoped-for retirement 
age--they are able to, again, move into Medicare. They come off their 
employment-based plan, maybe get some supplemental coverage as part of 
their retirement package. But the fact of the matter is that helps move 
people out of the workforce at an appropriate age of 65 and opens up 
jobs for younger Americans. To the extent that you now are going to say 
that Medicare won't be there until age 67, it, frankly, is going to 
force a lot more people to stay in the workforce longer than I think 
really most people believe would be the case today. So, in fact, it 
would create that job lock that would prevent, again, the workforce to 
continue to refresh itself with young Americans.
  So the fact is that having a solid retirement health insurance plan 
like Medicare helps young Americans because it, again, allows the 
workforce to continue to circulate people, older Americans out and 
younger Americans in. That's why, again, the folks who had the genius 
to have the strength to pass Medicare in 1965, they solved a lot of 
problems in the U.S. economy, in the

[[Page 16156]]

U.S. society that really extended far beyond just the patients who that 
program covers.
  Mr. GARAMENDI. Well, there are certainly a series of things that we 
know we can do to reduce the cost of Medicare. Some of those are 
already in place. They've been brought forward by the Affordable Care 
Act. Others are yet to be done. The prescription drug issue is out 
there, enormous savings, $160 billion or $150 billion right there over 
a 10-year period.
  The fraud in the system, some of that was dealt with with the 
Affordable Care Act, but there's much more that can be done. There are 
fraudulent billings for durable medical equipment as well as other 
kinds of services that are provided. Those need to be addressed. The 
systems that are being put in place, that is, moving away from fee-for-
service, will significantly address that.
  In the area of hospitalization, again, there are programs that are 
viable, that are not yet implemented, that are not part of the savings 
that have already been calculated, for example, programs on the dual 
eligibles. The dual eligibles are those people that do not have 
sufficient income, but are already quite ill that may be 20 years of 
age, and they're getting Medicaid as well as Medicare. There are 
savings that can be found in the way in which we organize that.
  For those seniors that are on Medicare, an organized health care 
system that keeps them healthy, that is, taking the prevention program 
a step further, or two or three steps further, so that there is a 
continuity of care and there is a follow-up, maybe a social worker or 
simply somebody on the phone saying how are you doing; are you taking 
your medicine; are you able to get the food that you need so that 
people can stay healthy. A healthy population significantly reduces 
cost.
  The use of the Affordable Care Act--not just for Medicare, but for 
the total cost of the system--has a very, very powerful cost reduction 
in it; and it's called ``insurance.'' Forty million Americans are going 
to be insured. That means that those people are less likely, far less 
likely to go to the emergency room to get their care.
  The Affordable Care Act also provides for clinics. Where a private 
doctor may not be available, a clinic would be available. So all of 
these things provide more care to people and, in doing so, reduce the 
cost of the extraordinarily expensive care that comes from when people 
don't get continuing services of health care.
  So Medicare is a huge issue before all of us. On the Democratic side, 
we're saying, yes, there are savings available in Medicare, we should 
take advantage of those, but we're not going to cut benefits. And we're 
not going to privatize Medicare or end Medicare as we know it. There 
are other things that we can do, we're willing to do it; let's 
compromise on those things that make sense without destroying the 
Medicare program.
  Not on our watch are we going to see the benefit package reduced in 
such a way as to harm seniors--no way. And no way are we going to end 
Medicare as we know it. We'll draw a line in the sand; we'll save the 
money; we'll put that cost curve even on a better trajectory, and that 
is a very, very formidable and positive trajectory there.
  Let's spend just a moment of time, as we come towards the end of our 
time, on Social Security, which many people--well, not on the 
Democratic side, but let's talk about Social Security and should it be 
on the cutting table here, should it be part of the deficit reduction.
  Mr. Courtney.
  Mr. COURTNEY. Well, again, what's remarkable--and I know both of you 
are well aware of this--is that Social Security, over the last 3 or 4 
years, 2 out of those last 4 years there was no COLA; there was zero 
percent increase for seniors on Social Security. Again, as we all know, 
that's a formula that's tied to the Labor Department basket of goods 
that they spill out every year since the 1970s when COLA was first 
enacted, and where the economy at that point produced that result.
  Now, the last 2 years there have been moderate increases through the 
COLA formula; but, again, Republicans want to go deeper. They want to 
come out with a new cost-of-living adjustment formula called the 
``chained CPI,'' which would depress the existing COLA formula that 
already ended up with a zero percent 2 out of the last 4 years and make 
that even lower for seniors.
  As I think many of you know, you go to a senior center and you talk 
about, how come we didn't get a COLA this year or how come the COLA is 
so small, and you explain to them how the formula works. Well, the fact 
of the matter is that Labor Department formula that we use today uses a 
lot of goods and services that seniors don't buy. They don't buy flat 
screen TVs, they don't buy laptop computers, where prices have come 
down because of competition in those areas. They concentrate their 
spending on food and fuel and prescription drugs, which, if you look at 
just that basket of goods, the COLA would be higher than the existing 
formula, certainly not lower.
  So for the Republicans to come out with a proposal that says we 
should depress the COLA formula that we have today that, again, really 
doesn't match up with the profile of what a senior goes out to the 
supermarket and buys one week to the next, and is really going 
backwards in terms of really the economic security of people over age 
65.
  I know the gentleman from Michigan would like to share his thoughts.
  Mr. CURSON of Michigan. Well, I think the great majority of our 
citizens don't understand that Social Security is not funded by tax 
dollars. The confusion lies because over the years the contributions 
made by workers to fund Social Security created a surplus. With that 
surplus, they loaned that surplus to other government-funded projects, 
and they're being paid back with government money. That government 
money every year is now playing into the repayment. That's why people 
think that you can cut Social Security to take the tax dollars out.

                              {time}  1520

  Well, if that was a private insurance company that had a surplus and 
loaned that surplus to another company, that first company would expect 
the second company to pay it back. So that cannot be part of this 
equation. Social Security and the Federal money that goes into Social 
Security cannot be part of the equation in this fiscal cliff debate.
  Now, certainly with the expectancy of Social Security only surviving 
until 2038, before it has reduced benefits, in the very near future, 
this great Hall has to discuss how to fix that; and all the great minds 
in this Hall, I'm sure, can. But it does not need to be a part of this 
debate. This should not be a part of whatever legislation we settle in 
this last lame-duck session of this Congress.
  Mr. GARAMENDI. Well, you are certainly well stating my position and I 
believe the position of our colleagues and I believe of the President. 
Social Security is not part of the current deficit problem. It is an 
issue. We'll have to deal with it at any time between now and the next 
7, 8 years. And we can. It's been done before.
  At least three times in my memory, Social Security has been adjusted. 
One was discussed earlier with the issue of the COLA. That's been 
adjusted. There are things that can be done to deal with Social 
Security, but that is a debate separate and apart from the deficit and 
the fiscal cliff debate.
  The fiscal cliff debate is a tax issue, and it's also a spending 
issue. Today we focus largely on the issue of what are we going to do 
about Medicare, a big part of the Federal expenditures. And our 
argument is this: we're here to protect Medicare for seniors, period. 
We're not here to cut the benefits for seniors. We're here to see to it 
that Medicare, which has been a program for seniors since 1964-65, is 
going to continue to be there for seniors as well as the benefits 
package that's there. There are reforms and changes that can be made to 
reduce the cost of Medicare but not to reduce the benefits. We've 
talked about many of those.
  So here's where we're coming. Within that area, there are very, very 
significant savings that can be made. The

[[Page 16157]]

prescription drug benefit, $150 billion over 10 years. Other issues 
having to do with keeping people healthy, to extend their health care, 
issues having to do with how much we pay for certain services, fraud 
and abuse. All of those things could add up to the potential savings--
not the potential savings--to the savings that the President has called 
for, which is somewhere in the range of $300 billion over 10 years--
additional savings over and above what has already taken place in the 
Affordable Care Act. And we've seen in this decline in the inflation 
rate in health care some of the effects of the Affordable Care Act. So 
there are things that can be done and will be done.
  Social Security is not a part of this debate.
  But I also want to point out here in the last closing minutes of this 
a couple of things that I think are very, very important. The President 
has put forth a very detailed program calling for $1.6 trillion in 
additional revenue over 10 years; and that is money that is to come 
from the expiration of the George W. Bush tax cuts for the top 2 
percent.
  Now I want to make this clear. I said this earlier--yes, it's worth 
repeating because it's not said very often--every American taxpayer 
gets a tax reduction. The superwealthy to the very minimum taxpayer in 
this Nation gets a reduction in what the President is proposing. And 
that is to continue at the current tax rate for those with under 
$250,000 adjusted gross income. For those who have income over and 
above that, they get that tax reduction. And above that, they're going 
to pay an additional amount up to 3.9 percent in two different 
tranches. So everyone gets a tax break.
  But those superwealthy, the 2 percent, they're going to pay more, and 
that will amount to a substantial amount of money over 10 years. And, 
frankly, they've had 12 years of really low, low taxes--the lowest 
taxes, really, ever since the 1930s.
  The President has also proposed something that's very important. We 
talked about this last week. I want to talk about this again the next 
time we come here. And that is, how do we grow jobs? How do we put 
people back to work?
  The President has proposed an additional $50 billion. He did this 
more than a year ago in the American Jobs Act, and he's put it back on 
the table: $50 billion in infrastructure. Let's build the foundation. 
That deserves a lot of discussion; and, frankly, it's something we 
ought to enact here right away and put people back to work.
  There are other savings that he's proposed over the course of the 
next 2 years. We don't have time now. I notice my time has just about 
expired, if you would like to take a final shot at this, Mr. Curson.
  And by the way, this is the first opportunity I have had to spend 
part of my hour with you. You are a very articulate spokesperson for 
the working men and women in this Nation. You know the issues of 
Medicare and Social Security so very, very well. And I know, coming 
from Michigan and Detroit, you know the need to build the jobs portion 
of our economy. So why don't you close, and then I will wrap this up.
  Mr. CURSON of Michigan. Thank you for that, and I thank you for your 
comments.
  But without a doubt, we could take an hour talking about rebuilding 
the infrastructure, the jobs it would create, the need in America to 
fix our bridges and our roads. If you are about to drive over a bridge, 
you want it safe. It doesn't matter if you are a Republican or a 
Democrat, you want that bridge to hold you and your car up as you go 
over it. That needs to be done.
  Much of our infrastructure is crumbling. The power grid is crumbling. 
If it goes out, it doesn't matter what party you are affiliated with. 
You want your lights on; you want your refrigerator to work; you want 
your house warm.
  So all of those things that could be done and would put America back 
to work and create revenue from people working, when they get that 
paycheck, then they would have money to send their kid to a dance class 
or to go get a haircut. All the small businesses in the area spawn off 
of that money from creating jobs, rebuilding our infrastructure. That 
should be on the forefront of our agenda, and I certainly hope we have 
a chance to talk about that.
  Mr. GARAMENDI. How about next week? We'll come back to the floor next 
week, and we'll pick up the issues of infrastructure, of jobs and the 
like.
  This week we need to focus on what has been put on the table by the 
Republicans and the Democrats on how to deal with the fiscal cliff, 
dealing with the issue of Social Security and Medicare. Social 
Security--no, not part of this problem. It is something we'll deal with 
perhaps in the next Congress or even in the one beyond that because we 
do have time to deal with Social Security.
  Medicare--for those who want to privatize Medicare, end it as we know 
it with a voucher or a premium support program--no. No way, no how are 
we going to go there.
  For those that want to work on changing the way in which Medicare 
operates to get savings, such as negotiating drug prices, dealing with 
fraud and abuse, the various payment systems that are in Medicare, all 
of which can save money and to continue the work of the Affordable Care 
Act, and the way it has already brought the inflation rate down from 
the 4 percent, 5 percent range down into 2, 2.5 percent range, this is 
an extraordinary savings right here. And that will be calculated in the 
years ahead. And, frankly, this will add up to hundreds of billions of 
dollars in the reduction and the projected cost of Medicare in the 
years ahead.
  So we're making progress. We've got work to do, and we're prepared to 
do it. The Democrats are prepared to put together a compromise. Let's 
get to work on it. The American public expects us to do that. And we 
can, and we will.
  With that, Mr. Speaker, I yield back the balance of my time.

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